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.

THE TRIPLE BURNER (3)

In the last Clinical Tip (September 2011) we discussed the role of the Triple Burner as the avenues of fluids, a view deriving primarily from the Nei Jing. In the previous Clinical Tip (August 2011), we discussed that of the Triple Burner as the agent of the Yuan Qi, a view deriving primarily from the Nan Jing. We shall now discuss the view of the Triple Burner in relation to the movement of Qi.

3) The Triple Burner governing movement of Qi
Chapter 38 of the Nan Jing mentions the function of the Triple Burner in governing all Qi in the body. “The Triple Burner stems from the Yuan Qi; it governs all Qi in the body, it has a “name but no form”, it belongs to Hand Shao Yang, it is an external Fu.”1

This short passage summarizes most of the aspects of the Triple Burner:
1) It stems from the Yuan Qi (discussed in the August Clinical Tip).
2) It governs all Qi of the body (we shall see how below).
3) The Triple Burner has “a name but no form”, i.e. it is not an actual organ but a function.
4) It pertains to the Shao Yang with the Gall-Bladder.
5) It is a Fu.

Let us explore now the meaning of the Triple Burner governing the movement of Qi. The movement of Qi in general is called the “Qi Mechanism” (Qi Ji 气 机). This Qi Mechanism consists in the ascending/descending and entering/exiting of Qi in different places and different organs. Each organ has a particular direction of flow of Qi, e.g. Spleen-Qi ascends while Stomach-Qi descends. In each channel, Qi flows in an upward or downward direction. As acupuncturists, we are very familiar with the ascending/descending movement of Qi.

We use this movement every time we insert a distal and a local point to treat a particular problem along a channel. For example, when we use L.I.-1 Shangyang (for example) and L.I.-15 Jianyu to treat a pain in the area of the acromio-clavicular articulation of the shoulder, we are making use of the ascending/descending movement of Qi along the Large Intestine channel. By stimulating the ascending/descending movement of Qi in the channel, we are removing the obstruction and therefore the pain.



We are somewhat less familiar with the “horizontal” movement of Qi, i.e. entering and exiting of Qi. Qi enters and exits in and out of various structures and organs. For example, Qi enters and exits the space between skin and muscles, the Membranes, the joint capsules, and all other cavities. Moreover, Qi “enters and exits” in every part of the body among the Tai Yang, Shao Yang and Yang Ming and among the Tai Yin, Jue Yin and Shao Yin.



Take the shoulder as an example. On the scapula we have Tai Yang (Small Intestine channel), on the lateral side of the arm we have the Shao Yang (Triple Burner channel) and further forward the Yang Ming (Large Intestine channel). Within this zone of the body, the Tai Yang area is on the most Yang area (the scapula), the Yang Ming on the most Yin area (because it is near the Lung channel) and the Shao Yang in the middle: this ties in with the view that the Tai Yang “opens onto the Exterior”, the Yang Ming “opens onto the Interior” and the Shao Yang is “the hinge”. Exactly the same reationship exists in the Yin between Tai Yin (most exterior of the Yin), Jue Yin (the hinge) and Shao Yin (most interior of the Yin).



The “Avenues of Qi” (Qi Jie 气 街) described in chapter 52 of the Ling Shu are another example of the entering and exiting of Qi (“horizontal movement of Qi”): “In the chest Qi has streets; in the abdomen Qi has streets; in the head Qi has streets; in the lower legs Qi has streets. Therefore if [there is a problem with] Qi in the head, stop it at the brain; if [there is a problem with] Qi in the chest, stop it at the front of the chest and at the Back-Shu points; if [there is a problem with] Qi in the abdomen, stop it at the Back-Shu points and at the Chong Mai on the right and left of the umbilicus which is the Moving Qi [or Dong Qi]; if [there is a problem with] Qi in the lower legs, stop it at ST-30 Qichong [here called Qijie] and at BL-57 Chengshan.”2
Notice how it recommends the use of points in the front and the back for each area: in the chest, use the front of the chest and Back-Shu points; in the abdomen Back-Shu points and Chong Mai points; in the legs, ST-30 (front of leg) and BL-57 (back of leg). This suggests a “horizontal” movement of Qi within each area.

The Triple Burner controls the ascending/descending and entering/exiting of Qi in the Qi Mechanism. One of the words most frequently used in Chinese books to describe this function of the Triple Burner is tong 通 which means “free passage”, “to pass through”, “penetrate”: this describes the function of the Triple Burner in ensuring that Qi passes through in the Qi Mechanism, in all the cavities and in all organs. This whole process is called “Qi Transformation by the Triple Burner”: the result of the Qi transformation is the production of Nutritive-Qi (Ying Qi), Defensive-Qi (Wei Qi), Blood and Body Fluids. That is also why the Triple Burner is said to control “all kinds of Qi”.

The “Central Scripture Classic” (Zhong Zang Jing, Han dynasty) says: “The Triple Burner is the three original Qi of the body, it is the Yang organ of clear [Qi], it controls the 5 Zang and 6 Fu, Ying Qi and Wei Qi, the channels and the Qi of the interior and exterior, left and right, above and below. When the Qi of the Triple Burner has free passage, Qi passes freely into interior, exterior, left, right, above and below. The Triple Burner irrigates the body, harmonizes interior and exterior, benefits the left and nourishes the right, it conducts upwards and descends downwards.”3

As mentioned in the previous Clinical Tip, chapter 66 of the Nan Jing also confirms that the Triple Burner controls the movement of Qi in general: “The Triple Burner makes the Yuan Qi separate [into its different functions] and it controls the movement and passage of the 3 Qi [of the Upper, Middle and Lower Burner] through the 5 Zang and 6 Fu.”4 The “3 Qi” are the Qi of the Upper, Middle and Lower Burner: apart from referring generally to all the types of Qi in each Burner, this passage also refers specifically to the Gathering Qi (Zong Qi) in the Upper, Nutritive-Qi (Ying Qi) in the Middle and Defensive-Qi (Wei Qi) in the Lower Burner. Although the Defensive-Qi exerts its influence primarily in the Upper Burner and the superficial layers of the body (the space between skin and muscles), it originates in the Lower Burner from the Ming Men. Chapter 18 of the Ling Shu says: “Ying Qi originates from the Middle Burner; Wei Qi originates from the Lower Burner.”5

Chapter 38 of the Nan Jing also confirms that the Triple Burner exerts its influence on all types of Qi: “The Triple Burner stems from the Yuan Qi: it supports all of the Qi.”6 Chapter 31 confirms the influence of the Triple Burner on the movement of Qi in all parts of the body: “The Qi of the Triple Burner gathers in the avenues of Qi [Qi Jie]”.7 This means that the Triple Burner is responsible for the free passage of Qi in all channels but also all structures (such as cavities) of the body.

Thus, the Triple Burner’s function in governing the movement of Qi is quite similar to the Liver’s free flow of Qi and indeed, there are many similarities. With regard to the movement of Qi, it is useful to compare and contrast this function of the Triple Burner with those of Liver in ensuring the free flow of Qi.

The Liver ensures the free flow of Qi and this aids the ascending and descending of Qi in all organs, and especially in the Stomach, Spleen and Intestines: the Triple Burner's influence on the ascending/descending and entering/exiting of Qi extends to all organs. Moreover, the Triple Burner controls the entering and exiting of Qi in all parts of the body and especially the body cavities: the Liver has no such function in relation to the body cavities.

Clinical application
As the Triple Burner controls the movement of Qi in the Qi Mechanism. Its points may be used in a similar way to the Liver points to ensure the free flow of Qi. The main point I use to move Qi in the Triple Burner is TB-6 Zhigou.


1. Nanjing College of Traditional Chinese Medicine 1979 A Revised Explanation of the Classic of Difficulties (Nan Jing Jiao Shi). People’s Health Publishing House, Beijing, first published c. AD 100, p. 94.
2. 1981 Spiritual Axis (Ling Shu Jing). People’s Health Publishing House, Beijing, first published c. 100 BC, p. 111.
3. Hua Tuo 1985 Classic of the Central Scripture (Zhong Zang Jing), Jiangsu Science Publishing House, Nanjing, p. 39. Written in Han dynasty.
4. Classic of Difficulties, p. 144.
5. Spiritual Axis, p. 52.
6. Classic of Difficulties., p. 94.
7. Ibid., p. 80.

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.

Resolving Dampness and Phlegm with acupuncture

When I give lectures I often hear that "ST-40 resolves Phlegm": I wish! Resolving Phlegm involves much more than simply using ST-40. In order to resolve Dampness or Phlegm, it is necessary to activate the Three Burners.
The Triple Burner is described in the Nei Jing as the official in charge of irrigation: this means that the Triple Burner is responsible for the transformation, transportation and excretion of fluids in all parts of the body and all organs. This is one of the most important functions of the Triple Burner.
The terms used in Chinese in connection with the Triple Burner’s influence on the body fluids are often shu 疏 which means “free flow” and tong 通 which means “free passage”. Therefore the Triple Burner is like a system of canals and waterways to channel irrigation water through the proper fields and then out: this ensures that body fluids are transformed, transported and excreted properly.
The Triple Burner’s function in relation to body fluids is closely dependent on its function of controlling the transportation and penetration of Qi. The Triple Burner influences the ascending/descending and entering/exiting of Qi in the Qi Mechanism:
it is the coordinated and harmonized ascending/descending and entering/exiting of Qi in all organs and structures that ensures that the body fluids also ascend/descend and enter/exit in the proper way in all places. Essentially, the transformation and movement of fluids depends on Qi.
This whole process is called “Qi Transformation by the Triple Burner”: the result of the Qi transformation is the production of Nutritive-Qi, Defensive-Qi, Blood and Body Fluids. That is also why the Triple Burner is said to control “all kinds of Qi”. This sums up the way in which acupuncture can influence the transformation, transportation and excretion of fluids: it can only achieve this through Qi.
Herbal medicine resolves Dampness by using herbs which are actually diuretic (e.g. Fu Ling, Zhu Ling, Ze Xie, Yi Yi Ren, etc.); and it resolves Phlegm by using herbs that are drying (e.g. Ban Xia, Dan Nan Xing, etc.). Acupuncture can resolve Dampness or Phlegm only by regulating the ascending/descending and entering/exiting of Qi in the Qi Mechanism.
Secondly, one must resolve Dampness or Phlegm by regulating the fluid movement, transformation and excretion by the Triple Burner. In my experience, in order to do this, it is necessary to activate all three Burners which means that one should not hesitate to use more points than one would normally use. For example, to resolve Phlegm from the prostate (i.e. Lower Burner), I would use many points from the Lower Burner (listed in previous slide) plus some from the Upper and Middle Burner.
Please note that when we say that we need to “regulate the Triple Burner”, we do not do that by using Triple Burner points necessarily. Many points regulate the fluid metabolism by the Triple Burner and especially points on the Ren Mai: indeed these are the most important ones.

POINTS TO ACTIVATE WATER TRANSFORMATION BY THE THREE BURNERS
- Upper Burner: Du-26 Shuigou, Ren-17, LU-7, LI-4, LI-6, TB-4, TB-6
- Middle Burner: Ren-9 Shuifen, Ren-12, ST-22, Ren-11
- Lower Burner: ST-28 Shuidao, Ren-5, BL-22,, BL-39, SP-9, SP-6, KI-7.

T.B.-4 and BL-64 in combination move Qi in the Triple Burner and activate Water Passages.

NOTE: the three points in blue (Du-26 Shuigou, Ren-9 Shuifen and ST-28 Shuidao) activate the fluid transformation in each Burner. Shui means “water” and those points are therefore “Water Ditch”, “Water Separation” and “Water Passages” respectively. The points in red are strategic points on the Ren Mai that have the same function, Ren-17, Ren-9 and Ren-5 for the Upper, Middle and Lower Burner respectively. As we can see, Ren-9 pertains to both groups of points and that is why this point is such an important point for the metabolism of fluids and a point I would always use to resolve Dampness or Phlegm.
This means that when I resolve Dampness and Phlegm, I do not hesitate to use quite a lot of points to activate all three Burners but giving predominance to the points where the Dampness or Phlegm is situated. For example, if there is Phlegm in the Lower Burner (e.g. prostatic hyperplasia), I would use many points from the Lower Burner but also some from the Middle and Upper Burner. This is an example of such a point combination: Ren-3, BL-22, Ren-5, ST-28, SP-9, ST-40 (Lower Burner), Ren-9 (Middle Burner) and LU-7 (Upper Burner). With variations, this point combination could also be used for Phlegm in the Uterus.