Clarification of Oriental Medicing medical theory and practice continued: Full and Empty do not exist on their own but are relative and interrelated
By Markus Grasser MRSS(T)
Thank you to all of you who responded last autumn to my article (I DID ANSWER PROMPTLY MYSELF BY WRITING THIS ARTICLE BUT IT WAS NOT PUBLISHED TILL NOW). The main criticism to what I wrote seemed to center around the belief that Kyo and Jitsu are more fluid, flexible, relative and interrelated terms of reference to use when diagnosing compared to ‘fixed’ TCM patterns and concepts such as Full or Empty, ‘which can exist in and of themselves’.
I would like to put my view across that this is a grave misrepresentation of TCM and its terms such as Full and Empty and its use of patterns. I would like to show that just like shiatsu diagnosis and treatment, TCM is vibrant and responsive to subtle changes in the moment and knowing this can deeply enrich our treatments.
As some of the reponses to my article related to “TCM” in it’s limited “post cultural revolution version” i will from now on use the terms Chinese or Oriental Medicine (CM/OM) to avoid such confusion.
In the human body, when it is out of balance, Chinese medicine usually diagnoses two or more co-existing patterns. All of the patterns are seen, in their most simple form, as either excess or deficient. In my last article I wrote that these patterns directly correspond in a palpatory, energetic way to the kyo and jitsu qualities found in the relevant meridians.
So if a particular pattern combination reveals itself to be the most empty in the body and the most full this will also be what we find under our hands. However this does not necessarily mean that these are the two meridians that we treat. What we decide to treat needs to be decided at the moment using our palpatory skills, the other 3 pillars of diagnosis, our intuition, personal style and trial and error etc. However, when we do select what we feel to be the appropriate, reactive kyo/jitsu combination we will still be able to find that these full and empty qualities mirror the fullness and emptiness of one or more of the CM patterns we have for this person, though it maybe not always be so obvious, especially with a limited understanding of CM and how patterns manifest.
So, I do agree with those who wrote in to the magazine on this point. What I disagree with is the argument that states that the energetic configuration of the patterns do not directly correspond to the tone of the meridians and vice versa (see my September article).They do indeed correspond but this is only the beginning of how we find which are the most relevant meridians to treat.(see future article on Choosing a Treatment Principle) Any CM practitioner worth their salt will choose from amongst an often complex array of pattern information what they think to be the most ready, effective point of intervention.(For some guidelines see Maciocia “The Foundations Of Chinese Medicine” under “Principles of Treatment” and “Ben and Biao” (root and manifestation) especially under multiple roots and manifestations, ch.35)
WHAT I WANT TO SHOW IN THIS ARTICLE IS HOW FULL AND EMPTY DO NOT EXIST ON THEIR OWN IN OM BUT JUST LIKE KYO AND JITSU ARE RELATIVE AND INTERRELATED.
(ANDREW !: ICHANGED IT TO BIG AND BOLD AS THIS HEADING SEEMS EVEN MORE IMPORTANT TO ME THAN THE OTHER ONES WHICH ARE SUBHEADINGS !.O.K ?)
When I first began to study shiatsu I too believed that CM was a fixed, clumsy way of diagnosing the living, changeable energy under my hands. I enjoyed feeling how the kyo and jitsu configuration changed not only from week to week but throughout the session under my fingertips. (From reading the responses to my article I think all of us can relate to the excitement of this alive, in-the-moment feeling of giving Shiatsu)
So I started to deepen my understanding of Oriental Medicine because I wanted to understand more about the interrelationships that seemed to reveal themselves so strongly through the various kyo and jitsu findings and how they could change over time.
Inspired by my hands-on shiatsu experience i was not satisfied by the way many “TCM” books oversimplified CM and/or presented patterns in an isolated manner and i knew deeply that there was more to it than it may seem to some at first. Thus i did not give up and searched until i found all that richness i knew from direct touch mirrored in the classical approach.
From studying with various teachers and experienced practitioners as well as more advanced books, it became clear to me that:
- Not everything fits into a beginners book but deeper understanding of CM can be found in more advanced books.
- There are many aspects of understanding and practice that may well be even mainstream Oriental Medicine but nevertheless are not necessarily pointed out in books yet are implicit/pointed out in the personal teachings and the practical treatment records of senior practitioners.
- That Oriental Medicine is much, much more extensive than the simplified “TCM” version we often encounter in the West.
A word about patterns
You do not need to have all the signs and symptoms of a particular pattern to diagnose it as such. Thus different people with the same named pattern may have quite different signs and symptoms. Also you will find many more signs and symptoms that may not be written about in basic textbooks or anywhere else, but nevertheless are expressing the particular energy being impaired.
The most important thing here to me is to see how exactly a particular energy is out of balance in each particular person. The more we can get a direct sense of the energetic current (rather than just looking at the signs) pertaining to the various channels/organs being out of sink the more individual the treatment will be.
Thus, patterns are not fixed, but about how a particular energy ( e.g. the upwards rising life asserting energies of the Liver) unfolds or doesn’t unfold (e.g. tight inner thighs and tense diaphragm.).
FULL AND EMPTY ARE RELATIVE AND IN RELATIONSHIP TO EACH OTHER:
It has been suggested in the last newsletter that this was not the case and that relativity and interrelatedness actually were the characteristics of Kyo and Jitsu only.
Also it was written that Kyo and Jitsu are based on Yin and Yang implying to me as a reader that Full and Empty were not.
And thirdly that Full and Empty can exist in and of themselves.
But if you study the usage of patterns in Oriental Medicine, you can see that patterns are often paired up to describe very intimate, changeable interrelationships with each other, which reveals the VERY HEART OF ORIENTAL MEDICINE:
Rather than diagnosing just the single parts of the person it is all about interrelationship.
Full and Empty are based on Yin and Yang and therefore are characterized by the very essence of Yin and Yang which is their relativity and interrelatedness.
This is very clearly described in Giovanni Maciocia’s “Foundations of Chinese Medicine” under “Yin/Yang”.
The same idea is continued under “5 Elements” (I WANT TO POINT OUT THAT THE ABOVE IS THE VERY ESSENCE OF THE 5 ELEMENTS OR MORE OBVIOUSLY ALSO CALLED THE 5 PHASES !. IT IS THEIR FLUIDITY, CHANGEABILITY,INTERRELATEDNESS AND RELATIVITY THAT ARE THE VERY HALLMARKS OF THIS SYSTEM. THAT IS EXACTLY WHAT THE “SHEN/GENERATION”,”KO/CONTROL” AND THE COSMOLOGICAL CYCLES ARE ABOUT. BUT AS THIS IS SO OBVIOUS WITH THE 5 ELEMENTS I WILL NOT GO INTO DETAIL IN RELATION TO THEM !), “Yin Organ Interrelationships” as well as “The Transformation of Qi”.
Thus there are many Full/Empty interrelationships that are clearly described in basic textbooks. E.g.:
Kid Yin xu/Liv Yang Rising
Kid Yin xu/Heart Fire
SP Qi xu/Phlegm in the Lungs
Liv Qi Stagnation/Sp Qi xu
Etc., etc…….
This way of understanding patterns is clearly spelt out in Shudo Denmei’s “Meridian Therapy”(p.30):
“Excess can thus occur……in response to deficiency….(this) is called reactive excess. The concept of deficiency and excess in the framework of the 5 phases is easy to understand using the analogy of a seesaw. When the amount of qi in two phases is equal, the seesaw is level and there is no deficiency or excess…………generally, for every excess in one meridian there is a corresponding deficiency in another.”
Dynamic and Changing Patterns
In practice the above patterns are often closely interwoven and they can change their relative proportions from week to week and even within a session .
In treatment the most reactive combination of channels /patterns can also change from one week to another. E.g. the focus in one treatment could be KID Yin Xu and Liver Qi Stagnation (manifesting e.g. as KID kyo and GB jitsu) but can become Kid Yin Xu and Heart Fire in the next (e.g. KID Kyo/ SI Jitsu). This does not necessarily mean that the Liver Qi stagnation has disappeared but only that this week the focus on KID/H maybe more appropriate.
And this will be reflected in what we palpate on a daily basis……
EVEN IN THE MOST JITSU PATTERNS IT IS IMPORTANT TO TONIFY EVEN IF THIS IS NOT NECESSARILY SPELT OUT ALL THE TIME
In terms of Chinese Herbal Medicine it is interesting to see that even a prescription that is indicated for “pure” Liver qi stagnation without deficiency such as ”Chai Hu Shu Gan San” translated as “Course the Liver decoction” includes a major Blood/Yin tonic in up to twice the dose of the Liver Qi moving “emperor” herb.
To me this clearly shows the applied wisdom of the principle of tonifying whilst dispersing, acknowledging that very Kyo/ Jitsu relationship even in so called “fixed isolated” patterns such as Liver Qi Stagnation. One would never just use purely moving herbs.
So, in many instances even when it is said that the action of a prescription is focused on a certain pattern, the herbs used will actually address other interrelated patterns as well and this includes the relationship of full and empty even if this is not necessarily spelt out. It just is an implied part/art of treatment.
Many, many examples of this principle can be found in action even if you sometimes have to look behind the obvious.
PATTERNS CAN BE VERY SUBTLE WITH DIAGNOSES RELYING ON FINE TUNED PALPATION
For example, with regards to the above point a), in Macioca’s “Practice of Chinese Medicine” he expounds in much more detail relationships he had not even mentioned in his “Foundation of..” For instance, in the relationship of Liver Yang rising to Lu Qi Xu in the treatment of headaches (p.23) He writes that if there is Lung Qi deficiency this will contribute to Liver Yang rising. In terms of the 5 elements this is called “Metal not controlling Wood”. He points out that treatment of the Lungs is indicated even in the absence of other Lu signs and symptoms purely based on the weakness of the Lung pulse. He does not talk about other palpatory findings but I think it would be legitimate to add, from a whole body palpation point of view, the client would reveal a Kyo Lu diagnostic areas as well as weak Yu/Bo/Source points and Channel.
I think this is a very important example of how even in the absence of big, obvious signs and symptoms but solely palpatory ones, it is recommended to support the Kyo.
It does not have to be spelt out in every excess pattern that if there is Lu xu, we would tonify the Lu, if Kid Xu, ton the Kid etc…. in Oriental Medicine this is just implied!
This is clearly pointed out in the Japanese Meridian Therapy School. See e.g. Denmei (see above).
Other Important Relationships
Other examples are abundant e.g. in Macleans “Clinical Handbook Of Internal Medicine”. He also clearly shows the importance of treating the whole person and he also elucidates many more important interrelationships such as:
Kid Yin Xu/Liv Qi Stagnation
Kid Xu/Stagnation of Lu Qi in the chest
Kid Xu/Liv Fire
Sp Qi Xu/ Liv Qi Stagnation
Lu Qi xu/Liv Qi Stagnation
Etc.etc.
However it is important to realize that any number of combinations and proportions of patterns are possible and these are merely the most common relationships. And again as I said in my introduction, though these patterns will embody themselves directly in the meridian system, the choice of patterns to work, is another ball game.
INDIVIDUALLY CREATED ACUPUNCTURE POINT SELECTIONS WILL ALSO REFLECT THE UNDERSTANDING OF THE INTERRELATEDNESS OF FULL AND EMPTY EVEN IF THIS IS NOT ALWAYS SPELT OUT
As for acupuncture, the common misconception (but unfortunately also often a reality!) about treatment is that only those points suggested under the various patterns are used.
Yet Maciocia writes in his “The Practice Of Chinese Medicine” in appendix I that: “ the art of acupuncture consists in selecting the right points and combining them in a harmonious way. The lists of acupuncture points which have been given for each pattern in this book are not formulae or prescriptions; they merely set out possible points from which to choose. For each treatment, some points have to be selected ……..in a meaningful way.”
And this, as he writes, brings into play the channel sytem as a whole !,”…. balancing yin yang, left right, top bottom, rising and descending qi, arms and legs, channels from different elements “etc etc.
For example in the treatment of Liver Fire, Kid 6 or SP 6 will commonly be included IN BASIC TEXTBOOK’S “POINTLISTS” acknowledging that very Wood Excess /Water Deficient relationship, even though some people think that in CM Liver Fire is seen as a pure excess pattern. (p.28 “The Practice of…”) and only treated by clearing fire.
AND AGAIN IT GOES WITHOUT SAYING: IF THE LUNGS ARE KYO: TONIFY THE LUNGS…IF THE SPLEEN IS KYO TONIFY THE SP ETC.
THIS DOES NOT HAVE TO BE INCLUDED UNDER LIVER FIRE !
TCM Patterns can look as if they can exist in and of themselves but in practice will be treated as relative and interrelated
This understanding of the interdependence and interrelationship between patterns is practically used all the time but often only the building blocks are presented in the basic literature, leaving a fragmented impression for many students.
E.g.: in a book certain points, and herbs may be listed for a certain pattern, yet it is simply assumed that the experienced practitioner will create a complete and harmonious treatment by addressing the whole energetic imbalance! (I.E. ALSO ANOTHER OR OTHER INTERRELATED PATTERNS)
A great historical example of somebody who always spelt out the intricate interrelationships of meridians and organs, highlighting that no patterns exists on their own was Li Dong Yuan, the great 12th century chinese doctor, author of the famous “Pi Wei Lun” (Treatise on the Spleen and Stomach).
The whole book is abundant in examples of this and famous for it.
On the subject of Liver Qi Stagnation in the commentary on the text it quotes Li (p.56) as saying “in case of Qi Stagnation, to administer sweet flavoured medicinals”. Bob Flaws, the translator, goes on to explain that ”this is because the Nei –Jing (“Classic of Difficulties”) says that the sweet flavour is relaxing and qi stagnation is commonly associated with tension. This line also helps underscore the clinical reality that one rarely sees pure qi stagnation as described in undergraduate textbooks. Because of the interrelationship between the spleen and liver, supplementing the spleen in the case of liver depression (qi stagnation) does not typically cause unwanted side effects but rather renders the coursing of the liver and rectification of the qi all the more efficient.”
AS I SAID, THE WHOLE BOOK IS FULL OF EXAMPLES BUT MAYBE THE CHAPTER THAT PUTS IT THE CLEAREST IS CH.2 OF BOOK TWO.
THIS IS WHERE LI DONG YUAN DEFINES YIN FIRE, WHICH IS A PATHOGENIC UPWARD STIRRING OF THE MINISTERIAL/LIFE GATE FIRE.
IN THE COMMENTARY ON P.82 IT SAYS “ LI IDENTIFIES FIVE DISEASE MECHANISMS WHICH CAN GIVE RISE TO YIN FIRE (….).THESE ARE 1) SPLEEN QI VACUITY 2) LIVER DEPRESSION (QI STAGNATION) 3) DAMP-HEAT 4) YIN-BLOOD VACUITY AND 5) STIRRING OF MINISTERIAL FIRE. ALTHOUGH I MUST EXPLAIN THESE ONE AFTER THE OTHER IN A LINEAR FASHION, THE READER SHOULD UNDERSTAND THAT THESE FIVE DISEASE MECHANISMS ARE ALL MUTUALLY INTERDEPENDANT !.THIS MEANS THAT ANY ONE OF THESE MECHANISMS CAN RESULT IN THE CREATION OF ANY OF THE OTHERS. BECAUSE OF THIS, REAL-LIFE PATIENTS DO NOT TYPICALLY EXHIBIT ONLY ONE OR ANOTHER OF THESE FIVE, BUT RATHER THREE,FOUR OR ALL FIVE AT ONE TIME.”
WHAT FOLLOWS(in the book) IS A VERY DETAILED DESCRIPTION OF THIS VERY MUTUAL INTERDEPENDANCE,RELATIVITY AND INTERRELATEDNESS OF ALL THE PATTERNS, WHICH BRINGS US BACK TO THE VERY TITLE OF THIS ARTICLE !
TO SUMMARIZE
TCM patterns may be described initially by themselves to facilitate an understanding of the various parts just like when we first learn meridians as separate lines in the body. But if we are to benefit from this ancient and time tested tradition, they have to be seen in the context of the whole and thus their fluidity, relativity and interrelationships, the hallmarks of Chinese medicine, become not only more and more understandable to us intellectually, but we can also begin to integrate this knowledge with what we find intuitively and in our direct experience of our clients on the futon.
CBShiatsu and Classical Diagnosis
By Tim Mulvagh MRSS(T), MBAc, MRCHM
CBShiatsu relies on a holistic view of the patient. This includes an understanding and appreciation of their past history, their current circumstances, environment and activities, emotional state, current condition, complete palpatory diagnosis and so on.
A central tenet of CBShiatsu is that diagnosis of any one part of the body, be it the hara, the channel, a diagnostic point or the tongue, is only truly meaningful within the context of an understanding of all the other diagnostic indicators. That is to say that to feel the hara or to view the tongue by themselves - although the entire energy system is said to be reflected in each of these areas - is not in itself the whole picture. Secondly, the very process of using all the main diagnostic indicators takes the practitioner through the landscape of the patients body-mind. Classical diagnosis is like a guided tour of the patient and when done by a centered practitioner, is nothing less than a treatment in itself because it guides the practitioner´s energy to "the place" where the treatment is needed. This is very profound and is one of the reasons for the great variety of diagnostic skills found in oriental medicine. If on the other hand one relies on one indicator alone, say the hara, one may well find that the Spleen is kyo and the Small Intestine is jitsu and this of course will guide the practitioner to focus on these channels in general, but unless extremely gifted and experienced, it would be easy for a peactitioner to underestimate the significance of what they are feeling and indeed pass over or even miss altogether "the place" to treat.
In terms of classical diagnisis one might say that the process of diagnosis as impiortant as the diagnosis itself. I am reminded here of the Aboriginal practice of the Walk-about. Here the person learns how to walk their world; it is considered a deeply spiritual practice. Through the Walk-about a person not only learns about the environment but they deepen their connection with that environment until some kind of unity and harmony is reached between that person and their world. The Walker and the Walked become one, both supporting and fulfilling each other. The same is true of classical diagnosis, the practitioner, through diagnosis, "walks the world" of the patient and as he walks he develops a profound connection them. The therapeutic connection is made from the harmony created between the two, through which the healing process arises. If we only use one diagnostic indicator we may well be able to get a glance of the whole but we may miss the opportunity to truly get in touch with its entirety.
Classical diagnosis arises out of the profound undertanding of energetic anatomy and physiology described in the classics of oriental medicine. It calls on the practitioner to use all of the senses in its process. Its is said to have "four pillars" that of looking, listening and smelling, asking and of course palpating. The sense of taste is considered within the context of the five flavors (pungent, sweet, bitter, salty and sour), which is important when considering diet and herbal medicine.
The depth, development and seriousness of the patient's state is understood by the practitioner through making the journey of diagnosis and treatment arises spontaneously from this process.
It is not enough just to understand what is happening, nor is it enough to just feel what is happening, the trick is - and I thinks its the same with most things in life - is to actually "be" there, fully present in the right place at the right time. Classical diagnosis will take you the practitioner to "the place" of treatment and it is in this way our diagnosis, experience, action and treatment unite.
