Lurking Pathogens 11
Qì level 2: Spleen patterns
In our previous installment, we looked at Lung pathology in the Qì level. We’ll continue on here with the Spleen patterns.
Spleen Shō
The Spleen shō is divided into two subtypes: Spleen-Triple Burner and Spleen-Pericardium. Spleen-Triple Burner addresses the Qì level itself; since the five-phase pairing is Earth and Fire, Triple Burner is substituted for its Fire-phase Yīn partner Pericardium. Though this would seem to violate the JMT principle of combining Yīn organs for tonification, Triple Burner, though a Yáng organ, is the avenue for the Yuán Qì (per Nán Jīng 66, see Unschuld, 1986) and thus contains essence Qì though it does not store it; it also contains the organs which store the essence, i.e. the Yīn organs. The importance of the Triple Burner in LP theory was noted in earlier in this series and thus it is our position that it merits inclusion as a subject of root treatment.
Spleen-Pericardium, which is the Spleen shō pairing proper, is seen then as a transitional pattern between the Qì and Yíng levels. It represents one route into the Yíng level, more associated with dampness and phlegm, The other route will be discussed in the Yíng level section following.
Spleen-Triple Burner (Sān Jiāo)
Pathogens of a damp nature tend to directly attack the Spleen or quickly pass through the upper burner to the middle burner. Once lodged in the middle, they disrupt the central Qì dynamic of ascending (raising the clear) and descending (downbearing the turbid). This results in a buildup of turbid fluid which spills over into the flesh and floods the spaces between the tissues, the zone of the Triple Burner and membrane source. Symptoms associated with this include fatigue, low grade fever, heaviness and body aches, swollen tongue with thick coating and slippery or soggy pulses. Damp skin eruptions such as miliaria may occur. In this scenario, restoring the Qì dynamic is of primary importance. The Spleen and Stomach work together to ensure proper ascending and descending, and the Triple Burner governs entering and exiting (Maciocia, 2015). The turbidity combined with depressive heat may cause the formation of phlegm, further complicating the picture. Because the Triple Burner belongs to the Shàoyáng division, ribside pain, bitter taste and irritability may be seen. Acrid and aromatic agents are used in herbal medicine to cut through turbidity, and bitter substances can dry dampness and restore the Stomach’s downbearing.
Spleen points to rectify the Qì dynamic include SP-3 (taì bái) and SP-4 (gōng sūn) (Ellis et al., 2004); the former is more suited to presentations with significant deficiency, whereas the latter is better used for conditions of excess. SP-8 (di ji), as mentioned in the previous section, is a useful choice to restore the Qì dynamic as well. SP-5 (shāng qiū), with its damp-transforming and acrid actions, works well for dampness in the muscles inhibiting bending and stretching, as it is a jing-river point which binds the meridian sinew. SP-9 (yīn líng qúan) is well-known for its actions in draining damp and transforming phlegm.
Maciocia (2006) gives TB-4 (yáng chí) and TB-6 (zhī gōu) as points to affect the membranes; TB-6 (zhī gōu) especially is a point that is known to clear the Triple Burner and restore the Qì dynamic (Maciocia, 2006). TB-5 (wài guān) is the master point for the Yángwéi Mài, the Extraordinary Vessel linking the Yáng functions of the body; in combination with GB-41 (zú lín qì), it opens the Dài Mài to regulate ascending and descending functions throughout the body. TB-10 (tiān jǐng) is an often overlooked point which is indicated for treating phlegm disorders.
Points for the membranes, such as Ren-6 (qì hǎi) and Ren-15 (jiū wěi), or BL-51 (huāng mén) may prove useful in treatment. For more Shàoyáng division presentations, GB34 (yáng líng quán), GB-38 (yáng fǔ), and GB-40 (qiū xū) can all be considered. GB-34 (yáng líng quán) is frequently combined with TB-6 (zhī gōu) to clear heat from the Shàoyáng. GB-38 (yáng fǔ), the Fire point, likewise can be used for heat. GB-40 (qiū xū) clears pathogens from the midstage, i.e., Shàoyáng (Ellis et al., 2004).
Points: Root treatment: SP-3 (taì bái), SP-4 (gōng sūn), SP-5 (shāng qiū), SP-9 (yīn líng qúan); TB-4 (yáng chí), TB-5 (wài guān), TB-6 (zhī gōu), TB-10 (tiān jǐng).
Additional points: Ren-6 (qì hǎi), Ren-15 (jiū wěi), BL-51 (huāng mén), GB-34 (yáng líng quán), GB-38 (yáng fǔ), GB-40 (qiū xū), GB-41 (zú lín qì).
Spleen-Pericardium
In the proposed model for treating LP, the Spleen-Pericardium shō is related to a scenario in which the buildup of turbidity in the Triple Burner begins to cause the formation of phlegm which blocks the Pericardium, causing disruption of the normal function of the Heart to communicate with the other Zàng and even with the outside world. Depression of Qì and phlegm can lead to heat formation with may present as irritability, vexation, anxiety and so forth. Sleep may be interrupted, or the patient may be somnolent. In short, the picture of the distressed Spleen is complicated by alterations in the patient’s psychoemotional function. As the heat builds up, there may be growing signs of heat in the Yíng level, including tongue reddening which begins at the tip and leads to a darker or more crimson coloration over the rest of the tongue. The coating may be thick, and as the pathology progresses it may become dry before it begins to recede. As the heat penetration increases, there may be purplish spots on the skin, and possibly bleeding of bright or dark red blood, including heavy periods or blood in the stool. The pulse becomes more rapid and slippery.
At this point, the phlegm must be transformed, with acrid and salty tastes. If the heat becomes more prominent, bitter agents are employed. As with the previous subtype, the Qì dynamic must be restored.
As before, SP-4 (gōng sūn) is important to rectify the Qì dynamic, and in combination with PC-6 (nèi guān), it activates the Chōng Mài or Sea of Blood, along with the Yinwei Mai, often used for psychoemotional indications. SP-10 (xuè hǎi) may be used to clear heat from the Yíng level or the Xuè level and can be especially indicated in cases where there is bleeding or where purplish skin lesions occur. PC-4 (xī mén) clears the Yíng and cools blood as well as recitifies Qì. PC-5 (jiān shǐ) sweeps phlegm from the Pericardium. PC-3 (qū zé) cools heat but its salty nature can also help clear stuck phlegm. PC-8 (láo gōng) clears fire. PC-9 (zhōng chōng) can be bled to cool blood; in this, its astringent, retaining nature can be seen to be overruled by the physical removal of a small amount of bleeding.
Points: Root treatment: SP-4 (gōng sūn), SP-10 (xuè hǎi); PC-3 (qū zé), PC-4 (xī mén), PC-5 (jiān shǐ), PC-6 (nèi guān), PC-8 (láo gōng), or PC-9 (zhōng chōng) depending on the manifestations.
Next time, we’ll move on to pathology and acupuncture treatment at the Yíng level.
Note: this newsletter is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.
References
Ellis, A., Wiseman, N., Boss, K., & Cleaver, J. (2004). Fundamentals of Chinese acupuncture (Revised ed). Paradigm Publications.
Maciocia, G. (2006). The channels of acupuncture: Clinical use of the secondary channels and eight extraordinary vessels. Elsevier Health Sciences.
Maciocia, G. (2015). Foundations of Chinese Medicine: A Comprehensive Text (3rd Edition). Elsevier Health Sciences (US).
Unschuld, P. U. (1986). Nan-ching: The classic of difficult issues: with commentaries by Chinese and Japanese authors from the third through the twentieth century. Berkeley: University of California Press.