Lurking Pathogens 5
A convergence of models
At this point, we’re going to shift to exploring a point of convergence between Warm Disease theory and the Nán-Jīng-based Five Phase Japanese Meridian Therapy (JMT) that we have written at length about in the past. This is taken pretty much straight from my doctoral thesis, which was a continuation of the work I started in my NAJOM article during the pandemic (Hayden, 2021).
Four levels and four shō: a convergence of models
The first point of convergence in the acupuncture treatment of LP involves the four shō model (details of which can be found here) and the Four Levels system used in the Warm Disease school. Each of the Four Levels is identified with pathogenic infiltration of specific organs, as shown in Table 1.
There is some overlap between levels associated with the Lung; the upper respiratory passages and skin correlate to the Wèi level, where the Lung viscus is involved with the more yáng aspect of the Qì level.
Pathodynamics in warm disease
As we discussed in an earlier post, the pathogenic penetration in warm disease tends to move inward from Wèi to Qì, Qì to Yíng, and Yíng to Xuè. Depending on the pathogen, the transmission may happen more quickly, as in the case of dampness, which passes through the Wèi level or directly attacks the Spleen in the Qì level (Liu, 2005). The normal response of the body in the Wèi and Qì levels is to employ the Lung’s diffusing, outthrusting function or the natural upbearing movement of the Spleen to vent the pathogen upward and out. Alternatively, it will utilize the Lung’s downbearing function and its governance of the waterways with the assistance of the Stomach, Intestines and Bladder to drain the evil downward.
If the pathogen penetrates to the Yíng level, measures must be taken to vent it back out to the Qì level, with its multiple routes of elimination. This becomes rather more difficult the deeper the evil Qì penetrates, and if the heat falls deep into the Xuè level the treatment focuses more on supplementing Yīn to counteract the possibility of Yīn or Yáng collapse.
LP enter through the same route as more ordinary seasonal pathogens, the major difference being the response of the Zhèng (correct or upright) Qì. If the Zhèng Qì is unable to mount a swift defense, the pathogen will slip in virtually unopposed, and lodge either in the Qì or Yíng levels, where it will create a subclinical depressive heat scenario which may last for some time until the body is challenged by a new stressor either from without or within. At that time, the treatment principle remains the same: if the pathogen is in the Qì level, one must dislodge and eliminate it, and if it is in the Yíng level, one must push it back out to the Qì level.
Nan Jing 69, LP pathodynamics, and four shō
The reader may recall the normal course of the generating (sheng) cycle of the five phases, shown in Figure 1. Here, the Heart as Yīn Fire phase organ has been replaced by the Pericardium, as the latter is the Yīn Fire phase organ normally treated in JMT.
Figure 1
The typical route of entry and passage of warm disease pathogens including LP inward from one of the four levels to the next can be seen to move contrary to the generating cycle, as mentioned in Nán Jīng 69 (Figure 2). The four levels have been superimposed onto the five-phase diagram alongside the Zàng organs they represent.
Figure 2
The direction of pathogenic elimination corresponds to rectification of the generating cycle (Figure 3). The routes of exit from the body are via the Qì level, specifically through draining the Fǔ organs of elimination (Large Intestine, Bladder), or the Wèi level, outthrusting (tòu) from the còu lĭ or surface striations. The sequence is interrupted between the Lung and Kidney as the schematic is intended to show a one-way route from the depth to the surface, rather than an endless cycle.
Figure 3
Treatment with acupuncture can make use of the JMT four shō schematic to move the pathogen outward through the series of levels and their associated Zàng organs in the direction of elimination. In this case, a five shō structure is restored from the original Nán Jīng 69 model, employing the Fire phase but using the Pericardium meridian rather than the Heart (Figure 4).
Figure 4
In Figure 4, the Kidney (KD) shō is shown with two aspects, Yīn and Yáng. In its Yīn aspect, the Lung may be used to enable mobilization of the body’s Yīn via the Rèn Mài by use of its master point LU-7 (liè quē) in conjunction with its coupled point KD-6 (zhào hǎi) to nourish and protect against Yīn collapse. In its Yáng aspect, the Kidney may be employed to mobilize the body’s Yáng Qì and regulate the surface in cases where the patient suffers deficiency and the Lung itself is not strong enough to eliminate the pathogen from the Wèi level. Both aspects, as well, may be used to supplement the essence and boost the defensive Yáng to protect the body from future pathogenic invasion. More details will appear as we continue.
For clarity, a rearrangement of the diagram is shown in Figure 5. This image gives a view of the process of pathogenic invasion and elimination vertically from surface to depth and vice versa.
Figure 5
In harmonizing the two models, there is some overlap between the levels and shō. For example, the Wèi level primarily involves the Lung, where the Qì level involves both Lung and Spleen. The Spleen shō, which includes treatment of the Pericardium, may be seen as transitional between the Qì and Yíng levels, either to prevent further pathogenic penetration inward or to vent from the Yíng to the Qì level. The Qì level is particularly complex as it involves the Fǔ organs and pathways of elimination; variations on addressing its myriad disturbances will be expanded upon in the following posts.
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
Hayden, R. (2021). Five phases, four levels, three burners: Building resistance in the pandemic era. North American Journal of Oriental Medicine. 27(83). 5-6.
Liu, G. (2005). Warm pathogen diseases: A clinical guide. Eastland Press.
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.