Compassion as the driving force of Classical Chinese Medicine practice
A while ago, I began a series of posts designed to describe my experiences with Dr. Liu Lihong, renown Classical Chinese Medicine clinician and scholar. He visited NCNM in Portland just about a month ago, delivering powerful lectures and teaching us all with grace and simplicity. Many folks have asked me to share what he had to say about the Fire Spirit school of Chinese herbalism, a school that takes the use of Fu Zi (aconite) and Gui Zhi (cinnamon) to be its guiding methods. Unfortunately, I didn’t take written notes - only a recording - and it is taking me some time to transcribe. It may have to wait until school is out in a couple of weeks, when I have time between clinic shifts.
The truth of the matter is that the most powerful information that Dr. Liu gave us really had nothing to do with the practicalities of herbal formulations. I would like to share what I learned about a lecture he gave in our Medical ethics class about compassion in Classical Chinese Medical practice. I will soon share more of what I learned from this contemporary master of our medicine.
Medicine as the Bodhisattva way
Dr. Liu started out by talking about the concept of a Bodhisattva in Buddhism. In my reading, I have discovered that not everyone agrees on the definition of this concept. A basic understanding of Bodhisattva reveals a being who is either enlightened or well on their way who decides to hold off Nirvana in order to help other human beings reach enlightenment. By this definition, they embody the purest compassion and service to humanity. Certainly a noble goal for anyone, particularly a physician.
Dr. Liu wanted to help us understand what it would mean to live as a Bodhisattva. He explained that for him living this principle in daily life certainly involves living life to its fullest while striving to deeper understanding of what it means to be alive. Living a full life was explained to involve coming to a state of balance in health both in body and in the emotions. That way both Xing (form) and Shen (spirit) will be unified and harmonious. This allows us to be a great resource of inspiration for our patients while also allowing us the ability to walk our path with strength and purpose.
How do we do accomplish this task? By following the guiding hands of the ancients. 文化 (Wen Hua) is a Chinese term that’s something like “culture.” Dr. Liu related to us that the deep meaning of the term encompasses more than what the normal American interpretation might reveal. It isn’t just a collection of wheres and whens and whats, but a body of knowledge produced by great people that can be used for transformation of human lives. The study of culture and cultural artifacts, like the Classical Chinese texts, is more than an empty academic exercise. Or, at least, it should be.
The ancient texts, like those written by Kongzi (Confucius) are part of the Wen Hua that we can use in our quest to follow the Bodhisattva way. It isn’t important that we analyze the texts in an analytical manner. The important thing is that through our study of the texts, we allow them to Hua - to transform us. I think I understand from what Dr. Liu was saying that he believes Chinese medicine knowledge is this way as well. Many of us know a person who has nearly encyclopedic knowledge of Classical texts or Zangfu differentiation or herbs or acupuncture, yet remain a mean-spirited and uninspired person. This is a waste of the information.
So, our goal should be to allow what we are learning to transform us. Our program at NCNM, I believe, really takes this matter to heart. The whole first year is all about breaking you open to receive the teachings fully. It’s a tulmultuous year for many. My experience was truly a birth process. I felt the pain and the subsequent release of that pain only to be shot into an unknown world that is both breathtaking and a little frightening! On the other hand, these last two years have been a lot of information, taking it in and trying to figure out how to use it. I feel that it would be easy to become obsessed with the consumption and reproduction of information, forgetting to be transformed. Now that I look closely at the next three weeks, I realize that it is another birthing process. Our finals are pretty laid back and my mind and spirit naturally turn to cultivation. I find myself wanting to do Qigong, wanting to spend time in nature, wanting to read texts that inspire me. I find myself reading back over my first year notes, reconnecting to the symbolism we were steeped so heavily in during our first year.
Words to live by
I realize the truth of what Dr. Liu was teaching us as I’ve described above. But, there was more. After talking to us about the process by which we can get closer to enlightened awareness, and the purpose of that in turning us into superior physicians, he let us in on what he believed to be the highest truth of the Way of the Bodhisattva. It’s a simple statement, echoed through many cultures in one form or another. In this instantiation, it is expressed in a slightly different form than most Westerners are used to - by Kongzi (Confucius):
子曰、其恕乎、己所 不欲、勿施於人
Zǐyuē, qí shù hū, jǐ suǒ bù yù, wù shī yú rén
The master said, it’s perhaps “Shu”, do not place upon others what you would not have placed upon yourself.
I acknowledge my translation could use work. :) But, you get the point. It’s another statement of the Golden Rule - in this negative form sometimes called the “Silver Rule.” Important within it is the character 恕 Shu. This character is composed of three radicals. On the bottom, we have the Heart. Above that on the left we have the radical for Woman and on the right the Mouth radical. So, “Shu” is something like a woman speaking her heart. Or the kind of speech that comes from the strength of a woman’s heart. Opposed to this elsewhere is the character for anger, 怒 Nu, which looks very similar. The only difference is the upper right radical which is a picture of a hand. The woman radical and the hand radical together as a character by themselves means “slave.” So, anger is when your heart is enslaved. We can look at this in an external way - as when someone is somehow preventing us from living our heart’s desire. But, Dr. Liu asked us to look at it differently. Anger is, he suggested, like not having a master within yourself - when one loses control. Shu is an antidote to this - it is living out our heart’s greatest desires, our heart’s purest desires. This gives us ultimate freedom and it allows us to arrive at our true nature which is always productive of behavior in line with the “Golden Rule” as listed above.
Perhaps you’re not sure what this has to do with Chinese medicine, but for me it was clear.
- To achieve mastery in medicine, we must not only learn from the Classical texts and the wisdom of our teachers, but also allow this information to transform us on a deep level.
- This transformation will be on many levels. Physically, we will “follow our own advice” and live in accordance with the ways that our teachers lay out for us. Emotionally and spiritually, we will walk the path of the Boddhisattva.
- This path is one that brings us into line with Shu - opening to our true nature through living the truth of our heart. This in part involves, and is productive of, behavior in line with the Golden rule.
- This Golden rule indicates that we should treat others as we treat ourselves, or that we should not do to others what we would not have done to ourselves.
- In some sense, all of this tells us to polish ourselves into the kind of doctors that can serve as great examples for our patients. But, we must also allow our patients to be a mirror for us - when we gaze into that mirror we must always be asking ourselves if we are treating our patients as we would want to be treated in similar circumstances.
I’d be interested to hear what you think about this in the comments.
Eric
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Tags: buddhism, Classical Texts (general), Personal Development, professional-development, study, studying.-confucianismRelated posts
Using the imagination in Classical Chinese medicine
The importance of the role of pattern differentiation in Chinese medicine cannot be overstated. Some go so far as to say that Classical Chinese Medicine is “pattern medicine.” What on Earth can that mean? I think about it in a few ways. First, Chinese medicine takes patterns very seriously. I don’t think most Chinese medicine physicians have theoretical discussions about what constitutes causality. Nor do they seem to be interested in carrying out complex calculations about the distribution of particular disease states across space or time. Despite this apparent failure, Chinese medicine practitioners through history have been interested in the correlation between disease states and other features of the human environment. They have taken a keen interest in the rise and fall of particular conditions in particular places at particular times. Second, a strong feature of our medicine is the perception of subtle patterns in a seemingly hopelessly complex tangle of symptoms and subjective feelings. Where other medical systems throw out the pieces that don’t fit, good Chinese medicine practitioners are always mindful of the “stray” symptoms. They always seem to come into play at some point. Finally, Chinese medicine relies on patterning to allow relatively quick training of practitioners. This can go too far, as it has in many iterations of contemporary Chinese medicine.
Taking all of this into consideration, I find the idea of patterns to be an interesting one. Recently in a class about pharmacology, we began to discuss the role of the imagination in medicine. All human beings have imagination - though some of us are more skilled in using ours than others seem to be. Our professor began to get us thinking about imagination as being especially useful in becoming aware of patterns. How does that make sense to me? Well, let’s look briefly into the meaning of “imagination”:
imagination |iˌmajəˈnā sh ən|
the faculty or action of forming new ideas, or images or concepts of external objects not present to the senses
ORIGIN Middle English : via Old French from Latin imaginatio(n-), from the verb imaginari ‘picture to oneself,’ from imago, imagin- ‘image.’
Taking this definition at face value, what my professor was saying makes lots of sense. The pattern is not present to the senses. Which is to say that I cannot point to anything that is, for instance, “Yang Ming disease.” I do take in a large amount of data (pulse, tongue, color, sound, odor, presenting emotion, symptoms, lab results, subtle information heretofore undefined) through my various senses, but this thing Yang Ming disease is never taken in. It is a concept, an organizing concept. In some real sense, Yang Ming disease is not there. It is an unbelievably useful structure that I can use to order the data I am taking in and craft a treatment that is a response to the disease state being presented by my patient. My ability to grasp this imaginative construct is crucial in my efficacy.
We can take this further, though I get a little weak in the knees as I depart from that relatively solid conceptual ground. We can use structures like Yang Ming disease in a way that is imaginative, or we can turn them into prisons from which no healing can escape. Let’s take Yang Ming disease as an example. The defining line of Yang Ming disease in the Shang Han Lun states:
In Yang Ming disease, the Stomach family is full.
Boy, talk about a range of possible interpretations. We can look deeply into the characters, we can look at all instances in the history of Chinese medical texts of those characters, we can look at all the Yang Ming formulas and see how they treat this “fullness” of the “Stomach family,” we can do many things in order to understand the statement. But, if we don’t let our imagination run free, our efforts may never bear fruit. Once we have obtained all of that data as I listed above, we must let our minds explore. What would the Stomach family being full do in terms of psycho-emotional disturbance? What images come to mind when we consider the Stomach family being full? What is our subjective experience of this disease state?
I believe this kind of activity, while perhaps not good material for scholarly publication, is crucial to my development as a Chinese medicine practitioner. It helps me to understand the formulas and point protocols more fully, not to mention nourishing me deeply as a human being. I also believe that the use of imaginative faculties is, at least in part, behind the brilliance of ancient Chinese medical theory.
I’m interested in hearing how others think about this issue. It’s a small thing, perhaps, but interesting to consider.
Eric
Tags: imagination, Learning, patternsRelated posts
Fiddling with things : Deepest Health upgrade
A few quick notes:
If you read the site by feedreader or email subscription, the video on the last post might not have come through. It is worth your time to visit the site to watch the video. I promise
For everyone - you may notice some slight changes on the site over the next couple of weeks. I’m experimenting with different ad servers, placement of certain elements, as well as updating some of my pages (about the author, resources, etc). Please let me know if something looks terrible. :)
Thanks,
Eric
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Pregnancy in Chinese medical texts
I’m away at a Qigong retreat this weekend (we take one a term in the Classical Chinese Medicine program at NCNM), but didn’t want to leave you folks without content. :) Two fellow bloggers were kind enough to offer posts - one from G. Michael Reynolds over at the Life Giving Sword and the other from Yael Ernst at Chinese Medicine Notes. I hope you will enjoy them both.
First up, Yael with her post about Pregnancy in Chinese medical texts. I don’t talk much about women’s health here, but not because I have no interest in it. I think this will provide a good introduction for folks who are wondering what Chinese medicine has to say about the process of pregnancy and its effects on the female body.
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In the post The Foundation of Pregnancy we looked at the physical aspect of pregnancy in women. In this post I would like to present what Sun Si Miao (http://www.taijichinesemedicine.com/sunsimiao.htm) wrote regarding the pregnancy itself. But, before I talk about Sun Si Miao, I would like to present Ye Heng Yin, and his description of conception. Ye Heng Yin was a gynecology expert from the Qing dynasty. He wrote the Nu Ke Zhi Nan (A Guide to Gynecology).
In this guide, Yin says that the Tian Gui is the contribution of the father and the mother, the form of heaven and true Qi that are formed in the body. The essence and blood that changed form, from fluids and grains, are the root of the creation of post-heaven. In males- Tian Gui arises at 8X2 (16), since men are Yang and belong to the sun. That is why their daily essence becomes more and more vital. In females - Tian Gui arises at 7X2 (14), since women are Yin and belong to the moon. That is why their blood flows out of the body once a month. At the time when man and woman unite, the original Qi of pre-heaven, the essence of post heaven, the blood, the Yin and the Yang all gather together. This allows for the arrival of children.
One must not treat or touch the meridian during it’s month of effect on the pregnancy
Moving now to Sun Si Miao… He explains that in each month, the fetus is nourished by a different channel and each has it’s own different effect and impact on pregnancy. The pulse of the organ system involved will be weak, as its Qi nourishes the fetus. If during treatment we need to address the channel during its month of effect, we can do so. We simply have to use indirect methods. We can access the organ system through the Back-shu points or by treating a paired organ (using five element or six conformation pairing, or some other).
Now for some specifics regarding the individual months of pregnancy…
1st month
Gestation of Raw Material. The fetus is like a dew drop!
The meridian of this month: Liver. The liver has a role in everything that has to do with the period and during pregnancy. This reminds us of the power of spring.
2nd month
The fetus is at the level of CV3. The fetus is referred to as Gao - fertility dough.
The meridian of the month: Gall Bladder. The GB is in charge of the essences. We still have the energetic influence of spring, the breakthrough of life. Since this month is very important for the fetus to be rooted in the uterus, it is a resting time for the mother.
3rd month
The beginning of the embryo. The fetus is like a silkworm’s pupa.
The meridian of the month: Pericardium. You can read more about Pericardium through a Classical Chinese Medicine perspective at Deepest Health.
4th month
The fetus connects with the Dantian. The body and form are becoming much more solidified.
The meridian of the month: San Jiao/Triple Burner
The element of the month: Water. The Zhi of the mother goes to the fetus. The first 3 months are very basic and there’s no certainty. As of the 4th month there’s a good chance for the fetus to survive the pregnancy and the elements come into the picture as do heavenly energies. When matter has the vital potential for life the rest of the elements come in.
5th month
The Uterus is being held firm in its place. One can feel the fetus moving in the Uterus.
The meridian of the month: Spleen. It is recommended to the mother to do things in their right timing and in a balanced way. The balance and stability of Earth needs to be invoked.
The element of the month: Fire. The Shen of the mother goes to the fetus.
6th month
The fetus is like a fish in its mother Uterus. It has real stability and form.
The meridian of the month: Stomach. The eyes and mouth are developing and the 5 tastes are in the fetus’ mouth. Salivary glands also develop in this month. It is recommended for the mother to eat delicate and sweet food.
The element of the month: Metal. The Po of the mother goes to the fetus.
7th month
The fetus grows big. The hair, the bones and ligaments are formed and all the sense organs are developing.
The meridian of the month: Lung. It is said that the mother should avoid cold, yelling and crying.
The month of the month: Wood. The Hun of the mother goes to the fetus.
8th month
Zang Fu completed.
The meridian of the month: Large Intestine. The 9 orifices are completed at this point.
The element of the month: Earth. The Yi of the mother goes to the fetus.
It is said that the mother’s spirit should be calm so not to create shocks in the Qi flow. One can feel the reactions of the fetus according the mother’s moods.
9th month
The fetus receives the Jade essence, which is the seal of approval that everything is ready.
The meridian of the month: Kidneys. It is recommended to the mother to avoid tight clothes and to eat sweet food.
10th month
Fetus is ready to come out.
The meridian of the month: Bladder. It is possible to treat this meridian if there’s a need to start labor or if you want to turn the fetus from a breech position. All the Yin organs are completed, the Yang organs are clear from stagnations, the heaven and earth were absorbed, the spirit of the man (fetus) is complete and all that is left is to be born. The mother should concentrate on the Dantian.
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Bibliography:
Extraordinary Fu- Elisabeth Rochat de la Vallee and Claude Larre
Chinese Gynecology studies with Yael Saslove- 2006- Israel
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From the Editor (Eric): With all of this in mind, how can we extend our understanding of pregnancy from a Chinese medicine perspective? How can we best advise our patients during their pregnancy? It seems that most Western people in contemporary times want to live their normal lifestyle during and directly after pregnancy, not taking the time necessary to fully nourish themselves and their fetus. What are the consequences of this? We would all love to hear your ideas and experiences in the comments.
Tags: Classical Texts (general), guest-post, pregnancy, sun si miao, women's healthRelated 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 Jing
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