Deepest Health Chinese Medicine Podcast : Interview with Dr. Arnaud Versluys LAc, PhD (Part 2 of 3)
I’m glad so many people enjoyed the first episode of this podcast interview with Dr. Arnaud Versluys LAc, PhD. The second part finds Dr. Versluys expanding on his definition of Classical Chinese medicine by discussing how one uses the Shang Han Lun in contemporary clinical practice, particularly concerning complex diseases typically seen in modern times. He also discusses the importance of specializing in a particular style of Chinese medicine and gives some advice to those of us seeking knowledge in this profession. I think you’ll really enjoy the information AND the audio quality - I think I finally got it right. :) Check it out at the bottom of this article!
If you missed the first part of the interview with Dr. Versluys you can find it here. For more background on the six conformations read the article linked here. I also encourage you to check out Dr. Versluys’ website, particularly the forums - a great place for discussing Canonical Chinese Medicine.
Dr. Versluys uses a few names that may be unfamiliar to listeners - I want to clarify these things for you. Li Dong Yuan is the author of The Treatise on the Spleen and Stomach (Pi Wei Lun)
and Jin Gui Yao Lue
I’ll release the final part of the interview early next week - it’s a short piece focusing specifically on the issue of herb substitution and the possibility of growing Chinese herbs in the United States. I hope you enjoy today’s podcast! As always, feel free to leave any comments - discussion is a great thing! :)
Eric
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Tags: arnaud versluys, ccm, herbs, interview, Learning, Podcast, six conformations, tcm, versluys, Zhang Zhong JingRelated posts
Salt Sensitive Hypertension and Classical Chinese Medicine, Part 3
This is the final post in a three part series by Brandon Brown, blogger and student of Classical Chinese Medicine at NCNM. You can read the first two parts here and here, and can read references for the article by visiting Brandon’s site here.
Salt in the Classics
Salt is mentioned a number of times in the classics. In the Neijing Suwen, salt is considered the flavor of the Kidney. But what does this mean exactly? What follows are the most descriptive and instructive references from the Suwen followed by my translations.
Chapter 67
北方生寒，寒生水，水生鹹，鹹生腎，腎生骨髓，髓生肝。其在天為寒，在地為水，在體為骨，在氣為堅，在藏為腎，其性為凜，其德為寒，其用為，其色為黑，其化為肅，其蟲鱗，其政為靜，其令，其變凝冽，其眚冰雹，其味為鹹，其志為恐。恐傷腎，思勝恐，寒傷血，燥勝寒，鹹傷血，甘勝鹹。
“The north generates cold, cold generates water, water generates salty, salty generates kidneys, kidney generates the marrow, marrow generates the liver. In heaven it is cold, on earth it is water, in the body it is bone, its qi is hard, in the Zang it is the Kidney, its nature is cold(shivering), its virtue is cold, it is “use”, its color is black, it changes into solemn-ness(seriousness), it is worms and fish-scales, its government is stillness(jing), it causes, its pathological change is congealing coldness, its natural disaster is ice hail, its flavor is salty, it is will by fear. Fear impairs the kidney, thought defeats fear, cold damages blood, dryness defeats cold, salty damages blood, sweet defeats salty.”
Chapter 3
味過於鹹，大骨氣勞，短肌，心氣抑。
Excess salty flavor, causes great hardening of bone Qi, shortens the muscles, and restrains heart Qi.
Chapter 5
鹹勝苦。
Salty defeats bitter.
Chapter 10
是故多食鹹則脈凝泣而變色 。
Therefore, much eating of salty makes the pulse concrete and the color changing.
Chapter 22
心欲耎，急食鹹以耎之，用鹹補之，甘寫之。
The Heart desires softness, anxious people eat salty that softens it, use salty to mend it, sweet drains it.
—-
These excerpts from the Suwen indicate the myriad functions of salt. In Chinese Medicine, the Salty flavor is typically used to soften nodules as mentioned in Chapter 22, but we also see in Chapter 3, 10, and 67 that salt can pathologically also create hardness of Bone Qi, restrain Heart Qi, damage blood, and cause the pulse to be very firm. We can read these lines in typical Chinese Medicine fashion: that as a remedy, the salty flavor has a purpose in softening nodules, in moderation salt perhaps allows the Kidney to perform its function of storing, but pathological excess consumption of salt can lead to sclerosis.
In Chinese Medicine, the 5 flavors that go with the 5 organs typically counteract the nature of the targeted organ. For example, the energetic nature of the Liver is up and out whereas the flavor Sour astringes and contracts. The Heart, the fire organ, is up and bitter is down. For the Lung, its nature is contracting down and in, whereas pungent is the opposite: up and out. For the Kidney, as we see in Chapter 67 above, the energetic nature is definitely to store by freezing. Salt, must counteract this freezing nature, as we know that it does from our experience: salt both reduces the freezing point of water and raises the boiling point. The presence of salt liquefies ice, and thus can soften hardness (tumors, goiter, etc.). But because salt has an affinity with the Kidney it counteracts the storing nature of the organ, liquefying the Kidney energy (perhaps Jing) to be used in the body as Qi. Therefore we see again that, salt pushes out from the inside.
In their paper on the Classical Energetics of the Five Flavors (find in references section), Arnaud Versluys and Jessica Atkins describe the therapeutic actions of the five flavors in terms of tonification and purgation. In cases of excess or deficiency, the organs can be respectively purged or tonified with the appropriate flavor as shown in the figure below.
Figure 2: The actions of the 5 flavors
Organ: Excess of, purge with : Deficiency of, tonify with
Fire : Sweet : Salty
Earth : Bitter : Sweet
Metal : Pungent : Sour
Water : Salty : Bitter
Wood : Sour : Pungent
According to their interpretation, the salty flavor purges excess in the Kidneys and tonifies the Heart. In the case of SSH, chronic overexposure to dietary salt may act medicinally and impair or purge the storing function of the Kidney and thus over-tonify the Heart. Because the Kidney is also said to store pre-natal essence if there is no pathological influence to expel in the Kidneys, it is possible that what is purged is actually pre-natal essence (Jing). This essence is circulated throughout the body, transformed to Qi by the Liver function, and transformed and stored as Shen by the Heart. Shen, and thus consciousness, have as a substrate the brain, but Shen is housed in the Heart.
Therefore, the use of salt habitually may increase the Jing-Qi-Shen generation cycle, which makes us sharp and awake, but has the detrimental effect of possibly depleting pre-natal essence if the Kidneys are not constantly tonified. In the Suwen it mentions that at 8 times 7 years (56 years old), the hair (ruled by the Kidney) turns gray and the signs of aging begin to become visible. “The kidneys’ ability to excrete sodium declines gradually with age. If, with age, salt consumption is not reduced, sodium balance is maintained by raising fractional sodium excretion, which requires elevation of BP” (Khalil 2005). The 
accumulation of salt in the ocean over the years has begun to take its toll.
Because purgation of the Kidney in a non-pathological condition also tonifies the Heart, an interesting consequence of excess in the Fire element is that it easily overflows onto its child organ, the Earth. This would lead the Earth to become overwhelmed and thereby inhibiting it to control the Water element, whose function is diminishing due to the natural processes of aging. In CM, we say that the “Earth rules the muscles” and in the SSH case this clearly relates to the smooth muscle of the vasculature losing its ability to contract. Due to an excess in the Heart domain, the smooth muscle becomes dry, stiff, and brittle. The patho-mechanism of this is illustrated below.
The standard American diet is predominantly made of the flavors salty and sweet. The overwhelming absence of bitter (with the exception of Shen disturbing coffee and beer) and the overwhelming abundance of salt and sugar in the standard American diet may explain the danger of increased exposure to dietary salt.
Conclusion
It is not surprising that decreasing daily dietary salt intake will help in treatment SSH. However, what we learn from the classics and the physiology of salt in the body is that Kidney tonification is essential for SSH.
Because the Earth element has become so affected by this chronic exposure to salt, purging the Earth of excess with the bitter flavor will be important. Like a lone neuron in the brain, salt consumption is entangled in the higher social structures that predominate our times: working long hours, using the mind instead of physical labor for generating a living, exposure to a barrage of psycho-sensory information in terms of television, music, and people, along with increasing anxieties about all of it. Seen in this context it really is no wonder why SSH is a modern disease of the “developed” world.
Brandon Brown
Tags: five phases, heart, human physiology, kidney, liver, lung, metal, nature, neijing, salt, student, translationsRelated posts
The six conformations: an exploratory post
The topic of the Six Conformations is huge. So huge, it’s been a bit intimidating to write about. But, it’s something that we hear a lot about in our Classical Chinese Medicine studies here at NCNM in Portland. So, as most times, see this as the beginning of a long exploration. If you’re here without much knowledge of the Six Conformations I hope that this, and related posts, will help broaden your understanding. If you’re here with lots of knowledge of the Six Conformations, I hope you will share your wisdom with us in the comments.
The Six Conformation system is another on par with the Five Elemental Phases. It is a way to sort the macrocosm and microcosm into manageable chunks that have meaningful relationships with one another. It’s worth mentioning that the Shang Han Lun is based on Six Conformation differentiation. In heaven, they refer to weather patterns - or atmospheric Qi. In the human being, they refer to systems in the body. This is important. When people hear about the Six Conformations, they often think about the channels only - so when I say Taiyin, folks automatically think, “Spleen and Lung channels.” This is erroneous thinking, even though many influential books translate Liu Jing as “Six Channels.” Just as the Five Elemental Phases don’t refer only to organs or layers of the body, but include those; the Six Conformations don’t refer only to channels or even their paired organs, but include those.
Let’s get the nitty gritty details out of the way. What are the Six Conformations?
- Taiyang - 太陽 - Great Yang - associated with the Bladder and Small Intestine organ systems
- Yangming - 陽明 - Yang Brightness - associated with Large Intestine and Stomach organ systems
- Shaoyang - 少陽 - Lesser Yang - associated with the Gallbladder and Triple Burner organ systems
- Taiyin - 太陰 - Great Yin - associated with the Lung and Spleen organ systems
- Shaoyin - 少陰 - Lesser Yin - associated with the Heart and Kidney organ systems
- Jueyin - 厥陰 - Reverting Yin - associated with the Pericardium and Liver organ systems
There’s a lot of layers of information associated with each of these categories. I couldn’t hope to look at all of it in one blog post. Let’s look at the most basic layers.
Climactic factors (for better or for worse)
The Six Conformations are related to Six climactic factors/Qi (Liu Qi). These should be in balance in nature, but when they are out of balance we know them as the Six Evils.
- Taiyang - Cold : associated with water, contracting quality
- Yangming - Dryness : associated with metal, dessicating quality
- Shaoyang - Fire : associated with fire, flaring/ministerial in quality
- Taiyin - Damp : associated with earth, sticky and heavy in quality
- Shaoyin - Heat : associated with fire,
- Jueyin - Wind : associated with wood, wandering in quality
As I said above, people often think Six Conformations = Six Channels. Me, I have the opposite problem — I have it so embedded in my head that the Six Conformations = Six Channels = Six Qi (atmospheric and evil) that sometimes I become a bit confused by it. My understanding so far is simple — when we talk about the Six Conformations out of context (as we are now) the concept includes shades of all these meanings (Qi/climactic factors, Jing/channels, layers of the body, etc) and much more. When we are looking at a Conformation more specifically as in a disease, we can tease out what piece of information is most relevant for us at the time. I hope this is clear. It’s a hard thing to explain.
The order of the conformations and the layers of the body
The specific order I keep using as I list the conformations is not without reason. While there is some discussion about the placement of Yangming, most of my teachers seem to agree on this order.
Taiyang is the most outward of the conformations. It governs the most superficial layers of the body and is associated with the Weiqi or defensive force of the human being. Think of the premiere formulas associated with Taiyang - Gui Zhi Tang and Ma Huang Tang. Both strongly resolve the surface. Yangming is the next layer deep - both in some sense physically and also in terms of how external pathogens must progress in their quest to do harm. It is in the Yangming stage that we get great fevers, this is a storehouse of immense Qi and Blood force in the average person. Think how well this resonates with the Stomach and Large Intestine organ systems, both deep dealers in the most basic, primal functions of life. The last Yang conformation, and thus the last protector against a disease becoming deeply internalized, is Shaoyang. Shaoyang is said to “pivot” (a long discussion) between internal and external, and thus has a kind of oscillating quality.
Now we enter the interior of the body, going ever deeper. Taiyin is the first of the Yin conformations and in some way exemplifies a kind of “doing without doing” — the most active of the passive organ systems. Going a layer deeper we find Shaoyin, the north and south poles of the body - Heart and Kidney, the basic axis of the functioning of the human body. When external pathogens reach this deeply, serious disease is the result. Finally, Jueyin - the deepest, but also the possibility of rebirth into the Taiyang conformations in the classic cyclic manner of Chinese philosophical systems. Jueyin is deeply involved with blood, as can be seen clearly in its encompassing of both Liver and Pericardium.
Pairing of the organ systems : insight into pathology
The more I write about this, the more I find to write. For now, I’ll just mention one quick thing. The conformations can be paired in the following way:
- Taiyang - Shaoyin : BL/SI with KD/HT
- Yangming - Taiyin : ST/LI with SP/LU
- Shaoyang - Jueyin : GB/TB with LR/PC
Anyone can see the wisdom of these pairings - reuniting the five elementally associated organ pairs. We have been taught that these are pairings of mutual support. Taiyang is supported by Shaoyin, and Shaoyin feeds Taiyang. Thus, when you have a disease in one, the other is somehow involved. There are particular ways that we have learned to understand this system of differentiation. But a simple thing to consider is this — take one manifestation of Yangming disease, serious constipation. What happens if one over purges in Yangming disease and why? It’s easy enough to say that overpurging (using cold and bitter materials) will cause damage to the Spleen that can manifest itself in a variety of ways, including as diarrhea. Why is that?
One way to explain it is to consider that Taiyin is the support of Yangming, so that when you overtax Yangming it will draw energy from Taiyin, ultimately depleting it. Of course, there are people who would explain this in a much more nuanced way but when I’ve mentioned it to others they seem to understand. Hopefully it will be helpful to you.
I’ll talk more about how I’m learning about the six conformations in the future. I’ll be interested to read any comments - add your thoughts to the discussion!
Eric
Tags: classical-chinese-medicine, shang-han-lun, six conformations, Theory, Zhang Zhong JingRelated posts
Questions for the ancients
I’m part of the student government association at NCNM in Portland, OR and I am currently working on creating a scholarship for Classical Chinese Medicine students at our institution. The SGA funded the scholarship and now I’m just working on logistics. Part of the scholarship application will involve students answering a question - with the best answer (as judged by a panel of students) getting the nod for the award. Anyway, as I was brainstorming potential questions I became lost in thought at my potential answer to one. I thought I would pose it to you, my readers.
If you could ask three questions of any ancient scholar of Chinese medicine, who would it be, why, and what would your three questions be?
For me, it would definitely be Zhang Zhong Jing. I know that in ten years time I will have much more insightful questions, but right now my questions would be:
1. To what extent did you base your work on the Neijing and Tang Ye Jing?
2. What’s up with Wu Zhu Yu Tang? I mean, seriously.
3. Are there any diseases you feel can’t be treated by what you present in the Shang Han Lun and Jin Gui? If so, what are they and why can’t they be treated by the formulas and procedures set out in those books?
As a bonus, I would ask him if he has an intact copy of the Tang Ye Jing and, if so, if I can have it. :D
Post your questions in the comments.
Eric
Tags: ancient scholars, books, chinese-herbs, Classical Texts (general), classical-chinese-medicine, formulas, Learning, ncnm, Portland, scholar, scholarship application, shang-han-lun, student government association, tang-ye-jing, Zhang Zhong JingRelated posts
Why does Classical Chinese Medicine seem so complicated?
This is the first part of a two part guest article by my friend and peer, Michael Givens. Michael is also a third year student of Classical Chinese Medicine at the National College of Natural Medicine in Portland, OR. He shares my fervor for the medicine and has been an inspiration to me as I seek to plumb the depths of this profession we have both chosen. I hope you will enjoy what he has to say. Please do leave your thoughts in the comments - he is a regular reader of the blog.
—
When I first started to study Chinese medicine (long before I became a student at NCNM), I fell instantly in love with it because it made so much sense to me. When I read the Huangdi Neijing Suwen for the first time, it was as if all the questions I had about life, my place in relation to nature and the stars, the interplay between light and shade, warmth and cold, and how life seems to exist somewhere between them all were illuminated by Huangdi, Qibo and the other sages. The cycle of the five dynamic movements in nature and how they manifest inside and out of all things, defined for me what I felt was already true; I had found a detailed system that defined the wholeness I had been searching to understand.
As I pursued my studies as a Chinese medicine student, I began to see how my initial understanding was limited and superficial, and soon, rather than being the clearest and most elegant text I had ever read, the Neijing became the most complicated. I found myself spending hour upon hour trying to draw out the inter-lapping cycles of the six confirmations, influencing each other on the right and the left through time, in the heavens and on earth, connecting to the heavenly stems and earthly branches and the five movements…I quickly became lost in the details of such an amazingly intricate systematic understanding of the nature and movement of Qi.
When I first learned about the five organs and their relations to the five “elements”, it seemed so clear; yet, as I deepened my understanding of physiology (Chinese physiology that is), simple concepts like “Fire generates Earth, Earth generates Metal, Metal generates Water” became extremely complicated. How is it, after all, that Fire descends through the malleability of Metal, physiologically, or that Metal really descends only when Fire descends? What does it mean that Water, while it resonates with the flavor of Salty, is actually reduced by Salty and strengthened by Bitter? What is at the heart of the difference between the six atmospheric conditions and the five dynamic processes and how do they interact physiologically? Questions such as these began to plague me.
Of course, this is what happens as one deepens his or her understanding of something; and, as one narrows his or her focus from the “big picture” to the minutia, the complexities of the universe become overwhelming. Yet, the beauty of Chinese medicine lies in the central view that the Chinese sages held. Rather than lose themselves in the grand picture, focusing only on the Dao or on the stars alone, and rather than (as Western science has done) lose themselves in the smaller and smaller details of the parts, the sages of Chinese medicine maintained an open view of both through using the language of symbolism and correspondences and remaining focused on processes and dynamics, functions and movements. So, though I was swimming out in the ocean of stars, and at the same time swirling amidst the tiny fragments of manifestation, by taking on this central position of the Chinese, I found a way to begin to have clarity and understanding and to flow with the movement of nature.
This is not to say that I would advocate ignoring the details and taking for granted the whole, not at all in fact; as I said earlier, the Neijing incorporates extremely detailed understandings of the very large and the very small, though there is a much stronger emphasis on the very large. What I have found is that one’s lens is what matters, regardless of what one is looking at. The lens of the Chinese medical sages allowed them to see dynamic processes and functional qualities rather than matter or manifestation. Though much of what a Chinese doctor does is to examine the symptoms and manifestations (especially in that the pulse is so very important), the treatment comes about through understanding function and movement, quality and time.
But, this is where a new confusion arises and is really what I meant by the title of this article. Chinese medicine is complicated just because it’s complicated, to be sure. But, how we are learning about Chinese medicine is also complicated. At times we are looking from a point of view of function, and at times we are looking from a point of view of materials. At times we learn of formulas and treatments that are based on an understanding of processes, and at times we learn formulas and treatments that are based on a desire to supplement matter.
—
How is a student of this medicine to behave? How are we to wade through this sea of complexity that so many years of history have created for us? That will be the topic of the second part of Michael’s article - to be released soon. Thanks for reading.
Eric
Tags: classical-chinese-medicine, five phases, focus, Learning, Michael Givens, neijing, overwhelm, Science, symbolism
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