The Triple Burner

The Triple Burner is probably the most widely discussed topic on Chinese medicine and, over the centuries, there have been many different theories on its nature. In this Clinical Tip, I will try to elucidate the main ideas on the nature of the Triple Burner and it will probably take more than one Clinical Tip.

“Burner” is a translation of the word jiao which means “burned” or “scorched”. It is also called “Warmer” while others choose not to translate it and call it the “San Jiao”. Some Chinese doctors distinguish between two basic views of the Triple Burner, one according to which is has “no form” (which is primarily from the Nan Jing) and another according to which it has “a form” (which is primarily from the Nei Jing). Although this distinction is important (and I will expand on it below), I think there are at least four different ways of looking at the Triple Burner, as listed below.

1) The Triple Burner as the activator of the Yuan Qi
2) The Triple Burner as a system of waterways
3) The Triple Burner governing movement of Qi
4) The Triple Burner as a system of cavities
5) The Triple Burner as a three-fold division of the body
6) Relationship between Triple Burner and Pericardium

1) The Triple Burner as the activator of the Yuan Qi
The view of the Triple Burner as the activator of the Yuan Qi derives from the Nan Jing, primarily chapters 8, 38, 62 and 66.

Chapter 8 of the Nan Jing says: “Sometimes the Cun Kou is normal and yet the patient dies. Why is that? The pulses of the 12 channels all originate from the Yuan Qi. This Yuan Qi is the root of the 12 channels, it is the Motive Force [Dong Qi] between the Kidneys, the root of the 5 Zang and 6 Fu and of the 12 channels, the gate of breathing and the origin of the Triple Burner. It is the spirit that guards against pathogenic factors (or evil influences). Such Qi is the root of humankind; if the root is cut stalks and leaves wither. When the Cun Kou is normal but the patient dies, it means that the Yuan Qi has been cut off internally.

This chapter establishes some very important principles. First, it talks about the Yuan Qi: it says that Yuan Qi is between the Kidneys (like the Ming Men) and that it is the root of the 12 channels, the Triple Burner and the 5 Zang and 6 Fu.

Secondly, it makes a very important statement when it says that this Yuan Qi is the “spirit” (shen) that guards against evils. This is a remnant of “demonic” medicine, i.e. the system of medicine in which disease is due to the invasion of evils spirits and the cure is effected by the shaman.

The clinical significance of this chapter is huge. Firstly, it establishes the idea that the Yuan Qi (and therefore the Kidneys) is the root of the 5 Zang and 6 Fu, of the 12 channels and of the Triple Burner.

Secondly, it establishes the relationship between the Triple Burner and the Yuan Qi (and therefore Ming Men). Later in chapter 66, the Nan Jing says that the Triple Burner is the “envoy” of the Yuan Qi in between the Kidneys. In this chapter 8, the Yuan Qi is also called Motive Force or Throbbing Qi or Moving Qi (Dong Qi).

Thirdly, this passage establishes the principle that the Yuan Qi (and therefore the Kidneys) play a role in the resistance to pathogenic factors. Interestingly, it calls the Yuan Qi the shen that protect from pathogenic factors (or evils).

This is of huge clinical significance because it means that our resistance to pathogenic factors depends not only on the Wei Qi and therefore Lungs but also on the Kidneys and the Yuan Qi (and also Jing due to the extraordinary vessels). In any case, Wei Qi stems from the Lower Burner (chapter 18 of the Ling Shu).

This is of clinical significance not only in resistance to pathogenic factors but also in the pathology of allergic asthma and allergic rhinitis, the root of which is also in the Kidneys, the Jing and the Yuan Qi.

Fourthly, this chapter is significant because for the first time it gives the view of the Triple Burner as the “envoy” of the Yuan Qi stemming from between the Kidneys. From this point of view, the Triple Burner allows the Yuan Qi to spring forth from between the Kidneys and perform its role in various parts of the body. For this reason, BL-22 Sanjiaoshu is just above BL-23 Shenshu.



Chapter 38 of the Nan Jing reiterates the relationship between the Triple Burner and the Yuan Qi. It says: “How come there are 5 Zang but 6 Fu? There are 6 Fu because of the Triple Burner which stems from the Yuan Qi. The Triple Burner governs all Qi in the body, it has a “name but no form”, it belongs to Hand Shao Yang, it is an “external Fu” [or “extra Fu”]. That is why there are 5 Zang but 6 Fu.”

This chapter actually describes four separate important aspects of the Triple Burner: first, it is a Fu organ (which brings the count of Fu organs up to 6); secondly, it stems from the Yuan Qi; thirdly, it governs all Qi of the body; fourthly, it has a “name but no form”, i.e. it is a function rather than an organ (which actually contradicts the first point).

The relationship between the Triple Burner and the Yuan Qi is explained also in the rather obscure chapter 62. This says: “The Zang [channels] have 5 jing, ying, shu, jing and he points; but the Fu have 6 [points], why? The Fu are Yang, the Triple Burner moves in the Yang channels, hence it has an additional shu point called Yuan.”

I personally think that the influence of the Triple Burner on the fact that the Yang channels have an extra shu point is due to the relationship between the Triple Burner and the Yuan Qi and to the fact that the Triple Burner “moves among the Yang” as this chapter says. In other words, as the Triple Burner is the envoy of the Yuan Qi and it moves among the Yang, it could be said to “seed” the Yang channels with its Yuan Qi (deriving from the space between the Kidneys). In fact, the Nan Jing says that the Yuan Qi comes out of the space between the kidneys through the envoy of the Triple Burner and goes to the 5 Zang and 6 Fu and the twelve channels. The reason it seeds only the Yang channels is due to the fact that it “moves among the Yang”.

Chapter 66 of the Nan Jing is the main one that discusses the relationship between the Triple Burner and the Yuan Qi. It says: “Below the umbilicus and between the kidneys there is a Throbbing Qi [Dong Qi] which constitutes a person’s life [sheng ming ]. This [Throbbing Qi] is the root of the 12 channels, also called Yuan Qi. The Triple Burner is the envoy of the Yuan Qi [or it allows the Yuan Qi to separate into its different functions]. It is responsible for the passage of the three types of Qi in the 5 Zang and 6 Fu. “Yuan” is a honorary designation of the Triple Burner. Hence the places where its Qi comes to a halt are called “Yuan” [points]. When the 5 Zang and 6 Fu are diseased, select the respective Yuan point.”



This chapter is the main source for the view of the Triple Burner as the “envoy” of the Yuan Qi: it allows the Yuan Qi to emerge from the space between the Kidneys and it facilitates the Yuan Qi’s differentiation into its different functions in different places.

Thus, the Triple Burner “mobilizes” the Yuan Qi by making it differentiate into its different forms to perform different functions in different places and organs. It is through the Triple Burner that the Yuan Qi can perform its functions. The Yuan Qi is closely related to the Ming Men and shares its role of providing the heat necessary to all the body’s functional activities.

The following are examples of functions carried out by the Yuan Qi which are aided by the Triple Burner:

• The Yuan Qi provides the heat necessary to the Spleen to transform and transport food essence and to the Kidneys to transform fluids. The Middle Burner makes sure that Yuan Qi reaches and assists the Spleen to transform and transport food essences and the Lower Burner ensures that Yuan Qi warms the Kidneys to transform fluids
• The Yuan Qi facilitates the transformation of Gathering Qi (Zong Qi) into True Qi (Zhen Qi). It can do this through the action of the Upper Burner in transporting Qi through the various passages in the chest.
• The Yuan Qi facilitates the transformation of Food-Qi (Gu Qi) into Blood in the Heart. The Upper Burner ensures the smooth passage and transportation of Qi in the chest for this transformation to take place.

Thus, the Triple Burner helps the Yuan Qi to differentiate itself into different forms to perform different functions in different places.

The relationship between the Triple Burner and the Yuan Qi of the Kidneys is reflected in the location of the Back-Shu point of the Triple Burner (BL-22 Sanjiaoshu) just above the Back-Shu point of the Kidneys (BL-23 Shenshu).

From this point of view, the Triple Burner has “no form”, i.e. it is a function and not an actual Fu organ. The Nan Jing says succintly: “It has a name but no form” (you ming wu xing).

Clinical Application

The relationship between the Triple Burner and the Yuan Qi has important clinical applications. It means that the Yuan Qi performs its warming and facilitating function through the Triple Burner. Thus, if we want to activate the Yuan Qi in the different Burners we need to activate the Triple Burner as well and the points I use are as follows:

- Upper Burner: Ren-17 Shanzhong to stimulate the diffusing and descending of Lung-Qi and warm the Lungs
- Middle Burner: Ren-12 Zhongwan and Ren-9 Shuifen to stimulate the descending of Stomach-Qi, the transportation and transformation (yun hua) by the Spleen and the rotting and ripening by the Stomach.
- Lower Burner: Ren-5 Shimen and BL-22 Sanjiaoshu to stimulate the transportation, transformation and excretion of fluids in the Lower Burner.

For example, in case of Dampness in the Lower Burner and specifically in the Kidneys and Bladder causing urinary problems occurring against a background of Kidney-Yang deficiency, one can use Ren-5 Shimen and BL-22 Sanjiaoshu to activate the Triple Burner (or specifically Lower Burner) and Ren-4 Guanyuan and BL-23 Shenshu to tonify the Kidneys and the Yuan Qi. Note how Ren-4 and BL-23 (related to Kidneys) are just below Ren-5 and BL-22 respectively (related to Triple Burner) reflecting the view that the Yuan Qi emerges from between the Kidneys through the Triple Burner.

BL-22 SANJIAOSHU

Since the previous Clinical Tips were about the Swollen tongue and Phlegm, the use of acupuncture to resolve Dampness and Phlegm and the use of ST-40 to resolve Phlegm, I would like to stay with the subject of fluids pathology and discuss the use of the point BL-22 Sanjiaoshu.
I have mentioned this point in a previous entry as one of the points to resolve Dampness and/or Phlegm. BL-22 is called Sanjiaoshu, i.e. "Shu [point] of the San Jiao" and it is obviously situated just above BL-23 Shenshu, the Back-Shu point of the Kidneys: as we shall see below, this is very significant.
Given that the Triple Burner is an Arm channel, i.e. Arm Shao Yang, and therefore a channel of the upper limbs, why should the Back-Shu point of the Triple Burner be in the lower back near the kidneys and not in the upper back?
The book "An Explanation of Acupuncture Points" (1654) has a very interesting observation. It says that the Pericardium (Arm Jue Yin) has a Back-Shu point at BL-14 Jueyinshu (in the upper back) and the Triple Burner has a Back-Shu point at BL-22 Sanjiaoshu. Notice how the Pericardium has a Back-Shu point in the upper back (not by chance just above the Heart Back-Shu point BL-15 Xinshu) and the Triple Burner has its Back-Shu point at BL-22 Sanjiaoshu in the lower back, just above the Kidney's Back-Shu point BL-23 Shenshu (Fig. 1). "Logically" as the Triple Burner channels is associated with the Pericardium channel, the Triple Burner's Back-Shu point should be in the upper back also because the Triple Burner is an Arm channel (Arm Shao Yang). We shall soon see why it is in the lower back, just above the Kidney's Back-Shu point.







To explain why the Triple Burner Back-Shu point is next to the Kidney's we need to explore the nature of the Triple Burner. The Triple Burner's nature has occupied Chinese doctors for centuries and there are different views of it; as usual in Chinese medicine, different view are contrasting but not necessarily mutually-exclusive ones. For centuries, Chinese doctors have been discussing whether the Triple Burner "has a form" (you xing) or not. The Chinese expression "has a form" means that the Triple Burner is an actual Fu organ; if the Triple Burner "has no form", then it is not like the other Fu but just a complex of functions "without form". Both these views are correct!
Chapter 38 of the Nan Jing has the famous statement that the Triple Burner "you ming er wu you xing", i.e. it "has a name but not a form". The Chinese expression is very elegant in that it contrasts you (it has) with wu you (has no, it does not have) and also rhymes ming (name) with xing (form). Therefore according to the Nan Jing, the Triple Burner has no physical entity like the other Fu organs but it is a set of functions.
What are the main functions of the Triple Burner in the Nan Jing? Chapter 8 discusses the function of the Triple Burner: "This Yuan Qi is the root of the 12 channels, it is the Motive Force (Dong Qi 动 气) between the Kidneys, the root of the 5 Zang and 6 Fu and of the 12 channels, the gate of breathing and the origin of the Triple Burner."
Chapter 66 of the Nan Jing further explains the function of the Triple Burner and it is the origin of the famous view of the Triple Burner as the "envoy" of the Yuan Qi. It says: "Below the umbilicus and between the kidneys there is a Throbbing Qi [Dong Qi 动 气] which constitutes a person’s life [sheng ming 生 命]. This [Throbbing Qi] is the root of the 12 channels, also called Yuan Qi [原 气]. The Triple Burner is the envoy of the Yuan Qi [or it allows the Yuan Qi to separate into its different functions]." Figure 2 illustrates this passage.

This is a very important statement that links the Triple Burner not only with the Yuan Qi but also with the Ming Men which is called also the "Minister Fire". It may be because of this that the Triple Burner is said to belong to the “Minister Fire”. The Minister Fire is the physiological Fire of the Kidneys that is essential to all the Zangfu and all physiological processes. It is in the Kidneys but it comes out of the Kidneys through the intermediary of the Triple Burner and that is why the Triple Burner's Back-Shu point is not by chance above BL-23 Shenshu, the Back-Shu point of the Kidneys (Fig. 3).

Notice that I have two different translations of a crucial few words above, i.e. either "the Triple Burner is the envoy of the Yuan Qi" or "it allows the Yuan Qi to separate into its different functions". This second translation was proposed by Steve Clavey and it is one that has great merit. This interpretation means that the Triple Burner allows the Yuan Qi to separate into its different forms in different parts of the body to perform is various functions. The places where the Qi of the Yuan Qi "comes to a halt" are the Yuan points on each channel.
There is another interesting significant symmetry in the location of points and that is the one between BL-22 Sanjiaoshu and Ren-5 Shimen. BL-22 is the Back-Shu point of the Triple Burner and is above BL-23 Shenshu (Kidney’s Back-Shu); Ren-5 is the Front-Mu point of the Triple Burner and is above Ren-4 Guanyuan (a point closely related to the Kidneys). Note that Ren-5 also tonifies the Yuan Qi.
Thus, the location of BL-22 just above BL-23 and of Ren-5 just above Ren-4 (a point that tonifies the Kidneys and is related to Jing) confirms the above view of the Triple Burner as the agent allowing the Original Qi to emerge from between the Kidneys and be activated all over the body to perform its various functions. In practice, I often do use both these points (BL-22 and Ren-5) to stimulate the Triple Burner’s metabolism of fluids.
But going back to the point BL-22 what are its functions? I had the rather lengthy introduction above because some of its functions are related to the Triple Burner's being the "envoy" of the Yuan Qi. We could also call it the “agent” of the Yuan Qi.
The ancient book "An Explanation of the Acupuncture Points" mentioned above breaks down the actions of the point BL-22 according to Upper, Middle and Lower Burner.
- Upper Burner: headache from invasion of Wind-Cold, vomiting and rebellious Qi with digestive symptoms and dizziness.
- Middle Burner: (substantial) masses of the internal organs, a feeling of distension and fullness with emaciation, no appetite, shoulder pain, backache with rigidity.
- Lower Burner: turbidity, diarrhoea, abdominal distension, borborygmi.
Modern books lists more symptoms and these can be found in Deadman and Al Khafaji's "Manual of Acupuncture" (p. 282) and my own "The Channels of Acupuncture" (p. 984-5). Among the indications, modern books mention also the Shao Yang Syndrome, i.e. alternation of chills and fever, bitter taste, dry throat, etc.
From what I can see the old texts do not mention these indications under BL-22; for example, the Compendium of Acupuncture (Zhen Jiu Da Cheng) and the ABC of Acupuncture (Jia Yi Jing) do not mention it. I suspect this is a modern addition inspired by BL-22 being the Back-Shu point of the Triple Burner. However, and this is an important point, the "Triple Burner" that is the "agent" of the Yuan Qi and the Triple Burner as Water passages have nothing to do with the Triple Burner as the Shao Yang channel! In other words, there is an apparent dichotomy between the Triple Burner as the agent of the Yuan Qi and the Triple Burner as the Shao Yang channel. Thus, to treat the Shao Yang Syndrome I would definitely use points from Triple Burner channel and particularly T.B.-5 Waiguan and not BL-22.
Modern books list also oedema, difficult urination, turbid urine, blood in the urine and these indications are indeed also in the old texts. I personally use this point almost exclusively for the Lower Burner and especially to promote the transformation, transportation and excretion of fluids in the Lower Burner, hence the symptoms of oedema, difficult urination and turbid urine. I use this point in all cases of Dampness or Phlegm in the Lower Burner in combinations that I posted on an earlier blog and a previous Clinical Tip.
But another reason why this point would act on the fluids of the Lower Burner is to do with its function with regard to the Minister Fire of the Kidneys. Just like it is the "envoy" of the Yuan Qi, it is also the envoy of the Minister Fire. The Minister Fire heats the fluids in the Lower Burner and this (physiological) heat is essential to the transformation, transportation and excretion of fluids.
Thus, the point BL-22 acts on the fluids metabolism in the Lower Burner for two reasons. Firstly, the point transforms fluids and therefore resolves Dampness because the Triple Burner is a system of waterways for the transformation, transportation and excretion of fluids. The famous chapter 8 that compares the Zangfu to “officials” says that the Triple Burner is the official in charge “of irrigation and controls the Water passages”. Secondly, the point transforms fluids through its activation of the Yuan Qi and of the Minister Fire.
Thus, as the Triple Burner’s Back-Shu point is on the Bladder channel, there is a connection between these two channels. Interestingly, there is another connection between the Triple Burner and the Bladder channels that is highlighted in the “ABC of Acupuncture” (Jia Yi Jing) by Huang Fu Mi. This connection occurs via the point BL-39 Weiyang which is the Lower He point of the Triple Burner. The He points of the Triple Burner, Small Intestine and Large Intestines (all Arm channels) are T.B.-10 Tianjing, S.I.-8 and L.I.-11 Quchi respectively. However, since the organs of these three channels are located in the Lower Burner, these three channels also have three so-called “Lower He” points which are BL-39 Weiyang for the Triple Burner, ST-37 Shangjuxu for the Large Intestine and ST-39 Xiajuxu for the Small Intestine.
The “ABC of Acupuncture” says that the point BL-39 Weiyang, Lower He point of the Triple Burner, is used for abdominal distension and pain with retention of urine. The text specifically says that this is a “Triple Burner disease” and this confirms the nature of the Triple Burner as a system of waterways for the transformation, transportation and excretion of fluids.
In conclusion, there are at least four aspects to the Triple Burner:
1) It is a system of waterways that transport and excrete fluids
2) It is the “envoy” of the Yuan Qi and Minister Fire
3) It is a system of “cavities” (not discussed here)
4) It is a Shao Yang channel that treats mostly problems of the Shao Yang area in the shoulder and head (especially ears) and also the Shao Yang Syndrome from the Shang Han Lun.