Monday, January 3, 2011

ON P-6 NEIGUAN

P-6 Neiguan is one of the most important and most widely used acupuncture points. First of all, let us analyse the name “Nei Guan”. “Nei” means “inner” and there is no disagreement about this. However, the second half of the name “Guan” can have different interpretations. In ordinary, every-day language, “guan” means to “shut”, “close”, “turn off”, “lock up”. If we go to a shop and we find it closed, one would say that the shop “guan le”, i.e. it is shut or “it shut” (in the past). If we interpret “guan” in this sense, then P-6 is an “inner closure”, an “inner stop cock” or something similar. Could it be interpreted in this way? Yes, it could, and in this sense, P-6 would be the point that closes the Yin in the Interior and this should be seen in relation and analogous to T.B.-5 Waiguan, the “outer closure”, i.e. the point that closes the Yang on the outside.

However, the nature of P-6 is such that it is a very dynamic point and this does not fit in with its translation as “inner closure” because “closure” implies to stop something, as for example, when one closes a tap (faucet) to stop the flow of water.
If we look up the other meanings of “guan” (as in Chinese one word can have multiple meanings), we find that it also means “mountain pass”, “critical juncture”, “customs house” or “barrier” (of a customs house). According to G. D. Wilder and J. H. Ingram, Analysis of Chinese Characters, 1922, “guan” is a cross bar of a gate, to shut or bar the gate, a custom-house barrier. The character is composed of the radical “Men” (door). Inside the “door” there is “guan”, which means to pass threads through a web with a shuttle. The script represents the warp of a textile. The down strokes in the lower part represent a shuttle carrying the thread through to form a woof. By extension, it means to fix transversely. The cross bar of the gate passes through the slots and iron loops like a shuttle passing through the warp.

Translating “guan” in this way, would change the meaning of “Nei Guan” entirely. The point would then be an “inner critical juncture” or an “inner barrier” (of a customs house). Notice that it is the barrier of a customs house that is open to let goods through. This would change the nature of the point entirely, making it a dynamic point that is a critical juncture and that lets things through. In my opinion, this reflects the nature and functions of P-6 more accurately. The reference to “fixing transversely” is also interesting as it would be an allusion to the flow of the Luo channels flowing “transversely” in relation to the Main channels that flow “vertically” (P-6 is of course the Luo point of the Pericardium channel).

The “Su Wen” in chapter 8 says: “The Pericardium is the ambassador and from it joy and happiness derive”. The Pericardium is closely related to the Heart and, indeed, the Nei Jing and the Nan Jing constantly refer to the “5 Zang and 6 Fu”, the 5 Zang being the Heart, Liver, Spleen, Lungs and Kidneys, i.e. the Pericardium was assimilated to the Heart: the two could not be separated being so close anatomically. However, chapter 8 of the Su Wen does mention the 12 Organs and it lists their functions including those of the Pericardium. The Su Wen’s reference to “joy” and “happiness” also makes it sound like the Pericardium has similar functions to those of the Heart. Notice however that in this chapter, the Pericardium is called ”Shan Zhong”, i.e. the “centre of the chest” (where Ren-17 is), not the usual “xin bao luo”, i.e. the “luo of the heart’s envelope”. As we shall see, this is because the Pericardium has several different functions corresponding to its multi-faceted nature.

So, the first aspect of the Pericardium’s nature is that it is closely connected to the Heart and that it is in the centre of the chest; the reference to “joy” and “happiness” implies that it somehow houses the Shen in the same way as the Heart does. This is the first clinical use of the Pericardium channel and of P-6, to affect the Shen. Like the Heart, the Pericardium houses the Shen and it therefore influences our mental-emotional state deeply. For example, a deficiency of Blood will affect the Pericardium as well as the Heart, making the person depressed and slightly anxious. Heat in the Blood will agitate the Pericardium and make the person agitated and restless. Phlegm obstructing the Pericardium will also obstruct the Shen causing mental confusion.

Emotions “stir” both the Heart and the Pericardium by agitating the Minister Fire and making it flow upwards to these two organs. Li Dong Yuan said: “Not a day goes by in people’s lives that the Minister Fire is not stirred”. In Chinese medicine, there is this idea that the Minister Fire should be “concealed” in the Lower Burner: it performs its function of warming the organs in the background and it should not be seen. Emotions stir up the Minister Fire and cause it to leave its “place of concealment” in the Lower Burner: that is when the patient suffers from “Heat” and there are symptoms of Heat such as a red face, a feeling of heat, thirst, etc. Notice that emotional stress usually leads to Heat, it never leads to Cold.

The Pericardium houses the Shen (with the Heart)
•Blood deficiency of the Pericardium will cause depression and slight anxiety
•Blood Heat of the Pericardium will cause anxiety, insomnia and agitation
•Phlegm in the Pericardium will cause mental confusion and, in severe cases, mental illness
•The Pericardium affects emotional problems from relationship problems
Although assimilated to the Heart, the Pericardium has an important difference from the Heart channel. The Pericardium channel controls the Qi of the chest and it moves Qi and Blood, more than the Heart channel does. For example, P-6 has an important influence on the movement of Qi in the chest (hence its use for chest pain); the Heart channel does not have such a function. In other words, I use HE-7, for example, to nourish Heart-Blood and settle the Shen while I would use P-6 more to move Qi and Blood in the chest causing physical symptoms such as chest pain and mental-emotional symptoms such as depression (from Qi stagnation).

The second aspect and function of the Pericardium is its relationship with the Liver within the Jue Yin channels: Liver and Pericardium are the Jue Yin channels which are the “hinge” of the Yin channels. Thus, when we use the Pericardium channel, we indirectly use the Liver channel too. In my clinical experience, I use P-6 exactly in this way: besides its other functions, it moves Liver-Qi and stimulates the movement of the Hun (see below).

The Pericardium function on the mental-emotional plane is the psychic equivalent of the Pericardium’s moving of Qi and Blood of the Heart and Lungs in the chest: just as it does that on a physical level, on a mental-emotional level, the Pericardium is responsible for “movement” towards others, i.e. in relationships. Given that the Pericardium is related to the Liver within the Terminal-Yin channels, this “movement” is also related to the “movement” of the Hun from the ego towards others in social, relationships and familial interactions. For this reason, on a mental-emotional level, the Pericardium is particularly responsible for a healthy interaction with other people in social, love and family relationships.

Moreover, the “moving” nature of the Pericardium is also enhanced by its relationship with the Triple Burner as a channel (within the “Minister Fire” channels). As the Triple Burner is responsible for the free flow of Qi (together with the Liver), the Pericardium’s relationship with the Triple Burner accounts for its action in moving Qi and Blood and its mental-emotional function of “movement” towards others.

Thus the Pericardium is a unique organ in that it has three sets of relationships: with the Heart, with the Liver (Jue Yin channels) and with the Triple Burner (within the Minister Fire channels). Notice also how the Pericardium is related to the Jue Yin (the hinge of the Yin) through the Liver and to the Shao Yang (the hinge of the Yang) through the Triple Burner. Thus the Pericardium is doubly the “hinge”: I believe this contributes to its dynamic nature. This makes it such a complex and rich channel with so many interactions and different functions.

The book “An Explanation of Acupuncture Points” (Jing Xue Jie, 1654) confirms this dual nature of the Pericardium by listing the actions of P-6 under the two heading of Heart and Liver. In other words, it lists the Heart-related and Liver-related actions of P-6. Under the Heart-related indications it lists poor memory, chest pain and (when Empty) head and neck ache. Under the Liver-related indications, it lists red eyes, elbow pain and hot palms.

The symptom of head and neck ache is interesting for me as it is something I have noticed frequently in practice, i.e. that P-6 is effective in treating headache, especially occipital and temporal. I believe this is due to the connection between the Luo point of the Pericardium and the Triple Burner channel.

RELATIONSHIP BETWEEN PERICARDIUM AND MINISTER FIRE
The “Minister Fire” (Xiang Huo) is the Fire of the Gate of Life (Ming Men). This Fire is essential to the healthy functioning of the body.
Although many doctors such as Zhu Zhen Heng (1281–1358) identified “Minister Fire” with the Fire of the Ming Men (and therefore the Kidneys), others, such as Zhang Jie Bin (1563–1640), identified the “Minister Fire” with such internal organs as the Kidney, Liver, Triple Burner, Gall Bladder and Pericardium. In fact, the Minister Fire is said to go upwards to the Liver, Gall-Bladder and Pericardium (in so doing it is compared to the “Fire Dragon flying to the top of a high mountain”) and downwards to the Kidneys (in so doing it is compared to the “Fire Dragon immersing in the deep sea”).

Thus, purely from a 5-Element perspective, the Minister Fire pertains to the Pericardium and the Triple Burner (as opposed to the Emperor Fire of the Heart), while from the perspective of the Internal Organs, the Minister Fire is the Fire of the Ming Men pertaining to the Kidneys. However, there is a connection between the two views as the Minister Fire does flow up to the Liver, Gall-Bladder and Pericardium. In pathology, this has an even greater relevance as the pathological Minister Fire (driven by emotional stress) flares upwards to harass the Pericardium causing mental restlessness, agitation, anxiety and insomnia.

NATURE AND FUNCTIONS OF P-6
1) HEART
The Pericardium is closely related to the Heart and P-6 therefore acts on the Heart. I use it primarily to move Qi and Blood, not so much to nourish Blood and the Shen. I use P-6 to move Qi and Blood and P-7 Daling to subdue Qi and calm the Shen.

2) MOVING QI IN THE CHEST
P-6 is an important point to move Qi and Blood in the chest: this is one of the main functions that distinguish it from Heart points. On a physical level, it moves Qi in the chest when Qi stagnation is causing chest pain; it is also very effective for traumas of the chest causing stagnation of Qi and/or Blood. To treat the chest, P-6 combines very well with ST-40 (I usually needle them contralaterally, i.e. one on the right and the other on the left).

3) MOVING LIVER-QI
The Pericardium is coupled with the Liver within the Jue Yin channels (the “hinge” of the Yin). P-6 therefore moves Liver-Qi. When would one want to use the Pericardium rather than the Liver to move Liver-Qi? I would use P-6 especially for mental-emotional problems deriving from relationship problems and causing Liver-Qi stagnation. Using P-6 will treat both the Liver and the Heart simultaneously, which makes it so useful in mental-emotional problems. Another reason for using P-6 to move Liver-Qi is when the symptoms are located in the Upper Burner, for example pre-menstrual breast distension. In this context, P-6 combines very well with LIV-3 (usually contralaterally, i.e. one on the right, the other on the left).

4) THE PERICARDIUM AND THE HUN
As we have seen above, the Pericardium is associated to the Liver within the Jue Yin. The Liver houses the Hun which provides “movement” to the Shen: this “movement” provides creativity, inspiration, planning, sense of direction in life to the Shen. Without these, the Shen would suffer and the person would be depressed. P-6 is excellent to stimulate the movement of the Hun and I therefore use it very frequently in depression (and not only that deriving from Liver-Qi stagnation). When used for depression, I frequently combine it with Du-20 Baihui.

5) P-6 AS LUO POINT
P-6 is the Luo point of the Pericardium channel. As a Luo point, it has a dynamic nature and I use it primarily to move rather than to tonify. I see P-6 as having a “centrifugal” effect. Contrary to it being a point that “closes” (if we interpret “guan” in its name as ‘closing”), I actually see it as a point that opens and moves. In mental-emotional problems, it moves Qi, relieves stagnation and “opens” the patient to a new emotional awareness.

6) P-6 SYNERGISTIC EFFECT
P-6 has a synergistic effect on acupuncture points prescriptions. The addition of P-6 to any prescription increases the therapeutic effect. Just as P-6 has this effect on a physical level, it has one on a mental-emotional level, i.e. it can bolster the effect of a point combination for mental-emotional problems. The Pericardium is the hinge of the Yin channels, and, being the Luo point, P-6 is the “hinge” of the Hinge: in its capacity as “hinge” it connects things.

1 comment:

  1. what an inspiring article-:) what about P-6's relation to the Yin wei extra channel?

    ReplyDelete