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.

ON GUILT

For all have sinned and fall short of the glory of God 1 Romans 3.23 In the previous Clinical Tip I discussed sadness and grief deriving from loss as a pervasive emotion in Western patients. In this Clinical Tip, I discuss another common emotional cause of disease in Western patients, i.e. guilt. Guilt is a pervasive emotion in Western patients. It is completely missing from Chinese medicine books and one could say that it simply does not exist in the Chinese psyche. It could be argued that guilt is intrinsically related to the Judeo-Christian religions and especially the Christian religion with its concept of “original sin.” I have never seen expressions referring to “feeling of guilt” as an emotional cause of disease in modern or old Chinese books. It could be argued that this is due to the fact that a feeling of guilt is more or less absent in Eastern societies. In fact, the concept of guilt is totally absent in all three major Chinese religions/philosophies of Confucianism, Daoism and Buddhism. Indeed, Confucius did not even believe in the value of punishment for crimes. Fingarette concurs that the concept of guilt is absent in the Analects of Confucius. The Analects do mention the word chi 耻 in several passages but this is shame rather than guilt. Fingarette says: “If we are unaware of the crucial differences in perspective, these texts on chi lend themselves easily to the assimilation of Confucian shame with Western guilt. Although chi is definitely a moral concept, the moral relation to which it corresponds is that of the person to his status and role as defined by li (rituals). Chi looks outward, not inward. It is not, as is guilt, a matter of the inward state, of repugnance at inner corruption, of self-denigration, of the sense that one is as a person, and independently of one’s public status and repute, mean or reprehensible. The Confucian concept of shame is a genuinely moral concept, but it is oriented to morality as centering in li, traditionally ceremonially defined social comportament [behaviour], rather than to an inner core of one’s being.”2 It should be stressed that what concerns us here in dealing with emotions, is not guilt but the feeling of guilt which is totally unrelated to an actual crime or transgression. For example, a person may have committed a crime but feel no guilt at all; conversely, a person may have committed no crime or transgression but feel guilty (which is usually the case in our patients). Guilt (and shame) are considered by some to be “moral” emotions as they bear upon morality. Wollheim says: “The role of the moral emotions is to provide the person with an attitude, or orientation. What is distinctive of the moral emotions is that the attitude is reflexive. It is an attitude that the person has towards himself/herself as a person.”3 Guilt is strongly linked to a sense of self and specifically to a negative sense of self: this is probably an important reason for the absence of guilt in Chinese culture as the self in Chinese culture is not the individualized, inward-looking, psychological self of Western culture, but a socially-constructed self. This may also account for the presence of shame in Chinese culture (related to a social sense of self) and the absence of guilt (related to an individual self). Guilt can manifest in many different ways, e.g.: – Feeling of responsibility for negative circumstances that have befallen oneself or others – Feeling of regret for real or imagined misdeeds, both past and present – Feeling responsible (and guilty) for any negative thing that occurs to members of one’s family or one’s partner – Taking responsibility for someone else’s misfortune or problem. The above are only a few examples of the sort of behaviour induced by feelings of guilt. A feeling of guilt may be due to the transgression of social or religious taboos or from having done something “wrong” which is later regretted. However, a feeling of guilt may also be innate and not related to any specific action. This innate feeling of guilt derives often from upbringing. This latter feeling is indeed the most destructive one. Guilt is self-reproach for some actual misdeeds or an in-born feeling of guilt totally disconnected from any misdeeds. Guilt includes a sense of inadequacy and despair not found in shame. Guilt does not require any particular offence and the doctrine of Original Sin is an example of this. When assailed by a feeling of guilt, a person is one’s own judge and a more ruthless and less reasonable judge than any real judge. Guilt is inwardly-directed and its object is the self; in this sense, it is almost the “opposite” emotion to that of anger as this latter emotion is usually directed at another person. Guilt is based on a moral criteria of having broken a law of morality (real or imagined). The “mythology” of guilt is the doctrine of the Original Sin. The “authority” providing the criteria is absolute and unquestionable. Guilt is a “dark” emotion with no redemption; it is a much “darker” emotion than shame and in my experience, more difficult to “treat” (if that is the right word). As for disharmonies induced by guilt, this emotion can have different effects in different people. First of all, it may lead to Qi stagnation: it affects any organ and especially the Lungs, Heart, Liver and Kidneys. Due to its “dark”, “stagnating” character, the Qi stagnation may cause Blood stasis easily. This Blood stasis may be in any part of the body and any organ but particularly in the Lungs, Heart, Liver and Kidneys. The pulse is Wiry or Firm. Under certain conditions, guilt may also cause sinking of Qi and affects the Kidneys causing some urinary problems or menstrual problems from sinking of Qi. The tongue has a red tip and possibly purple body. When guilt is the emotional cause of disease, the pulse is Wiry or Firm if there is Qi and Blood stagnation. If there is sinking of Qi of the Kidneys, the pulse is Deep and Weak on the Kidney positions, possibly slightly Overflowing on the Heart position and Choppy in general without wave. How does one “treat” guilt? It is possibly the most difficult to “treat”: it is a ‘dark” and deep-seated emotion and that is probably why it easily gives rise to Blood stasis. I generally choose the points depending on the patterns induced by guilt. I generally treat the Heart, Lungs, Liver and Kidneys. Some examples of points used would be HE-7 Shenmen, P-7 Daling, LU-7 Lieque, LU-3 Tianfu, LIV-3 Taichong, KI-4 Dazhong, KI-9 Zhubin, G.B.-13 Benshen, Du-24 Shenting. Of course, possibly with guilt more than any other emotion, a true healing cannot take place without a conscious effort of introspection from the patient with the help of psychotherapy. 1. Holy Bible, New International Version ®. 1984 International Bible Society. Online version www.biblegateway.com [Accessed 2007]. 2. Fingarette H 1972 Confucius - The Secular as Sacred, Waveland Press, Prospect Heights, Illinois, p. 28. 3. Wollheim R 1999 On the Emotions, Yale University Press, New Haven, p. 148.

Clinical Tip of the Day no. 3

A red tip of the tongue is very common. The tip corresponds to the Heart and the Shen and a redness of the tip always indicates emotional stress affecting the Heart: the redder the tip, the more intense the stress. Why is the tip affected and why does it become red? The Heart is affected by all emotions as it houses the Shen that feels them. When we feel angry, anger affects the Liver automatically, but it is the Shen of the Heart that “feels” the anger. Thus, a red tip of the tongue may be caused by any of the emotions, e.g. anger, sadness, grief, worry, fear, etc.

Why does the tip become red? The first effect of emotional stress is some Qi stagnation: when Qi stagnates, it frequently gives rise to Heat and hence the redness of the tip. If, besides being red, the tip is also swollen and has red points, it indicates that the emotional stress is even greater.