This
year,
Dr
Wang
Juyi
has
worked
as
a
doctor
in
Chinese
medicine
for
fifty-one
years.
He
became
known
in
the
West
through
the
book
Applied
Channel
Theory
in
Chinese
Medicine,
written
with
his
apprentice
Jason
Robertson.
Dr
Wang
is
famous
for
his
research
into
the
clinical
application
of
Chinese
medicine,
his
appreciation
of
the
Chinese
medical
Classics,
his
system
of channel
theory
and
palpation,
and
his
constant
wish
that
his
students
surpass
him
in
skill
through
applying
these
principles.
In this second second article
we
keep
looking at
Dr
Wang´s
system
and
his
own
history
– which
spans
half
of
the
20th
century
of
Chinese
medicine
and
into
the
21st.
This time, we will look further at his life, his system of palpating
channels, and his study of point-pairs in acupuncture.
Dr
Wang Juyi graduated with the first university class in Chinese
medicine in 1962. His teachers were all trained in older styles of
Chinese medicine, among them names that later would become famous in
the West too, like master herbalist Qin Bowei and ”Golden Needle”
Wang Leting. Dr Wang´s working life has been in the state hospitals
in China; he has seen TCM be shaped out of the Classical Chinese
Medicine (CCM), been head of the hospital he worked in, editor of
Chinese Acupuncture
(the Lancet for
Chinese medicine) and finally gone into private practice in Beijing,
which he still maintains. Today, he is 75, tall, with good energy and
a strong, gravelly voice. He takes obvious joy in transmitting his
research and knowledge to younger generations.
Graduating
with the first university class in 1962
”What
was that class like?”
”Well,”
he says, ”a lot of the teachers didn´t have any experience in
teaching. They usually lectured according to the Classics and talked about their clinical
experience too. We were the first university class ever, a brand new idea, so
things were being tried out as we went along. And when new students didn´t
understand, many teachers weren´t interested in helping them.”
We
are sitting in his own clinic at his desk with translator and student
Jonathan Chang behind him. And behind Jonathan on the wall is the
famous quote from legendary doctor and Daoist Sun Simiao of the Tang
Dynasty, saying ”The Skilled Acupuncturist
treats all patients equally”.
”And
the class was just as varied,” Dr Wang adds. ”Some of my
classmates were already doctors. Others had just left high-school.”
When
the students did clinical observation, often it turned out that what
the teacher said in the classroom was not how they worked in clinic.
Many students began wondering if the theories were correct or not.
”He gets good results in clinic, but why?”
Dr Wang started questioning the gap between
the two. He waivered between ”This is
good..” and ”...but
it doesn´t match the theory...”
”I often saw the effectiveness of their treatments,” he continues, in his gravelly voice, ”but I equally often didn´t see the theory that explained what happened. I had this view up until I began practicing myself. By that time, I had huge amounts of information memorized – point-combinations, herbal formulas, old songs of points and their usages – lots of it, but very little use in clinic. It was only later I began to understand how the theory fit with the practice, and by that time I had also started to research channel theory.” And this began his lifelong research into channel theory, channel diagnosis and point-pairs.
”I often saw the effectiveness of their treatments,” he continues, in his gravelly voice, ”but I equally often didn´t see the theory that explained what happened. I had this view up until I began practicing myself. By that time, I had huge amounts of information memorized – point-combinations, herbal formulas, old songs of points and their usages – lots of it, but very little use in clinic. It was only later I began to understand how the theory fit with the practice, and by that time I had also started to research channel theory.” And this began his lifelong research into channel theory, channel diagnosis and point-pairs.
A
deeper look at Channel Theory
For
the first instalment and its overview of the basics, please see
http://www.acupractitioner21.blogspot.se/2013/05/interview-with-dr-wang-juyi-on-channel_9265.html. This time we are going to look a bit deeper at Dr Wang´s system for
palpating and diagnosing using the meridians, jingluo zhenduan.
”Channel
theory is, in my view, the basis for all Chinese medicine.”
This is something he often says during courses. Then he guides
students to some of the comments on this in the Classical texts to
back it up (see part 1 of this series).
The
foundation of his system is to palpate the meridians. This is done in
specific ways, going along the meridian from the starting point
(usually fingertips or toes) and ending at the knee or elbow. One
reason for this is something called the Five Classified Points, or
the Five Transport Points – sets of five points along each meridian
who have a very strong and specific effect on the entire system.
Over
the decades, Dr Wang has mapped specific pathological changes on the
channels and what they indicate in the health of a patient. Each
meridian has different indications in different places, depending on
what kind of change it is and in which place. Students are also
taught to feel for how the physical part of the meridian feels – is
it tense, large, weak, or even soft? What´s the skin like? Is it
smooth, grainy, is the fascia rough? Are there nodules on the
channel? They can be soft, hard, come in different lines or be
single. Where are they? Does the skin change anywhere on the
meridian, or the temperature?
”It
is important to do channel differentiation, not just pattern
differentiation. Always integrate channel transformation in your
enquiries.”
– Dr
Wang Juyi in lecture
Part
of his channel palpation is five stages:
1)
Observation
2)
Palpation of blood vessels (including taking the standard pulse)
3)
Palpation along channel pathways
4)
Pressing
5)
Light touching with palm
The
Five Tissues and actually going home to a point
These
palpation techniques will show which channels are affected, and
usually reveal that one or two are the most affected, either towards
yin or yang. The practitioner will then integrate the findings on the
meridians with the diagnostic information gathered from tongue,
pulse, and all the other diagnostics that are part of Chinese
medicine.
During
the palpation lessons his phrase is, ”You
want to iceskate, not tapdance”.
This helps students to flow along
the channel inwards instead of stop-starting on small parts of it.
The iceskating also aids relaxation, as the stop-start will more
easily create a tense nervous system in the patient. Each
point-location should be based on palpation skills, and each location
will be guided by several of the five different tissues:
1) Skin
2) Sinew
3) Muscle
4) Blood (vessels)
5) Bone
”The point will always be found in a crevasse.” When Dr Wang started out fresh from university, he followed what he had been taught; anatomical landmarks and images, same as is usually taught in Western acupuncture schools with more or less precision. But over time, he realized that they often didn´t match the actual location of the point. Many points were in slightly different places, and each person had their own size that he had to learn to adapt to. Then he had to find the point, open it, and finally needle. These days he teaches this individuality of physiology very clearly to his students, and have found a large number of point locations that in fact are slightly different than the textbook would try to standardize.
Except
for trips and longer periods abroad, Dr Wang has lived in Beijing his
entire life, and many of his similes about Chinese medicine are based
on the city. ”Finding the correct location
is as if you are going to meet a friend at their apartment. Many
practitioners use a very general address when they are less specific
about where the point is. But there is a big difference between being
in the right neighbourhood, on the right street, or actually pressing
the doorbell at your friend´s place.”
The
Six Levels of Chinese Medicine: healing geography in depth
Daoist
practices teach that the deeper in our system we feel, the deeper
level of our emotions, mind and psyche we also activate and access.
This is one reason why any qigong- or meditation-practice working on
this should be taught in careful stages over a long time. Speeding
that process up often creates an unstable system in the practitioner,
which is one of many reasons to look for a skilled teacher that one
can have long-time contact with.
Dr
Wang´s treatments are often phrased within the greater framework of
something called the Six
Levels.
The
Six Levels give a geography in depth of the body and mind of a
patient (and of the practitioner). Each level is linked to two
meridian systems at that depth, and their corresponding organs and
emotions, and the way they help our internal landscape interact with
our external one (you can find a longer blogpost discussing our
internal landscape and Dr Wang´s view on the Jueyin-level at
http://www.acupractitioner21.blogspot.se/2013/01/classical-chinese-medicine-and-body-as.html).
They
Six Levels are written about in the Neijing, the oldest medical
textbook, but really reach an apex in the Chinese medical classic
called the Shanghan Lun, the Classic of
Febrile Disease caused by Cold. The
Shanghan Lun was written in the 200´s by legendary doctor Zhang
Zhongjing. It charts the progression of how an external factor (an
illness, or pressure from our surroundings) goes deeper into our
system level by level. The book teaches the concept of bianhua,
change, as it moves from one level to the next, and how the physician
can stop it, intercept it, block it from moving deeper or help the
system expel it.
The
first and most external level of the Six is Taiyang,
Ultimate Yang, which covers the huge area of the back of our body and
includes the meridians of the Bladder and Small Intestine with all
their respective organs, functions, and links to our emotions and
mind. Then it continues deeper by stages until it reaches Jueyin,
Absolute Yin, the deepest yin, the deepest levels of blood and
stillness and healing in us, linked to the Liver and Pericardium.
The Shanghan Lun part I and II
The Shanghan Lun is primarily focused on herbal medicine. It´s writings have
given rise to one of the main herbal traditions of Chinese medicine – Shanghanpai.
During the Tang dynasty, legendary doctor and Daoist Sun Simiao also utilised
the system using acupuncture instead of herbs. In the Shanghan Lun, Zhang
Zhongjing wrote down diagnostics and treatments not only for each level, but
was also very detailed information about how far the illness has moved within
that level itself.
”Clause
1-4: During the first day of febrile disease caused by Cold, the
syndrome is at the Taiyang Channel. If the pulse is quiet, the
syndrome is not transmitting into the next channel. When the patient
is restless and nauseated, and the pulse is speedy and mighty, then
the syndrome is transmitting.”
– Shanghan
Lun, Zhang Zhongjing, New World Press 2007, transl. Luo Xiwen
The
original Shanghan Lun was split up and the second part is now called
the Jingguyi Yaolue, Synopsis of Prescriptions
of the Golden Chamber.
One of the most well-known teachers in the West on Shanghan Lun, Dr
Arnaud Versluys, adds that the original Shanghan Lun was meant to
begin with external factors affecting us, while the second part of
the book, before they got separated, was intended to cover internal
conditions that affect us, thus giving a complete overview.
”One
should carefully protect one´s Body Resistance and avoid the attack
of climatic pathogenic factors. Otherwise, channels and collaterals
will be violated and health endangered. In case pathogenic factors
have invaded the channels and collaterals, medical treatment should
be given in time to stop the transmission of pathogenic factors into
the viscera and bowels.”
–
Jingui
Yaolue, Synopsis of Prescriptions of the Golden Chamber, Zhang Zhongjing, transl. Luo Xiwen, New World Press 2007
The Six Levels help us understand how problems and illnesses can begin at different levels in us, and how they can progress to become worse the deeper they go. For a practitioner, it should help us understand how to find at what level the patient´s problem is, and how to treat that and gently allow the system to open instead of trying to attack deeply into it to fix ”the problem”we perceive being there.
”If
you only rely on experiential points handed down to you, or tricks of
the trade, you don´t understand why something works or not."
– Dr
Wang Juyi in lecture
Point-pairs:
the synergy of simplicity
You can read a definiton of point-pairs in the box above, but in short, it´s the art and science of how one point interacts with another. A point-pair should create a synergy larger than the two points alone. Dr Wang has made it one of his areas of research, and systematically tried them out over half a century. He also worked in the state hospitals, which meant that a calm day was 50 patients, and some days he had a 100 – patients and treatments enough to slowly and patiently try things out, systemize them and catalogue them. In the West, a busy acupuncture clinic might have 30 or 40 patients a week.
Point-pairs
have been used in Chinese medicine since antiquity. Dr Wang tried out
the classical ones and the ones handed down in his family and from
other older doctors. Some gave good clinical results, some not that
much. He also did continous research on what different points did,
and what different meridians were most effective for.
For
example, his usage of the Heart meridian and the Pericardium
meridian. In some Chinese medical schools, the Heart meridian is not
used due to old custom. ”It took me a long
time, but eventually I learned to separate the effects of points on
the HT and PC meridians. I found out that the points on the PC
meridian treats the cardiac muscle better, and emotional issues,
while the HT works better for regulating or improving the
conductivity of the heart, the endocardium and the valves. It took me
decades to get this understanding in clinic, and to prove it
clinically too.”
A
point-pair example: visiting the Tai Yin level
In
the book, Dr Wang collects many of the point-pairs he has tried in
depth. But if you train for him he also goes through uncountable
other ones that are less general and more focused on specific
treatments. He usually says that using point-pairs increases the
treatment effect while helping the practitioner to keep track of
which points were actually successful in that treatment. And, very
importantly, the fewer the points used, the easier it is for the
patient´s system to listen to the information they are trying to
give to body and mind. Using lots of points will be like standing in
the middle of a train-station with 20 people screaming at the patient
over the background noise. We looked at this in the previous
instalment, but to quote Dr Wang,”Don´t
make
the
mistake
that
using
more
acupuncture
points
is
better.
It
is
quite
harmful
to
the
body.”
We
are going to take one example here to illustrate the concept of
point-pairs.
SP9+LU5, Yinlingquan+Chize
This
is point 9 on the Spleen channel, near the knee, combined with point
5 on the Lung channel, on the elbow crease. They share specific
characteristics within their respective meridian, being so called
hexue, he-sea
points or
uniting
points. Their general effect is to treat
counterflow and regulate organ qi transformation. It is here that the
channel qi dives inwards toward the organs themselves. Hexue
are placed around the elbows and knees.
There
is a longer section on this pair in Dr Wang´s book, since it is very
useful and treats a broad range of conditions. It is a primary pair
for regulating and treating the Tai Yin
(Ultimate Yin) level of the Six Levels, which covers the Spleen and
Lung and sets a rythm in the body. To write on all the effects of
this pair would demand a separate article, but some of the conditions
it helps with are general oedema, psoriasis, gynecological issues and
grief, it helps stabilize the heart rythm, tonify qi, build houtianqi
– post-birth qi – and increase the general quality of fluids in
the body.
Using
this pair will also create a general resetting of the qihua,
the qi transformation in the Tai Yin level, and help regulate the
ascending/descending movement of the lung while giving a stimulation
of the movement of clear qi upward from the spleen. One of Dr Wang´s
senior students, US-based Yefim
Gamgoneishvili, used this pair so much for a while and with such
great success that Dr Wang started referring to him as ”SP9 LU5”!
In the third part of this series we talk to Yefim in an interview I
did in Beijing in the spring of 2013, and he will describe his
experiences using Dr Wang´s system for fifteen years here in the
West.
Dr
Wang uses the SP9+LU5 pair as a yin-version of the very well known
Four Gates, Siguan,
(LI4+LIV3),
and he often uses it as a general treatment for many patients before
becoming more specific in treating their condition. A very important
factor is that it sets a rythm in the body again, something even more
crucial here in the West where people have such a stressed and
erratic lifestyle.
The
future of Chinese medical training
”Oh.
Right. Well, before our class,” says Dr Wang, ”there were two
different kinds of training in Chinese medicine in China. There were
smaller schools, where courses usually lasted 3-5 years, and
pre-liberation we also had live-in apprentices. Often people learned
from their family first – in the educated middle classes, many had
studied Chinese medicine on their own or in the family, so knowledge
was handed on.” The live-in apprentices started at 14-15. The
arrangement was that they didn´t pay, but worked for their teacher
and got food, lodging, and knowledge back.
In
his book on the Shanghan Lun used with acupuncture, Classical Chinese
Medicine-practitioner and Daoist Jeffrey Yuen adds that there was
another version, mentorship,
where the person gave their life savings to a master and then took
them on as an apprentice.
”Once
the universities began, though,”, says Dr Wang, ”there were still
apprenticeships and continued education classes outside, but less
than before.”
”Do
you think the current system works, compared to the old one?””Fairly well,” he nods, slowly. ”I don´t completely agree with it, though.
There are too differing levels among the teachers in the courses. I hope
that the training system will be improved. One thing that I am involved
with is to do this, where we want the courses for basic education, but then
a system of apprenticeship with a master on the side.”
Two
courses with Dr Wang will be held in Dublin this year, again arranged
by Cyril Bonnard. One course will be on the basics of Dr Wang´s
system, the other more advanced for those with previous experience.
Courses begin on the 14th
of June and clinic days have been arranged to add more depth. If you
are interested, you can find more information at
www.equilibreacupuncture.ie.
Daniel
Skyle
©
2013.
Daniel
Skyle
is
a
student
of
Dr
Wang
Juyi.
He
has
trained
in
Daoism,
chinese medicine,
qigong
and
the
internal
martial
arts
for
more
than
twenty
years.
He
currently
has
two
clinics
in
Sweden
where
he
works
with
Classical
Chinese
Medicine,
acupuncture,
and acupuncture for aid-work.
His
blog,
with the previous instalment of this article, can
be
found
at
www.acupractitioner21.blogspot.se. He will soon publish the first book on Daoism in Swedish, Daoism - the Tradition of Change: shamen, mountain hermits and meditation masters, which will come out in English in 2014. It contains a chapter on Chinese medicine and Daoist medicine, and is the first in a series of books on Daoism as a living tradition, with interviews with Daoist practitioners in China today. Next is a book of essays on spirituality and spiritual practice, including material from Classical Chinese Medicine. His books can be pre-ordered through acu@smallchange.se
”The
term ”point-pairs” refers to two points often used together in an
acupuncture treament. Each pair can be thought of as having a
specific effect on qi transformation which, when properly chosen,
helps to transform a pathodynamic in a way that might be likened to
turning a key in a lock. Point pairs should not be thought of in the
context of treating a particular symptom or even disease, but should
always be considered in the context of their effects on the
physiological system as a whole. This is a very important point. When
considering the information below, the practitioner should always
keep in mind that these pairs are understood as having specific
effects on the qi transformation of the channel system. They are not
used to ”treat headache” or even for basic TCM functions such as
”resolving dampness”. Each pair has a specific effect on the qi
transformation of one or more of the six channels, as described in
earlier chapters.”
-
Extract from Applied
Channel Theory in Chinese Medicine – Wang Juyi´s lectures on Channel Therapeutics, by Dr Wang
and Jason Robertson, Eastland Press 2008