Lurking Pathogens 9
Cartography: Wèi level
Cartography: Mapping the territory
[Need some review? Click on the hyperlinks for a the previous posts on the concept of shō, on the four levels, and on the convergence model of the two.]
One possible map for the harmonization of the four levels model with the five shō is outlined here. The five shō have been extended in some cases to better align with the four levels and to include some important clinically-observed patterns (Figure 1). It is important to remember that this is not an absolute; it is the map we have developed and have been working with in the clinic, and will doubtless be refined with time.
Figure 1: Four-level and five-shō harmonization map
The patterns and their corresponding levels will be the subject of the next several posts, starting with the Wèi level. It is important to note that the point selection may vary with the presenting circumstances, for example the nature of the pathogenic factor involved (warm-heat, dry-heat, summerheat-heat or summerheat-damp, etc). The points given are illustrative of the basic treatment principles of the particular level in which the pathogens are found.
Wèi level patterns
Lung [Yáng]
In initial stage of seasonally-contracted warm pathogen diseases, the Wèi level corresponds to an acute exterior excess heat / wind-heat or dry-heat pattern in most TCM texts. The terrain consists of the Yáng portions of the Lung system: nose, throat, upper bronchi, and the surface, i.e. the skin and body hair. It is typically treated with cool acrid surface-relieving formulas such as Sāng Jú Yǐn (Mulberry Leaf and Chrysanthemum Decoction). In terms of Lurking Pathogens (LP), it is not a pattern which shows up much by itself because the pathogen is able to enter this zone without provoking the typical symptoms of fever with slight chills, sore throat, dry cough, and floating rapid pulse. It may present at the end of a course of therapy if the LP is outthrust to the Wèi level; if so, it would signal the final campaign of opening the surface to vent the pathogen out of the body. Another possibility is that it would present at the very beginning as a trigger event that causes the LP express. In the latter case, one would see interior heat or damp heat signs (in other words, Qì level signs) presenting along with the exterior manifestations.
The pattern has here been named Lung (Yáng) as the essential method would be to treat the Lung to open the surface with lifting and venting, along with whatever Yáng meridians (for example, Small Intestine, Bladder, Large Intestine, Triple Burner) one might wish to employ depending on what symptoms manifest. In cases of fever, dispersing sanshin can be used especially on the upper back in the BL10 (tiān zhù) to BL 13 (fèi shū) area. Chinetsukyū can also be useful on the shoulders and upper back.
Points: LU-7 (liè quē); Yáng meridian points such as SI-3 (hòu xī), BL-62 (shēn mài), LI-4 (hé gǔ), LI-11 (qū chí), TB-5 (wài guān); GB-20 (fēng chí), BL10 (tiān zhù) to BL 13 (fèi shū) area with contact or superficial needling or dispersive sanshin.
Kidney [Yáng] Shō
Though the Kidney is found in the Xuè level, it has both a Yīn and Yáng aspect which relates to not only the fluids and essence, but the Wèi Qì as well (Maciocia, 2015). The link with the Lung on the generating cycle demonstrates this relationship. Thus the Kidney shō in its Yáng aspect can be effectively applied in cases where the pathogen is at the Wèi level but the patient has an underlying Kidney deficiency which makes it difficult to achieve complete outthrusting. Supplementing the Kidney gives the Zhèng Qì an extra boost from the deepest level of the body. For this, KD-7 (fù liū) is an ideal point as it is the metal point, resonant with the acrid flavor, and the standard mother-child tonification point. Though sources differ on whether it is more of a Yáng- or Yīn-supplementing point, its fluid-regulating indications give it a strong Yáng-tonic reputation. It is also classically paired with another metal-phase point, LI-4 (hé gǔ), to regulate sweating, thus it can be seen as the Kidney meridian point most connected with the surface. Maclean et al. (2018) notes its importance in treating lingering pathogenic factors. Its name, “Return Flow” (fù liū) can be seen as referring to its fluid-metabolism function, but in the case of LP, it may also indicate the final piece in returning the proper flow of the generating cycle itself.
There are several options for pairing with the Lung meridian. First, the standard mother-child combination with LU-8 (jīng qú), metal upon metal, with the implication of emphasizing the venting nature of the acrid flavor, is perhaps an obvious choice. LU-7 (liè quē), with its exterior releasing indications, is another. LU-5 (chǐ zé), the water point, is the choice for many JMT practitioners (Shudo, 1990) for treating the standard Kidney shō. With its salty downbearing nature, and its position as the he-sea point, the most absorptive of the five-shu categories, it makes for a counterweight to the lifting, effusive action of KD-7 (fù liū). The pairing, with LU-5 from the surface to the depth and KD-7 from the depth to the surface, can be seen as restoring the ascending-descending Qì dynamic to the entire body. Other points that have been found useful in this pattern are master points for Dū Mài and Yángqiāo Mài, as well as Dū Mài points on the upper thoracic spine and vertex.
Points: KD-7 (fù liū); LU-5 (chǐ zé), LU-8 (jīng qú), or LU-7 (liè quē); SI-3 (hòu xī), BL-62 (shēn mài); DU-10 (líng tái), DU-11 (shén dào), or DU-12 (shēn zhù); DU-20 (bǎi huì), or DU-22 (xìn huì).
As the series continues, we will move to the Five-Phase patterns associated with the Qì 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
Maciocia, G. (2015). Foundations of Chinese Medicine: A Comprehensive Text (3rd Edition). Elsevier Health Sciences (US).
Maclean, W., Lyttleton, J., Bayley, M., & Taylor, K. (2018). Clinical handbook of internal medicine: The treatment of disease with traditional Chinese medicine. Eastland Press.
Shudo, D. (1990). Japanese classical acupuncture: Introduction to meridian therapy (S. Brown, Trans.). Eastland Press. (Original work published 1983).
Shudo, D. (2003). Finding effective acupuncture points (S. Brown, Trans.). Eastland Press.