lördag 16 juni 2012

Acupuncture and Summer: the Chinese Medical Classics, the heart, the shen, Fire Element, Shakespeare, poetry and picnics

Summer is the season of flowers and warmth, the time for talk and picnics; the time for our heart to relax and open when the Fire Element has its time with sunlight, blue skies and warmth on our skin, on our face, and our life.

In Classical Chinese Medicine (CCM) it is linked to several things: the Fire Element, which in turn links to the heart, pericardium small intestine and sanjiao, the Triple Burner; it links to the feelings of joy and our ability to spread warmth to others through talking, being happy and communicating. It also helps us with the feeling of anxiety and how to learn to keep our fire burning in a balanced way in the hearth that is ourselves. Summer links to one of the liuxie, the Six External Factors; Summer Heat. It is the time when our skin should be open and we should let warmth enter us and sweat leave us through open pores.

In this post we will look at summer in all these aspects, and we will take an extra look at how the practitioners who wrote the Chinese medical classics Neijing, Nanjing and Jia Yi Jing (The Systematic Classic of Acupuncture and Moxibustion) commented on summer between 1800 and 2500 years ago.
But first, let´s listen to a wiser voice than mine, and look at Shakespeare´s Sonnet 18 where a human being who lived in the 1500´s describes love in the language of summer...

Shall I compare thee to a summer's day?
Thou art more lovely and more temperate;
Rough winds do shake the darling buds of May,
And summer's lease hath all too short a date;
Sometime too hot the eye of heaven shines,
And often is his gold complexion dimm'd;
And every fair from fair sometime declines,
By chance or nature's changing course untrimm'd;
But thy eternal summer shall not fade,
Nor lose possession of that fair thou ow'st;
Nor shall Death brag thou wander'st in his shade,
When in eternal lines to time thou grow'st:
So long as men can breathe or eyes can see,
So long lives this, and this gives life to thee.

–William Shakespeare

Part of the very core of Classical Chinese Medicine is for the practitioner to move with the seasons, and for him or her to help patients move with the seasons in nature and the seasons of their life. The seasons will change the patient´s system, including on the level of pulse. Thus it becomes important for the practitioner to be aware of this, otherwise a perfectly healthy seasonal pulse can be misunderstood as an imbalanced or pathological one, and misdiagnosis  might take place. We´ll look at this from a Nanjing perspective later on.
But first, here is the comment of the Neijing Suwen, the first book of the Yellow Emperor´s Classic of Medicine, from about 2400 years ago. First it describes summer:
  The period of three months of summer is called the season of flourishing as all the living things in the world are prosperous and beautiful. On the Summer Solstice, Yang energy reaches its summit and Yin energy begins to emerge, thus, the intercourse of yin and yang energies occurs at this time. As Yang energy forms the vital energy of things and Yin energy shapes things, the combination of vital energy and the shaping energy cause all living things on earth come into blossoming and yield fruits.

The practitioners who wrote the Neijing then continue with advice on how to act during summer so as to move easier with it, and how important it is to let our skin and interaction with the world be open during the summertime.
  In the course of intercrossing heaven-energy and earth energy one should, like in spring time, sleep when night comes and get up early in the morning. He should not detest the sunshine nor get angry often, so as to correspond to the property of summer energy of growth that promotes growing of the flowers and fruits. One´s skin should be perspired for letting off the yang energy to avoid the heat being stagnated, in other words be”keen on the exterior”.
Finally, it lists what happens if we go against the season:
  These are the ways of preserving health in summer. If these principles are violated by a man, his heart will be hurt, as heart associates with fire and fire is vigorous in summer. If one fails to adapt to the property of summer energy which is growth, his heart will be hurt, and he will contract malaria (fever, ed.) in autumn. This is because his adaptability to atumn energy has been weakened due to his inability of following the property of summer energy, which is growth, to perserve health. In this case, it´s called”inadequate offering to harvest.
              – Chapter 2, p14. All quotes are from the Wang Bing version, 762 AD during the Tang Dynasty, Huangdi Neijing Suwen, Yellow Emperor´s Canon of Internal Medicine, translated by Wu and Wu, China Science and Technology Press, 2005

You can read the previous posts about different seasons here:






The quote above was from chapter 2 of the Neijing. The Neijing is seen as the bible of Chinese medicine and it says something, I believe, that the practitioners of that time thought the idea of changing with the seasons so important that they put it in the second chapter out of about 80 or so in the book. The principles of changing with seasons, of moving with change itself, bianhua, is part of the spiritual tradition called Daoism. In the earlier posts you can also read the Neiye-quote (the Classic of Internal Training) about changing with the seasons, written down about the same time as the Neijing itself.

The Fire Element links to summer, and is the time when Fire should be relaxed and allowed to blossom in our life; this is the time when we should be open, enjoy life, talk to friends more and let ourselves enjoy the warmth and the langorous way that time moves during the summer.
  The Fire Element links to our heart, our small intestine, our ability to feel joy in our life and the capacity for anxiety when we feel low. Our Fire Element links to our ability to feel warmth toward others and to share and communicate with them – and even better, if we can move with we can let the flame of joy leap from our heart to someone else´s and keep lighting up and lightening the entire world!
  Summer is the time when this will blossom in us. Ideally, it is the time when we allow ourselves to follow
Fire more and to be more open to the world, both physically and emotionally.

Other ways we see this is through the pulse. Pulse-taking is one of the main diagnostic techniques used in Chinese medicine. Here we can read how the Nanjing, the Classic of Difficulties, one of the major Chinese medical classics, describes the pulse of Summer:
In Summer, the movement in the vessels is hook-like because it corresponds to the heart, the southern region, and to the phase of Fire. During that season all things flourish; the branches and the leaves are spread out, and they all point downward and are curved like hooks. Hence, the respective movement in the vessels comes swiftly and goes slowly. Hence, it is called ”hook-like”.
                                                    – The Fifteenth Difficult Issue, Nanjing, Unschuld, p201

Present-day Chinese doctor and Daoist master Jeffrey Yuan says this:
  ”The summer´s pulse is one when you take the person´s pulse, it should feel like something comes up and scatters against your fingers. That´s the spreading nature of Summer.”

The warnings about what happens when people go against summer written by the physicians and Daoists who wrote the Neijing, is continued by Huang Fumi, writer of the first monograph and more structured medical textbook in China, the Zhenjiu Jia Yi Jing, the Systematic Classic of Acupuncture and Moxibustion, (ca 260 AD).
  The Jia Yi Jing is the first book to take the information from the Neijing and other books and systemize it in a more structured way. It also contains the only extant text from a book called Mingtang, the Brilliant Hall, a book revered at the time but of which we have no copies left – except the quotes that Huang Fumi saved for us.
  If the heart is affected by apprehension, thought and worry, this injures the spirit. If the spirit is injured, this leads to fright and loss of control of oneself, cleaving of the major muscular masses, and shedding ofthe flesh. Should the hair become brittle and the facial colour prematurely aged, death will come in winter.
  The Suwen says: the sound of the heart is laughing, the manner of pathological change is anxiety, and its emotion is joy. Joy injures the heart. The Jiu Juan and the Suwen both say: the merger of essence and qi in the heart leads to joy.

                   – Jia Yi Jing – the Systematic Classic of Acupuncture and Moxibustion, p3. Huang Fumi, transl. Chace and Yang

If one runs counter to the qi of summer, taiyang will not grow, and the heart qi will be hollow within.
  ...as the ebb and flow of yin and yang in the four seasons is the root of all things, the sage acts in accordance with the root by nourishing the yang in spring and summer and nourishing the yin in fall and winter. To go against the root is to fell the stem.

                                                                    –  p5, ibid.

(you can read more about who Huang Fumi was here: http://www1.chinaculture.org/library/2008-01/31/content_26664.htm).

We can also see how other Chinese sources see the Fire Element and Heart, here a later text from the Internal Martial Art of Xingyiquan, which researches the Five Elements of Daoism and Chinese Medicine through practical training for both body and mind. Paoquan is one of the Five Fists, and linked to Fire.
  Paoquan belongs to Fire and is the opening and closing of the one Qi. Like a cannon suddenly blasting and suddenly hurling its ball. Its nature is the most violent and its shape is the most fiery. In the body, it belongs to the heart, and in the fist it is Pao. If it is performed correctly, then the body is comfortable and unrestrained, and the qi is harmonized. If it is performed incorrectly, then the movement of the four limbs are not smooth and the qi is weird. When its qi is harmonious, then inside the heart is clear and spiritual When its qi is weak, then inside of the heart is blurred and confused. The learner should study deeply.
                                                         – Xingyi Classics

But enough of classical texts. The Fire Element and summer are linked to the heart, but also to the small intestine, sanjiao and pericardium; the last is called xinbao in mandarin, something that wraps around and cradles the heart, almost like a comforting hug.
  The pericardium surrounds the heart; in Chinese medicine, it is an organ in itself and is called the Heart Protector – it guards the core of our heart, our mind and emotions, against too much pressure from the outside. In the oldest texts, Neijing and Nanjing, the view was that you never treated the heart directly – all treatments were indirect, via the pericardium. This was probably due to two things: back then, the heart was called the Emperor, in honor of the Emperor who ruled China, and treatments might have been based on that same caution and honor. But it seems likelier to me that the physicians of that time respected the heart as the core of our being that it is, and preferred the gentler treatment to affecting it directly.
  In the Neijing and Nanjing, there also existed no heart meridian, only the pericardium meridian – the heart meridian was literally invented and added on in later times. Today in TCM the heart meridian is treated very commonly, while more Classical Chinese Medicine might use it but more respectfully, and often still prefers to treat through the pericardium.

Here, from Elisabeth Rochat de la Vallée and Father Larres book on the Sanjiao and Heart Protector:
  The expression xinbao luo designates the two aspects necessary to a central power: the guard and protection with the idea of an envelope which encircles and prepares for life, and then all the communication systems without which no authority can exist. For example, if in time of war there are no messengers, or if the sovereign does not know what is happenings, then there is disorder. In the pathology of the heart, which covers the pathology of the heart as a communicator or in its enveloping asepcts, there are a lot of disorders and illnesses which are the result of losing contact with the spirit that is in the heart. A good example of this breakdown in communication is seen in the case of tan, phlegm, when this obstructs or veils the orifices of the heart with resulting physical or mental symptoms.
                      –  p15, Heart Master, Triple Heater, Larre and Rochat de la Vallée, Monkey Press 1992

We will talk about tan, phlegm, and the different kinds of phlegm in a coming post. But during this discussion it´s also worth adding that even though it makes things easier to explain, in Classical Chinese Medicine our entire being is seen as one, interlinked and whole. As Rochat de la Vallée pointed out in one of her lectures, ”If you speak of different versions of the heart you´re in a Western model,” – a phrase I´ve heard echoed from acupuncturist, herbalist and teacher James Cattermole of London.

The void of the heart can only manifest through the radiance of the spirit, but looking at the other side we see the manifestation of the heart in the form of this envelope. What we call the envelope of the heart can perhaps also be seen as all the membranes around the heart, and there are ancient texts in the classics which say that this is so. Then we can go further and say that it is the pericardum, or not just the pericardium but the myocardium. If the heart of the heart shelters the spirit then the invisible aspects of the heart must then enveloped and protected, but they must also be manifested in a visible aspect. That is to say Buckingham Palace is not the queen, but it gives a good impression of the royalty in England. It represents the crown. This is linked to the idea of emperor. So I think these envelopes are to be taken as everything that manifests the visible aspects of the heart.                                                                                     – ibid, p14

Summer is the time for our heart and Fire Element to be relaxed and open to the outside, just as winter is the time for keeping that Fire warm inside, in the hearth that is us.
  Just like nature flourishes and blossoms, so should we, if our system moves in balance with the seasons. As we saw in the quote from the Jia Yi Jing, ” ...as the ebb and flow of yin and yang in the four seasons is the root of all things, the sage acts in accordance with the root by nourishing the yang in spring and summer and nourishing the yin in fall and winter. To go against the root is to fell the stem.”
  Taiyang is the largest yang surface of the body, covered by the Bladder and Small Intestine meridians. It helps our body and mind to adapt to external circumstances and to be open or closed to surroundings as needed. Taiyang should help us sweat in summer and then gently close in autumn to keep our warmth all through winter with its tests of storms, cold that makes the cheeks red, and falling snow from gray skies.

Well, this post has gone on for long enough. It´s time to go out and enjoy the summer instead. If you want to read more about heat and summer heat, and how they can affect us, I can recommend this post by Giovanni Maciocia on his blog: http://maciociaonline.blogspot.se/2012/05/diagnosis-patterns-and-treatment-of.html.
  Summer is the time to let ourselves and our life blossom. It´s our chance in the year to enjoy warmth and to let ourselves soften and open up to the outside, both in our everyday existence and also in the greater sense of how we see and act in our life. We are going to sum up the view of summer in Chinese medicine with a quote borrowed from Western doctor and poet William Carlos Williams. I hope you have a good summer. Now I´m going outside to enjoy the sun. Bye.

In summer, the song sings itself.                                – William Carlos Williams

Daniel Skyle © 2012