Sunday, October 30, 2011

THE TRIPLE BURNER AS A SYSTEM OF CAVITIES AND A THREE-FOLD DIVISION OF THE BODY 4) and 5)

4) The Triple Burner as a system of cavities
The Triple Burner is a system of body cavities. There are many cavities in the body, some large, some small. For example, the chest cavity, the abdominal cavity, the pelvic cavity, the joint cavities, the space between skin and muscles, the space above the diaphragm, the spaces in between the Membranes, and the spaces between these and the abdominal cavity. Such cavities are called Cou in Chinese medicine; the term Cou is usually used in conjunction with Li meaning "texture". Although the term Cou Li is often used to indicate the space between skin and muscles, such space is only one of the cavities of the body.

The cavities of the body are generally irrigated and lubricated by various fluids and the Triple Burner controls these cavities also because it controls the transformation, transportation and excretion of fluids in all parts of the body. Moreover, the Triple Burner controls the movement of Qi in and out of such cavities. This movement is the "entering and exiting" of Qi in the Qi Mechanism discussed in the last Clinical Tip. The entering and exiting of Qi in and out of the cavities is extremely important both for the proper circulation of Qi and for the transformation and transportation of body fluids in and out of such cavities.

The abdominal cavity contains the Membranes (Huang): these include the superficial and deep fascia, the mesentery, the omentum and the stroma enveloping all internal organs. The superficial and deep fascia are connective tissues that envelope the muscles. The mesentery is the double layer of peritoneum attached to the abdominal wall and enclosing in its fold the abdominal viscera. The omentum is a fold of peritoneum passing from the stomach to another abdominal organ. The stroma is the framework, usually of connective tissue, of an organ. The Membranes (Huang) have the function of wrapping, anchoring and connecting the organs. In other words, the organs in the abdominal cavity are not in a kind of vacuum connected by acupuncture channels. The occupy a solid space that is surrounded by Membranes. The Triple Burner is responsible for the movement of Qi in and out of the Membranes.

Therefore, when seen as a system of body cavities, the Triple Burner is not an organ but a complex of cavities outside or in between the internal organs. The "Classic of Categories" (Lei Jing, 1624) by Zhang Jing Yue says: "Outside the internal organs and inside the body [i.e. between the skin and the internal organs], wrapping the internal organs like a net, there is a cavity that is a Fu. It has the name of a ditch but the shape of a Fu [Yang organ]."1 He also said: "The Internal Organs have substance; the cavities are like a bag that contains that substance".2 The Selected Historical Theories of Chinese Medicine (Zhong Yi Li Dai Yi Lun Xuan) says: "There is a Minister Fire in the body which moves within the cavities and up and down in between the Membranes: it is called the Triple Burner".3

In the chest cavity, the Triple Burner controls the entering and exiting of Qi which is governed by the Zong Qi. In the abdominal and pelvic cavity, the Triple Burner controls the transportation and transformation of Qi in the Membranes. In the space between skin and muscles, the Triple Burner controls the diffusing of Wei Qi and the entering and exiting of Qi in and out of that space. This function of the Triple Burner regulates the flow of Wei Qi in this space, the opening and closing of pores and sweating. In the joint cavities, the Triple Burner controls the entering and exiting of Qi and fluids in the joint capsules: this contributes to irrigating and lubricating the synovial membranes.

To summarize, the body cavities are:

the chest cavity
the abdominal cavity
the pelvic cavity
the joint capsules
the space between the skin and muscles
the space above the diaphragm
the spaces in between the Membranes
the spaces between the Membranes and the abdominal cavity.

The Triple Burner’s function of controlling waterways, that of governing the movement of Qi and that of controlling cavities are all inter-related and depend on each other. For example, the transformation of fluids depends on the ascending/descending and entering/exiting of Qi in the body cavities.

Clinical application
With regard to the Triple Burner governing the body cavities, I would single out two areas of clinical significance.

a) The first is the "space between the skin and muscles", generally referred to as the Cou Li space (although this term encompasses other spaces too). This is the space where the Wei Qi circulates and where sweat is. We should not interpret "space between skin and muscles" in a strict, Western, anatomical sense: it is not literally the space between skin and muscles in an anatomic sense but in an energetic sense. It is the Exterior of the body where Wei Qi circulates and where the Luo channels course.

The Triple Burner regulates the entering and exiting of Wei Qi and sweat in and out of this space and when its function is normal, sweating is physiological (not too much not too little), Wei Qi circulates normally and protects from invasions of external pathogenic factors. When the entering of Qi prevails over the exiting of Qi, the Cou Li space is said to be "tight" or "closed": when this happens, the person does not sweat enough and, if he or she succumbs to an invasion of Wind, they will not sweat and will have a temperature. When the exiting of Qi prevails over the entering of Qi, the space is said to be "lax" or "open" or "not consolidated". When this happens, the person will suffer from spontaneous sweating and if they suffer an invasion of Wind, they will not have a temperature. They will also be prone to invasions of Wind.
To regulate the Cou Li space one needs to regulate the Triple Burner and the Wei Qi with points such as LU-7 Lieque, LU-9 Taiyuan, L.I.-4 Hegu, ST-36 Zusanli and BL-13 Feishu.
For example, to consolidate the Cou Li space one can use LU-9 Taiyuan, L.I.-4 Hegu, BL-13 Feishu and ST-36 Zusanli. To "relax" the Cou Li space, one can use LU-7 Lieque and L.I.-4 Hegu.

b) The second area of clinical significance is the Qi movement in the abdomen. As discussed above, the abdomen contains the Membranes (Huang) which are the structures that are in between the organs and between these and the skin. When there is stagnation of Qi in the abdomen, this is not only in the channels but also in the Membranes and this contributes to the feeling of distension or fullness of the abdomen.

To regulate the Triple Burner in the abdomen and relax the Membranes, one can use Ren-5 Shimen (Front-Mu point of the Triple Burner), Ren-6 Yuan point of the Membranes (Huang) and BL-22 Sanjiaoshu (Back-Shu point of the Triple Burner).

5) The Triple Burner as a three-fold division of the body
Chapter 31 of the Nan Jing that describes the Triple Burner as the "avenue of water and food" also describes the three divisions of the body: "The Triple Burner is the avenue of water and food, and the beginning and end of Qi. The Upper Burner extends from below the heart and diaphragm up to the mouth of the stomach; it is charge of receiving and it does not discharge. It is treated via the Tan Zhong point [Ren-17] which is 1 cun and 6 fen below the point Yu Tang that is in between the breasts. The Middle Burner is located at the central duct of the stomach [Zhongwan]; it does not extend any further up or down; it controls the processing of water and food and it is treated at the sides of the umbilicus [ST-25?]. The Lower Burner starts above the upper opening of the bladder; it separates the clear from turbid; it controls discharge and it does not intake; it acts as a transmitter. It is treated one inch below the umbilicus [Ren-6 or Ren-5?]. Hence, one speaks of a Triple Burner. It collects at Streets of Qi [Qijie, ST-30].

Chapter 18 of the Ling Shu also describes the three-fold division of the body into three Burners: "The Upper Burner comes out from the mouth of the stomach, it runs along the gullet, passes the diaphragm and spreads in the chest. The Middle Burner comes out at the stomach. The Lower Burner comes out at the lower end of the small intestine and pours into the bladder."

The three-fold subdivision of the body is discussed in several passages of the Nan Jing in conjunction with pulse diagnosis, i.e. assigning the three pulse positions cun, guan and chi to the Upper, Middle and Lower Burner respectively. The Mai Jing (Pulse Classic) also has the same assignment of pulse positions: "The Cun position governs the Upper Burner including the skin and hair up to the hands; the Guan position governs the Middle Burner including the abdomen and back; the Chi position governs the Lower Burner and the lower abdomen up to the feet."

Chapter 18 of the Nan Jing says practically the same: "The Cun position is ruled by Heaven and reflects diseases from the chest to the head; the Guan position is ruled by Person and reflects diseases between the diaphragm and umbilicus; the Chi position is ruled by Earth and reflects diseases from the umbilicus to the feet."

1. Cited in Wang Xue Tai 1988 Great Treatise of Chinese Acupuncture (Zhong Guo Zhen Jiu Da Quan), Henan Science Publishing House p. 46.
2. Wang Xin Hua 1983 Selected Historical Theories of Chinese Medicine (Zhong Yi Li Dai Yi Lun Xuan), Jiangsu Scientific Publishing House, p. 161.
3. Ibid., p. 159.

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