HEAT FROM QI STAGNATION

When Qi stagnates it frequently gives rise to Heat. This is why emotional stress which leads to Qi stagnation usually leads to Heat and that is why the tip of the tongue (reflecting the Heart and the Shen) becomes red.

Heat from Qi stagnation has the same characteristics and clinical manifestations as those of Full Heat but it differs in the treatment principle. To clear Full Heat, we use herbs and formulae from the category of AClearing Heat@ or AClearing Organ Heat@.  To clear Heat deriving from Qi stagnation, we need to use herbs and formulae from the AMoving Qi@ category and adapt them to clear Heat.

Although we always stress Liver-Qi stagnation, practically all organs may suffer from Qi stagnation and I will discuss particularly three: Liver, Lungs and Heart.

a) Heat from Liver-Qi stagnation

Hypochondrial or epigastric distension, a slight feeling of oppression of the chest, irritability, melancholy, depressed mood, moodiness, propensity to outbursts of anger, a feeling of lump in the throat, a feeling of heat, red face, thirst, pre-menstrual tension, irregular periods, pre-menstrual breast distension, heavy periods.

Tongue: red on the sides, with coating.

Pulse: Wiry, especially on the left side and slightly Rapid.

Acupuncture

P-6 Neiguan, G.B.-34 Yanglingquan, LIV-14 Qimen, LIV-3 Taichong, T.B.-6 Zhigou, LIV-2 Xingjian.

Prescription

Dan Zhi Xiao Yao San Moutan-Gardenia Free and Easy Wanderer Powder.

This tongue has red sides (especially the left one) while the rest of the tongue has a normal colour.  This is from Liver-Qi stagnation giving rise to Heat.

b) Heat from Lung-Qi stagnation

A feeling of lump in the throat, difficulty in swallowing, a feeling of oppression or distension of the chest, slight breathlessness, sighing, sadness, slight anxious mood, depressed mood, crying, breast distension in women, feeling of heat, thirst, red cheeks.

Tongue: slightly Red on the sides in the chest areas.

Pulse: very slightly Tight on the right cun position.

Acupuncture

LU-7 Lieque, ST-40 Fenglong, Ren-15 Jiuwei, P-6 Neiguan.

Prescription

Ban Xia Hou Po Tang Pinella-Magnolia Decoction plus Zhu Ye Folium Phyllostachys nigrae.

Lung-Qi stagnation derives from sadness, grief, shame, guilt and especially worry: it affects throat and chest.  In women it also affects the breasts.

c) Heat from Heart-Qi stagnation

Palpitations, a feeling of distension or oppression of the chest, depressed mood, a slight feeling of lump in the throat, slight shortness of breath, sighing, poor appetite, chest and upper epigastric distension, dislike of lying down, weak and cold limbs, pale complexion.

Tongue: slightly Pale-Purple on the sides in the chest area.

Pulse: Empty but very slightly Overflowing on the left cun position. 

Acupuncture

HE-5 Tongli, HE-7 Shenmen, P-6 Neiguan, Ren-15 Jiuwei, Ren-17 Shanzhong, LU-7 Lieque, ST-40 Fenglong, L.I.-4 Hegu.

Prescription

Mu Xiang Liu Qi Yin Aucklandia Flowing Qi Decoction.

Ban Xia Hou Po Tang Pinellia-Magnolia Decoction.

Both prescriptions plus Zhu Ye Folium Phyllostachys nigrae and Lian Zi Xin Plumula Nelumbinis.

Heart-Qi stagnation may derive from sadness, grief, worry, shame and guilt.

This tongue shows a slightly purple colour in the chest area on the left.  This may reflect Qi stagnation of Heart or Lungs or both.

DIAGNOSIS, PATTERNS AND TREATMENT OF HEAT

Heat is an extremely common pattern in practice and it is therefore very important that we understand its aetiology, pathology, diagnosis, patterns and treatment. To give an idea of the frequency of Heat in practice, in my clinic in England in a database of over 2500 patients, 46% had a red tongue and 32 a pale tongue. In other countries with a warmer climate, I suspect the incidence of red tongue (and Heat) would be even higher. One reason why Heat is so common is that it is often the consequence of emotional stress, but this will be discussed later.
I have decided to write something on Heat also because I find that even in Chinese books, the subject is not discussed properly and the terminology used is often not precise as they sometimes use the terms "Heat" and "Fire" interchangeably and they are not.
The discussion of Heat will be structured under the following headings:
Aetiology of Heat
Full Heat
Heat from Qi stagnation
Empty Heat
Distinction between Heat and Fire
Damp-Heat
Phlegm-Heat
External Heat
Latent Heat
Yin Fire
Heat and the 4 LevelsAETIOLOGY OF HEAT

First of all, when we talk about the aetiology of Heat, we mean Full Heat (or Wind-Heat), not Empty Heat.  This is because Empty Heat derives from Yin deficiency, so the aetiological factors that lead to Yin deficiency eventually lead to Empty Heat.  In my experience, the most important aetiological factor leading to Yin deficiency is overwork: I do not mean excessive physical work but Aoverwork@ in the sense of working long hours without adequate rest, leaving home in the early morning and returning in the late evening for years on end. This life habit is also combined with stressful situations at work (or the commute) and irregular eating.  All these factor combine to deplete Yin of the Stomach, Liver and Kidneys. Yin deficiency eventually leads to Empty Heat. 

In my experience, there are three major causes of Full Heat: emotional stress, diet and an external pathogenic factor that penetrates into the Interior.

a) Emotional stress

All emotions eventually lead to Heat and that is why a red tip of the tongue is so common and also such a reliable indicator of emotional stress.

Initially, emotions affect only Qi and do not cause Heat directly: they cause either Qi stagnation or Qi deficiency or both. Thus, initially (and I stress initially), all emotions affect Qi only.  Emotions such as worry, pensiveness, anger, fear, shame and guilt cause Qi stagnation; emotions such as sadness and grief cause Qi deficiency.  However, also the emotions that cause Qi deficiency, often also cause a concomitant Qi deficiency.  For example, sadness and grief weaken Lung-Qi: a weak Lung-Qi in the chest leads to come impairment in the circulation of Qi in the chest and therefore to some Qi stagnation as well.

After some time (and this may not be very long, e.g. weeks), Qi stagnation leads to Heat.  As all emotions affect the Heart, the tip of the tongue becomes red. All emotions affect the Heart because the Heart houses the Shen and the Shen is the one that recognizes and feels the emotions. When we say AI feel angry@ who is that AI@?  It is the Shen of the Heart.  Anger will affect the Liver automatically but it is the Heart who Afeels@ it.

 

This picture shows a good example of red tip.  The tip is bright-red (a different shade than the rest of the tongue body) and it is also swollen.

b) Diet

First of all, it is important to realize that when we say Adiet@ in the context of aetiology of disease, that includes drinks.  Indeed, excessive consumption of alcohol is probably the main source of heat in a diet.  Any type of alcohol is hot and the higher the alcohol content, the hotter the drink.  Thus, vodka is hotter than wine.

Apart from alcohol, all meats are hot (or warm) but especially lamb and beef: therefore excessive consumption of these two types of meat is also a source of heat.  All wild meats are also hot, e.g. pheasant, grouse, rabbit, deer, elk, reindeer, wild boar, etc.

Apart from the above foods, most spices are also a source of heat, e.g. mace, ginger, curry, cumin, chilly, etc. 

c) External pathogenic factor penetrating into the Interior

An external pathogenic factor frequently penetrates into the Interior if it is not expelled at the Exterior stage.  When this happens, every external pathogenic factor has the tendency to change into Heat: thus, even Wind-Cold can turn into Heat once in the Interior.  Indeed, this is exactly what happens in the 6 Stages patterns from the Shang Han Lun: the Tai Yang stage is characterized by Wind-Cold and this can transform into the Yang Ming stage of Stomach-Heat.  Of course, external Wind-Heat and Summer-Heat have even a stronger tendency to turn into Interior Heat.

I find this aetiology of internal Full Heat actually quite common, especially for Lung-Heat. Many people suffer an invasion of Wind-Heat: if the Wind-Heat is not expelled at the exterior stage, it may go into the Interior and turn into Lung-Heat or Lung Phlegm-Heat.  This is more likely to happen when antibiotics are resorted to.  This is called Residual Heat, i.e. Heat left over from an invasion of Wind-Heat.  It is very common in children.

This type of Lung-Heat is often symptomless but the tongue shows it very clearly with a redness or red points in the front third. The tongue below has red points in the front third (Lung area).

CLINICAL MANIFESTATIONS OF HEAT

The general clinical manifestations of Full Heat are a feeling of heat, red face, thirst, anxiety, red face, dry stools, scanty-dark urine, a Rapid-Full pulse, and a red tongue with yellow coating.

Beyond these, it is difficult to generalize as other manifestations will depend on the organ affected. Note that some of these symptoms and signs may be caused by Empty Heat too and therefore tongue and pulse are important to differentiate Full from Empty Heat: in Empty Heat the tongue is without coating and red and the pulse must have some Empty quality and especially Floating-Empty.

Aside from the above clinical manifestations, there are other diagnostic guides which indicate Heat.  Any raised, red skin eruption which feels hot, indicates Heat. For example, acute urticaria normally takes this form. As for pain, any burning sensation indicates Heat. For example, the burning sensation of cystitis, or a burning feeling in the stomach. Any loss of blood with large quantities of dark-red blood, indicates Heat in the Blood. As far as the mind is concerned, any condition of extreme restlessness or manic behaviour, indicates Heat in the Heart.

a) Lung-Heat

Cough, slight breathlessness, feeling of heat, slight chest ache, thirst, red face.

Tongue: Red in the front third with yellow coating.

Pulse: Overflowing on the right cun,  possibly slightly rapid.              

Acupuncture

LU-5 Chize, LU-10 Yuji, LU-7 Lieque, L.I.-11 Quchi, LU-1 Zhongfu, BL-13 Feishu.

Prescription

Qing Bai San Clearing White Powder

b) Stomach-Heat

Burning epigastric pain, thirst, acid reflux, nausea, vomiting soon after eating, excessive hunger, foul breath, a feeling of heat.

Tongue: red in the centre with a yellow coating.

Pulse: Rapid and slightly Overflowing on the Right-Middle position.

Acupuncture

ST-44 Neiting, ST-34 Liangqiu, ST-21 Liangmen, Ren-12 Zhongwan, Ren-13 Shangwan, L.I.-11 Quchi, L.I.-4 Hegu, Ren-11 Jianli.

Prescription

Bai Hu Tang White Tiger Decoction.

Yu Nu Jian Jade Woman Decoction.

Qing Wei San Clearing the Stomach Powder.

c) Liver-Heat

Irritability, propensity to outbursts of anger, temporal headache, dizziness, red face and eyes, thirst, bitter taste.

Tongue: Red with redder sides and dry-yellow coating.

Pulse: Wiry-Rapid.     

Note: this pattern is usually described as ALiver-Fire@ in Chinese books. Liver-Fire is a more

intense form of Liver-Heat. I will discuss the difference between Heat and Fire later.  The clinical manifestations listed above are those of Liver-Heat. 

Acupuncture

LIV-2 Xingjian, LIV-3 Taichong, G.B.-20 Fengchi, Taiyang extra point, G.B.-13 Benshen, Du-24 Shenting. In case of headaches: G.B.-1 Tongziliao, G.B.-9 Tianchong, G.B.-8 Shuaigu, G.B.-6 Xuanli.

Prescription

Long Dan Xie Gan Tang Gentiana Draining the Liver Decoction.

Dang Gui Long Hui Tang Angelica-Gentiana-Aloe Decoction.

Please note that these prescriptions are for Liver-Fire. Therefore, for Liver-Heat, I would reduce the dosage of the bitter-cold herbs such as Long Dan Cao Radix Gentianae scabrae and Huang Qin Radix Scutellariae.

d) Heart-Heat

Palpitations, thirst, mental restlessness, insomnia, feeling of heat, red face.

Tongue: Red with redder tip and yellow coating.  In more severe cases the tip could also be swollen.

Pulse: Overflowing-Rapid especially on the Left-Front position. 

Note: this pattern is usually described as AHeart-Fire@ in Chinese books. Heart-Fire is a more intense form of Heart-Heat. I will discuss the difference between Heat and Fire later.  The clinical manifestations listed above are those of Heart-Heat.

Acupuncture

HE-9 Shaochong, HE-8 Shaofu, HE-7 Shenmen, Ren-15 Jiuwei, Du-24 Shenting, Du-19 Houding.

Prescription

Dao Chi San  Draining Redness Powder.

Please note that this prescription is for Heart-Fire. Therefore, for Heart-Heat, I would reduce the dosage of the bitter-cold herbs such as Huang Lian Radix Coptis.

e) Spleen-Heat

The Spleen can have Heat! Of course, it is much more prone to Cold but the pattern of Spleen-Heat does exist and it is usually combined with that of Stomach-Heat.  The clinical manifestations are listed below.

Burning epigastric and/or abdominal pain, excessive hunger, red tip of the nose, dry lips, thirst, dry stools, feeling of heat, yellow complexion.

Tongue: red on the sides, middle section, with dry-yellow coating.

Pulse: Overflowing (especially on the right guan position) and slightly rapid.

Acupuncture

SP-2 Dadu, L.I.-11 Quchi, ST-44 Neiting, Ren-11 Jianli.

Prescription

Xie Huang San Draining the Yellow Powder.

This tongue is red on the sides in the middle section (Middle Burner): this is more apparent on the right side. The sides of the tongue usually reflect the Liver but when they present a pathological aspect only in the middle section of the sides (Middle Burner), they reflect a pathology of the Spleen, in this case Heat because they are red.

BACTERIA IN THE FOETUS AND ASTHMA

An article in the New Scientist reports a new discovery about bacteria in the foetus. It was previously thought that the foetus could not be affected by bacteria from the mother in the womb and that they could only get bacterial contamination from the mother's vagina at birth. New research shows that this is not so and that bacteria in fact colonize the foetus’s gut in the womb.

This has two interesting implications in Chinese medicine, one to do with the idea of Toxic Heat from the uterus and the other with the aetiology of allergic asthma.

According to Chinese medicine, we are all born with "Toxic Heat from the uterus". Dr J. Shen used to give new-born babies a herbal formula to eliminate such Toxic Heat: its elimination would prevent that person from suffering from skin diseases later in life.

Pilar Francino and her colleagues at the University of Valencia in Spain collected and froze the meconium of babies from 20 women. They removed the outer layers of each sample to rule out any bacteria picked up after birth, then looked for bacterial DNA.

The team not only identified bacteria in the babies' meconium - which before then was thought to be sterile - they found bacterial communities so developed that they seemed to fall into two categories. Around half of the samples appeared to be dominated by bacteria that produce lactic acid, such as lactobacillus, while the other half mostly contained a family of enteric bacteria, such as Escherichia coli.

Francino's team checked up on the health of the infants at 1 year of age, and again at 4. The group were surprised to find that infants born with more lactic acid bacteria were significantly more likely to develop asthma-like symptoms, while those born with more enteric bacteria were at a greater risk of eczema.

This is a fascinating finding that, to me, further confirms my view that the aetiology of allergic asthma is congenital (either from the parents or due to events in the womb during gestation). It is also interesting that one group of bacteria would predispose the child to asthma and the other to eczema, which further confirms the common aetiology of allergic asthma and eczema. Furthermore, the presence of these two groups of bacteria affects precisely the organs that are linked in Chinese medicine, i.e. lungs and large intestine.

MIRROR NEURONS: THE ARENA OF SHEN AND HUN?

In 1992 an Italian neurophysiologist in Parma was doing brain research using macaque monkeys. They were specifically researching an area of the brain called F5, located in the premotor cortex.

      Area F5 contains millions of neurons that specialize in coding for one specific motor behaviour: actions of the hand, including grasping, holding, tearing and, most important, bringing objects (food) to the mouth. As Iacoboni explains "For every macaque these actions are as basic and essential as they come. We Homo Sapiens are grasping and manipulating objects from the moment we fumble for the snooze button in the morning until we adjust our pillows at bedtime. All in all, we perform hundreds, if not thousands, of grasping actions every day."¹ That it why the Rizzolati team chose area F5 for close investigation.
    One day the neurophysiologist Vittorio Gallese was moving around the lab during a lull. A monkey was sitting quietly in the chair; suddenly as Vittorio reached for something, he heard a burst of activity from the computer that was connected to the electrodes surgically implanted in the monkey’s brain. To an experienced neurophysiologist, this signalled a discharge from the pertinent cells in area F5. Vittorio immediately thought that this was strange as the monkey was sitting quietly not grasping anything, yet the neurons affiliated with the grasping action had fired nevertheless.
     Through many other painstaking experiments, the neurophysiologist came to the discovery that, within the F5 motor area, there are dedicated neurons (about 20%) that fire not when one performs an action but when one watches someone else performing an action e.g. grasping, bringing objects (usually food) to the mouth, kicking a ball, playing tennis, etc. They even fire when one simply hears a word such as "kick". Mirror neurons imitating a grasping action fire even when the object grasped is hidden from view (behind a screen), but not if the monkey knows that there is no object.
    Crucially, mirror neurons are involved in predicting the meaning of a certain action: this is essential in communicating and relating to others. Iacoboni says: "The action recognition process implemented [by the mirror neurons] is some sort of simulation or internal imitation of the observed action. Given that our own actions are almost invariably associated with specific intentions, the activation in my brain of the same neurons I use to perform my own actions may also allow me to understand the intentions of other people."²    For example, if I watch someone grasping a cup soon after having an argument with that person, thanks to the mirror neurons, I know whether he or she is grasping the cup to get a drink or whether they are about to throw the cup at me. Quiet simply, mirror neurons differentiate between the same action associated with different intentions.
    After years of experiments by many different neurophysiologists, mirror neurons are now thought to be involved in much more than "imitating" motor actions in one’s brain when watching someone else performing a motor action. They are now thought to be involved in emotional bonding, empathy and language.
It is now thought that mirror neurons play a role in empathy, the capacity to feel other people’s emotions. The brain area connecting mirror neurons to the limbic system (responsible for our emotions) is the insula. In other words, we feel and understand the emotions of other people thanks to our own mirror neurons which are activated by the sight of someone’s smiling, frowning, crying, etc. Thus, "our mirror neurons fire when we see others expressing their emotions, as if we were making those facial expressions ourselves. By means of this firing, the neurons also send signals to emotional brain centres in the limbic system to make us feel what other people feel."³
    Essential to this empathy based on mirror neurons are other people’s facial expressions that trigger the firing of our mirror neurons. To James (of the James-Lange theory of emotions), this phenomenon means that "our mental life is knit up with our corporeal frame, in the strictest sense of the term."⁴ Incidentally, that is the connection between emotions and the Po in Chinese medicine.
    Mirror neurons also play a role in the development of a sense of self. Social context is critical in developing a sense of self. Isolation seems to inhibit the ability to develop a sense of self; rich social context facilitates it. The presence of others, the continuous relations and interactions one must have with others facilitates the development of our sense of self. Mirror neurons fire when we observe actions and when we perform those same actions. There is a strong link between social environment and a sense of self and this link is at least partly due to mirror neurons.
    There is now a mirror neuron hypothesis in relation to autism. In autism there is an "imitation deficit", i.e. the child is unable to translate from the perspective of another individual to one’s own perspective. It is now believed that the key neural deficit in autism is a dysfunction of mirror neurons. As Iacoboni says, "a deeply felt mirroring that moves people closer to each other and makes emotional connectedness possible seems to be the main deficit of patients with autism."⁵
    What has all this to do with Chinese medicine and, in particular, with Shen and Hun? I think there are interesting connections between the role of Shen and Hun and mirror neurons. Shen and Hun together are responsible for emotional empathy and relating to others. Consider the Chinese ideogram for "shen".

    The right side of the ideogram is very interesting: it is pronounced "shen" and it means "to express, to explain, to stretch, to extend".

   The last two meanings, "to stretch" and "to extend", are crucial to an understanding of what the Shen does. It is responsible for "extending" towards others, for connecting with others, for emotional connection and empathy. In other words, for the function of the mirror neurons.
    However, the Shen cannot perform that function alone: it relies on the help of the Hun and that is why ancient books say that Shen and Hun are related work in unison (they are both Yang in nature), as opposed to the relation between Po and Jing (both Yin in nature).
    How does the Hun help the Shen? The Hun is responsible for a different type of consciousness than that of the Shen. It is responsible for intuition, planning, life dreams, ideas, inspiration and, incidentally, also artistic inspiration. How does the Hun perform these functions? Through its movement: the Hun is always moving in the sense of searching, exploring ideas, nurturing life dreams, etc. Without the input of the Hun the Shen would be an inert consciousness. The input of the Hun is therefore essential for the Shen to perform its function of relating and connectedness with others. Again, this is the Chinese medicine equivalent of the function of mirror neurons.
    The movement of the Hun has to be just "right", not too much, not too little. If the movement of the Hun is deficient, the person may become depressed; if the movement of the Hun is excessive, the person may be slightly "manic". I relate autism in children to a deficient movement of the Hun that leads to an impaired function of the Shen in relating to others. As we have seen, this has been related to a dysfunction of mirror neurons.
    Conversely, I relate hyperactivity in children to an excessive movement of the Hun and, interestingly, hyperactive children are often artistic (which is a function of the Hun).
    How does one stimulate the movement of the Hun? I use the Gall-Bladder channel and especially GB-40 Qiuxu. To restrain the movement of the Hun, I use LIV-3 Taichong. Other points that regulate the Shen and Hun and Du-24 Shenting and GB-13 Benshen.

1. Iacoboni M, Mirroring People, Picador, New York, 2009, p. 10.
2. Ibid., p. 30.
3. Ibid., p. 119.
4. Calhoun C, Solomon R, What is an Emotion?, Oxford University Press, 1984, p. 125.
5. Iacoboni, Mirroring People, p. 175.     The left part of the ideogram (by itself pronounced shi) indicates something spiritual, it evokes heaven and stars, also an ancient altar for sacrifices, signs from Heaven. I like the word "numinous" in relation to this quality of Shen.

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THE TRIPLE BURNER - RELATIONSHIP WITH PERICARDIUM

This is the 6th and last instalment of the discussion on the Triple Burner.

6) Relationship between Triple Burner and Pericardium
Although they are interiorly-exteriorly related, the relationship between Pericardium and Triple Burner is somewhat tenuous: such a relationship is more applicable to the channels, rather than to the organs themselves.

The Nei Jing and Nan Jing always refer to the "5 Zang and 6 Fu" (omitting the Pericardium), but also to the "12 channels" (including the Pericardium). Originally the Pericardium was not considered as separate from the Heart; the two were considered a single organ, which is perfectly logical considering their close anatomical relationship. In fact, when the Ling Shu lists the Yuan points of the 5 Zang in chapter 1, it lists Daling (P-7) as the Yuan point of the Heart.1
A passage from Chapter 38 of the Nan Jing makes it clear that the Pericardium and Heart were, in those times, considered as one organ. It says: "The Zang are 5; only the Fu organs are 6: why is that so? The Fu organs are 6 because of the Triple Burner...it has a name but no form, and its channel pertains to the Hand Shao Yang. [The Triple Burner] is a Fu organ and that is why these are 6."2

This passage is revealing because of its starting question: in fact, the very question "the Zang organs are 5, why are there 6 Fu organs?" implies that it is taken for granted that the Heart and Pericardium are part of the same organ and that therefore it is strange that the Fu organs are 6. The answer explains that the Fu organs are 6 due to the existence of the Triple Burner.

However, within the reply, it says that the Triple Burner "has a name but no form" thus implying that the Triple Burner is different from the other regular Fu organs and their total makes 6 only by adding the Triple Burner.3 The passage also makes clear that the Triple "has a name but no form", i.e. it is not really an organ like the others but a complex of functions: however, it does say that there is a channel associated with it.

Chapter 39 of the Nan Jing is even more specific about the fact that the Triple Burner is not actually associated with a Zang organ: "Each of the Zang organs has a Fu one associated with it. The Triple Burner is also a Fu organ but it is not associated with any of the Zang organs. That is why some say that there are only 5 Fu organs."4

Chapter 25 of the Nan Jing specifically addresses the conundrum that there are 11 Internal Organs but 12 channels: "There are 12 channels but 11 Internal Organs (5 Zang and 6 Fu), why? One channel [jing] has two separate vessels [mai] in the Arm Shao Yin [Heart] and Heart Master [Xin Zhu, Pericardium]. The Pericardium has an Exterior-Interior relationship with the Triple Burner, both have a name but no form [you ming er wu xing], and that is why there are 12 channels." This passage is extremely revealing because it confirms that Heart and Pericardium were seen as one, when it says that one channel [jing] has two separate vessels [mai] in the Arm Shao Yin [Heart] and Heart Master [Xin Zhu, Pericardium].

With regard to the question of 5 Zang and 6 Fu, the author of the Nan Jing seems to be playing games with the reader because, in chapter 39, it says that the Zang could be considered to be 6 and the Fu 5! It says: "There are 5 Zang and yet 6 Fu, how is that? One speaks of 6 Fu but they are actually 5. Although one speaks of 5 Zang, there are actually 6. The Kidneys are two Zang: the left is the Kidney and the right is the Ming Men. The Ming Men houses the Spirit (jing shen). In men it stores the Jing in women it houses the Uterus. The Qi of the Ming Men penetrate the Kidneys. That is why there are 6 Zang. How come there are 5 Fu? [That is because] Each Zang is associated with a Fu, the Triple Burner is a Fu but it does not belong to any of the 5 Zang: that is why there are 5 Fu."5

With the development of the channel theory, the Triple Burner was associated with the Pericardium (given their corresponding position on the arm) and their number totalled 12, including the Triple Burner and Pericardium channels.

Although the Pericardium and Triple Burner channels are exteriorly-interiorly related within the 5-Element scheme, this feels like a somewhat "forced" relationship to make a square shape fit in a round hole, i.e. the 5 Elements into 12 Channels. In fact, some Chinese teachers and doctors go so far as saying that the Pericardium and Triple Burner organs are not interiorly-exteriorly related as the other organs are.

As channels, the Pericardium and Triple Burner channels have a close and symmetrical relationship; they occupy symmetrical positions on the arm. The Triple Burner belongs to the Shao Yang channels which are the "hinge" between the Tai Yang and the Yang Ming channels; the Pericardium pertains to the Jue Yin channels which are the "hinge" between the Tai Yin and Shao Yin channels. Being the "hinge" implies that these channels can connect the Yang and Yin channels, i.e. the Triple Burner connects the three Yang and the Pericardium the three Yin.

The Pericardium and Triple Burner channels are symmetrical in so far as the former provides the opening point of the Yin Wei Mai (P-6 Neiguan) and the latter of the Yang Wei Mai (T.B.-5 Waiguan): the Yin Wei Mai links all the Yin channels and the Yang Wei Mai all the Yang ones. This is another reason why the Triple Burner and Pericardium channels connect the three Yang and three Yin of the arm respectively.

The "Medicine Treasure" even says that the Triple Burner is interiorly-exteriorly related to the Ming Men.6 Since the Ming Men is also called the "Minister Fire", this explains the attribution of Triple Burner to Fire and specifically Minister Fire in the 5-Element context. The Pericardium is obviously closely connected to the Heart and naturally belongs to the Fire element, hence the connection between Pericardium and Triple Burner within the Fire Element and their name of "Minister Fire".

The "Selected Historical Theories of Chinese Medicine" clarifies the relationship between the Triple Burner and Pericardium: "The Heart is the Emperor who has a Minister. The Triple Burner cavities are like a capital which houses both the Emperor and the Minister. The Pericardium in the centre of the chest is like a palace that houses only the Emperor. The palace is inside and is Yin, the capital is outside and is Yang; hence the Triple Burner is a Yang organ and the Pericardium a Yin organ".7

In exploring the relationship between Pericardium and Triple Burner, there is an interesting symmetry between the location of the Back-Shu point of Heart and Kidneys (Shao Yin) and those of Pericardium and Triple Burner. The Heart and Kidneys communicate with each other and their Back-Shu points are BL-15 and BL-23 respectively. The Pericardium and Triple Burner’s Back-Shu points are symmetrical in that they are one point above those of the Heart and Kidneys, i.e. BL-14 and BL-22 respectively.





The Back-Shu point of the Pericardium is naturally just above that of the Heart because of the close anatomical connection between the two organs. The Back-Shu point of the Triple Burner is just above that of the Kidneys because of the Triple Burner being the "envoy" or "ambassador" of the Yuan Qi as it emerges from between the Kidneys (see previous blog post).


Clinical application
There are interesting clinical applications of the Triple Burner and Pericardium channels in the mental-emotional sphere.

First, emotional stress makes the physiological Minister Fire of the Kidneys rise and become pathological: when the Minister Fire is pathological, a person has "Heat". All emotions tend to cause Qi stagnation first and stagnant Qi easily generates Heat: that is why, in mental-emotional stress, the tip of the tongue (reflecting the Heart and the Shen) is red. As we have seen above, chapter 38 of the Nan Jing even says that the Ming Men (same as Minister Fire) is the residence of the Spirit (Jing-Shen). Zhu Dan Xi said: "Not a day goes by in people’s lives that the Minister Fire is not stirred."

The Triple Burner and Pericardium channels affect the mental-emotional state because emotional stress makes the Minister Fire rise towards these two channels; therefore when the Minister Fire is aroused by emotional problems and it rises towards the Pericardium and Triple Burner channels, points of these channels can be used to clear Heat and calm the Mind.
In this context, I use particularly P-6 Neiguan to stimulate the movement of the Hun when the person is depressed, or P-7 Daling to calm the Shen when the person is anxious.


There is another interesting clinical application of the Triple Burner and Pericardium points related to their being "hinge" channels, i.e. the Triple Burner (Shao Yang) is the hinge between Tai Yang and Yang Ming and the Pericardium (Jue Yin) is the hinge between Tai Yin and Shao Yin. Being the "hinge" on a psychological level means that these channels are "mediators" in the sense that they can affect a person's capacity to relate to other people and points of these two channels can therefore be used especially for depression: for this, I use T.B.-3 Zhongzhu and P-6 Neiguan.

1. Ling Shu, p 3.
2. Nan Jing, p. 94.
3. Ibid., p. 94.
4. Ibid., p. 95.
5. Nan Jing, p. 110.
6. Wang Xin Hua 1983 Selected Historical Theories of Chinese Medicine (Zhong Yi Li Dai Yi Lun Xuan), Jiangsu Scientific Publishing House, p. 2.
7. Ibid., p. 161.

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.