Fundamentals of Oriental Medicine

Course Code

OM315
4 Units

EMPEROR'S COLLEGE MTOM COURSE SYLLABUS

FUNDAMENTALS OF O.M.
Wilcox, Lorraine
Fall 2011
COURSE DESCRIPTION This introductory course provides the foundation for the study and understanding of Oriental Medicine. Students are given a detailed overview of the various Oriental medicine theories and practices, highlighting the concepts of yin and yang, the five phases, the five vital substances, the zang fu, jing luo, the causation of disease, as well as the fundamental diagnostic concepts. ______________________________________________________________________________ LEARNING OBJECTIVES In this course, students will be taught the classical East-Asian view of the universe and the human body and the interconnectedness of the two. They will learn the basic principles and theories of Yin-Yang, Five Elements, Eight Principles, Etiology, Qi, Blood, and the Organs, with reference to the Nei Jing (The Yellow Emperor's Inner Classic) and other classic texts. ______________________________________________________________________________ COURSE PREREQUISITIES None ______________________________________________________________________________ REQUIRED TEXTS Chinese Acupuncture & Moxibustion Edited by C. Xinnong. Foreign language press, Beijing, China. 3rd Edition, 2010 CAM Foundations of Chinese Medicine by G. Maciocia. Churchill Livingston, Philadelphia. PA. 2nd Edition 2005 GM Acupuncture: A Comprehensive Text ACT ______________________________________________________________________________ RECOMMENDED TEXTS Statement of Facts, Flaws A Practical Dictionary of Chinese Medicine, Wiseman ______________________________________________________________________________ COURSE REQUIREMENTS Quizzes will be given at the beginning of most classes. There will be NO make-up quizzes. 25% Quizzes 25% each for Test 1 and Test 2 (50% total for these two tests) 25% Final Examination
GRADING SCALE: 100-90% A, 89-80% B, 79-70% C, 69% and below F
______________________________________________________________________________ SPECIAL NOTES To pass this course, students must have full and prompt attendance. Students can miss no more than 20% of this 10week course (no more than 2 full absences). Arriving late to class (more than 15 minutes), returning late from breaks (more than 10 minutes) or leaving before the class ends (more than 15 minutes) is counted as 1/2 absence. Absences and late arrivals/early departures combine in computing 80% requirement for full attendance, e.g., 1 absence and 2 late arrivals = 2 absences. Also, please turn your cell phones off during class.
Course Code
OM315
4 Units
Wilcox, Lorraine
Fall 2011
If you miss a class you are responsible for all materials from the class you missed. ______________________________________________________________________________ CLASS ONE (The syllabus is subject to change at the discretion of the instructor.) Reading Assignment: Each week, read the relevant section in Foundations of Chinese Medicine and Chinese Acupuncture & Moxibustion.
Week 1: Yin and Yang Theory, Five Elements Part 1 Read: GM: 3-23, 25-26; CAM: 13-27. ______________________________________________________________________________ CLASS TWO Week 2: quiz; Five Elements Part 2, The Five Substances (qi, blood, essence, spirit, fluids) Read: GM: 23-73; CAM: 51-59. ______________________________________________________________________________ CLASS THREE Week 3: quiz; The three types of organs (Zang, Fu and Extraordinary). Liver, gall bladder, heart, and small intestine Read: GM: 93-127; 191-194, 199-203; CAM: 31-35, 40-41. ______________________________________________________________________________ CLASS FOUR Week 4: Test 1; Pericardium, san jiao, spleen, and stomach, extraordinary organs Read: GM: 143-152, 165-169, 185-189, 209-236; CAM: 35-36, 40-43. ______________________________________________________________________________ CLASS FIVE Week 5: quiz; Lungs, large intestine, kidneys, and urinary bladder Read: GM: 129-142, 153-164, 195-197, 205-207; CAM: 36-40, 41. ______________________________________________________________________________ CLASS SIX Week 6: quiz; Types of qi, manufacture of qi and blood, fluid metabolism Read: GM: 75-86. ______________________________________________________________________________ CLASS SEVEN Week 7: Test 2; Causes of disease: External, Internal, and Neither-External-nor-Internal Read: GM: 237-283; CAM: 263-271. ______________________________________________________________________________ CLASS EIGHT Week 8: quiz; Disharmony of Yin and Yang, Conflict between Right Qi and Evil Qi; Abnormal Ascending or Descending of Qi; Eight Principles Read: GM: 381-416, 427-443; CAM: 271-274, 295-303. ______________________________________________________________________________ CLASS NINE Week 9: quiz; Prevention and nourishing life; Channels and network vessels; eight extraordinary vessels Read: CAM: 61-69, 83-4, 89, 95-6, 101-2, 112-113. ______________________________________________________________________________ CLASS TEN Week 10: quiz; Principles of treatment and treatment principle; methodology; pattern identification Read: GM: 417-423, 1113-1128.
Course Code
OM315
4 Units
Wilcox, Lorraine
Fall 2011
______________________________________________________________________________ CLASS ELEVEN Week 11: Final Exam ______________________________________________________________________________ REFERENCE MATERIAL
______________________________________________________________________________ FACULTY INFO Wilcox, Lorraine Please check with instructor during class to get updated contact info. [email protected]
FUNDAMENTALS OF EAST ASIAN MEDICINE Instructor: Lorraine Wilcox L.Ac. [email protected]
Table of Contents
Class 1 ........................................................................................................................................... 3 Yin Yang ........................................................................................................................... 3 The Principles of Yin and Yang.............................................................................................. 4 The Tai Ji Diagram and the Principles of Yin and Yang ......................................................... 4 Taiji, the Dao, Heaven and Earth, Yin and Yang .................................................................... 6 The Taiji, Heaven and Earth, Yin and Yang, Man, and the Human Body................................ 7 The Five Elements ............................................................................................................. 8 Class 2 ........................................................................................................................................... 9 The Five Elements, continued .................................................................................................... 9 Relationships.........................................................................................................................10 The Stems and Branches ...........................................................................................................11 The Ten Heavenly Stems ()........................................................................................11 The Twelve Earthly Branches ().............................................................................12 The Seasons ..........................................................................................................................13 The Twenty-four Solar Terms (jie qi)................................................................13 The Five Substances:.................................................................................................................14 Essence jing......................................................................................................................14 Qi qi4 ...............................................................................................................................14 Spirit shen.........................................................................................................................15 Blood xue .........................................................................................................................16 Body Fluids jinye..........................................................................................................16 Class 3 ..........................................................................................................................................17 The Organs zang fu (viscera and bowels) ..........................................................................17 Liver gan..............................................................................................................................18 Gall Bladder dan ..................................................................................................................20 Heart xin...............................................................................................................................20 Small Intestine xiao chang...............................................................................................22 The Five Spirits .....................................................................................................................23 Class 4 ..........................................................................................................................................24 Pericardium xin bao or xin zhu.................................................................................24 Triple Burner san jiao.......................................................................................................24 Spleen pi ..............................................................................................................................25 Stomach wei........................................................................................................................27 Extraordinary Organs qi heng zhi fu..........................................................................28 Class 5 ..........................................................................................................................................30 Lungs fei ..............................................................................................................................30 Large Intestine da chang ...................................................................................................32 Kidneys shen ........................................................................................................................33 Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac. 1
Urinary Bladder pang guang.............................................................................................36 Minister Fire .................................................................................................................36 Class 6 ..........................................................................................................................................37 Functions of Qi (review) ...........................................................................................................37 Qi Pathology .........................................................................................................................39 Blood ........................................................................................................................................40 Blood Pathology....................................................................................................................40 Body Fluids ......................................................................................................................41 Class 7 ..........................................................................................................................................44 Three Causes of Disease ( Etiology) ..................................................................................44 External Causes of Disease:.......................................................................................................44 Wind ( feng1) ....................................................................................................................44 Cold ( han2) ......................................................................................................................45 Dampness ( shi1) ...............................................................................................................45 Dryness ( zao4)..................................................................................................................46 Fire ( huo3) .......................................................................................................................46 Summerheat ( shu3)...........................................................................................................46 Internal Causes of Disease [ seven affects].........................................................................47 Neither-External-Nor-Internal-Causes of Disease ......................................................................48 Class 8 ..........................................................................................................................................50 Pathogenesis .............................................................................................................................50 Root and Branch ( ben3 and biao1)...................................................................................51 Eight principles pattern identification () .....................................................................52 Class 9 ..........................................................................................................................................56 Preventing Disease & Nourishing Life ......................................................................................56 The Channel and Network Vessel System .................................................................................58 You Must Understand the Channels and Network Vessels .....................................................60 Class 10 ........................................................................................................................................61 Principles of Treatment .............................................................................................................61 Straight treatment and paradoxical treatment .........................................................................61 Supporting the Right and Dispelling the Evil .........................................................................61 Regulating Yin and Yang ......................................................................................................63 Treat according to the person, the season, the place ...............................................................63 Case Study ............................................................................................................................64 From Diagnosis to Treatment ....................................................................................................64 TCM Methodology....................................................................................................................65 Pattern Identification ( bian4zheng4) .................................................................................66 Appendix: A Short Course in the Pinyin Romanization Method: ...................................................67
Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.
Class 1 Yin Yang

Yin yang is the guiding principle in the dao of medicine. Liu Hongsi (Qing dynasty) Eight Methods of Medicine Volume 1 Yin Yang
In the Universe YIN YANG Water Fire Cold Heat Night Day Moon Sun Dark Bright Winter Summer Autumn Spring North South West East Right Left Earth Heaven Space Time Square/flat Round Heavy Light Descends Ascends Form Formless Matter Energy Female Male Rest Activity Stillness Movement Contraction Expansion Storage Dispersing
In the Body YIN YANG Female Male Right Left Front Back Abdomen Chest Body Head Interior Exterior Viscera/zang Bowels/fu Blood Qi Construction/ying Defense/wei Structure Function Anatomy Physiology
In Disease YIN YANG Cold Hot Pale Red Quiet Restless Still Moving Wet Dry Soft Hard Slow Rapid Descend Ascend Chronic Acute
In the whole human body, there is nothing outside of yin and yang. Tang Rongchuan (Qing dynasty), Discussion of Blood Patterns Discussion of Yin Yang, Water and Fire, Qi and Blood
The Principles of Yin and Yang

Yin and yang oppose each other. Hot (yang) and cold (yin) are opposites. Even though yin and yang are opposites, they depend on each other. Summer (yang) cannot occur without winter (yin). o Yin and yang are rooted in each other. Yin is generated from yang and vice versa. Yang protects and animates yin. Yin nourishes yang. As soon as the winter solstice occurs (maximum yin), the days start getting longer (yang grows). o Yin and yang consume and support each other, creating balance. As night (yin) grows, day (yang) declines. o Yin and yang control each other. The day cannot become infinitely hot and bright (yang) as the sun begins to set after noon, so yin comes in to control yang. Yin and yang transform into each other. What goes up (yang) must eventually come down (yin) after it reaches its peak. Winter turns to spring and then summer. o When yin or yang overflow, they transform. Extreme yang must transform into yin. Extreme yin must transform into yang. Day turns into night. Winter turns into summer. Yin and yang can be divided but cannot be separated. Yin and yang are infinitely divisible. Yin always exists within yang and yang always exists within yin. The upper body is yang, but the chest is yang mixed with yin. However, yin and yang cannot be separated from each other. Separation of yin and yang is death.
Tai Ji Diagram () The Great Polarization
The Tai Ji Diagram and the Principles of Yin and Yang

Black and white, right and left, upper and lower, represent opposition. The curved line (separating the two parts that fill the whole circle) represents mutual dependence. They fit perfectly into each other like a lock and key. One side increasing as the other decreases represents a mutual consuming and mutual supporting nature. One side flowing into the other represents mutual transformation. The dot on each side represents the divisible nature, and that yin exists within yang, and vice versa.
In a person, when yin and yang are even, there is order. When they are skewed, there is disease. Wu Kun (Ming dynasty), Investigation of Medical Formulas Volume 3 Blood Patterns
1. yang Balanced xu Vacuity Deficiency, empty shi Repletion Excess, full yin
Unbalanced
2. yang Yin vacuity yin yang Yang vacuity yin
3. yang Yang repletion yin yang Yin repletion yin
4. yang yin Excessive yang damages yin yin yang Excessive yin damages yang
Hot
Cold
Tai Ji, the Dao, Heaven and Earth, Yin and Yang
One yin and one yang are called dao. This could also be translated, Alternating yin and yang are called the dao. Yijing - Appended Sentences, Part 1 Section 5 (Zhou dynasty) The dao gives birth to one. The one gives birth to two. The two give birth to three. The three give birth to the ten-thousand things. The ten-thousand things carry yin on their backs and embrace yang in their arms. The blending of their qi is considered harmonious. Laozi, Chapter 42 (Zhou dynasty) The changes have the tai ji, which gives birth to the two modes. The two modes give birth to the four images. The four images give birth to the eight gua. Yijing - Appended Sentences, Part 1 Section 11 (Zhou dynasty) When the tai ji separates, there are only these two: yin and yang. When yin qi circulates, it becomes yang. When yang qi condenses, it becomes yin. Zhu Xi (Song dynasty) When the tai ji moves, it gives birth to yang. When its movement is extreme, then there is stillness. When it is still, it gives birth to yin. When its stillness is extreme, it returns to movement. Each movement and each stillness is the root of the other. Taiji Diagram Explanation by Zhou Dunyi (Song dynasty) Heaven and earth have assigned positions and the changes are carried out in between them. Yijing - Appended Sentences, Part 1 Section 7 (Zhou dynasty) Yin and yang are the dao of heaven and earth, the guiding principle of the ten-thousand things, the father and mother of mutation and transformation, the root beginning of life and death, the mansion of spiritual brightness. Elementary Questions, Chapter 5 (Warring States Period)
The Tai Ji, Heaven and Earth, Yin and Yang, Man, and the Human Body
What has gathered together into a body is a tai ji. Like this, each thing also possesses a tai ji. Master Zhus Classified Conversations, Volume 94, by Zhu Xi (Song dynasty) All things once they come into being have a body. Moreover, each body has a qian and a kun. Observing the Changes Chant, by Shao Yong (Song dynasty) Although man lives on the earth, his fate is suspended from heaven. When heaven and earth combine qi, this is called man. Elementary Questions, Chapter 25 (Warring States Period) Once human life has form, yin and yang cannot separate. Elementary Questions, Chapter 25 (Warring States Period) Heaven and earth are a big tai ji. The human body is a small tai ji. The human body also is equipped with the two modes, four images, and the eight gua. Medicine and Yijing are One Theory, by Shao Tongzhen (Qing dynasty) The human body is a small heaven and earth. Attached Supplement of the Categorized Classic - Medicine and Yijing, by Zhang Jiebin All the qi of the ten-thousand things is heaven and earth. Combine it and it is one heaven and earth. The qi of heaven and earth is the ten-thousand things. Scatter it and it is ten-thousand heavens and earths. That is why, when a person doesnt know oneness, he is inadequate to know the tenthousand. When a person doesnt know the ten-thousand, then he is inadequate to be called a physician. Classic of Categories Diagram Wings - Discussion of the Taiji Diagram, by Zhang Jiebin (Ming dynasty) If you do not know heaven, earth, and man, you cannot be taken as a doctor. Xu Lingtai (Qing dynasty) Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac. 7
The Five Elements Wood grows upward and spreads outward. It does not like to be restrained. It bends and
straightens, like a bow. mu4: means wood but also means trees, and includes as a category all living and growing plants. Fire flares upward. It is hot and bright. Earth is sowing and reaping. It represents the planting and harvesting of crops. It likes warmth and dryness. The earth receives all things without discrimination. tu3: means earth in the sense of soil, dirt, what you could pick up in your hands. di4 is also translated as earth, but this means earth in the sense of planet earth and is especially used as the opposite of heaven, or in the trinity of heaven, man, and earth. Metal has the qualities of purification, elimination, and reform. Metal implements help man cut grain and slaughter animals, thereby ensuring his survival. jin1: means gold specifically or metal in general. Water moistens and descends to low places. It has the qualities of moistening, downward movement, and coldness. Five Elements Fire Earth
Wood Metal Water Part 1: memorize for the first test Spring Summer Between Autumn Winter Season East South Center West North Direction Wind Summer-heat Dampness Dryness Cold Weather Birth Growth Transformation Withdrawal Storage Phase Red Yellow White Black Color Green-blue Sour Bitter Sweet Acrid Salty Flavor Liver Heart Spleen Lungs Kidneys Yin organ Stomach Large intestine Urinary bladder Yang organ Gall bladder Small intestine Part 2: memorize for the second test. These are associated with the yin organ of the element. Eyes Tongue Mouth Nose Ears Sense orifice Sinews Vessels Flesh Skin Bones Tissue Nails Complexion Lips Body hair Head hair Bloom Anger Joy Thought Sorrow Fear Emotion Shouting Laughing Singing Wailing Moaning Sound Spirit Thought Corporeal soul Will/mind Spirit Ethereal soul Part 3: these will not be on any test Tears Sweat Drool Snivel Spittle Fluid Surging Moderate Downy Stone-like Pulse String-like Element
Class 2
The Five Elements, continued
The Five Elements with Earth as the Center (Earths Perspective)
The Five Elements with Earth Equal to the Other Elements (Heavens Perspective)
Relationships:
1. Normal relationships A. Each generates (produces) the next element going clockwise (the child). Example: wood engenders fire (The mother feeds her child) B. Each drains (leaks) the previous element going clockwise (the mother). Example: wood leaks water (The child takes from the mother) C. Each controls the second element going clockwise (the grandchild). Example: wood controls earth (The grandmother keeps discipline in the household) 2. Abnormal relationships A. If control is too strong, it overwhelms (overacts on) the second element going clockwise. Example: wood may overwhelm earth (The grandmothers discipline is too severe) B. If the element that would normally be controlled fights back counterclockwise, this is called rebellion (insulting). Example: wood may rebel against metal (The grandchild talks back to the grandmother)
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The Stems and Branches

The Ten Heavenly Stems ()
CHINESE PINYIN Jia Yi Bing Ding Wu Ji Geng Xin Ren Gui NUMBER 1 2 3 4 5 6 7 8 9 10 ELEMENT Yang Wood Yin Wood Yang Fire Yin Fire Yang Earth Yin Earth Yang Metal Yin Metal Yang Water Yin Water
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The Twelve Earthly Branches ()

CHINESE BRANCH Zi Chou Yin Mao Chen Si Wu Wei Shen You Xu Hai NUMBER 1 2 3 4 5 6 7 8 9 10 11 12 ANIMAL Rat Ox Tiger Rabbit Dragon Snake Horse Sheep Monkey Rooster Dog Pig ELEMENT Yang Water Yin Earth Yang Wood Yin Wood Yang Earth Yin Fire Yang Fire Yin Earth Yang Metal Yin Metal Yang Earth Yin Water HOUR 11p-1a 1-3am 3-5am 5-7am 7-9am 9-11am 11a-1p 1-3pm 3-5pm 5-7pm 7-9pm 9-11pm MONTH CHANNEL 11th GB th 12 LV 1st LU nd 2 LI rd 3 ST th 4 SP 5th HT 6th SI th 7 UB 8th KI th 9 PC th 10 SJ
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The Seasons
Whenever you follow the qi of the four seasons, there is health. Whenever you go against it, there is disease. The Categorized Classic, Zhang Jiebin (Ming dynasty)
The Twenty-four Solar Terms (jie qi)
THE SEASONS SPRING SUMMER FALL WINTER MONTH 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th
First day of the season in: CHINA THE WEST February 4th March 21st May 5th June 21st August 7th September 23rd November 7th December 22nd BRANCH Yin Mao Chen Si Wu Wei Shen You Xu Hai Zi Chou ELEMENT Wood Wood Earth Fire Fire Earth Metal Metal Earth Water Water Earth SEASON Spring begins February 4th Summer begins May 5th Autumn begins August 7th Winter begins November 7th 13
The Five Substances:

jing essence qi shen spirit xue blood jin ye body fluids
Essence jing: Essence is stored in kidneys. It is original water. It is a sticky refined body
substance (yin). Jing transforms into dense fluid essences such as marrow, spittle, semen, vaginal fluids, breast milk, and blood. Before-heaven essence: from parents, cant be replenished, can be conserved. After-heaven essence: from spleen and stomach, food and drink Kidney essence: a general term for both Functions of essence: Essence is the basic yin substance from which all yang (physiology) springs. Growth, reproduction, development (7 & 8 year cycles of Su Wen, Chapter 1) Produces marrow Basis of constitution Basis of kidney qi, source (yuan) qi
Qi qi4: Qi has many meanings. Some of them are air, gas, vapor, aura, environmental forces,
anything of a particular nature, breath, strength. (Not appropriate to spell chi or chi. Energy is not a synonym.) Functions of Qi in the Body Activity or movement: all physiological functions and physical movement depend on qi Transportation or movement: transports qi, blood, fluids, etc., around the body. Transformation: transforms qi from food and air into usable qi and blood. Transforms fluids, etc. Containment: holds sweat in, holds the lower orifices shut, holds blood in the vessels. Defense: defends the exterior of the body from invasion. Raising: raises the organs and keeps them in their place, raises clear yang to head. Warming: helps keep the body warm.
Human life is the gathering of qi. When it gathers, there is life. When it disperses, there is death. If life and death belong to the same category, then why should I worry? That is why the ten thousand things are really one... That is why it is said that there is only one qi under all of heaven. The sages value oneness. Zhuangzi - Zhi Travels North (Zhou dynasty)
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Heaven and earth, yin and yang are rooted in and emerge from the one qi. Study Notes of Medicine Part 1, You Zaijing (Qing dynasty) Qi is the root of man. When the root is severed, the stems and leaves wither. The Classic of Difficulties - 8th Difficulty
Spirit shen: The heart stores the spirit [or mind]. It is the root of consciousness and mental
activity The dictionary says: shen2: 1. soul, mind, spirit; 2. gods, deities, immortals, spiritual beings; 3. supernatural, marvelous, wondrous, miraculous, mysterious, mystical; 4. smart, clever, 5. appearances, looks, expressions, airs. Heart, spirit, and blood affect mental activities, including emotions, consciousness, memory, rational (sane) thought, sleep and dreams. Heart blood and yin nourish and anchor or root the spirit, which is very yang. The five shen are the five spirits, one in each zang (viscera, yin organ) shen spirit in the heart. This rules the other four. hun or ethereal soul in the liver. po or corporeal (animal) soul in the lungs. zhi or will (or mind) in the kidneys. yi or thought (reflection, ideation) in the spleen.
The hearts spirit is the governor of the five spirits. Yang Shangshan (Sui dynasty) Since the Ming dynasty (1368-1644) some doctors said the brain was in charge of intelligence and memory.
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Blood xue: part of yin, a very dense form of qi. Functions: Nourishes the body. Secondarily, blood moistens. Example: blood moistens the eyes, sinews, skin, hair. The material foundation for shen (spirit, mind). Heart blood nourishes and anchors the shen (which governs emotions, consciousness, sleep, etc). Also anchors the ethereal soul (hun) and qi. Important in women for gynecology and to nourish the fetus. Hair is the surplus of blood. Manufacture: food qi from the spleen is sent up to the lungs and heart. There, it is transformed into blood by source (yuan) qi. Also kidney essence marrow bone marrow blood for menstrual blood.
Blood is the mother of qi. Qi is the commander of blood. Qi circulates blood. When qi moves, blood follows. Qi generates blood. Qi holds in the blood. It makes the blood stay in the vessels. Qi gathers the blood. Blood harmonizes qi. Blood is the dwelling place of qi. Blood anchors and nourishes qi. Males use qi as the main thing. Females use blood as the main thing. Chen Wenzhao (Ming dynasty)
Body Fluids jinye

Fluids moisten first, and nourish secondarily. They also help anchor qi. Two Types: Jin is liquids (thinner). They are clear, thin, and light, so they can move fast. They are controlled by the lungs and the upper jiao. They moisten and nourish the skin and flesh, and make sweat, tears, saliva, mucus, and part of blood. Ye is humors (thicker). They are turbid, heavy, and dense so they move slowly. They move on the interior, and are controlled by the spleen, kidneys, and the middle and lower jiao. They moisten the brain, marrow, joints, and lubricate the interior of the sense orifices. Elementary Questions, Chapter 21 Drinks enter into the stomach. Their essence qi roves and spills out and is transported upward by the spleen. Spleen qi disperses the essence, and returns it up to the lungs, which regulate the waterways and keep them flowing freely. They transport it down to the urinary bladder. When qi flows properly, body fluids circulate. Yan Yonghe (Song dynasty)
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Class 3
The Organs zang fu (viscera and bowels)
Organ type Viscera/zang/yin organs Bowels/fu/yang organs Extraordinary organs Characteristics Store Dont drain Solid Full but cannot be filled 5 Dont store Drain Hollow Fill, but cannot be full 6 Store Dont drain Hollow 6
zang: yin organs, viscera (viscus). = flesh, = to store. The viscera produce and store purified substances, and do not deal with food or discharge waste. They are inherently solid or full, so they cannot fill up and empty. The viscera are the lungs, liver, heart, spleen, kidneys, (pericardium does not count). They are yin: yin is dense and solid and likes to store. fu: yang organs, bowels. = flesh, = seat of government. The bowels are hollow and transform food and drink. They are like grain (tax) collection centers of ancient Chinese governments. They fill up and empty but do not stay full. They fill up and empty as food enters, is digested, and the waste excreted. They transmit, move, and decompose food, and convey waste. They do not store purified substances. Bowels are the large and small intestines, gall bladder, urinary bladder, stomach, and san jiao (triple burner). They are yang: moving; and are considered more shallow as they connect to the outside of the body. The extraordinary organs do not follow these rules. They have characteristics of both. We will discuss them later. They are the brain, uterus, vessels, marrow, bones, and gall bladder.
Elementary Questions, Chapter 11 The brain, marrow, bone, vessels, gallbladder, and uterus of the females: these six are generated by earth qi. All of them store in yin and their image is in the earth. Thus, they store and do not drain. They are called the extraordinary organs. Now, the stomach, large intestine, small intestine, triple burner, and urinary bladder: these five are generated by heaven qi. Their qi is the image of heaven. Thus, they drain and do not store. They receive the turbid qi of the five viscera. They are called the house of conveyance and transformation. This turbid qi is unable to stay for a long time so it is transported and drained... Those that are called the five viscera store essence and qi but dont drain. Thus they are full but are unable to fill up. The six bowels convey and transform things but do not store. Thus they fill up but are unable to stay full. For this reason, when water and grains enter the mouth, the stomach fills up, but the intestines are empty. When the food descends, the intestines fill up, but the stomach is empty. Thus it is called filled up, but not full, or full but not filled up. ***
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Liver gan: the military general

The liver corresponds to wood element. The liver is in charge of planning and strategy: It holds the office of the general: drive and resolution come from the liver. The liver governs upbearing: Normal liver flow is upwards and outwards, as well as in all directions, like a tree growing. It does not like to be confined. The livers emotion is anger. The liver governs free coursing (ensures smooth flow of qi): o qi mechanism of the whole body o emotional state o digestion, including secretion of bile o timing of the menstrual cycle The liver stores blood: o regulates volume of blood during physical activity and rest o menstruation (related to chong vessel, the sea of blood) o liver blood moistens eyes and sinews The liver is the root of pre-heaven qi in women Ye Tianshi (Qing) The liver opens into the eyes: It moistens eyes. Tears are the fluid of the liver. The liver houses the ethereal soul [ hun]: Rooted in liver blood. The liver governs the sinews and manifests in the nails: o smooth movement: liver problems can cause convulsions, spasms, tremors The liver generates internal wind when it is not happy. The liver is the foot reverting yin or jue yin channel. (Sometimes translated as absolute yin.)
Elementary Questions, Chapter 8 The liver is the official who is a military general. Strategy and planning comes out of it. Zhu Danxi (Yuan) from Danxis Heart Methods The liver only has superabundance; the kidneys only have insufficiency. Elementary Questions, Chapter 52 The liver is born on the left. Elementary Questions, Chapter 10 When a person lies down [or sleeps], the blood returns to the liver. The liver receives the blood and the person is able to see. The feet receive the blood and are able to walk. The palms receive the blood and are able to grasp. The fingers receive the blood and are able to hold.
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Wang Bing (Tang) said in his notes to Elementary Questions, Chapter 10 The liver stores the blood and the heart moves it. When a person moves, blood moves through all the channels, whereas when he rests, the blood returns to the liver. Why is this so? Because the liver governs the sea of blood. Elementary Questions, Chapter 4 The east direction is green-colored. It enters to connect to the liver. It opens its orifice in the eyes. It stores its essence in the liver. Magic Pivot, Chapter 17 Liver qi flows to the eyes. When the liver is harmonious, the eyes can to distinguish the five colors. Elementary Questions, Chapter 23 The liver forms tears. Magic Pivot, Discussion of the Nine Needles, Chapter 78 The liver stores the ethereal soul. Magic Pivot, Chapter 8 What follows the coming and going of the spirit is called the ethereal soul. Magic Pivot, Rooted in Spirit, Chapter 8 The liver stores blood. Blood is the abode of the ethereal soul. Elementary Questions, Chapter 67 The east direction produces wind. Wind produces wood. Wood produces sourness. Sourness produces the liver. The liver produces the sinews. The sinews produce the heart When its spirit is located in heaven, it is wind. Located on earth, it is wood. Located in the body, it is the sinews. Located in qi it is softness. Located in the viscera, it is the liver. Elementary Questions, Chapter 44 The liver governs the bodys sinews and membranes. Elementary Questions, Chapter 74 All wind, shaking, and dizziness corresponds to the liver.
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Gall Bladder dan: the judge

The gall bladder corresponds to wood element, and is paired with the liver (close relationship) The gall bladder is also an extraordinary organ. It does not deal with food and waste The gall bladder stores and excretes bile: It receives bile from the liver and stores it until needed in digestion. Bile is a clear fluid. The gall bladder is the mansion of clear fluid. The gall bladder controls judgment and decision-making: also courage. The ability to maintain balanced judgment in the face of adversity. Weak gall bladder qi leads to timidity. The gall bladder helps control the sinews: similar to the liver, but related to qi, not blood The gall bladder is the foot lesser yang or shao yang channel.
Elementary Questions, Chapter 8 The gall bladder is the official of central correctness. Decisions and judgment come out of it. Magic Pivot, Chapter 2 The liver unites with the gall bladder. The gall bladder is the bowel of central essence.
Heart xin: the emperor

The heart corresponds to the fire element. The heart governs the blood and the vessels (or blood vessels). All blood homes to the heart. o mai can mean either vessels or pulse The heart stores the spirit [shen, mind]: the seat of consciousness, perception, emotions, memory, logical thought, mental activity, sleep and dreams. o shen2: The dictionary says one of its definitions is soul, mind, spirit. o The five shen are the five spirits, one in each zang (viscera, yin organ) 1. shen2 spirit in the heart 2. hun2 or ethereal soul in liver 3. po4 or corporeal (animal) soul in lung 4. zhi4 or will (or mind) in kidney 5. yi4 or thought (reflection) in spleen o Heart blood and heart yin help anchor and nourish the spirit. o Since the Ming dynasty (1368-1644) some doctors said the brain was in charge of intelligence and memory. Sweat is the fluid of the heart: blood and body fluids have a common origin. o Li Shizhen (52-21): Sweat originates in the heart. While it remains within the body, it is blood. When it is excreted through the skin, it becomes sweat. Therefore, when there is excessive perspiration, there will not be much blood left in the body. Or when someone loses a great amount of the blood, it will be difficult for him to perspire. 20
The heart is reflected in the face. It manifests in the complexion and facial expression The heart opens into the tongue and governs speech which should be coherent and without excessive laughter. The emotion of the heart is joy. The heart is hand lesser yin shao yin channel.
Heart and liver: Both relate to blood. The heart moves (and governs) blood and the liver stores blood. The heart stores spirit (shen) and the liver stores ethereal soul (hun). Both need yin and blood to anchor and nourish their yang spirit. Both affect sleep and dreams. The heart governs emotions. The liver governs the smooth flow of qi and thus affects the emotions. Elementary Questions, Chapter 8 The heart is the sovereign official. Spirit illumination comes out from it. Elementary Questions, Chapter 44 The heart governs the bodys blood and vessels. Elementary Questions, Chapter 10 All blood belongs to the heart. Magic Pivot, Discussion of the Nine Needles, Chapter 78 The heart stores the spirit. Magic Pivot, Chapter 28 The heart is the governor of the five viscera and the six bowels That is why when someone suffers sorrow and grief, worry and anxiety, the heart stirs. When the heart stirs, the five viscera and the six bowels are all agitated. Magic Pivot, Rooted in Spirit, Chapter 8 The heart stores the vessels. The vessels are the abode of the spirit. Elementary Questions, Chapter 23 The heart forms sweat.
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Elementary Questions, Chapter 10 The heart is united with the vessels. Its glory is the complexion. Elementary Questions, Chapter 67 The south direction produces heat. Heat produces fire. Fire produces bitterness. Bitterness produces the heart. The heart produces blood. Blood produces the spleen. When located in heaven, it is heat. Located on earth, it is fire. Located in the body, it is the vessels. Located in qi it is growth. Located in the viscera, it is the heart. Wang Bing (Tang) said in his notes to Elementary Questions, Chapter 10 The liver stores the blood and the heart moves it. When a person moves, blood moves through all the channels, whereas when he rests, the blood returns to the liver.
Small Intestine xiao chang:

The small intestine corresponds to fire element, and is paired with the heart The small intestine governs receiving, containing, and transforming The small intestine governs the separation of the clear (pure, qing) and the turbid (impure, zhuo). o The clear is sent to the urinary bladder and becomes urine. The turbid continues on to the large intestine and becomes stool. The small intestine is hand greater yang or tai yang channel.
Elementary Questions, Chapter 8 The small intestine is the official who receives and contains. Transformation of substances comes out of it. Magic Pivot, Chapter 2 The heart unites with the small intestine. The small intestine is the bowel of receiving and containing.
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The Five Spirits

Chinese medicine teaches that each of the five yin organs of the body house one type of spirit. These five spirits are discussed in the Huangdi Neijing Suwen , Chapter 23: The five yin organs are the storing place: The heart stores the spirit (shen), the lungs store the corporeal soul (po), the liver stores the ethereal soul (hun), the spleen stores the thought (yi), the kidneys store the will (zhi). Thus it is said the five yin organs are storing places. The heart houses the shen2 or the spirit. Its function involves the mind, emotions, consciousness, and memory. It is also more or less in charge of the other four spirits while the person is living. It is adversely affected by excessive joy (excessive enjoyment). It processes all incoming sensory and intuitive information, and supervises the body and minds reaction to it. The liver houses the hun2 or the ethereal soul. This is close to our western concept of soul or spirit. It enters body during the perinatal period and survives after death. It is yang, ethereal, and without substance. Its immaterial nature is portrayed in the Chinese character, which consists of cloud and ghost . If liver blood or liver yin is very weak, the hun can leave the body temporarily at night. There will be the sensation of floating while falling asleep. It is adversely affected by anger, frustration, or depression. It is closely linked with the concept of spirits and demons. Heiner Fruehauf says the character hun originally meant the light (not the body) of the moon. Just as the moon reflects sunlight, the hun reflects the waking consciousness of the shen. Zhang Jingyue (Ming) said, This dim state of consciousness during dreaming, or the elusive visions we see meandering during nocturnal sleep, all fall under the category of hun. Hun is what is called on in prayers to ancestors. Wandering hun that cause trouble are hun that roam aimlessly because they have no one to perform rituals for them or make offerings to them. The lungs house the po4 or the corporeal soul. The po is attached to the body. It enters at conception and goes to the earth with the body at death. It gives us the capacity for sensation, feeling, hearing, and sight. It is a very physical aspect, considered yin. The po is closely linked to breathing and survival or animal instincts. It is the bodys basic reactive instincts. Breathing is the most fundamental instinct, so the po resides in the lungs. It is adversely affected by grief or sadness. Heiner Fruehauf says that the character po originally meant the body of the moon. Kong Yingda said, The spirit of form is called po. When human beings are first born, they can see and hear, their hands and feet can move. These actions are due to the workings of the po. Zhang Jingyue said, The effect of po is that we can move and do things, that there is itching and pain. The spleen houses the yi4 or thought or reflection. It relates to applied thinking, studying, concentrating, memorization. It is the ability to think and remember. It is adversely affected by too much thinking or obsessive thought. The kidneys house the zhi4 or will. It is mental drive, determination, single-mindedness, and the pursuit of goals. It also affects memory. It is adversely affected by fear or fright. Death Death is said to be a separation of yin and yang, more specifically, po (corporeal soul) and hun (ethereal soul). The spirits of the other organs mentioned above are not considered functional after death. Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac. 23
Class 4 Pericardium xin bao or xin zhu:

Pericardium is also fire element. The pericardium is paired with san jiao (triple burner), discussed below. When we discuss the five viscera and six bowels, the pericardium is not counted, although the pericardium channel is as important as any other channel. The pericardium is the protective screen of the heart. The pericardium is discussed in some febrile diseases (when evils try to invade the heart, they must first pass through the pericardium). Some say the pericardium corresponds to minister fire (others say ming men life gate or other organs are minister fire). The pericardium is hand jue yin or reverting (or absolute) yin channel.
Elementary Questions, Chapter 8 The dan zhong (pericardium) is the official who is a statesman and messenger. Joy and elation come out of it.
Triple Burner san jiao: It is a summary of function of the yang organs, plus the three yin
organs that relate to fluid metabolism: lungs, spleen, and kidneys. Although the triple burner has three parts, it is a unified system. The san jiao corresponds to fire element, and is paired with pericardium. Most, but not all, old books say it is formless. The san jiao is a pathway for source qi: The kidneys are the origin of the san jiao. Source (yuan) qi originates in lower jiao between the kidneys, and spreads to the organs through the three jiao, then enters the twelve channels and emerges at the yuan source points. o The making of post-heaven qi is a type of qi transformation activated by source qi. The san jiao is three divisions of the body, and its main function is governing the waterways: It is in charge of movement of qi and fluids through all three jiao. It represents three divisions of the waterways. o The upper burner is like a mist: Everything above the diaphragm, especially the heart and lungs. The lungs dispersing function: Distribution of fluids by the lungs and defense qi all over the body, especially to the skin and flesh, as a fine vapor, clear and light. The upper burner also governs intake: it controls receiving (absorbing) but not excreting. o The middle burner is like a muddy pool or bubbling cauldron or foam: Diaphragm to waist: especially the spleen and stomach. Digestion of food and drink and transportation of nourishment to all parts of the body. The clear and turbid are mixed. The clear goes up and turbid goes down. The middle burner controls the rotting and ripening of food and drink. Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac. 24
o The lower burner is like a ditch: Below the waist: liver, kidneys, intestines, bladder, uterus. Turbid and heavy. The turbid part of food and drink, and excretion of the turbid. The lower burner governs exit: it controls excreting but not receiving fluids and wastes. Also reproduction. The triple burner is the hand lesser yang or shao yang channel.
Li Dongyuan said the san jiao is a physical manifestation of the three treasures. Magic Pivot, Chapter 18 The upper burner is like a mist. The middle burner is like a foam. The lower burner is like a sluice. Magic Pivot, Chapter 18 (Translation by Nigel Wiseman) Magic Pivot, Chapter 2 The triple burner is the bowel of the central sluice. The waterways come out of it. It belongs to the urinary bladder. It is the solitary bowel.
Spleen pi:
The spleen corresponds to earth element and the center. The spleen governs transportation and transformation : Spleen yang and spleen qi do this o Spleen transforms and transports qi Transforms qi from food and drink by extracting qi and beginning the process of transforming grain qi into true qi and blood. Transports food qi and food essence to various parts of the body, including the flesh and the four limbs o Spleen transforms and transports fluids Transforms fluids from diet into body fluids. Transports clear fluids up to the lungs and let turbid fluids continue on down The spleen likes dryness and the stomach likes moisture: In disharmony, the spleen forms phlegm. The spleen raises the clear while the stomach descends the turbid. o Spleen qi moves upwards and holds the organs up in their place o The spleen sends grain qi and fluids to the upper jiao, prevents food from passing through the digestive tract too quickly, and raises clear yang to aid the sense orifices and brain The spleen is in charge of the production of qi and blood: It is the root of post-heaven qi.
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The spleen governs the muscles and flesh of the whole body, especially the four limbs:
The spleen manages or controls the blood, causing it to stay within the vessels: spleen earth is like the banks of a river, keeping the water (blood) flowing through the proper path. The spleen opens in the mouth and manifests in the lips. The spleen channel connects with the root of the tongue and scatters below the tongue. When the spleen is harmonious, the mouth recognizes the five flavors. The spleen is the granary official from whom the five flavors are derived. The spleens fluid is drool. The spleen stores yi reflection and its emotion is thought: thinking, studying, concentrating, focusing, memorizing (spleen is school-type of thinking and memorization. Heart is clear thinking and emotional memories, kidney is short-term memory.) The spleen is the foot tai yin or greater yin channel.
Liver and spleen: The liver stores blood and the spleen holds blood in the vessels, as well as helping to make blood. Both help with digestion: spleen transportation and transformation, liver with smooth flow of qi and bile The qi of both tends to move upward. Spleen and heart: The spleen makes blood and holds it in the vessels. The heart governs blood. Blood is made around the heart. Elementary Questions, Chapter 74 All dampness, swelling, and fullness is ascribed to the spleen. Elementary Questions, Chapter 44 The spleen governs the bodys muscle and flesh. Elementary Questions, Chapter 10 The spleen is united with the flesh. Its glory is the lips.
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Classic of Difficulties, 42nd Difficulty The spleen governs keeping blood inside. It warms the five viscera and stores reflection. Magic Pivot, Chapter 17 Spleen qi flows to the mouth; when the spleen is harmonious, the mouth is able to know the five grains. Elementary Questions, Chapter 4 The center is yellow-colored. It enters to connect to the spleen. It opens its orifice in the mouth. It stores its essence in the spleen. Elementary Questions, Chapter 5 The center produces dampness. Dampness produces earth. Earth produces sweetness. Sweetness produces the spleen. The spleen produces the flesh. The flesh produces the lungs. The spleen governs the mouth. Magic Pivot, Discussion of the Nine Needles, Chapter 78 The spleen stores reflection (intent).
Stomach wei: spleen and stomach are the root of after-heaven qi

The stomach corresponds to earth element, and is paired with spleen: a close relationship. The term middle jiao means the spleen and stomach together, digestion and production of post-heaven qi. The stomach is in charge of receiving and fermenting or rotting and ripening: It is a bubbling cauldron. The stomach is called the sea of water and grains. Stomach qi descends The stomach assists the spleen in transportation of food essences Stomach qi is important in diagnosis and prognosis: Its qi reaches the pulse, and the tongue coating is related to stomach. Because stomach qi is the root of man, if there is stomach qi, there is life. If stomach qi is strong, the prognosis is good. The stomach is the origin of fluids: The kidneys are the (exit) gate of the stomach. The stomach is the the foot yang ming or yang brightness channel.
Elementary Questions, Chapter 52 The spleen is the envoy. The stomach is the market. Elementary Questions, Chapter 8 The spleen and stomach are the officials of food and granaries. The five flavors come out of them.
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Magic Pivot, Chapter 33 The stomach is the sea of water and grains. Magic Pivot, Chapter 2 The spleen unites with the stomach. The stomach is the bowel of the five grains. Magic Pivot, Chapter 2 The large intestine and small intestine both belong to the stomach, which is foot yang brightness. Elementary Questions, Chapter 9 The spleen, stomach, large intestine, small intestine, triple burner, and urinary bladder are the root of the food granary. They are the dwelling of construction [ying]. They are called the vessel. They are able to transform the dregs and sediments. They pass on the flavors so that they can enter and exit. Their bloom is in the four whites of the lips. Their fullness is in the flesh. Their flavor is sweet. Their color is yellow. They are in the category of reaching yin. They communicate with earth [element] qi.
Extraordinary Organs qi heng zhi fu:

Organ type Viscera/zang/yin organs Bowels/fu/yang organs Extraordinary organs Characteristics Store Dont drain Solid Full but cannot be filled 5 Dont store Drain Hollow Fill, but cannot be full 6 Store Dont drain Hollow 6
Extraordinary organs store like yin organs, but are hollow like yang organs. They do not decompose food nor excrete wastes. They store purified substances. All are said to be directly or indirectly related to the kidneys. Elementary Questions, Chapter 11 The brain, marrow, bone, vessels, gallbladder, and uterus of the females: these six are generated by earth qi. All of them store in yin and their image is in the earth. Thus, they store and do not drain. They are called the extraordinary organs.
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zi3gong1: uterus o The uterus regulates menstruation, conception, pregnancy. o It is closely related to kidney (essence), and ren (qi) and chong (blood) vessels. o The liver stores blood in the uterus and chong vessel, releasing it in menstruation. o The uterus stores the fetus. o Men have the room of essence which stores semen. nao3: brain o The brain is the sea of marrow (stores marrow). o The brain controls memory, concentration, intelligence, sight, hearing, touch, smell. o The kidneys make marrow to fill up the brain. o The brain is also related to heart blood and the governing (du) vessel.
Magic Pivot, Chapter 33 The brain is the sea of marrow. sui3: marrow o Marrow includes bone marrow, spinal cord, and brain. o The kidneys make marrow. It is related to essence. o Marrow helps make blood (menstrual blood according to some). gu3: bones o The bones store marrow, and are related to the kidneys.
Elementary Questions, Chapter 17 The bones are the mansion of marrow. Elementary Questions, Chapter 44 The kidneys govern the bodys bones and marrow. mai4: vessels, any pathway of blood or of qi. o The vessels store blood (and also qi). o This character also means the pulse.
Elementary Questions, Chapter 17 The vessels are the mansion of blood. Elementary Questions, Chapter 44 The heart governs the bodys blood and vessels. dan3: gall bladder o The gall bladder stores bile, so it is different from other yang organs (fu). It is a bowel because it plays a role in the processing and conveyance of food and stands in interior/exterior relationship with the liver, its paired viscera. 29
Class 5
Lungs fei: the prime minister
The lungs are metal element. The lungs govern the qi of the whole body. This includes respiration as qi also means air and breath. o The lungs extract clear qi from air (descending it) and disperse dirty qi (dispersing it) o The lungs assist in the formation of the bodys qi: great (air) qi combines with grain (food) qi to make gathering (ancestral) qi ( zong qi) in the chest. o Lung qi pushes qi-blood through the vessels and channels The lungs are in charge of orderly flow (administration): They are the prime minister. o They help heart qi circulate blood. Qi moves blood. o They also push qi through the channels The lungs are in charge of descending and dispersing qi and fluids. o Qi: part of their function of governing qi. Descending: The lungs descend great (air) qi upon inhalation. They also push the bodys waste down through the large intestine. Dispersing: The lungs are in charge of the outward movement of qi, and thus connect with the skin and body hair. They disperse defense qi, which governs the opening and closing of pores and protects against invasion of external evils. The lungs govern the exterior of the whole body, controlling the skin, body hair, and pores. o Fluids: The lungs are the upper source of water: The lungs open and regulate the water passages. Descending: Lungs descend fluids to the kidneys and urinary bladder and help in the urinary function. Dispersing: Lungs disperse fluids to moisten the skin, like a mist. The lungs are lid or canopy: the florid canopy of the five viscera, the highest organ. The lungs open into the nose and connect with the throat. o Breathing and smelling. Snivel is the fluid of the lungs. o The lungs govern the voice (like the sound of a metal bell). The lungs are the receptacle that holds phlegm (the spleen makes phlegm). The lungs are the delicate organ and cannot endure heat or cold: The lungs are most external zang (viscus, yin organ), easily attacked by external evils. The lungs store the corporeal (animal) soul po: Related to breathing, sighing, and crying.
The emotion of the lungs is sorrow (sadness, grief). The lungs are the hand greater yin or tai yin channel. 30
Liver and lungs: The liver controls smooth flow of qi and the lungs govern qi. The liver upbears while the lungs downbear. These contain the ethereal soul (hun) and the corporeal soul (po). Heart and lungs: Both are in the upper jiao. They are the emperor (governing blood) and the prime minister (governing qi). The pulse consists of heart blood with lung qi pushing it. Sweat is the fluid of the heart. Defense qi from the lungs moves the sweat to the surface and opens and closes the pores. Spleen and lungs: The spleen sends food qi up to the lungs, where it combines with air qi to make gathering or ancestral qi (zong qi). Both contribute to fluid metabolism. The spleen makes phlegm and the lungs store phlegm. Both are tai yin (greater yin) channels Elementary Questions, Chapter 8 The lungs are the official who is the minister in charge. Regulation and restraint come out from them. Elementary Questions, Chapter 10 All qi belongs to the lungs. Elementary Questions, Chapter 21 The lungs face the hundred vessels and transport essence to the skin and body hair. Magic Pivot, Chapter 47 Defense qi is what warms the divisions of the flesh, fills the skin, fattens up the interstices, and manages their opening and closing. Elementary Questions, Chapter 10 The lungs are united with the skin. Their glory is the body hair. Magic Pivot, Discussion of the Nine Needles, Chapter 78 Heaven is yang. In the five viscera, it corresponds to the lungs. The lungs are the lid [or canopy] of the five viscera and six bowels. The skin unites with the lungs; it is the yang aspect of man.
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Elementary Questions, Chapter 44 The lungs are the chief of the viscera. They are the lid [or canopy] of the heart. Magic Pivot, Chapter 17 Lung qi flows to the nose; when the lungs are harmonious, the nose is able to know stinky from fragrant. Magic Pivot, Discussion of the Nine Needles, Chapter 78 The lungs store the corporeal soul. Elementary Questions, Chapter 4 The west direction is white-colored. It enters to connect to the lungs. It opens its orifice in the nose. It stores its essence in the lungs.
Large Intestine da chang:

The large intestine corresponds to metal element, and is paired with the lungs. Lung qi pushes the stool down. Lung yin moistens the large intestine. The anus is called gate of the po. The large intestine governs conduction and conveyance of waste: it receives the leftovers (turbid part) of food and drink from small intestine, reabsorbs some fluid, and excretes stool. The large intestine likes moisture and is averse to dryness. Malfunction of the large intestine is more often related to the spleen or stomach pathology. The large intestine is the hand yang brightness or yang ming channel. The large intestine and the stomach together are the yang ming channels. Therefore, its diseases are mostly treated through the stomach (and its pair, the spleen).
Magic Pivot, Chapter 2 The lungs unite with the large intestine. The large intestine is the bowel of conducting through the pathways Elementary Questions, Chapter 8 The large intestine is the official who conducts through the pathways. Mutation and transformation comes out of it. ***
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Kidneys shen:
The kidneys correspond to water element. The kidneys store essence and govern birth, growth, reproduction, development, and aging: They are the root of before-heaven qi. o jing essence: before-heaven from parents, partly replenished by after-heaven essence. o Essence governs birth, growth, reproduction, fertility, sexual maturation, and development, as well as constitution. It is the material foundation for semen, menstrual blood, breast milk, marrow, etc. o Although essence is yin, it is the material basis for both kidney yin and kidney yang, and source (yuan) qi. The kidneys manifest in the head hair: essence nourishes it, giving color and thickness. The kidneys are the foundation of yin and yang for the whole body. They are the origin of water and fire. Kidney yin and kidney yang rely on each other. They are like an oil lamp: yin is the oil and yang is the flame. o Kidney yin is original yin or original water. It is the fundamental substance for birth, growth, reproduction. o Kidney yang is original yang or original fire. It is the heat and moving force of all physiological processes. Fire Water Pre-heaven original yang, life gate original yin, essence heart kidneys Post-heaven The kidneys engender marrow, fill up the brain, and govern the bones: o The kidneys make bones, teeth, bone marrow, the brain, and spinal cord. Marrow fills up the brain and spinal cord which are the sea of marrow. The teeth are the surplus of the bones. The low back is the mansion of the kidneys. The knees are also related. o The kidneys control strength and skill: the capacity for hard work, also skilled and delicate activities The kidneys store the zhi will or mind: the mind as it is focused on goals and ability to pursue them: will, purpose, ambition, or determination. zhi will can also mean mind, the capacity to think, feel, and respond, affect, emotion. It also implies memory (related to , to record). Fear and fright adversely affect the kidneys and the will. The kidneys cooperate with the triple burner to transform qi and move water. The kidneys govern the water of the whole body: The kidneys are the water organ. o The kidneys govern the five fluids. Spittle is the fluid of the kidneys. This is the fluid excreted in the mouth during meditation. o Fluids enter through the stomach, are sent up by the spleen, descended and dispersed by the lungs, eventually to the kidneys. o Kidney qi governs the excretion of turbid fluids through the urinary bladder. o Kidney yang and the san jiao warm and transform fluids, governing fluid metabolism as a whole. The kidneys open into the ears and also the two lower (yin) orifices, and control their opening and closing. The kidneys govern storage. 33
The kidneys absorb qi (control the reception of qi, grasp qi, or contain qi): kidneys pull qi down from the lungs. This is a kidney qi or yang function. Abdominal ( dan tian) breathing is proper. Ren 6, located on the dan tian, is the Sea of Qi. ming men huo - Life gate fire is associated with the kidneys: o Life gate fire is the basic fire of life, kidney yang, original or true yang. It has a preheaven connotation to it. It is the moving force of all physiological activity of the body, the source of fire or heat for all bodily functions: It warms the lower burner and the urinary bladder. It harmonizes sexual function and warms the essence and uterus. It assists the kidney function of reception of qi. It warms the spleen and stomach to aid digestion. It assists the heart function of housing the mind. Some doctors in the Ming dynasty discussed life gate fire and life gate water. The kidneys are the foot lesser yin or shao yin channel.
Classic of Difficulties, 36th Difficulty The two kidneys are not both kidneys. The left is the kidney. The right is life gate. Life gate is the abode of all spirit-essence. Source qi is tied to it. In males, it stores essence. In females, it is tied to the uterus. During the Ming dynasty, doctors said that life gate involved both kidneys, was between the two kidneys, or was the moving qi (source qi) between the kidneys. Kidney Functions Pre-heaven Post-Heaven -essence, marrow, bone, brain, teeth, ears, -grasping qi from the lungs head hair, constitution -governing the two lower orifices -birth, growth, development, aging -waterways, urination, fluids -sexuality, fertility -original yin, original yang Spittle is the fluid of the kidneys: Li Shizhen (Ming) said: Spittle is transformed from a persons essence qi... Thus, people who practice self-cultivation swallow these liquids to absorb the qi, calling it clear water irrigating the root of the soul. When people are able to refrain from spitting throughout the day, essence qi is constantly retained... If you [frequently] spit over a long period of time, it harms essence qi... Thus it is said, Spitting far is inferior to spitting near. Spitting near is inferior to not spitting at all.
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Liver and kidneys: The liver stores blood and the kidneys store essence, both yin substances. Both are in the lower jiao (functionally). Liver and kidneys have a common source. Essence and blood have a common source. Kidney yin nourishes liver yin. Kidney yang gives the liver its ascending function. Heart and kidneys: Mutual assistance of fire and water: Must be balanced and communicate with each other. Common root of spirit and essence (jing-shen): the heart stores the spirit and the kidneys store essence and will. Spirit is the external manifestation of essence. Both are shao yin (lesser yin) channels. Spleen and kidneys: The spleen is the root of post-heaven qi and the kidneys are the root of pre-heaven qi. Kidney yang (life gate fire) is the moving force in the digestion, supporting spleen yang. Both are important in fluid metabolism. Lungs and kidneys: The lungs govern qi and the kidneys are the root of qi. The lungs descends qi and fluids, and the kidneys absorb or receive them. The lungs have gathering (zong) qi and the kidneys have source (yuan) qi. Source qi transforms gathering qi into true qi. Zhu Danxi (Yuan) from Danxis Heart Methods The kidneys only have insufficiency. Elementary Questions, Chapter 10 The kidneys govern the bodys bones and marrow. Elementary Questions, Chapter 17 The low back is the mansion of the kidneys. Elementary Questions, Chapter 8 The kidneys are the official who makes strength. Ability and skill come out of them. Magic Pivot, Rooted in Spirit, Chapter 8 The kidneys store essence. Essence is the abode of the will.
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Magic Pivot, Discussion of the Nine Needles, Chapter 78 The kidneys store essence and the will. Magic Pivot, Chapter 17 Kidney qi flows to the ears; when the kidneys are harmonious, the ears are able to hear the five tones. Elementary Questions, Chapter 4 The north direction is black-colored. It enters to connect to the kidneys. It opens its orifice in the two yin. It stores its essence in the kidneys. Elementary Questions, Chapter 9 The kidneys govern hibernation. They are the root of sealing and storing. They are the dwelling of essence. Their flower is in the hair of the head. Their fullness is in the bones.
Urinary Bladder pang guang:

The urinary bladder corresponds to water element, and is paired with the kidneys. Kidney qi opens and closes the opening of the urinary bladder, and transforms fluids into urine. The urinary bladder governs the storage of fluids and humors. The urinary bladder is the official of the municipal waterworks. The urinary bladder removes water by qi transformation: It receives fluids from the lungs and small intestine, stores the fluids, transforms them into urine, aided by kidney qi/yang, and excretes the urine. Here, qi transformation means transformation of fluids in the urinary bladder by kidney qi. The urinary bladder is the foot greater yang or tai yang channel
Magic Pivot, Chapter 2 The kidneys unite with the urinary bladder. The urinary bladder is the bowel of body fluids. *** In Chinese medicine, there are three very controversial topics, and all are related to the kidneys: life gate ( ming men), triple burner ( san jiao), and minister fire ( xiang huo).
Minister Fire : Minister fire is a secondary fire (heart shao yin fire is sovereign fire) in the
body inhabiting life gate, pericardium, and/or various other organs. Even when it manifests in these other organs, it is thought to come essentially from life gate (kidney yang). Together, sovereign and minister fire warm the organs and power activity in the body. Some say minister fire is the fire of the liver and kidneys. In insufficient liver and kidney yin, minister fire can become hyperactive and flare up. This condition can also be called vacuity fire flaring up due to liver and kidney yin vacuity. Zhu Danxi (Yuan) called it yin fire. There are other things minister fire can refer to, but these are not commonly used in TCM. Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac. 36
Class 6
Functions of Qi (review) Activity Transformation Transportation Containment Raising Defense Warming The context of the following is in health versus disease: Right qi (or righteous or upright qi): [ zheng4 qi4] the sum of all healthy qi and other health-promoting substances in the body: antipathogenic factor. Evil qi [ xie2 qi4]: Qi, mostly from the weather, that can cause disease: pathogenic factors. Evils can also arise internally. When yin and yang are level, this is right qi. When yin and yang are skewed, this is evil qi. Wu Qian et.al. (Qing dynasty) If the root is full, how can there be disease! Tao Hongjing (Southern Liang dynasty) When benign qi meets a person, it is familiar like a brother. When malign qi meets a person, it causes more harm than weapons. Guanzi (Zhou dynasty) Source (or original) qi: [ yuan2 qi4] It is transformed from jing essence, associated with kidneys or life gate ( ming men). It is before-heaven qi. Its functions are: The basis of all physiological activity, activating the functions of all the organs Facilitates transformation of qi and blood (Example: gathering qi to true qi). Distributed by the triple burner to the whole body. Available to influence at the source points Center qi: [ zhong1 qi4] spleen-stomach qi, digestive qi. Also the spleen function of raising clear qi and the stomach function of descending turbid qi. The spleen-stomach are considered the middle (central) burner, so their qi is central qi. Context: ability to digest and make qi, raise qi.
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The next two are the raw materials for the body, post-heaven qi: Grain (or food) qi: [ gu3 qi4] Food enters stomach and its qi is extracted from it by the spleen. This qi is not yet usable by the body (like crude oil, still needs refining). It is sent up to chest to help form gathering qi and to the heart to help form blood. Great (or air) qi: [ da4 qi4] The qi from air, taken into the lungs, which helps to form gathering qi. Gathering (or ancestral) qi: [ zong1 qi4] a combination of grain qi and great qi. It gathers in the chest. It is the ancestor of true qi. It: gathers in the chest and nourishes the heart and lungs helps the lungs govern qi, control respiration, speech, and the strength of the voice helps the heart govern the blood, vessels, pulse and promote circulation to the extremities True qi: [ zhen1 qi4] gathering qi is transformed by source qi into true qi, which is what most of the body uses in the channels and organs. Context: the manufacture of qi. There are two types: Construction (or nutritive) qi: [ ying2 qi4] nourishes the organs, and the whole body. o Construction is located within the channels and vessels. It forms blood and flows with the blood. It is yin and refined compared to defense qi. It is what we work with in acupuncture. Defense (or protective) qi: [ wei4 qi4] coarser, more yang, slippery, and aggressive. o Defense is located outside the channels and vessels. o Defense protects against external evils. It opens and closes the interstices ( cou li: usually translated as pores) and controls sweating. It is dispersed to the surface of the body by the lungs. o Defense qi warms the surface of the body. o Defense moves in the yang during the daytime: It flows in the skin and flesh with body fluids. At night, it moves in the yin: It goes into the organs, leaving us more vulnerable to external attack. Defense is like the army troops guarding the borders of a country. Construction is like the support personnel who feed and supply the troops. The floating qi that does not follow the channels is defense qi. The essence qi that moves in the channels is construction qi. Magic Pivot, Chapter 52 (Warring States Period) Channel qi: [] Qi as it flows in the channels. Example: Qi of the heart channel. Organ qi: [] Qi as it is used by each organ. Example: spleen qi, kidney qi. Qi Mechanism qi ji: The activity, particularly the movement, of qi. PDOCM Movement of qi: enters or sinks , exits or floats , rises , and falls . Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac. 38
(You need to take some notes here.)
Qi Pathology
These are the main problems that can develop with qi. They will be studied in detail later. Qi vacuity (deficiency): [qi4 xu1 ] insufficiency of qi in any organ o Qi falling: [qi4 xian4 ] spleen or center qi falling Qi stagnation: [qi4 zhi4 ] decrease in the normal movement of qi due to the obstructive effect of excessive emotions, external injury, evil qi, static blood, or qi vacuity. Distention, fullness or pain is the result. o Qi constraint (depression or stagnation): [qi4 yu4 ] binding depression of liver qi, due to emotional causes. Qi counterflow (rebellion): [qi4 ni4 ] Improperly ascending qi of the liver, lungs or stomach.
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Blood: part of yin, a very dense form of qi. Manufacture: Same way as qi, except gathering qi and fluids are transformed to blood around the heart. o Also kidney essence marrow bone marrow blood. Some say this is menstrual blood. Functions (review): o Nourishes the body (primary function) o Moistens. Example: blood moistens the eyes, sinews, skin, and hair. o The material foundation for spirit. Heart blood houses, nourishes, and anchors the spirit (governing emotions, consciousness, and sleep). It also anchors the ethereal soul (hun) and qi. o Nei Jing: If the liver is supplied with blood, we can see. If the feet are supplied with blood, we can walk. If the hands are supplied with blood, we can grasp. Relationships: o Heart: governs the blood and vessels, blood is made around the heart. o Spleen: helps produce blood, spleen qi holds blood in the vessels. o Liver: stores blood during rest (in activity, blood goes to the flesh), menstruation (liver supplies blood to the uterus). Liver blood nourishes the eyes, sinews, and nails. o Qi and Blood: both are qi, but blood is more material and dense. Inseparable, in the channels and vessels. Qi generates blood Qi moves blood. When qi moves, blood follows. If qi stagnates, blood congeals. Qi holds the blood in the vessels. Qi is the commander of blood. Blood nourishes qi. It is also the material basis to keep qi and spirit from floating away. Blood is the mother of qi. o Essence and Blood: They can transform into each other.
Blood Pathology
These are the main problems that can develop with blood. They will be studied in detail later. Blood vacuity ( xue4 xu1): insufficiency of blood. o Blood dryness ( xue4 zao4): blood vacuity manifesting in signs of dryness Blood stasis ( xue4 yu1): impairment or cessation of the normal free flow of blood. Blood heat ( xue4 re4): a condition characterized by heat and blood signs, mostly occurring in externally contracted heat (febrile) diseases, though possible in diseases due to lifestyle. Blood cold ( xue4 han2): cold congeals, inhibiting movement of blood, causing stasis.
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Body Fluids jin1 ye4 (review)

Jin: liquids. Thinner. Moistens and nourishes the skin, muscles, sweat, tears, saliva, mucus. Ye: humor. Thicker. Moistens and nourishes the brain, marrow, joints, sense orifices. Functions: Moistening (primary) and nourishing (secondary). Elementary Questions, Chapter 21 Drinks enter into the stomach. Their essence qi roves and spills out and is transported upward by the spleen. Spleen qi disperses the essence, and returns it up to the lungs, which regulate the waterways and keep them flowing freely. They transport it down to the urinary bladder.
Fluid Metabolism
1. The stomach is the source of fluids, the sea of water and grains. 2. The spleen upbears the clear fluids, sending them towards the lungs. It is also in charge of transportation and transformation of fluids. The stomach allows the turbid fluids to pass downward. 3. The lungs are the upper source of water. They disperse clear fluids outward to the skin and flesh. They descend the turbid fluids toward the kidneys and urinary bladder.
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4. The turbid of the stomach is passed on to the small intestine. The small intestine separates the clear from the turbid. The clear of the small intestine goes to the urinary bladder to become urine. The turbid goes to the large intestine to become stool. 5. The urinary bladder excretes the turbid as urine. The large intestine excretes the turbid as stool. A small amount of clear is reabsorbed and recycled into the body from these two organs.
6. Kidney yang gives the needed fire to the three burners, spleen, small intestine, urinary bladder, and large intestine. Without this heat and movement, fluids would stagnate and grow cold. Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac. 42
Relationships Fluids and qi: o Qi transforms and transports fluids, holds body fluids in, produces body fluids. o Body fluids nourish and anchor qi. When qi transforms, water moves. Zhang Yinan (Qing dynasty) When qi flows properly, body fluids circulate. Yan Yonghe (Song dynasty) Fluids and blood: both are yin; they nourish each other
Fluid Pathology: Damage to fluids ( jin1ye4 sun3shang1): reduction of fluids by the heat or fire, as a result of enduring illness, excessive loss of blood, excessive urination, or overuse of herbs that promote urination or sweating. Fluid accumulation: edema, phlegm, rheum
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Class 7
Health is a balance between the body and the environment, and within the body between the organs, substances, etc. Disease is imbalance. Three Causes of Disease ( Etiology) External Causes of Disease (): The six qi assail the body from outside. Internal Causes of Disease (): The seven emotions can cause illness from the inside. Neither-Internal-Nor-External (Neutral) Causes of Disease (): Lifestyle, trauma, etc.
External Causes of Disease:

The six qi are wind, cold, dryness, dampness, summerheat, and fire. These are weather or climates, also related to the seasons and elements. Seasons: o wind = spring, wood; o summerheat or fire = summer, fire; o dampness = late summer, earth; o dryness = autumn, metal; o coldness = winter, water. o But these qi can occur at any time, causing illness. Example: living in a damp house. The body has normal physiological changes through the four seasons, and adapts to climate and weather. There is no disease if the weather is of normal strength and the body is strong. If the weather is extreme or unseasonable, or if body is weak, the six qi can cause disease. When they cause disease by being untimely or excessive, the six qi are called evils. It is also easy to catch disease with air conditioning, fans, central heating, dressing inappropriately, working in hot factory or in a refrigerated area, etc. The six qi invade the body from the environment through the defensive exterior. External invasion is always a repletion, but it can be complicated by vacuity (of right qi). An evil can combine with other evils or transform (most often into heat) within the body. Defining symptoms of exterior illness: sensations of cold and heat (feels hot but wants to keep covered up), fever and chills. Evils can invade the channels or joints: pain, loss of function.
Wind ( feng1)
Wind: spring, wood; a yang evil, so it damages yin and blood. It invades after sweating (when the pores are open) or while sleeping (when defense qi goes inward) or in vacuity of defense. Wind penetrates and carries other evils into the body with it: such as wind-heat, wind-cold, wind-dampness, etc. Wind sways the tops of the trees: it is a yang evil that moves upward and outward, so it first affects the upper body and the surface of the body (skin and defensive exterior). Wind comes and goes quickly, changes rapidly, moves swiftly, blows intermittently: Wind diseases have the same characteristics. Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac. 44
Wind has constant movement or inappropriate lack of movement: o Wind leads to movement or a feeling of movement: dizziness, vertigo, convulsions, tremors, spasms, tingling, numbness o It can also lead to non-movement: rigidity, paralysis, stiffness, etc. When exterior wind invades: through the skin, it interferes with defense qi and pores. This causes abnormalities in sweating. It causes aversion to wind or cold, fever or a feeling of heat, sneezing, cough, runny nose, stiff neck, headache, itchy throat, floating pulse. Treatment principle: dispel wind from the exterior (release the exterior). When exterior wind invades the channels: facial paralysis, or joint stiffness and pain that wanders: bi patterns ( impediment) o Treatment principle: dispel wind from the channels Interior wind is always due to the liver: convulsions, wind-stroke, etc. o Treatment principle: pacify (or subdue) wind. Cold manifests with low temperatures: patient feels cold in various areas, has aversion to cold, feels better with heat, likes to eat or drink hot foods. No thirst, pale. Cold slows down activity: functions decline and slow down like a river freezing over. Fluids are not transformed due to slow function and lack of warmth so cold diseases have watery fluids and a slow pulse. Cold congeals, stagnates, and contracts: the pores, sinews, and channels are obstructed; it obstructs circulation of qi and blood, causing severe pain, spasms, no sweating, stiffness. Heat disperses and removes the blockage. Internal cold can be repletion or yang vacuity. o Internal repletion cold is from external cold that goes deeper, or too much cold food. It consumes yang and eventually becomes vacuity cold. Treatment principle: warm what is cold (and fortify yang if necessary). Causes of dampness: damp weather, humidity, rain, damp environments, wet clothes, wading in water, working in damp places, sitting on damp ground, etc. It also can be caused by eating cold, damp, or raw foods. Dampness is heavy and moves downward, so it tends to affect the lower body, such as the legs and lower burner. A feeling of heaviness is also dampness. Dampness is turbid, sticky, stagnant, thick, clammy, dirty, and causes persistent diseases: Its diseases are prolonged and difficult to cure, often chronic, fixed location. Oozing sores, turbid discharges. Dampness obstructs qi circulation: stagnation, feeling of fullness or heaviness or swelling. Exterior dampness: aching of the whole body, possibly acute digestive upset. Dampness in the channels and joints: dull ache, swelling, lingering pain, fixed location. Interior dampness is from spleen vacuity leading to poor transportation and transformation, so fluids accumulate and become dampness, and digestion is disturbed. Treatment principle: transform or drain dampness.
Cold ( han2): winter, water, affects kidneys. Cold is a yin evil and easily damages yang qi.

Dampness ( shi1): late summer, earth, affects the spleen; it is a yin evil, so it impairs yang.
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Dryness ( zao4): autumn, metal, affects lungs; yang evil so it affects yin and blood.
Dryness is caused by dry weather, dry centrally-heated buildings, too much sweating or urination, etc., improper use of drying herbs. Dryness consumes fluids (including blood and yin): dry nose, throat, lips, tongue, and mouth; chapped skin, withered hair, constipation, scant urine, dry cough Treatment principle: moisten dryness.
Fire ( huo3): summer; sometimes also called heat (); A yang evil, so it injures yin and blood.
Fire is burning hot: fever, thirst, burning pain, the patient wants cold foods and drinks, aversion to heat, redness, rapid pulse. Rapid changes. Fire moves upward, and also disturbs spirit: mouth and tongue ulcers, headache, red eyes, delirium, agitation, restlessness, insomnia, mania. Fire consumes yin fluids: sweating, thirst, dry lips and throat, constipation, scant dark urine, and scant dark discharges. Fire can stir up internal wind: Fire and extreme heat easily engender wind, dimming consciousness. High fever, coma, convulsions. Fire can disturb the blood: Heat can boil the blood and make it leave the vessels. This causes bleeding and/or skin diseases. Fire can be from the environment, or any of the other evils tend to transform to heat or fire in the body. Internal heat can be from repletion or from yin vacuity
Summerheat ( shu3):
Summerheat has high temperature: extreme heat, high fever, aversion to heat, restlessness, thirst, profuse sweating, but absence of sweating later, surging rapid pulse, red tongue Summerheat has upward movement: Summerheats nature is upbearing and scattering. It affects the head: dizziness, blurred vision, headache. Summerheat consumes body fluids and damages qi: excessive sweating, thirst, dry mouth and tongue, scant dark urine, lassitude. Severe summerheat is sunstroke, sudden collapse, coma, disturbed consciousness, delirium, slurred speech. It can be fatal. Summerheat frequently combines with dampness: dizziness, feeling of suffocation, nausea, loose stools, lassitude, soggy pulse, thick slimy tongue coat. Treatment principle: clear summerheat (and transform dampness, if necessary).
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External Evils Enters through skin and pores How it happens Wind carries other evils with it with wind or through physical contact in warm disease (wen bing) theory, evils enter through nose and mouth orifices with food into the stomach lower orifices (bathing, swimming, sitting on the ground) What happens Symptoms
channels
defense fights sweating disrupted, fever and chills back lodges in the joints, blocks qi pain, no fever and chills flow disrupts the flow paralysis or atrophy, no fever and in the channels chills wind heat and pestilence qi epidemic diseases, fever and chills enter cold-damp or digestive symptoms, with or without damp-heat fever and chills enters cold, damp, or cold in uterus (infertility, menstrual damp-heat cramps), vaginal discharge, bladder enters infection, no fever and chills ***
Internal Causes of Disease [ seven affects]: Normal emotions cause no harm, but if
strong or long-lasting, emotions can cause disease. They affect the organs directly. Emotions cause diseases of the organs, and diseases of the organs can also cause excessive emotions to arise. Damage from emotions will always affect the heart, as well as the organ corresponding to the emotion. The hundred diseases are generated by qi. When angry, qi ascends. When joyful, qi slackens. When sorrowful, qi disperses. When fearful, qi descends. When cold, qi contracts. When hot, qi is discharged. When frightened, qi is deranged. When taxed, qi is consumed. When thoughtful, qi binds. These nine conditions of qi are not the same. Elementary Questions, Chapter 39 (Warring States Period) joy ( xi3): damages the heart (controlling mental activities). o Causes qi to slacken (move slowly or relax). o Excessive joy scatters the spirit. Lingshu, Chapter 8 o Includes excessive excitement, excessive stimulation, excessive enJOYment, addictions. o Leads to heart fire or heart yin vacuity heat: mania ( kuang), unceasing laughter.
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anger ( nu4): damages the liver (smooth flow of qi). o Causes qi to rise. o Expressed anger or rage causes (or is caused by) liver yang ascending, or liver fire. o Symptoms are mostly located in the head: headache, red face and tongue, wiry pulse, etc. o Anger includes resentment, bitterness, irritability, frustration, depression. These also damage the liver. Unexpressed anger causes liver qi depression. o Also digestive problems when the liver horizontally attacks spleen or stomach, as liver easily invades the earth organs. thought (pensiveness, worry, obsession, or preoccupation) ( si1): damages the spleen o Causes qi to bind (knot). o Includes obsessive or excessive thought, mental work, or studying. o Weakens spleen function, causing fatigue, loss of appetite, loose stools, phlegm. sorrow (sadness, grief, or anxiety) ( bei1): damages the lungs o Causes qi to disperse (dissolve, scatter). o Sorrow leads to lung qi vacuity: breathlessness, fatigue, crying, sighing. anxiety (melancholy or worry) ( you1): damages the lungs and spleen. o Excessive thinking and anxiety lead to qi binding. o Worry and anxiety damage the spleen, causing fatigue, loss of appetite, loose stools. o It also binds lung qi causing breathlessness, stiff shoulders and neck. fear ( kong3): damages the kidneys. o Causes qi to descend. o Depletes kidney qi causing bed wetting or incontinence. fright (shock) ( jing1): damages the kidneys (and heart). o Causes derangement of qi. Fright makes qi chaotic. o Palpitations, breathlessness, insomnia, night sweating, dry mouth, dizziness, tinnitus.
Neither-External-Nor-Internal-Causes of Disease a.k.a. Neutral Causes (Lifestyle,

trauma, etc.) o improper diet (): o overeating or malnutrition: The quantity of food should be appropriate. Either extreme damages the spleen-stomach. Eventually every organ suffers since post-heaven qi is affected. o overindulgence or avoidance of particular foods: We need a balance of the five flavors and the temperatures. Specific types of foods cause specific imbalances. Example: Habitual alcohol intake causes damp-heat. Too much spicy food damages yin. o eating too much cold raw foods: Puts out digestive fire of spleen yang. o eating unclean foods: contaminated, spoiled, or toxic foods, parasites. o food should be eaten when relaxed and calm, and at regular times. o Excessive intake of cold and cool medicines may result in damage to spleen yang. Book: Flaws, Bob; The Tao of Healthy Eating; Blue Poppy Press, Boulder CO; 1998. ISBN: 0-936185-92-9. www.bluepoppy.com
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o work and rest: Normal work or exercise does not cause disease. We need balance between activity and rest. o If qi used up in daily activities is replenished through food and rest, there is balance. Jing essence will not be used for daily activities in a balanced lifestyle. o Taxation ( overwork) causes consumption of qi. This includes people who exercise too much. Long-term taxation consumes essence, affecting aging, stamina, and ability to resist disease. o Excessive rest impairs circulation of qi-blood. It affects the spleen, which leads to poor transformation-transportation. This engenders phlegm and dampness because qi moves and transforms fluids. Activity moves qi and scatters dampness. o sexual taxation (): excessive sexual activity injures kidney essence and yin. For men, this is mainly through ejaculation. For women, this includes pregnancies and childbirth. o Sexual activity should be adjusted for age, health, season, etc. o trauma: gunshots, cuts, bruises, burns, fractures, sprains, insect bites, snake bites, animal bites, etc: cause stagnation of qi and stasis of blood in the channels and network vessels. Stagnation may remain even after the flesh and bones have healed. Bites may have toxins. o improper medical treatment: improper Western or East Asian treatment can cause illness or side effects. o parasites and toxins While disease causes are External, Internal, and Neither-Internal-Nor-External, we cannot forget that the ability to avoid disease is also based on the bodys right qi and constitution. Constitution: the fundamental physical and mental make-up of a person, composed of essence, qi, and spirit, but essence is the foundation. o dependent on parents health in general, their health at the time of conception, and the mothers health during pregnancy o It is bad for the child to have been conceived when the parents were too old, after too many pregnancies in a short time, while drunk, etc. o It is bad for the mother to smoke and drink during pregnancy, or otherwise lead an unhealthy lifestyle (emotionally or physically). o It is bad to receive an emotional shock during pregnancy. o constitution cannot be changed, for the most part. It can only be changed within limits by healthy lifestyle, and qigong. o constitution helps determine prognosis, as well as resistance to disease.
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Class 8
Pathogenesis: Three types of pathological processes: Disharmony of yin and yang: pathological changes involving repletion or vacuity of yin and yang. It frequently manifests as heat or cold. In the absence of an evil, treatment focuses on supplementation. o Heat is from yang repletion or yin vacuity. o Cold is from yin repletion or yang vacuity. o Sometimes there are false heat or false cold symptoms: false heat is when yin repletion walls off yang, and false cold is when yang repletion walls off yin. o In addition to heat and cold, disharmony of yin and yang can also manifest as disharmony between the viscera and bowels, qi and blood, construction and defense, exterior and interior, ascending and descending. o In internally caused disease or disease caused by the not-internal not-external factors, imbalance of yin and yang within the body is predominant. Conflict between right qi (yang, life) and evil qi (yin, death): Right qi is the sum of all the healthy qi and substances in the body that can resist disease. It includes the various physiologic activities of the body, the natural flux of yin and yang, production of qi and blood, and the flow of construction and defense. Evil qi opposes right qi, and refers to the various causative factors of disease. o If evil qi invades, it meets the opposition of the right qi, and there is a struggle. This has significance in onset, progression, and transformation of disease. The struggle destroys the yin - yang balance and causes disturbances in the functioning of the body, leading to pathological changes. o If evil qi invades, it must be repletion. o If right qi is insufficient, there is also vacuity. o For most diseases to occur, there must first be an imbalance within the body. In almost all cases, an evil cannot invade unless there is already an underlying insufficiency of right qi. Therefore, the right qi is the root and the evil qi is the branch. If an insufficiency of right qi leads to an invasion of evil, this is a combined repletion - vacuity condition. o In externally caused disease, the struggle is always between the evil and the right qi. Wind, cold, dampness, heat, dryness, or summerheat evils attempt to invade. The evils are met by defense qi when they reach the defensive exterior. A battle occurs. Some symptoms are due to this battle: aversion to cold, fever, shivering, sweating. If the right qi is stronger, eventually it wins and the patient recovers. When the evil is eliminated, the right qi may be weak for a while until the qi and blood is repaired, and the channels and organs are restored. If the evil is stronger, right qi cannot win, the patient becomes sicker, and may even die. o If an externally contracted disease is not resolved (neither the evil nor the right qi wins), the disease will go deeper inside and may become chronic. Or the disease may be eliminated, but yin and yang, qi and blood may be damaged and need significant time and care for recovery. Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac. 50
Right qi strong No external invasion weak Evil (wind, cold, fire, damp, dryness, summer-heat) invades (must be a repletion) Right qi wins recovery May need to repair right qi Right qi loses death
Right qi and evils struggle without victory Evil goes deeper Recovery Disease becomes Right if right qi chronic qi eventually wins loses Need to repair death right qi Abnormal descending and ascending of qi: This also includes qi entering and exiting (moving inward and outward). In disease, qi may not follow its usual direction of movement. For example, in illness, lung qi may not descend, causing cough. Spleen qi may not ascend, causing diarrhea. o The functional relationships between organs, channels, substances, yin and yang are maintained by ascending, descending, entering, and exiting of qi (the qi mechanism). o In this, spleen and stomach are most important: they are central so they are the pivot of the body. They also provide the material basis for the post-heaven nourishment. Root and Branch ( ben3 and biao1) To treat disease, seek its root. Elementary Questions, Chapter 5 (Warring States Period) The great summation in treating disease is that one must first clarify branch and root. In a tree, the roots are connected to the branches. The roots are mostly underground and invisible. The branches are above the ground and visible. While there are many ways to look at root and branch in medicine, the most simple and appropriate way for this class is to say that in illness: The root is the strength of right qi and the branch is an invasion of evil qi. The root is the cause or pattern and the branches are the symptoms. The earlier disease is the root. Later progression is the branch. The root is a chronic disease and the branch is an acute disease. In general, the root must be treated in order for the patient to recover. However, the guidelines are different in different types of situations. The rules for treatment are as follows: In acute disorders, treat the branch. For example, stop bleeding first (branch), then find out why and treat the cause (root) after the situation is under control. For chronic disorders, treat the root. For example, if the patient has a backache (branch) due to kidney vacuity (root), just supplementing the kidney (root) will cure the backache (branch). This is appropriate if the clinical manifestations are not too severe.
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In disease, there is root and branch. When acute, treat the branch. When chronic, treat the root. The method is divided into attacking and supplementation. Use supplementation for vacuity and use attacking for repletion. Gong Xin (Ming dynasty) ji: fast, rapid, tense, violent, urgent, emergency, impatient. So it is often translated as acute. huan: slow, unhurried, relaxed. So it is often translated as chronic. In most cases, the root and branch are treated simultaneously, but one or the other will be emphasized according to the above rules. For example, if a patient with vacuity (chronic, root) receives a wind attack (acute, repletion, branch), you may treat both conditions in one formula. o If the vacuity is extreme, it is more important to supplement the patient. o If the vacuity is mild, but the wind attack is severe, than the formula should focus more on expelling the evil. In trauma, the root and branch may be the same: stagnation of qi and stasis of blood are both the essential nature, and the symptom, pain, is nothing other than stagnation of qi and stasis of blood. Eight principles pattern identification (): a preliminary organization of data from the four examinations (looking, feeling, asking, and listening-smelling). Yin Yang Interior Exterior Vacuity Repletion Cold Heat This is the foundation for other methods of pattern identification. Nothing falls outside of these eight. However, these eight are not specific enough to be used alone clinically.
Exterior-interior: depth of disease within the body. For example, an external invasion begins as exterior, but if it goes in deeper, it becomes interior. There can also be simultaneous exterior and interior patterns, or patterns that are stuck between the exterior and interior (called shao yang). interior: organs, bones, etc. Can be hot or cold, vacuity or repletion. An interior repletion means an evil is present. An interior vacuity means insufficient qi, blood, fluids, yin, or yang (right qi). In interior patterns, there may be fever (sensation of heat in heat conditions) or chills (sensation of cold in cold conditions), but not both simultaneously. interior repletion heat: A heat evil is present, causing feverish feeling, no chills, sweating, thirst, full rapid pulse, red face, red tongue with yellow coat, plus symptoms of the affected organ. It is caused by eating hot-natured food, emotional excesses, qi stagnation, or an exterior evil moving inwards. This is also called yang repletion. Clear heat or drain fire. interior vacuity heat: Yin is insufficient, causing low-grade afternoon fever, no chills, feeling of heat in the palms, soles, and chest (five-heart heat); dry mouth and throat, dark urine, dry stool, night sweating; fine rapid pulse, malar flush, red peeled tongue, emaciation. This is yin vacuity. Nourish yin and clear heat.
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interior repletion cold: A cold evil is present, causing chilliness, cold limbs, no thirst, clear abundant urine, desires warm drinks, deep full tight pulse, pale face, pale tongue with thick coat. This is repletion of yin. Dissipate cold evil and warm coldness. interior vacuity cold: Yang is insufficient, causing chilliness, cold limbs, no thirst, listlessness, spontaneous sweating, loose stools, clear abundant urine, deep slow weak pulse, dull-pale face, pale tongue, thin white coat. Yang vacuity. Fortify yang and warm coldness.
o exterior: skin, flesh, channels, defense qi, sometimes lungs The lungs govern defense qi and the skin, so they are the most exterior of the organs Many skin problems are actually interior. Example: blood heat causing rashes. Clinically there are two types of exterior problems, although these may overlap. But the term exterior in the strictest sense means external invasion. external invasion: acute onset, short duration, simultaneous fever (feels hot) and chills (aversion to cold or wind), floating pulse, but the rest of the symptoms vary depending on cold or hot, repletion alone or vacuity and repletion combined. Important symptoms that help in differentiation are sweating or not, the pulse, and the severity of body aches. o exterior cold has slight fever, severe chills, no thirst, no sweating, thin white tongue coat, floating tight pulse, headache, muscle aches o exterior heat has more fever, slight chills, thirst, thin yellow (or white) tongue coat, floating rapid pulse, sore throat, sweating o exterior repletion (not combined with vacuity): same as exterior cold or exterior heat. The evil qi is the repletion. o exterior vacuity of defense: Vacuity of defense qi but no invasion at this time (pure vacuity): easy to catch cold, sweats easily even when cold. Vacuity of defense qi with wind evils invading (combined vacuity of defense and repletion of wind evils): slight or no fever, aversion to wind, slight body-aches, floating pulse, thin tongue coat. channel problems: painful obstruction ( bi impediment) is obstruction of the flow of qiblood in the channels and the joints by an evil, causing pain. Wind, cold, dampness, heat, or a combination. o wind: pain moves from place to place o cold: severe fixed pain, better with heat o dampness: lingering, swelling, heaviness, ache o heat: swollen, hot, red o also some facial paralysis or pain (Bells palsy or trigeminal neuralgia) is caused by wind invading the channels of the face. o There is often no fever and chills because the evil bypasses the defensive exterior of the body.
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Vacuity-repletion: weakness of right qi versus the strength of evil qi vacuity: Some aspect of the body is weak. There is no evil (unless it is a combined pattern). Symptoms include weakness, listlessness, curling up, quietness, weak breathing, weak pulse, chronic condition, dull lingering pain which is better with pressure, slight sweating. The more chronic the disease, the more likely it involves vacuity. o yang vacuity (same as internal vacuity cold, above): There are symptoms of qi vacuity plus coldness and copious fluids. There is insufficient yang to warm and activate the body. Symptoms are worse in the daytime, especially the morning. o yin vacuity (same as internal vacuity heat, above): There is insufficient yin to cool and nourish the body. Symptoms are worse in the afternoon, evening, or night. repletion: includes interior or exterior evils. See exterior category, and interior repletion heat and cold, above. The bodys right qi is still strong. Acute condition, strong pain worse with pressure. If face is red, it is all over; if sweating, it is profuse, coarse breathing, strong voice, thick tongue coat, strong pulse. Yin evils damage yang. Yang evils damage yin. Heat-cold: the nature of the disease heat: see above, from yang repletion or yin vacuity cold: see above, from yin repletion or yang vacuity A person can have both at the same time, for example, cold on the exterior and heat on the interior or vice versa, or they can have heat above and cold below. Can have true cold-false heat or true heat-false cold. These have contradictory signs and symptoms in extreme conditions. o In true cold-false heat, the interior is so cold that all the yang (heat) is pushed to the exterior. o In true heat-false cold, the interior is so hot that all the yin (cold) is pushed to the exterior. o Contradictory symptoms arise because the weaker aspect has deserted to the exterior. Since it is on the exterior, it is visible. o Careful examination will yield the appropriate diagnosis. Yin-yang Someone who is good at examination scrutinizes the complexion and presses the pulse to first differentiate yin and yang. Elementary Questions, Chapter 5 (Warring States Period) Yin-yang: general categories which embrace the other six principles. They are also two aspects of the body. yin: yin patterns have more yin than yang: o a repletion of yin o a vacuity of yang o a predominance of coldness, vacuity, or interior conditions yang: yang patterns have more yang than yin: o a repletion of yang o a vacuity of yin o a predominance of heat, repletion, or exterior conditions Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac. 54
collapse of yin is an acute critical form of yin vacuity: abundant perspiration, hot skin, hot limbs, dry mouth, desire to sip cold drinks, no loss or urine or stool, floating vacuous rapid pulse, red peeled short dry tongue. collapse of yang is an acute critical form of yang vacuity: chilliness, cold limbs, weak breathing, profuse but cold sweating, no thirst, frequent profuse urination or incontinence, loose stool or incontinence, minute deep pulse, pale wet swollen tongue.
1. yang Balanced xu Vacuity Deficiency, empty shi Repletion Excess, full yin
Unbalanced
2. yang Yin vacuity yin yang Yang vacuity yin
3. yang Yang repletion yin yang Yin repletion yin
4. yang yin Excessive yang damages yin yin yang Excessive yin damages yang
Hot
Cold
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Class 9
Preventing Disease & Nourishing Life
If the root is full, how can there be disease! Tao Hongjing (Southern Liang dynasty) According to the Su Wen (Elementary Questions), the highest medicine treats before there is disease, thereby preventing its occurrence. By keeping the righteous qi strong, disease is unable to develop. In addition, by treating a problem when it is small, it is never allowed to develop. These principles can easily be applied with moxibustion. The following are some definitions of key terms in this mode of treatment. Nourishing life: When there is no disease, moxibustion is applied to increase longevity or vitality and prevent the effects of aging. This is often done at specific times of the year. Supplementing vacuity: Supplementation (unlike nourishing life) implies that there is already a vacuity. Techniques to supplement are related to those for nourishing life but are not identical to those techniques. Supplementation is also commonly used in preventing disease, since it is hard for evils to invade when the body is strong. However, preventing disease may also involve the removal of repletion to prevent it from causing harm. Preventing disease: These techniques are sometimes, but not always, related to supplementating the righteous qi. They may be done when traveling or when certain diseases are prevalent. They are applied when no disease exists in the body. Preventing the progression of disease: In this case, the body already has an imbalance. Therefore, moxibustion is performed to prevent that imbalance or disease from worsening. For example, this method may be used to prevent windstroke in a patient who already has internal wind. Methods for Prevention and nourishing life Healthy Person benefit right preventive spirit, regular moxa and exercise emotions lifestyle herbs
avoid evils
Sick Person early diagnosis safeguard and treatment threatened areas
A person often loses the dao. It is not that the dao loses the person. A person often leaves life. It is not that life leaves the person. That is why one who nourishes life is careful not to lose the dao. Tao Hongjing (Southern Liang dynasty)
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Overall, when the qi of the four seasons is followed, there is health. When it is opposed, there is disease. Zhang Jiebin (Ming dynasty) When there are few desires, the heart is clear. When the heart is clear, there are few desires. Ping Xiqing (Qing dynasty) A clear heart results in few desires and longevity for people. Cui Dunli (Tang dynasty) Disease is spontaneously eliminated with a peaceful heart. Bai Juyi (Tang dynasty) The Five Behaviors and Ten Pleasures to Adjust the Emotions The Five Behaviors from Chen Zhi, a Song dynasty specialist in nourishing life 1. Sitting quietly (like allowing a glass of muddy water to settle) 2. Reading 3. Appreciating mountains and water, flowers and trees 4. Discussing ideas with good friends 5. Teaching children or juniors The Ten Pleasures Studying the meaning of the classics Learning the methods of the calligraphy models Calming the mind and sitting quietly Chatting with beneficial friends Drinking a little until half intoxicated Watering flowers and cultivating bamboo Listening to the qin [stringed instrument] and enjoying cranes Burning incense and brewing tea Climbing the city walls and viewing the mountains Telling fables and playing chess The Six Always by Shi Tianji (Ming dynasty) 1. Always be peaceful in mind: (do not covet, do not worry about personal gains and losses. If one has few desires, his mind will naturally be peaceful.) 2. Always be kind-hearted: (take pleasure in helping others.) 3. Always uphold justice 4. Always be cheerful: A good laugh makes one ten years younger; worry turns hair gray. 5. Always be pleasant 6. Always be contented *** Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac. 57
The Channel and Network Vessel System (): The pathways of qi and blood
pervading the whole body, connecting the bowels and viscera, the limbs and joints. The channels are the main pathways of qi and blood, whereas the network vessels are smaller branches ensuring the supply of qi and blood to all localities. Disturbances in the channels are reflected in abnormalities along their course. Acupuncture, acupressure, and cupping are largely based on the theory of the channels and network vessels. Channels (): Any of the main pathways of qi and blood. 12 Regular Channels (): The channels that form the basic structure of the channel system. Each channel homes to its own organ and nets to its paired organ, connecting bowels and viscera that stand in interior-exterior relationship. The twelve channels have the function of interlinking the bowels and viscera and providing a network of qi and blood by which the whole body is nourished. Yin Hand Three Yin Channels hand greater yin lung channel hand reverting yin pericardium channel hand lesser yin heart channel Foot Three Yin Channels foot greater yin spleen channel foot reverting yin liver channel foot lesser yin kidney channel Yang Hand Three Yang Channels hand yang brightness large intestine channel hand lesser yang triple burner channel hand greater yang small intestine channel Foot Three Yang Channels foot yang brightness stomach channel foot lesser yang gall bladder channel foot greater yang urinary bladder channel
Hand
Foot
The Circadian Clock TIME BRANCH CHANNEL 11 pm 1 am Zi GB 1 3 am Chou LV 3 5 am Yin LU 5 7 am Mao LI 7 9 am Chen ST 9 11 am Si SP 11 am 1 pm Wu HT 1 3 pm Wei SI 3 5 pm Shen UB 5 7 pm You KI 7 9 pm Xu PC 9 11 pm Hai SJ Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac. 58
o Twelve Cutaneous Regions (): areas of the skin lying on and corresponding to each of the twelve channels. Twelve Channel Sinews (): Sinews following the path of the channels, together filling the entire surface of the body. Morbidity of the channel sinews includes impediment (bi), hypertonicity, and slackening. Twelve Channel Divergences (): branches of each of the 12 channels that reach deeper parts of the body and then return to the primary channel. They have the function of complementing the main pathways by providing a link between the yin and yang channels. Network Vessels (): Branches of the channels that enmesh the body. 15 diverging network vessels ( bie luo): The larger network vessels of the 12 regular channels, du and ren, as well as the great network vessel of the spleen. grandchild network vessels ( sun luo): any of the finer branches of the network vessels. Floating or superficial network vessels ( fu luo), also know as blood network vessels: small branches of the network vessels in the surface of the body. These are actual blood vessels. The channels govern qi. The network vessels govern blood. According to Lingshu Chapter 10, all the vessels that are superficial and which can ordinarily be seen are network vessels. The twelve channels lie deeply between the divisions of the flesh. They are deep and cannot be seen. Eight Extraordinary Vessels (): Any of the eight vessels that do not home to any organs, have no interior-exterior relationships, and whose function is to supplement the insufficiencies of the other channels. They include: du (governing), ren (controlling or conception), chong (thoroughfare), dai (girdling), yang and yin qiao (yang and yin springing), yang and yin wei (yang and yin linking). 59
Three Types of Points jingxue: channel point jingwai qixue: non-channel point, also known as extraordinary points ashi xue: ouch point, sensitive on pressure. Could be a channel point, a non-channel point, or neither.
You Must Understand the Channels and Network Vessels

from The Book of Bian Ques Heart, First Volume, by Dou Cai (1164, Song dynasty) It is commonly said that if you study medicine but do not know the channels and network vessels, as soon as your mouth opens or your hands move, you will make a mistake. If you fail to understand the channels and network vessels, you will probably be unable to recognize the origin of disease symptoms. Investigate the transmission and mutation of yin and yang. For example, the three yin channels and the three yang channels of the Treatise on Cold Damage each have their own jurisdiction. The hundred diseases and the twelve channels can decide life or death. If the channels and network vessels have already been explained, then you can use medicinals to directly reach the site of the disease and the formula will prove effective. The reason that the ancient people gazed upon a patient and then knew his condition is that they merely inspected his channels and network vessels with care. It is passed down by tradition that Elder Mulberry Gentleman [Changsang Jun] conferred his cherished medicinals [to Bian Que], who drank the water of the upper pool1 and was then able to see the organs clearly. These are unfounded statements and thats all. [Dou Cai is saying the ancients did not have magical abilities to see into the body. They just knew how to inspect the channels carefully.] Modern man does not understand the channels and network vessels. He only studies the nature of the medicinals and disease mechanisms. Thus, he is without the ability to differentiate the location of the disease. If someone heedlessly experiments with medicinals, and by chance the treatment is correct, there will be a little recovery. Then he will claim credit for himself, but the condition still will not completely recover. If the treatment is incorrect, then on the contrary it will engender the disease. The reason for all this is because he does not know the channels and network vessels.
Rain water that has never touched the earth.
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Class 10
Principles of Treatment
Straight treatment and paradoxical treatment
1. Straight treatment : The principle of treatment whereby the nature and pathomechanism are addressed directly, as when a cold pattern is treated with hot medicinals and a hot pattern is treated with cold medicinals, or when vacuity patterns are treated by supplementing or repletion patterns are treated by attacking or draining. When there is repletion, drain it. When there is vacuity, supplement it. Elementary Questions, Chapter 20 (Warring States Period) 2. Paradoxical treatment : The non-routine principle of treating false signs with medicinals of the same nature, e.g., treating heat with heat, cold with cold, the stopped by stopping, and excessive flow by promoting flow. Treating cold with cold, for example, means using heavy doses of heat-clearing toxin-resolving agents to treat exuberant heat in externally contracted febrile disease presenting with false signs of cold such as aversion to cold or shivering, and cold limbs. There is counteracting and coacting treatment because there is slight and extreme disease. There is slight and extreme disease because there are true and false patterns. There is true and false cold and heat. There is also true and false vacuity and repletion. True receives straight treatment. Knowing it is not difficult. False receives paradoxical treatment. This is difficult. Zhang Jiebin (Ming dynasty)
Supporting the Right and Dispelling the Evil

Supplementing and draining : the course of a disease is actually the struggle between the right qi and the evil qi. You must diagnosis the relative strength of the evil and the right qi, or if there is any evil at all. Treatment should mobilize the right qi to defeat the evil. If the right qi is strengthened, the evil will be expelled. If the evil is expelled, the right qi can recover its strength. Both help each other. If the right qi is strong, evils cannot strike. When there are evils, right qi is usually weakened. If evil qi is exuberant, right qi becomes depleted. When right qi suffers damage, evil qi can spread. If you do not have enough right qi to recover, evils will not recede. If right qi is not exhausted, you have a chance to recover. Whenever treating disease, you must first secure right qi. Zhu Danxi (Yuan dynasty)
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When you supplement the right, evils are spontaneously eliminated. Shen Shiyu (Qing dynasty) When evil is eliminated, the right is secure. Eliminating evil is what is called supplementing the right. Ye Lin (Qing dynasty) When a body that has vacuity contracts an evil, you must eliminate the evil. As soon as you eliminate the evil, you can supplement the right. Otherwise, if you supplement the right when there is a lingering evil, the supplementation will go into the evil. When the evil obtains supplementation, there is more repletion and the right becomes more vacuous. Wu Jutong (Qing dynasty) supplementation: for vacuity. Invigorates resistance, strengthens whatever is weak, restores function or substance. bu means to mend or repair, as in patching clothes. Can supplement yin, yang, qi, blood, or any of the organs (especially spleen and kidney). Can use acupuncture, moxibustion, herbs, diet, qigong, meditation and/or rest. draining: an offensive method for repletion. Attacking the evil. Eliminates evils, reduces, expels, transforms or scatters evils or accumulations. xie means to pour out, or drain, like the dirty water in a bathtub. To use draining alone, the right qi of the patient must be strong. If the right qi is weak, draining must be combined with supplementation. Can use acupuncture, bleeding, herbs, cupping, etc. In situations with mixed vacuity and repletion: o Most often, drain the evil first or strongest. o When the evil is resolved, strengthen the body. o When there is evil qi, supplementation can strengthen the evil. o Only if the patient is too weak to receive draining treatment, should supplementation be primary. o In a well-designed treatment, you can: drain and supplement simultaneously: both evil and vacuity are not too strong, or patient is too weak to withstand draining methods alone. supplement first and drain later: the right qi is dangerously weak, even though the evil is strong. drain first and supplement later: strong evil needs to be dispelled urgently, and right qi can withstand the treatment, especially when the evil is the cause of the damage to right qi, or in exterior conditions. Treatment when evil invades and the patient does not have vacuity: drain or attack (exterior resolution, clearing heat, detoxification, precipitation, transform phlegm, transform damp, disinhibit water, break blood stasis, etc.) You can support the right, but only to enhance the attack or protect the interior. Only when the evil is resolved, can supplementation become the primary approach.
Treat internal damage like a minister. Treat external evils like a general. Wu Da (Qing dynasty) Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac. 62
Regulating Yin and Yang

Reduce repletion: A repletion of yin or yang means that an evil is present. A surplus of yin damages yang and vice versa. Repletion alone receives draining treatment. If repletion of yin or yang causes vacuity of the opposite, then draining and supplementation are both needed. See above. Supplement vacuity: an uncomplicated vacuity of yin or yang requires supplementation alone.
Treatment of the ten-thousand types of disease never goes beyond the one principle of yin and yang. Ma Zhaozhang (Qing dynasty) When yang has expired but yin is supplemented or yin has expired but yang is supplemented: this is called replenishing repletion or evacuating vacuity. It is decreasing the insufficient and increasing the superabundant. Classic of Difficulties (Han dynasty) The meaning of the two phrases adjust yin and yang, regulate the hard and soft is most essential. Its usage is most extensive. Overall, diet, rest, rising, and dwelling; or disease, treatment, pulse, and medicinals, all are most concerned with this and it cannot be overlooked. Zhang Jiebin (Ming dynasty)
Treat according to the person, the season, the place

The same disease has different treatments. Different diseases have the same treatment. Treat according to the season and weather: In the summer, you are likely to use less moxibustion and fewer warming herbs. Also the qi flows differently through the seasons, for example, in the summer it flows more superficially. Diet and lifestyle should vary with climate and season. Treat according to the place: here in L.A., there is less cold and dampness, and more dryness and heat. Treat according to the individual (age, sex, constitution): Herb formulas and point formulas can be adjusted for the condition of the patient. This gives better results than using an unmodified formula.
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Case Study
Chief Complaint: 48 year old male with poor appetite History: Poor appetite began 2-1/2 years ago He had a period of intense anger and strong emotional upset During that time, he felt distention and pain in the rib-sides and a decrease in appetite When he ate, he had indigestion He frequently belched (although this had been going on for over 20 years) and passed gas The Western doctor found no health problems Currently: His appetite is poor and he is never hungry His abdominal distention is worse after eating He drinks a lot of water He has difficulty falling asleep Urine is scant and yellow Stools are dry but with particles of undigested food His energy level is poor and he feels physically weak Pulse: sunken and wiry Tongue: dark body, red tip, thin slightly yellow coat PP2p63 From Diagnosis to Treatment Before we can pick a treatment for a patient, we must have a Chinese diagnosis. There is no Chinese formula used for headaches in the same way that we use Tylenol. If a patient has a headache we must first find out why. Is it cold? Is it heat? Is there repletion or vacuity? Is it gall bladder, stomach, or liver channel? Is it dampness or wind? What is the patients constitution? How strong is he or she today? We must know this before we prescribe. So we use the Four Examinations (asking, looking, feeling, listening and smelling) and arrive at a Chinese diagnosis. The diagnosis is based on a holistic look at the patient, not just on the chief complaint nor any one or two symptoms. This diagnosis must be phrased in Chinese medical terminology: eight principles plus organs and/or substances or evils, etc. We are still not ready to pick a formula or points. We must next come up with a Treatment Principle. The treatment principle states what steps we must take to rectify the diagnosis. Treatment almost always opposes the diagnosis. This is called straight treatment. If the patient has heat in the yangming channels of the head, causing a headache, the treatment principle is to clear heat in the yangming channels of the head. If the headache is caused by liver yang rising, we must subdue liver yang. Unlike a disease, naming the pattern (diagnosis) implies what we must do to correct it, and therefore the treatment. For example, one disease is the common cold. That tells us nothing about what the treatment should be. However, if the pattern is diagnosed as wind-cold invasion, this implies that we must expel the invading wind and also use heat against the cold. Diagnosis Treatment principle Treatment
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Next, determine the treatment. Select the method(s): acupuncture, moxibustion, cupping, herbs, diet, exercise, qigong, etc. Once the method has been selected, then chose the specific treatment using that method. We pick an herbal or point formula or write a formula that covers the treatment principle. It must take care of every part of the treatment principle, and cannot have any action that is not part of the treatment principle. For best results, classical prescriptions are modified to better fit the condition of the patient. The treatment tests the validity of the diagnosis. If correct, the patient will improve. However, correct diagnosis is a prerequisite for applying appropriate methods of treatment. Care must be taken that we follow the principle that treatment opposes the diagnosis. Without proper diagnosis, the treatment principle and therefore the treatment will be wrong. For example, in a wind heat external invasion, the patient may have aversion to cold, shivering, and cold limbs, even though other symptoms indicate the hot nature of the evil. If the doctor misdiagnoses this as cold, the treatment will make the patient worse. However, with the diarrhea occurring in dysentery that manifests as damp heat in the intestines, one cannot stop the diarrhea. One must actually use downward draining herbs to make sure the evil is expelled from the intestines. There are other cases like this. This is called paradoxical treatment. TCM Methodology 1. Four examinations 2. Pattern identification (Chinese diagnosis) 3. Treatment principle 4. Formulation of treatment plan 5. Periodic reassessment of results 6. Modification of treatment plan. ***
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Pattern Identification ( bian4zheng4): identification of disease patterns. Pattern identification is the process by which information gathered through the four examinations (looking, feeling, asking, listening and smelling) is classified into different patterns. Disease is a very specific set of signs and symptoms. A disease is a morbid condition that is characterized by a similar set of symptoms and a similar course in all that it affects. Disease: measles, common cold, etc. Symptom: something the patient reports: feeling of heat, thirst, impotence, etc. Sign: something the doctor can observe: pulse, complexion, tongue, etc. A pattern describes the underlying mechanism causing this set of signs and symptoms. One disease may have many patterns at different stages of its development. A pattern is a configuration of signs and symptoms. The signs and symptoms are examined as a unity, not one by one. Examples: exterior wind-heat invasion, spleen qi vacuity, etc. The nature and location of an illness can be established through pattern identification. Many important signs or symptoms in Chinese medicine are considered sub-clinical in Western medicine. EG: feeling of heaviness, emotional frustration, likes hot drinks, etc. Examples of types of pattern identification include: o eight-principle pattern identification o disease-evil pattern identification o qi-blood pattern identification o channel pattern identification o organ pattern identification o six-channel pattern identification o four-aspect pattern identification
The main thing in Chinese medical pattern identification is to base it on signs and symptoms, combining the four examinations. Qin Bowei, et.al. The same disease has different treatments. Different diseases have the same treatment. Examples of different diseases having the same treatment: diarrhea, prolapse, fatigue, or wasting muscles may all be due to spleen qi vacuity. Each would have a similar treatment. Examples of the same disease having different treatments: diarrhea may be due to spleen qi vacuity, spleen yang vacuity, spleen and kidney yang vacuity, liver attacking the spleen, damp heat in the intestines, cold damp in the intestines, etc. Each would have different treatment.
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Appendix: A Short Course in the Pinyin Romanization Method: (This article is from http://qi-journal.com) Pin in Chinese means spell and Yin means sound. The Pinyin Romanization method has generally replaced the older Wades-Giles method for attempting to romanize the Chinese language. This system has been official use since 1958 and was introduced by the People's Republic of China. It is yet another attempt at teaching Chinese pronunciation to foreigners. For the most part, Pinyin is slightly better for most words than previous romanization attempts, but as with other attempts, there are certain characters which do not transliterate very well, therefore is most useful only after a significant study of the system. After mastering the Pinyin system, it can actually be used to accurately pronounce most Chinese words. Pinyin spelling is used extensively on signs and posters throughout China, although they seldom use the accent marks that are needed to reproduce the tones of the language. Western newspapers, such as the New York Times, have adopted the Pinyin spelling to render Chinese names and terms. Part of the Pinyin (and other methods) romanization are the unique tones of the Chinese language. It is sometimes referred to as the language that is sung. Each syllable has a tone or movement of its pitch which is important to the meaning of the word. Unfortunately, there is nothing in English that parallels this concept. In English, an incorrect inflection of a sentence can render the sentence difficult to understand... in Chinese an incorrect intonation of a single word can completely change its meaning. The Chinese Language is based on tones. The most common language in China, Mandarin, is based on four or five tones.... For example: The word Ma in Chinese can be pronounced with 4 separate tones. In the first tone, the meaning of the word Ma becomes mother. In the second tone, the meaning of Ma becomes hemp or grass. In the third tone, the meaning of Ma becomes horse, and in the fourth tone the meaning of Ma becomes to scold or nag. With a little imagination, you can see where telling a parent that their child looks like her mom could be quite a disaster if the tones were not correct. How the Tones Work: Unlike music, the tones of Chinese involve different levels of sound relative to one another. Whereas English speakers express excitement, amazement, or sadness by varying the pitch and inflections of their words, in Chinese this is not possible, because the meanings of the words are based on these tones. The tones remain constant when whispering, yelling, and even while singing. One of the most common errors when first trying to speak Chinese is to raise the tone of the last word of every sentence as if asking a question. If the tone of the last word is raised, it then changes the meaning of that word. Note: Although we use a music scale below to represent the level of a Chinese language tone, it is not based on a particular scale. The tones are high or low depending on their relationship to other words within the sentence. A deep-voiced mans high note might be much lower on a scale than another mans low note. They do not correspond to a western-type note.
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THE FIRST TONE: The word is spoken with an even tone, at the highest level of the speakers voice (speech) range. A common mistake is to let this tone drop off when spoken at the end of a statement. Try saying Ma with the first tone, it means mother. THE 2nd TONE: The word is spoken with a rising tone. The tone begins near the bottom of the speakers range and rises upward to the top level, much like an American asking a question at the end of the sentence. A common mistake is to let the last word of a question to rise like the 2nd tone, even when the word should not be spoken with that tone. Try saying Ma with the 2nd tone, it means grass or hemp. THE 3rd TONE: Perhaps the most difficult to master, the 3rd tone is spoken by starting the word slightly above the bottom of the speakers range, then letting it drop to the bottom, then rise to about the middle of the range, something like an American speaker that is not too sure of an answer and drags the word out a little, as in saying yes to a question, but expecting to back it up with an explanation. Try saying Ma using the 3rd tone, it means horse. THE 4th TONE: This tone starts high and drop off quickly to the lowest range of the speakers range. It is sharp and quick as if answering a question with a emphatic NO. Try saying Ma using the 4th tone, it means to scold or nag. THE 5th TONE: This tone is often left out of the descriptions and Mandarin is often referred to as a 4 tone language. This is because the 5th tone is spoken very lightly, as if it has no tone. Try saying Ma lightly and quickly, it is sometimes used that way at the end of a sentence to make that sentence a question. Initial Sounds: These initial letters have the same pronunciation as in English: M-- (as in man) N-- (as in no) L-- (as in letter) F-- (as in from) S-- (as in sheep) W-- (as in woman) Y-- (as in yes) The following initial letters have slight differences as noted below. If the comment calls for a strong puff of breath, old your open hand several inches from your mouth and make certain that you can actually feel the breath as you pronounce the letter. P-- (as in pun) note: use a strong puff of breath K-- (as in cola) note: use a strong puff of breath T-- (as in tongue) note: use a strong puff of breath B-- (as in bum) note: no puff of breath D-- (as in dung) note: no puff of breath G-- (as in good) note: no puff of breath H-- (as in hot) note: slightly more aspirated than in English
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The following initial letters are the more difficult for English speakers: Zh-- (as in jeweler) Ch-- (as in zh above, but with a strong puff of breath) Sh-- (as in shoe) R-- (as in run) C-- (like the ts in its high, but with a strong puff of breath) J-- (as in Jeff) Q-- (like the ch in cheese) X-- (like the sh in sheep) Final (Ending) Sounds: The finals connect with the initial sounds to create the one syllable words that are the basis of the Chinese language. Although all words are one syllable, they are often combined to create terms made from several words. -a (as in father) -an (like the sounds of John or ahn) -ang (like the sound of an above (ahng) with the addition of g) -ai (as in high) -ao (as in how) -ar (as in bar) -o (like aw) -ou (like the ow in low) -ong (like the ung in jungle with a slight oo sound) -e (sounds like uh) -en (like un in under) -eng (like the ung in lung) -ei (like a long a or the ei in eight) -er (like the er in herd) -i (like a long e or the i in machine) -in (as in bin) -ing (like sing) -u (like the oo in loop) -un (as in fun) Putting It All Together (Intitial and Final Sounds): Try some of these words. You can refer to the individual intitial and final descriptions above if you need. Ni (sounds like knee) Hao (sounds like how with a little more aspiration) Dong (sounds like doong) Qi (sounds like chee) Gong (sounds like gung) Tai (sounds like tie) Ji (sounds like gee) Quan (sounds like chwan)
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Fundamentals of Oriental Medicine

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Fundamentals of Oriental Medicine

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EMPEROR'S COLLEGE MTOM COURSE SYLLABUS

GRADING SCALE: 100-90% A, 89-80% B, 79-70% C, 69% and below F

EMPEROR'S COLLEGE MTOM COURSE SYLLABUS

EMPEROR'S COLLEGE MTOM COURSE SYLLABUS

FUNDAMENTALS OF EAST ASIAN MEDICINE Instructor: Lorraine Wilcox L.Ac. [email protected]

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

Class 1 Yin Yang

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

The Principles of Yin and Yang

Tai Ji Diagram () The Great Polarization

The Tai Ji Diagram and the Principles of Yin and Yang

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

3. yang Yang repletion yin yang Yin repletion yin

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

The Five Elements with Earth as the Center (Earths Perspective)

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

The Stems and Branches

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

The Twelve Earthly Branches ()

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

The Twenty-four Solar Terms (jie qi)

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

The Five Substances:

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

Body Fluids jinye

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

Liver gan: the military general

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

Gall Bladder dan: the judge

Heart xin: the emperor

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

Small Intestine xiao chang:

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

The Five Spirits

Class 4 Pericardium xin bao or xin zhu:

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

Stomach wei: spleen and stomach are the root of after-heaven qi

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

Extraordinary Organs qi heng zhi fu:

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

Large Intestine da chang:

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

Urinary Bladder pang guang:

Introduction to East Asian Medicine 2010 by Lorraine Wilcox Ph.D., L.Ac.

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