1

Conduits of Consciousness: the Orifices of the Heart in Chinese Medicine Written by Stephen Higgins

A thesis submitted to the faculty of the National College of Natural Medicine in partial fulfillment of the requirements for the degree of Master of Science in Oriental Medicine Stephen Higgins Completed During the 2011-2012 Academic year

2 Abstract:

This work creates a context for the concept of the orifices, qiao (), in Chinese medicine. We presentto our knowledge for the first time in Englisha discourse on the various classical (and some modern) Chinese sources that discuss this concept, and reveal how these conduits of consciousness were conceptualized by ancient Chinese philosophers and physicians. We further discuss the function of the orifices in physiology, their dysfunction in pathology, and also touch upon various herbal treatments that address pathologies of the orifices, with a primary focus on the orifices of the heart (). While this work does represent a seminal English reference on the orifices, it merely serves as a preliminary discussion regarding this topic. Further research must be conducted in order to fully address the topic of the orifices, and forthcoming publication of this clinically-invaluable research can be expected.

3 Acknowledgements: My Thesis advisor, Dr. Long, is a Chinese medical scholar par excellence. His willingness to share his depth of knowledge has been a tremendous boon to me during my studies at NCNM, and I cherish our one-on-one conversations regarding the classics of Chinese medicine. Dr. Leon Hammer is an exemplary human being. I am sincerely touched to have gotten to spend time working with this inspiring man. My clinical understanding has been transformed by his pulse diagnosis lineage. Brenda Hood lent her analytical eye to this project, and the readability of my thesis is due in great part to her careful reading of my drafts. I could not have sustained this project without the love and support of my partner, Nathan Hoover. Maintaining our house and farm during my months of late-night writing was no small task, yet it often went on thanklessly. Let me thank him now. I am sincerely grateful for the love that we share and for all of his work at keeping our homesteadand relationshipin a viable state. I cannot thank you enough, my love. My friends and colleagues Sara Bowes, Solomon Buccola, and Britton Mann have been daily reminders that life neednt be an obscure, bitter decoction of Chinese medicinals. Sara remains one of my greatest resources. How can I possibly give enough thanks to my dear, dear friend? Her faith in me is but a small part of the encouragement and love that she shines into my life. I have been incredibly nourished by our friendship. Solomon and Britton have kept me laughingoften at myselfand have been like surrogate brothers to me during our time together in school. Thank you for your inspiration, my friends.

4 i Misfortune arises out of satisfied desires; good fortune arises from self restraint. The sagely use their hearts to guide theirs ears and eyes [while] the petty use their ears and eyes to guide their hearts.

1. Introduction: Overview and Goals of the Present Work

We present a preliminary discussion of sources that discuss qiao (), the orifices or apertures, of Chinese medicine as they relate to human physiology (including cognition and awareness), pathology, and treatment. Most commonly translated in medical contexts as orifices, the Chinese character qiao in its most general medical sense refers to any of the openings of the body.ii Within the texts of Chinese medicine, this character is used variously to describe the sense organs of the head, the urethra and anus, and the orifices of the heart()a persons consciousness, awareness, and desires, and a speculative [physical] entityiii. This final category, the orifices of the heart, will be our primary focus in this work. Our highest goal in writing is that a clear theoretical basis for the Chinese medical concepts specifically related to the heart orificesand to awareness in generalmight be elucidated. Furthermore, it is our hope that doing so might lead to a deeper understanding of these concepts which in turn enables Chinese

5 medicine practitioners to achieve greater benefit for patients. This understanding, while beneficial to the patient, is certainly not without personal implications for clinicians as well, for as Ted Kaptchuk, a celebrated writer of Chinese medical texts, relays in the foreword to the book Dragon Rises, Red Bird Flies: Psychology and Chinese Medicine by Dr. Leon Hammer, A medical encounter is always limited by how far the practitioner-guide can take the patient [and] the less the intervention is focused on the physical, the more crucial becomes the selfunderstanding, insight, and inner resources of the healer.iv An implicit goal of the thesis is to offer insights that have inspired us while researching and writing so that others might become similarly inspired. We dont suggest that our knowledge or treatment of the subject is exhaustive: we will herein be able to discuss and draw conclusions based on our findings, yet we will certainly have to apply and test our knowledge gained from this experience in the real world later. It is not our goal to critique opposing viewpoints (or our findings in general). Rather, we explore the concept of the orifices as understood by various authors throughout the history of Chinese medicine because our stance is that we can learn from all of our sources to the extent that we understand each one on its own terms. It is our hope to present a discourse that will add to the breadth, if not also the depth, of the available English language literature encompassing this topic. To the best of our knowledge, this work is the first English language reference on the subject. Accordingly, our greatest effort has been spent in reading, translating, and discussing classical Chinese medical sources that refer to the orifices (Note

6 that all translations are the authors unless otherwise stated in the text of the thesis.). Various difficulties occur in translating classical Chinese medical (and philosophical) texts that contain the same Chinese character. One difficulty lies in the mere act of translation itself: not only does doing so require time and thought, but also, as one classical Chinese grammar states it, we are forced into choices in the English version that limit the meaning compared to the original.v The earliest texts tend to speak more generally of the orifices: most occurrences in these texts are woven into discourse on various correlations between man and the cosmos (as is done in quotes shared later that are taken from the Huangdi nei jing ( )). Later authors that mention the subject tend to quote earlier texts as explanations or validations of their own works, so finding the same quote (sometimes with one or two variations in word choice) in multiple sources is not uncommon. We also draw upon the extensive clinical experience of Drs. Leon Hammer and Rihui Longwhose combined clinical experience includes more than eight decades of medical practiceas relayed in personal correspondences over the months spent working on this project. In short, we aim to present the orifices in an expository light by utilizing a systematic survey of textual sources in addition to referencing extensive clinical experience. While we can not begin to pretend to conceptualize these ideas in exactly the way that an ancient, foreign culture did, we can use what was written

7 by that culture from the earliest of references onward, touch upon more modern sources in Chinese and English, and utilize empirical evidence gained through clinical experience to begin to gain a greater, more clinically relevant view of the orifices. Above all else, we cleave to the ultimate goal that we are enabled to understand our world, our selves, and our patients with greater clarity.

2. Etymology: The Orifices in a Linguistic Context

I. Chinese Language Considerations: [Chinese characters] are the products of Chinese fancy and imagination and to some extent show the working of the Chinese mind. Therefore they interest us who are students of Chinese thought. Moreover, they may only seem to be fanciful because we are ignorant of the ancient customs out of which they arose, or of the forms of the utensils of which they are pictures, or of the variations of pronunciation in the different dialects. If any of us were entrusted with the task of inventing written symbols for both concrete objects and abstract ideas it is doubtful if we produce anything much less fanciful and we could produce nothing of such rich historic interest, as certainly invests the 3000 most primitive characters.vi

In this section, we introduce certain basic aspects of the Chinese language in order to uncover insights about the orifices that can be found on a linguistic, or verbal, level. The nature of the written Chinese language is such that meaning is encoded in characters through the usage of both phonetic and semantic components.vii That is, each character usually contains either an element that

8 indicates the nature of the thing being denotedviii (semantic) and/or another that suggests how the character is pronounced (phonetic). Both types of components contain more or less information in pictographic form; in fact, some simple characters began merely as pictographs of concrete objects and have experienced little modification in term of their written representations over the millennia. Like the cuneiform script of Sumer and the hieroglyphics of Egypt, the Chinese script is pictographic in origin. The sun, for example, was written as a circle with a dot in the center (now written as ri), while dog was represented by an unequivocal representation of the animal.ix In many cases, Chinese characters are made up of more than one component part and often even contain various smaller characters within them. These compound characters are comprised of elements- later called radicals or significs ()- which, when put together in a novel way, created a novel meaning often intimated by the component parts.x Because of the pictographic nature of the Chinese language, each radical, even when apparently serving a phonetic function, also conveys pictographic information that can often be relevant to the meaning of the character at hand. Thus, we should notethat in many phonetic combinations the phonetic part was chosen because its meaning had some suggestion of the meaning of the characterxi. In attempting to understand the character for orifices, then, part of our method will be to do so by breaking it down into its component parts in order to gain insights about its meaning. Although such study of the characters is chided at

9 times for being childishand fancifulxii, it also grants us information on a symbolic level of understanding that is merely childish in terms of its simultaneous simplicity and profundity. While we cannot deny that the ancient Chinese created enough radicals that they encapsulated their manner of thinking about their world by drawing pictures of it, they were also merely creating written forms of their spoken language, and we can only speculate as to the accuracy of our interpretations. Consequently, we shall proceed to explain the orifices through the Chinese character used to represent them, but we do so without becoming too attached to our fanciful ideas.

II. The Character Qiao ():

Qiao: Releasing white from the cave Heiner Freuhaufxiii

The character for aperture or orifice is made up of two or three distinguishable parts: the radical at the top, , and, depending upon interpretation, one or two parts below: and or, if taken together (placing the first radical on top of the left half of the second), . The radical found on the top, , is a commonly used radical that means aperture, hole, opening, den or cavityxiv,xv, and in the Shuowen jiezi (

10 ), an Eastern Han dynasty dictionary of the Chinese language, this character refers to a chamber within the earth()xvi. This dictionary goes on to say that all [characters that denote] cave-like things are derived from it(). In other words, this cave radical is most commonly found at the top of characters that denote an object that is capable of containing something else within itself, like a cave or an orifice. When the bottom of this character is broken down into two parts, the resulting radicals are , white or light and , to release or emit. According to lectures by Heiner Freuhauf, Sinologist and Chinese medicine practitioner, white in this character refers to light and yang that is more ephemeral (versus condensed light and yang that is termed yellow).xvii This character can also be thought of as having two component parts (taken as and , with the bottom portion remaining intact). In this instance, we have our top cave radicaltelling us that orifices can contain somethingand a character below pronounced jiao (which is phonetically similar to qiao), which means glittering or sparklingxviii. Thus here, when taken as two radicals, we have a glittering cave, a sparkling container, or a hole [that is] shined through xix.

11 The Shuowen jiezi tells us that our character qiao comes from cave () and sounds like jiao ()xx. In this dictionary, qiao is defined as kong (), emptyxxi. In explaining the orifices as cave-like things and defining them as empty, this dictionary gives us information about the morphology of the orifices, tells us that the orifices have a capacity to contain something, and implies their morphology and physiological function. The following quote emphasizes the role that emptiness plays in providing a space for consciousness or the spiritshow the Elisabeth Rochat de la Vallee, a scholar of classical Chinese medical texts, prefers to translate the term shen (), and which convention weve followed. The heart is essentially a void because the void is the only possible dwelling place for the spirits. Spirits can only rest and dwell in the void of the heart. The art of the heart, which is a famous discipline in Chinese philosophy, is the way to obtain and conserve this void which allows the spirits to be present The heart, as a void, has the possibility of receiving spiritual influences in the form of shen ( ) from all this emanates the radiance of the spirits, shen ming (). This enables life to be led, but in a subtle way which is subtle and imperceptible.xxii From an etymological perspective, the orifices emptiness functions as caves or tunnels through which light can travel into and out of the body. From our perspective, ephemeral light () can be thought of as sensory information that is released () into orifices () or shenming ()-spiritual radiancethat emits from a healthy persons orifices. In other words, because the heart stores the light of conscious awareness () and the orifices are the portals

12 allowing that light into and out of the heart, one can only be fully conscious if ones orifices are empty.

3. Orifice Anatomy and Physiology: In Chinese medicine, correct explanations of anatomy and physiology are far less important than traditional functional interpretations.xxiii

I. Anatomy and Chinese Medicine:

Anatomy can be defined as the branch of science concerned with the bodily structure of humans, animals, and other living organisms, especially as revealed by the dissection and the separation of partsxxiv. Imperial prohibitions to the dissection of corpses aside, an understanding of the human body revealed through reductionism and separation of parts is in stark counter-distinction to the ontology of the ancient Chinese. It is axiomatic that Chinese medicine is

13 holistic. We will show how even the discrete organs of the body are related to universal energies. Chinese medicine is a functional system in which anatomical detail is not or [is] only marginally important.xxv Because of this, Chinese medical conception of the human body is severely lacking in anatomical descriptions as such. Rather, it shares an understanding of the body more akin to physiology, which observes the way in which a living organism or bodily part functionsxxvi. When anatomical descriptions are given in the classics, they seem simply to define man by enumerating a list of his various parts: Man has essence and qi [or essential qi], body fluids, four limbs, nine orifices, five zang [and] sixteen sections (xxvii). Consequently, in order to more thoroughly comprehend the orifices in Chinese medicine, we must first understand their functional contribution to the entire life of the human organism and its role in the cosmosand this understanding is founded in the various correspondences that are obtained between nature, the zang organs, and the orifices themselves.

II. Five-Phase Correspondences:

If the five zang are disharmonious then the seven orifices are blocked.xxviii

14 When discussing Chinese medicinea medicine of systematic correspondencesxxixone naturally begins with five-phase theory. According to this theory, each of the five zang organs is linked to various phenomena with which it resonates. Five-phase theory includes associations in categories like the climactic factors, body tissues, hues, tones of the musical scale, and one of the clear or sensory orifices of the head and face (with one exception, described below). First appearing in the Neijing, these orifice-to-zang correspondences are well established in Chinese medical theory. Chapter five of the Suwen ( ) describes these strings of resonant categories in great detail, and is likely the source of the commonly recognized organ-to-orifice five-phase correspondences: In heaven the spirits become wind; on earth, vegetation (wood); in the body, tendons; within the zang, the liver; in the hues, fresh green; in the tones, jiao; in the voice, shouting; in movements and changes, grasping (or holding); in the orifices, the eyes; within the flavors, sour; [and] in the will (zhi, ) it becomes anger... In heaven it becomes heat; on earth, fire; in the body, the vessels (mai); within the zang, the heart; in hues, red; in the tones, jue; in the voice, laughing; in movements and changes, worry; in the orifices, the tongue; within the flavors, bitter; [and] in the will, joy In heaven it is dampness; on earth, the earth [phase]; in the zang the spleen; in the hues, yellow; in the tones, gong; in the voice, singing; in the movements and changes, hiccupping (or belching or vomiting); in the orifices, the mouth; within the flavors, sweet; within the will, thinking

15 In heaven it is dryness; in earth, metal; in the body, the skin and body hair; in the zang, the lung; in the hues, white; in the tones, shang; in the voice, crying; in the movements and changes, coughing; in the orifices, the nose; in the flavors, pungent; [and] in the will it is sadness In heaven it is coldness; on earth, water; in the body, the bones; in the zang, the kidneys; in the hues, black; in the tones, yu; in the voice, groaning; in movements and changes, trembling (or shivering); in the orifices, the ears; in the flavors, salty; and in the will, fear

In short, according to chapter 5 of the Suwen, the liver corresponds to the eyes, the heart to the tongue, the spleen to the mouth, the lungs to the nose, and the kidneys to the ears. Five-phase correspondences are relatively fixed, but different versions of these correspondences can be found in the Neijing and other texts. According to chapter 4 of the Suwen (), The liver corresponds to the eyes, the lung to the nose, and the spleen to the mouth (as above, in chapter 5).xxx Also in chapter 4, however, the heart is said to connect to the ears (usually thought of as the water phase orifice) and the kidneys to the two yin()or lower orifices.xxxi The following quote, most notable because its associations are radically different from those found elsewhere in the literature, comes from the Huainanzi () and is translated by Elisabeth Rochat de la Valle. Herein, this early Taoist text explains how the ancient Chinese viewed the formation of the universe

16 and the human body, and it also evidences a cosmology that acknowledges the interwoven nature of the various parts of the human body in relation to themselves and the universe at large. , xxxii It is the vital spirits that are received from heaven and the body form that is provided by earth. Thus it is said: one gives rise to two, two gives rise to three, three gives rise to the ten thousand beings. The ten thousand beings lean on the yin and embrace the yang and the powerful blending of qi makes harmony. Therefore it is said: at one month [a human being] is a rich paste, at two months it is a bulge, at three months it is a foetus, at four months it has flesh, at five months it has sinews, at six months it has bones, at seven months it is complete, at eight months it moves, at nine months it quickens [and] at ten months it is born. As the body becomes complete, the five organs then take form. For this reason, the lungs master the eyes, the kidneys master the nose, the gallbladder masters the mouth, [and] the liver masters the ears. The outer are for external expression and the internal are for inner organization thus the roundness of the head is in the image of heaven [while] the square made by the feet is in the image of earth. Heaven has four seasons, five moving forces, nine releasings, and 366 days; human beings similarly have four limbs, five organs, nine orifices, and 366 articulations. Perhaps the most interesting discrepancy that exists between this passage and five-phase theory found in the Suwen is that the gall bladder, not the spleen (so firmly rooted in the five-phase theory of the Neijing), is implicated as being one of the five zang organs. Regardless of the association described, because these orifices are inextricably linked to their associated zang organs and the zang organs govern overall physiology, the orifices depend upon the proper functioning of the zang organs in order to function properly themselves. According to the following quote

17 from Chapter 17 of the Lingshuxxxiii, the orifices proper functioning depends upon harmonious function of each orifices associated zang organ: The ongoing internal state of the zang organs can be diagnosed [externally] upon the seven orifices. (This sentence can be alternately translated as The zang organs send their normal qi internally and up to the seven orifices). Thus, lung qi communicates with the nose; when the lung is harmonious, the nose can distinguish rank and fragrant. Heart qi communicates with the tongue; when the heart is harmonious then the tongue can distinguish the five flavors. Liver qi communicates with the eyes; when the liver is harmonious the eyes can differentiate the five hues. Spleen qi communicates with the mouth; when the spleen is harmonious the mouth can distinguish the five grains. Kidney qi communicates with the ears; when the kidney is harmonious the ears can hear the five tones. If the five zang are disharmonious, then the seven orifices are not free and open. However, if various versions of the five-phase correspondences exist then how can a medical practitioner be sure of which zang to treat when dealing with pathologies of the orifices? The clinical reality is that a stress will affect the most vulnerable organ or area rather than the one assigned by [five-phase theory]xxxiv. Rather than narrow-mindedly observing one or another theory of correspondences, it is in our patients better interest to remember how all of physiology is imbued with the qi of heaven and earth.

III. Seven or Nine? Heaven and Earth, Turbid and Clear, Upper and Lower: xxxv Thus clear yang issues from the upper orifices, turbid yin issues from the lower orificesyin flavor issues from the lower orifices, yang qi issues from the upper orifices.

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The orifices can be categorized in several ways, and each organization emphasizes a different aspect of the orifices. Due to their dissimilar functions and locations, the nine orifices() of the body can be broken up into two groups: namely, the clear orifices(), or upper orifices()i.e. the sensory organs of the head; and the two lower orifices(), turbid orifices(), or, euphemistically, simply the two yin(). The term upper orifices refers to the two eyes, two ears, two nostrils, and the mouth, while lower orifices refers to the urethral meatus and anus. The term seven orifices () is used both generally (to refer to the orifices as a group) and also specifically refers to the upper orifices. A commentary on The rites of Zhou () by the late Han dynasty scholar Zheng Xuan () elucidates the distinction between the upper and lower orifices and explainsaccording to yin-yang theorythe reasoning behind such a distinction: xxxvi Of the nine orifices, two differ [from the others]. Seven of the orifices are found on the head and are clearly visible and therefore yang. [The other] two orifices are located on the lower part of the body and cannot be seen and thus are yin.

19 The descriptive terms upper and lower are the terms found in the earliest occurrences wherein the orifices are differentiated into two groups according to yin-yang theory, whereas the monikers clear orifices and turbid orifices seem to have come later in the history of Chinese medicine. Nonetheless, the terms turbid and clear likely refer back to a passage from Chapter five of the Suwen in which the basic functional difference between the lower and upper orifices was discussed in these terms: xxxviithus, clear yang issues from the upper orifices [while] turbid yin issues from the lower orifices yin flavor issues from the lower orifices [while] yang qi issues from the upper orifices. As previously mentioned, man is said to have either seven or nine orifices in toto (There are statements in the Neijing referring to both mans seven orifices and nine orifices.). Both the seven and the nine groupings include the upper (sensory) orificesthe distinction lies in whether or not the two lower orifices are included in the total count. When man is said to have seven orifices, it is the upper orifices that are included in our count (those that, as we will soon show, are the orifices that allow for perception and consciousness). By abstaining from the inclusion of the lower orifices, mans higher senses (hearing, smelling, etc. and-by extensionconsciousness) are emphasized, and a correspondence to heavenly energies is illuminated. The following quote illustrates this correspondence: Seven is [the number] of stars [in the dipper]; the stars are

20 mans seven orificesxxxviii. Moreover, to our surprise, just as one might say the eyes are the windows to ones soul in English, this correlation between the orifices and the spirits can be found in the Chinese philosophical classics as well: xxxix The orifices are the windows of the essential spirit. When man is said to have nine orifices, on the other hand, this tells us about the morphology of man and yields information on a gross anatomical, earthly level: for, by including the two lower orifices as part of our count, we thereby include such base activities as urination and defecation, and all of physiology (upper and lower) becomes implied. By adding the two turbid orifices (those responsible for defecation and urination) to our count, the nine orifices correspond to earth, which is also turbid: xl Heaven is round and earth square; in resonance with this, mans head is round and feet square. In heaven there are the sun and moon; in man, there are the two eyes. On earth there are nine provinces; in man, there are the nine orifices Even here, though, while linking the nine orifices to the nine provinces on earth, the eyes are likened to heavenly bodies.

IV. The Heart Orifices:

21 The Chinese Heart has a hole in it, through which thinking and reasoning are conducted, as ancients believedxli

As previously noted, we can think of the orifices in general as falling into two groups, the clear or upper orifices, and the turbid or lower orifices. Yet another category, the Heart orifices(), can refer to: the various sensory orifices, the orifices of the heart spiritxlii, or the capacity for clear thinkingxliii. A Practical Dictionary of Chinese Medicine 2nd Edition By Nigel Wiseman and Feng Ye describes how Although the literal meaning orifices of the heart implies that the term denotes a physical entity, the location of the entity is not explained. Thus the term either denotes a speculative entity or is merely a metaphor describing consciousness as a window on the outside world.xliv Although we do tentatively discuss an anatomical feature that may relate to the heart orifices per se, the most common entity to which the classics refer when speaking of these orifices is a metaphorical understanding of human consciousness. In ancient Chinese culture, the heartnot the brainis regarded as the center of human consciousness. In fact, according to cognitive linguist and Chinese language scholar Dr. Ning Yu, In Chinese, the word xin that primarily denotes the heart organ may also refer to it as the organ for thinking and the seat of thought and emotionsin this way, the Chinese word xin heart [] covers the meanings of both heart and mind as understood in English.xlv

22 According to our understanding of the classical record, consciousness resides inside of the metaphorical empty space maintained within the container of the heart, and awareness is the product of that consciousness reaching out to and bringing intelligible information back form the external world to the heart via the orifices. The orifices of the heart are essentially the portals into and out of this seat of thought and emotions, and they allow for communication between our inner experience and the outer world.

Because the heart orifices are conduits of consciousness, they function (when unobstructed) to grant the heart a capacity to observe the world clearly, and in both modern and classical Chinese the term heart orifices () can even be translated as the capacity for clear thinkingxlvi. Because the orifices act both as conduits for sensory input into the body (or mind) and the spiritual lightxlvii, Shenming (), outward from the heart-mind, it is these free and open() spaces that allow for a human beings ability to understand messages from the outside world and respond with clear intelligencexlviii. To the ancient Chinese the role of the heart was not only understood as a container for awareness, but also as the sovereign ruler of the body. Perhaps the most famous appearance of the heart as ruler metaphorxlix occurs in the eighth chapter of the Neijing suwen (), wherein the organs are likened to officials in the imperial government. Of the heart, it states that the Heart holds the office of lord and sovereign; spiritual brightness( Shenming) emanates from

23 it. (l). According to this system of officials, the heart is the sovereign ruler over all of the other zang organs and maintains the role of carrying the torch of spiritual brightness. In short, because the way the Chinese understood life in an individual was the same as the way they understood the control of life in the empireli, each organ plays a unique and necessary role in maintaining the governance of the whole body. The heart maintains primacy through its offices of lord and sovereign and master of the spirit, though, and its sovereignty could not occur without the orifices. According to the Xunzi, another Taoist text, the orifices function as celestial officials() that serve the celestial sovereign() that is the heartlii. In this metaphor, the orifices themselves are the emissaries through which sensory information is received and the heart- the ruler of consciousness- is sovereign over the interpretation. Moreover, communication between the sovereign (the heart) itself and the state (the body) is apparently only possible when these thoroughfares of the heart are unobstructed. As stated in the Hanfeizi, a philosophical text from the warring states period in the so-called legalist tradition of Confucian thought, Those who know how to govern the people exhibit quietude in their thought and contemplation, [while] those who know how to serve heaven maintain their orifices in emptiness.(liii)

24 V. The Anatomical Orifices of the Heart:

If we must ascribe an anatomical counterpart to the orifices, what might that counterpart be? The only apparent physical holes in the heart are the heart valves and the vessels that enter and exit the heart, but does Chinese medicine account for these anatomical features? In at least one modern school of Chinese medical thought with which we are familiar (the Shen-Hammer Contemporary Chinese Pulse Diagnosis system), some of the valves and vessels are taken into account. Additionally, (much to the chagrin of his contemporaries) a Qing dynasty Dr. by the name of Wang Qingren included decidedly anatomical descriptions of the human body in his medical writings, and he discussed an understanding of the hearts vessels in his controversial work Yilin gaicuo( ).liv In the modern version of the Shen-Hammer Contemporary Chinese Pulse Diagnosis system, there are two complimentary positions palpated on the radial pulse that correspond to the valves and vessels associated with the heart.lv That this system takes into account the anatomical orifices may be because it was passed down through Dr. Shen whose purview [was] more mental, emotional, and material and less wedded to the written classical record than to empirical findings tested by clinical experience. According to Dr. Hammer, Dr. Shen claimed to be able to access four valves and three large vessels entering and leaving the Heart.lvi Of these seven, Dr. Hammer is able to identify only two, the

25 complimentary positions referred to as the Mitral Valve position and the Large Vessel position. As Dr. Hammer writes, The mitral valve position described below is one that I discovered over time primarily by checking the quality in this area with objective biomedical data, such as echo cardiogram, and secondarily by relating the quality to symptoms such as panic associated in biomedicine with mitral valve prolapse.lvii With an especially light touch, the Mitral Valve is accessed laterally on the muscle-ligament connecting the styloid process [of the radius] and the scaphoid bone. The most common qualities found are Vibration and Slipperiness the qualities here are ephemeral, subtle, and sometimes moving around the position.lviii (Note that, while there is some overlap between pulse qualities as described in this pulse diagnosis system and other more widelyknown systems, weve left the names of qualities described in the Shen-Hammer system capitalized in order to distinguish them from qualities of the same name described elsewhere.) When pulse qualities can be palpated in this position, they are indicative of disturbances of the mitral valve (and indicate a certain amount of heart qi deficiency). Whereas a Vibration quality at this position is an indication of a mildly insufficient mitral valve, Slipperiness is a sign of a more serious prolapse of the valve, associated in biopsychiatry with panic disorders.lix In fact, Slipperiness in the mitral valve position occurs frequently and has consistently coincided with the biomedically-tested Mitral Valve Prolapse Syndrome [that is] attended by panic and phobialx which, not incidentally, are two symptoms that

26 indicate the type of changes in consciousness that can be associated with pathologies of the orifices. The other of the pulse positions that can be thought of as being associated with the heart orifices is the Large Vessel positionlxi. The location of this position and the interpretation of two of the findings possible therein follow: The Large Vessel position [like another of the complimentary positions associated with the left distal, or cun position] is also accessed by rolling the index finger medially toward the ulna. At the intersection of the tendon of the flexor carpi radialis and the scaphoid bone is a hole or cave-like place that is palpated by the lateral distal edge of the index finger. This hole is sometimes occupied by either an Inflated (indicating aneurysm) or a Tense-Tight Hollow Full-Overflowing quality (indicating hypertension).lxii According to a recent correspondence with Dr. Hammer, the Inflated quality in this position is also found with cerebral aneurysms as well as aortic, and we state- albeit speculatively- that this finding may point to a connection between the orifices, the seat of thought and emotions and the brain.lxiii

VI. Other Links: Physiology and the Orifices

Because Chinese medicine is a holistic science based in part upon the resonance that exists between man and the cosmos, many correlations can be drawn between his body and the body of the universe. As was previously done in our discussion on the five-phase organ-to-orifice correspondences, however,

27 competent physiology can also be described through links drawn between various discrete body parts and one another. According to the way in which the body is seen as an integrated whole in Chinese medicine, each part of the body requires appropriate nourishment delivered from the vital organs (the zang) via the meridians and vessels. The orifices, then, are merely one of the many body parts that need qi and blood in order to properly function: The various [types of] qi and blood of the twelve Channels and Three hundred and sixty-five collaterals ascends, running through the orifices. The essential yang qi ascends and runs through the eyes and becomes sight; the divergent [channels] qi runs through the ears and becomes hearing; the zong qi ascends to emerge through the nose and becomes [the sense of] smell; the turbid qi emerges through the stomach and runs through the lips and tongue to become flavors ( )lxiv Often, an aspect of physiology is taught only in contrast to pathology: according to a passage from the Neijing (as quoted in the Treatise on the Spleen and Stomach or Piwei lun()), Thus, the sagely transmit their essential spirits, serve the heavenly qi, and free their Shenming. Losing this, the orifices
become closed internally, the flesh and muscles become blocked externally, and the wei qi scatters. This is called self-injury, [and amounts to] decreasing [ones] qi.(

28 lxv) An interesting quote from Chapter 28 of the Lingshu describes the mechanism of crying, and it goes on to explain how ceaseless crying can lead to blindness: lxvi The eyes are the place where the convergence of the vessels is amassed, the pathway of the upper ye fluid(). The mouth and nose are the portals of the qi. Thus, if there is sorrow, grief, anxiety, and worry then these move the heart; if the heart moves then the five zang and six fu all shake; if [they] shake, then the convergence of the vessels is affected; if the convergence of the vessels is affected then the upper ye fluid pathway opens; if the ye fluid pathway opens then tears issue forth from it. The ye fluids are that which moisten the empty orifices through irrigation of the essences. Thus, if the upper ye fluid pathway opens, there are tears; if tears dont abate then the fluids become exhausted; if the fluids become exhausted the there is no irrigation of the essences; If there is no irrigation of the essences, then the eyes fail to see.

Although this quote describes a pathological situation, it teaches us much more about physiology when it states that the upper orifices require irrigation by the essences(note that the essences referred to here are likely either the subtle essences () provided to the body via spleen-stomach digestion, or perhaps the kidney essence which provides a foundation for all of the fluids of the body). The orifices are not merely a vehicle for sensation and awareness but also integral parts of human physiology that-just like any other body part- require nourishment and irrigation.

29 According to the Piwei lun, it is only the through nourishment provided by the stomach that the zang organs are able to reach out to their corresponding orifices: Qi from the five organs ascends to open the nine orifices( lxvii) and the nine orifices are under the rulership of the five zang organs which are able to keep the orifices free and uninhibited only upon the receipt of stomach qi ( lxviii). According to the Piwei lun, as long as the spleen and stomach are functioning properly, the entire body (including the orifices) maintains health: lxix If the spleen and stomach enjoy perfect harmony, then [mans] harvest is abundant: the entire body and other four zang flourish, the twelve channels maintain their [proper] position, the skin and body hair are thickened and consolidated, the tendons and bones are supple, the nine orifices are free and open, and external evil cannot attack

4. Orifice Pathologies There are a lot of disorders and illnesses which are the result of losing contact with the spirits that are in the heart. A good example of this breakdown in communication is seen in the case of phlegm tan (), phlegm, when this obstructs or veils the orifices of the heart with resulting physical and mental symptoms.lxx

Pathologies that affect the ears, eyes, nose, mouth, heart vessels and valves, urethra and anus are legion, and while there is certainly much to learn from an in-depth study of each of the aforementioned body systems and their

30 associated diseases in turn, it is beyond the scope of this project to completely embrace these topics. The discussion of pathologies affecting the orifices in the context of this work, then, is limited to the following two types: those that affect the orifices as a group, and those that affect the speculative [physical] entitylxxi known as the heart orifices (both of which categories act as conduits of consciousness). Due to the fact that the acquisition of sensory information and human consciousness are in sharper focus in this section of the thesis, it is not surprising that we consult source material herein that arises from the classics of Chinese culture and philosophy and literature in addition to medicine. If one was to ask: Are the ancient Chinese philosophical classics really relevant to the issue of modern Chinese medical practice? one must merely be reminded of this statement by Elisabeth Rochat de le Vallee: [the organs]functions and movements, their harmony and disharmony these concepts arise directly from the philosophical roots of Chinese medicine.lxxii In this particular context especially, it is necessary to view the extra-medical texts because doing so will proffer to us a more comprehensive view of the terrain in question, doing so from a vantage closer to that of the ancient Chinese.

I. Orifice Pathology in the Philosophical classics:

With the container metaphor, the heart is conceptualized as a container for affective and cognitive constituents of a person: emotions, thoughts, intellect,

31 knowledge, moral values and judgments, etc. For instance, Xunzi argued that it is possible for people to learn and understand things because their heart is empty inside so that it can receive things for storage and use. Although it has already stored up many things, as long as the person is, or tries to be, empty-hearted( xuxin), the heart-container should never be too full to accept new things The focus will be lost when reception of many things at the same time divides the attention-capacity of the heart-container.lxxiii

According to the earliest texts of Chinese philosophy in which pathologies affecting the orifices appear, intemperance in terms of desires and sensory input is the cause of the orifices becoming obstructed. As it can be found in the Daode jing, the appearance of this theory dates at least as far back as back the semimythological, pre-historic period of the Sanhuang dynasty. Next to the Bible and the Bhagavad Gita, the Tao Te Ching[Daode jing] is the most translated book in the world.lxxiv Thus, this deceptively simplelxxv text, attributed to the sage-author Laozi, is beyond requiring and introduction. Although the Chinese character for orifice as such never appears in it, a direct relationship between a persons desires and the function of conscious awareness is posited throughout the text of the Daode jing. Even in the first chapter a metaphor has been described in which there is a container located within that cannot be overfilled with desires if one is to be fully aware of the experience of life: In its oft-paradoxical manner, the Daode jing has this to say of the Dao (those ineffable, mysterious forces that unify all phenomena of the universe): Hence always rid yourself of desires in order to observe its secrets, but always allow yourself to have desires in order to observe its manifestations.lxxvi

32 According to the following passage from the twelfth chapter of the Daode jing, when ones orifices become (over-) stimulated, they can become filled to the extent that normal psychological function is impaired: The five colors make mens eyes blind, the five tones deafen their ears, the five flavors cause their mouths to fail to taste, and galloping around on horses and hunting causes their hearts to go mad. ( lxxvii). It is worthwhile to note that here- unlike in more widespread passages that articulate the concept of desires taking up too much space within the heart- stimulation alone is said to drive hearts mad. The implication here is that excessive stimulation acts as a surplus in the same way that excessive desires are capable of: for, we believe that to say, for example, that listening to the five tones in this context is to mean too much listening. Indeed, just as a physical container can only be filled to its capacity without provoking overflow, the metaphorical container of the heart can only fit so many desires and sustain the receipt of a certain amount of information without experiencing a disruption that inevitably affects the consciousness that is also contained therein. This is because, as sated in the Yinfu jing (), The heart wants peace and quiet [ and if] the heart is peaceful and quiet then the light of the spirit flourishes( lxxviii). Just as a fire requires a hollow center (literally heart), man requires an empty heart( lxxix).

33 After having come of age (and barring the slings and arrows of outrageous fortunethe heart-ache and the thousand natural shocks that flesh is heir tolxxx), it is up to our heart, the ruler of our conscious awareness, to decide whether or not we subject ourselves to overwhelming, chaotic experiences. According to Shizi, another warring states period philosopher, If the heart believes that it is not righteous to do so, the eyes should not dare to see what looks beautiful, the mouth should not dare to eat what tastes delicious, the ears should not dare to hear what sounds delightful, and the body should not dare to do what seems pleasurable( ) (translated by Ning Yu)lxxxi. For one, to learn our own individual capacities for stimulation is paramount, and developing self-knowledge through cultivation practices is the safest, most traveled road with which were familiar in order to achieve this end. For another, to become aware of our internally-held desires is primary, yet it requires the subsequent step of weighingwith our heartthe consequences (or righteousness) of our behavior. As stated in the Xunzi, It is once a plumb line is applied to wood that [wood] may become straight, once a grindstone is applied to metal that [metal] may become sharp. It is once a gentleman learns broadly and each day examines himself in three areas that his wisdom may become clear and his actions may become faultless. (

34 lxxxii). This is by no means a case for asceticism but rather a rationale for, on the basis of conscious awareness, truly experiencing a life fully lived.

II. Orifice Pathology in the Medical Classics: As we have seen, the orifices act as thoroughfares for the coming and going of the spirits by means of their emptiness. Moreover, consciousness, although immaterial, is only enabled to travel into and out of the void of the heart when the orificesan extension of the heartare equally empty. Consequently, when these conduits of consciousness are not free and open (), pathological changes occur. As described in the literature, these pathologies primarily occur when the orifices become confounded, closed, blocked or covered over ( , , , or )lxxxiii,lxxxiv by excess pathogenic influences such as phlegm and blood stasis. Generally speaking, the Neijing, Nanjing, Jinggui Yao lue, Piwei lun, and later literature from the warm disease tradition (including the Wenre lun () and the Wenbing tiaobian ()) mention pathology of the orifices in the following ways: in describing disease etiology; while enumerating general lists of pathologies that man can obtain through his being in disharmony with nature; while discussing correspondences between nature, man, and the zang organs and

35 their associations (as shared above); and when found as a sign or result of another pathology. According to the understanding found in more modern literature, likely founded upon the works of authors such as Li Gao (author of the Piwei lun), and Zhang Zihe (an author that differentiated various phlegm-related diseaseslxxxv), the causative factors of diseases that affect the heart orifices are impediments due to blood stasis and phlegm turbidity. These, in turn, cause an inability of the spirits to move freely through the orifices of the heart. As we will explain later, emotions and shock can also cause the qi dynamic to become disrupted and lead to stagnation that ultimately affects the heart orifices. Many of the Neijing references to pathologies that afflict the orifices describe them in the same language repeatedly, so an overview of these occurrences while noting the outstanding exceptions will suffice to comprehend their contribution to our discussion. The influence of this text (and that of the Shanghan lun(), which doesnt contain the character qiao per se) upon all later Chinese medical thought, however, cannot be doubted. In fact, many later authors quote the Neijing in their own texts when discussing how the orifices function, fall into pathology, or are treated. The Piwei lun, Wenbing tiaobian, and the Wenre lun also specifically mention the orifices in the context of disease transmission and treatment, and some of this material will also be translated and discussed.

III. Etiology: Neijing and Warm Disease

36

In the Neijing it is stated that the heart does not receive evils( )lxxxvi: for, as the metaphorical emperor of the body, every attempt is made by the bodys protective mechanisms to divert pathogenic energies away from this most essential part. Furthermore, of pathology affecting the heart, it is said it is only attributed to the heart [per se] when internal damage and vacuity damage cause a decline in function.lxxxvii However, diseases in the literature (and in the clinic) that affect the heart organ per se are not uncommon, and they can appear in cases in which either the pathogenic insult is great enough to overcome the bodys defenses (as in shock to the heartlxxxviii()), the persons heart itself is or has become weakened to the point of being susceptible to invasion by pathogenic factors, a warm pathogen follows an abnormal transmissionlxxxix, or when stagnation has been engendered internally due to emotional factors. Most often, pathology affecting the orifices appears in the Neijing as a description one of mans pathological states. This can be seen from the following excerpt from Chapter 17 of the Lingshu(): When the five zang are disharmonious then the seven orifices are not free and open( xc). Etiology is spoken of in broad terms- that is, when causative factors are even mentioned at all, as the following quote from Chapter 28 of the Suwen (a

37 passage which is quoted no less than three times in the Piwei lun) evidences : In headache with tinnitus and inhibition of the nine orifices, the intestines and stomach are the cause.(xci). According to warm disease theory, heat pathogens first attack the upper body and first penetrate the lung. If the pathogen is particularly strong or the patient particularly weak, the pathogen can also affect the pericardium.xcii In an extension of the metaphor of heart as sovereign, the pericardium is metaphorically said to act as the outer defense of the heartsuffering from exogenous pathogenic influences itself instead of the heartjust as would a palace wall(), or sentinel() for an emperor. [That the heart does not receive evils] explicitly emphasizes that whenever external evils invade [the heart-related networks], they mostly attack the pericardiac networkxciii. Moreover, because the pericardium and the orifices can both be viewed as the means through which the heart maintains contact with the rest of the body internallyand the rest of the world externallythey are sometimes seen as homologous, so it is of no great consequence whether the heart orifice or the pericardium is invaded by phlegm.xciv

IV. Etiology: The Piwei lun and the Qi mechanism

38 As mentioned in the section on physiology, the importance of the particular connection between the spleen and stomach and the orifices is treated further in the Piwei lun. The following quote states the premise upheld in this work: The nine orifices are ruled by the five zang which, upon the receipt of stomach qi, are able to free and open [them].( xcv). The primary pathology of the orifices mentioned in this text can be found in the chapter entitled On spleen-stomach deficiency leading to inhibition of the orifices( xcvi). According to the text, this pathology (associated with another pathology termed yin fire) occurs because the spleen and stomach lose their ability to up-bear clear qi and descend turbid qi: When the spleen and stomach have been overcome [by] yin fire, grain qi becomes locked up internally and doesnt flow [in its normal] descent. Thereupon, the clear qi fails to ascend and the nine orifices become inhibited. ( xcvii) Because of the understanding of the importance of the movement and functions ascribed to the qi dynamic (or qi mechanism ()) in the Piwei lun, it can be seen as a forerunner of more modern literature which stresses the importance of the qi dynamic in pathologies that affect the orifices. According to these sources, pathologies of stagnation tend to begin with some kind of causative

39 factor that inhibits the qi mechanism of the body. According to the modern text Pathomechanisms of the heart, all cases of qi counterflow and phlegm stagnation can congest the channels and network vessels, congesting the orifices of the heart.xcviii Although the qi mechanism is the pathway for the movement of physiological fluids and substances, it can also be the vector whereby phlegm stagnation is enabled to move from other body areas in the body into the orifices.xcix The value of heart qi lies in its ceaseless movement; it should not pause or stagnate for even a single moment. If it is damaged by the seven affects (anxiety, thought, resentment, anger, sorrow, fright, and fear) and the qi dynamic is [subsequently] inhibited, heart qi becomes depressedc

V. Phlegm Misting the Orifices:

Described using a term first coined by the Ming dynasty physician Zhang Ziheci, the most well-known pathology that affects the orifices of the heart is often termed Phlegm misting the heart orifices or phlegm confounding the orifices of the heartcii (). In their book A Handbook of TCM Patterns and their Treatments authors Bob Flaws and Daniel Finney expound the etiology of this pattern in a terse, TCM style: This pattern is mostly due to spleen vacuity and dampness engendering phlegm plus liver depression and qi stagnation, resulting in upward counterflow. This counterflow drafts the phlegm upward where it confounds the orifices of the heart, thus causing consciousness to be impaired. The spleen vacuity is due to

40 overeating uncooked, chilled foods or sweet, fatty, thick-flavored foods, overthinking or too much worry, or over-taxation, which can all damage the spleen. The liver depression is due to anger and frustration causing the liver to lose control over orderly reaching.ciii, Main symptoms of the pattern given in this book include emotional depression, withdrawal, muttering to oneself, staring at walls, sudden loss of consciousness of human affairs, no constancy in joy and anger, excessive, with phlegm, chest oppression, no thought for food or drink, [and] the sound of phlegm rattling in the throat.civ According to Dr. Hammer, the etiology of this pattern follows a slightly different trajectory. For one, systemic dampness might contribute to phlegm misting the orifices but [clinically] it is not seen as primary cv. According to Dr. Hammer, shock to the heart is the most common precipitating event that triggers the cascade of mechanism ultimately leading to phlegm misting the orifices: Shock to the heart is initiated by any sudden event that the heart experiences or anticipates as a danger to its existencephysical, mental, emotional and spiritual. The qi of the heart retreats or closes off outside contact to various degrees and this may ultimately include blood as well as fluid. This retreat may be conceived as being a protective function of the Pericardium. Dr. Shen referred to these conditions as `heart closed [a condition of qi stagnation, found with a Flat or Inflated quality] or `heart small [due to blood stagnation, and found with a Choppy quality]... Qi moves the blood and fluid. If the qi is deficient all substances within an organ become stagnant and the conditions in the Heart for the stagnation described above that leads to excess heat and damp [phlegm misting the orifices] is present. This is increasingly more common today than the scenario involving the spleen and liver mentioned above [in the quote taken from Flaws and Finney]. Since the movement of qi is essentially the definition of life, the organism experiences stagnation as dangerous and automatically acts to overcome it. The physiological mechanism begins by bringing metabolic [normal] heat to overcome the stagnation; If it succeeds, then there is no problem; If the stagnation is greater then the ability of the metabolic heat to move it, the metabolic heat starts accumulating and becomes `excess heat. The body

41 experiences `excess heat as a toxic pathogen and attempts to eliminate it or, failing that, balance it with something cool that we call yin or fluid. This combination of accumulating heat and fluid creates phlegm that in this instance `mists, `confuses or `obstructs the heart orifices cvi Because the orifices are most closely tied to the cognitive aspects of the heart, pathology of the orifices (in contrast with other heart patterns) is mostly mentalcvii. According to both Drs. Hammer and Long, the key feature of this pattern is that the patient is confusedcviii,cix, because phlegm confuses the messages that [move through] the orificescx. In the Chinese literature, misunderstanding the affairs of [other] people () is a symptom often attributed to this condition. As implied in the quote above, blood stagnation is also seen as a causative factor in the development of orifice pathology, and some clinicians have found that better clinical outcomes are achieved when blood stasis is treated in addition to phlegm stagnation.cxi The following passage, taken at length from Dr. Leon Hammers book Chinese pulse Diagnosis: A Contemporary Approach, explains the pathomechanisms involved in another pathology, phlegm-fire disturbing the heart orifices: Phlegm-fire congestion is the result of stagnant dampness from poor digestion which accumulates into mucus, combined with excessive heat from Liver qi stagnation. Since food is eighty percent water, a weak spleen (and/or Triple Burner), or excessive fluids or food that is difficult to digest can leave the digestive tract with more dampness (water) than it can handle. Chinese medicine teaches that this dampness (water) normally ascends to the Lung with Spleen energy to be digested or, more accurately, misted. If, in addition to poor digestion, the Lungs are weak and cannot digest this dampness that is normally dispersed through sweat or moved downward to the Kidneys, the dampness accumulates into mucus. Longstanding heat from Liver qi stagnation transforms into fire and combines with the mucus to become the more viscous substance

42 referred to as phlegm-fire, which goes to the Heart where it disturbs the orifices.cxii Dr. Hammer goes on to say that the condition of phlegm misting the orifices of the heart is essentially the same as phlegm-fire without the heat from the Liver. It involves only dampness rising to the Heart,cxiii and adds that the psychological symptoms [in phlegm misting the orifices] are of a more quiescent nature, such as depression.cxiv

Overall, conditions that affect the orifices are thought to be due to excesses that cause them to become clogged. However, as corroborated by both Drs. Hammer and Long, in the modern clinic these excess pathogenic factors most often arise primarily out of an overall state of deficiency. Purely excess conditions are rare in the cliniccxv. Because some of the diseases that affect the orifices can arise due to deficiency, differentiating the underlying causes is essential.

5. Treatment: Herbal Therapies

The formulas in this chapter aromatically open the sensory orifices associated with the spirit of the heart, which in Chinese medicine are said to be closed when there is a loss of consciousness or coma.cxvi

I. Herbs that open the orifices:

43 Because we have only found one secondary source with information on acupuncture treatment of the orificescxvii (and no primary sources) we have focused on herbal strategies for the treatment of orifice pathologies. When used generally- as in the name of a treatment principle- the term open(ing) the orifices () is usually reserved for diseases in which the sensory orifices associated with the spirit of the heart cxviii are the orifices in question. This term can also be made even more specific, of course, by explicitly stating that the orifices to be opened are those of the heart, as in opening the heart orifices()). Because the term orifices of the heart specifically refers to the capacity for clear thinkingcxix, diseases for which this treatment method is applicable can include such symptoms as were spoken of in the previous section on pathology and pattern differentiation, and include loss of consciousness. In fact, some sources even go as far as to translate this method of opening the orifices ( ) much less literally, opting for the word resuscitationcxx instead While a tendency exists within Chinese culture to venerate the works of former times and masters (as in the Piwei lun quoting and re-quoting the Neijing), lively debate between schools of differing opinion has also more or less always been a part of the history of Chinese medicine. According to our research, the concept of the orifices has remained fairly static over time. Various pathologies afflicting the orifices were described over the course of Chinese medical history, and treatment ideas suitable to treat these pathologies were concurrently created.

44 As we have seen, pathologies of the orifices occur when the latter become blocked by pathogenic influences of various kinds. Consequently, as Chinese medical interventions tend to be heteropathic in nature, the goal of Chinese medical treatments that treat these pathologies is to open the orifices() and eliminate pathogenic influences. Many Chinese medicinals can treat pathologies that afflict the orifices: some herbs relieve specific symptoms affecting the upper orifices of the head through functions like opening the orifices of the nose( ) for symptoms such as nasal congestion; some brighten the eyes() in diseases of diminished visual acuity; others affect the two yin orifices by facilitating the elimination of urine or feces or by decreasing excessive elimination thereof. Herbs that affect the orifices are said to open()(usually referring to the heart orifices),disinhibit or benefit(), or penetrate or free and open() the orifices. In the Shennong bencao jing (), the latter two terms are used in reference to medicinal substances beneficial effects on the orifices.cxxi The Shennong bencao jing, the seminal materia medica of Chinese medicine, mentions two of the herbal substances that are still commonly used today in treating obstruction of the orifices, namely Acorus ((shi) chang pu) and Polygala (yuanzhi).cxxii Herbs said to be able to Free the orifices() in this text include the following: Acorus (changpu, ) and Zizyphus (dazao,).cxxiii

45 Herbs said to benefit() the orifices are: Stalactite (shizhong ru, ), Limonite (kongqing, ), Azurite (Bai qing, ), Polygala (yuanzhi, ), Asarum (xixin, ), and Vitex (Manjingshi, ).cxxiv Interestingly, the only herb in the entire Shennong bencao jingcxxv said to open the heart orifices(here, , literally open the heart hole or foramen) per se is the herb Acorus, (Shi) chang pu. The entry for this herb follows:

Acorus flavor is acrid and warm. It primarily treats wind-cold-damp-bi [syndromes], cough and qi ascending in counterflow, opens the heart orifices, tonifies the five zang [organs], frees the nine orifices, brightens the eyes and ears, and [allows] the voice to issue forth. Long-term use [of this herb causes one to] neither be forgetful nor confused, and to live a long life. Another name for it is Changyang. It grows in pools and marshes.cxxvi

In general, the substances that affect the orifices possess an aromatic () quality, a term that describes an [herbs] ability to penetrate through turbidity and revive a particular function, either the digestive function of the spleen, or the cognitive functions of the spirit and sensory orificescxxvii. Indeed, the term aromatic is as synonymous with reviving function as to have become incorporated into the very name of the two categories of medicinals that act to do so: those that revive the spleen () are referred to as aromatic substances that

46 transform dampness () while those that revive the spirit () are termed aromatic substances that open the orifices(). In general, strongly aromatic substances are also said to be mobile and penetrating(), that is tending to move and penetrate blockages... move the qi and quicken the blood, free the channels and quicken the network vessels, or free the orifices and free the spiritcxxviii, but only some of them have an affinity to the orifices of the heart. In addition to herbs open the orifices due to their aromatic nature, one classical source also mentions that slippery substances are able to open the orifices: the Zhouli (), the rites of the Zhou, states that In general, herbs with a slippery nature nourish the orifices. Because slippery substances allow for free and smooth coming and going like an orifice they thereby are nourishing to the orifices. (cxxix ). According to Dr. Long, although this statement speaks of the orifices in general it is likely referencing only the lower orifices, which benefit from the lubrication provided by slippery substances (such as Talcum (hua shi, ) and Plantago seed (che qian zi, )cxxx. In Chinese Herbal Medicine: Materia Medica by Bensky et al, the following substances are listed in the chapter entitled Aromatic substances that open the orifices: Moschus (she xiang, ), Styrax (Su he xiang, ),

47 Borneolum (bing pian, ), Benzoinum (an xi xiang, ), Bovis calculis (niu huang, ), and Acorus (shi chang pu, ). In the summary of comparative functions at the end of the chapter, a brief synopsis and comparison of these herbs is given: Moschus (she xiang), Styrax (su he xiang), and benzoinum (an xi xiang) are all used to open the orifices and treat loss of consciousness. Moschus (she xiang) is the most intensely aromatic and penetrating substance in the material medica. Its penetrating action is the reason for its efficacy in the treatment of trauma and sores. Borneolum (bing pian) has a similar, but much weaker, action. Styrax (su he xiang) is especially useful for wind-stroke with collapse due to phlegm, and Benzoinum (an xi xiang) also invigorates the blood and treats chest and abdominal pain. Bovis Calculis (niu huang) is not as potent as Moschus in opening the orifices, but it is particularly effective in clearing heat and resolving toxicity. The two are often used together in treating coma associated with heat disorders. The ability of Acori tatarinowii (shi chang pu) to open the orifices is secondary to its general, aromatic action in dislodging phlegm.cxxxi Interestingly, Polygala (yuanzhi, ), an herb used often in the treatment of phlegm misting the orifices, is not found in this chapter but, rather, in another entitled Substances that calm the spirit, in the sub-section Herbs that nourish the heart and calm the spirit. Although the functions of calming the spirit (or mind) and dispersing phlegm may seem somewhat contradictory, calming the mind in the category of herbs that calm the mind should not be interpreted literally. The category of herbs that calm the mind include herbs that are pungent in taste and stimulate the mind and open the orifices. [such as Polygala] Yuan zhicxxxii From another standpoint, it appears that because this herb reestablishes communication between the heart and kidneys it functions to

48 anchor the spirit primarily and open the orifices with penetrating aroma as a secondary measure.

II. Formulas that open the orifices:

There are many formulas that have an effect of opening the heart orifices, and all incorporate both herbs that open the orifices in addition to others that support the overall direction of treatment. As weve discussed, not all cases of phlegm misting the orifices are due to identical pathological processes. Therefore, in addition to using some of the herbs described above that open the orifices, other herbal ingredients that aid in addressing the source of blockage in the orifices and address specific aspects of underlying pathology are also found in these formulas. As Steven Clavey, an author and translator of Chinese medical texts, points out in his book Fluid Physiology and Pathology in Traditional Chinese Medicine, As a general rule, phlegm treatments should first act to restore harmony to the body by eliminating the phlegm, and then proceed to correcting the process that created it. Thus for cold phlegm, one should warm yang to transform phlegm; for hot phlegm, one should clear heat to eliminate phlegm Phlegm misting the Heart requires not only the removal of phlegm (and whatever caused it), but also opening the Heart orifice and restoration of healthy blood to nourish the Heart and its Shen.cxxxiii As noted by Clavey, one should first act to restore harmony to the body by eliminating the phlegm, and then proceed to correcting the process that created it because phlegm is both the product of pathological processes and a diseasecausing agent in its own right.cxxxiv Because formulas that treat phlegm

49 obstructing the orifices were traditionally administered for the resuscitation of consciousness, formulas that function primarily to open the orifices were traditionally administered only for a short period of time. Formularies note that these formulas are contraindicated for long-term use in every case because even when the clinical presentation is appropriate for these formulas, they should only be used short-term for treating the acute symptoms [such as loss of consciousness]. If used long-term, their dispersing properties can readily injure the normal qi.cxxxv A distinction exists within warm disease theory between the formulas that warm and open the orifices () by clearing the heart and opening the orifices(), sweeping [away] phlegm and opening the orifices( )cxxxvi, and repelling foulness and opening the orificescxxxvii. This quote from Intro to English Terminology of Traditional Chinese Medicine by Nigel Wiseman, one of the pre-eminent Chinese medical language scholars, gives a detailed description of two of these various treatment methods applied to the orifices: : qingxin kaiqiao, clearing the heart and opening the orifices: A method of treatment used to address externally contracted febrile disease patterns, such as heat entering the pericardium, characterized by high fever with clouded spirit and delirious speech, vexation and agitation, parched lips and dry teeth, titanic reversal, and convulsion, including child fright wind bihui kaiqiao, repelling foulness and opening the orifices: Contraction of foul turbidity in hot weather, causing sudden oppression and distension in the chest and abdomen, ungratified urge to vomit and defecate, and, in serious cases, clouding reversal, phlegm-drool congestion and clenched jaw. It is treated by the method of repelling foulness and opening the orifices [with such formulas as]: yu shu dan, xing jun san, [and] su he xiang wan.cxxxviii

50 Formulas that open the orifices are most often divided into two categories: those that are cool and opening(), which treat hot-type closed disorders; and those that are warm and opening(), which treat cold-type closed disorders. The hot-type closed disorder is due to pathogenic heat or heat toxin sinking into the pericardium, and is treated by clearing the heat to open up the sensory orifices. The cold-type closed disorder is due to pathogenic cold and constrained qi generating turbid phlegm, which veils the orifices of the heart. It is treated by warming the cold and unblocking the qi to open the sensory orifices.cxxxix

Warm and opening formulas:

According to Bensky, et al. and Wiseman, the formula to treat cold phlegm misting the orifices is Suhexiang wan Liquid styrax pillcxl, cxli. Bob Flaws recommends Shun qi dao tan tang (Normalize the qi and abduct phlegm decoction) for the pattern phlegm obstructing the orifices of the heart, as he believes the pattern includes qi stagnation as a primary etiology (with the corresponding treatment principles that rectify the qi and resolve depression, transform phlegm and open the orifices.cxlii

Cool and opening formulas:

51

When a warm pathogen has transmitted abnormallycxliii or has sunken deep into the nutritive or blood layers, the pericardiumor orificescan become veiled by heat and phlegm. For treatment of hot phlegm, one should choose from the following formulas: Angong niuhuang wan, Niuhuang chengqi tang, Niuhuang qingxin wan, Zixue dan, and Huichun dan (Note that all of these formulas except Zixue dan contain Calculis Bovis Niuhuang)cxliv.

6. Conclusion

According to the available, extant source material outlining the basic theories of Chinese medicine, certain correspondences are as fundamental as to have become ubiquitous across various schools of Chinese philosophical and medical thought. The liver organ, for example, is always associated with the eastern direction while the Lungs are associated with the western direction (though it should be noted that the heart is classified as the earth-element organ in the Shuowen jiezicxlv). However, it cannot be denied that every village and every clan in China, Japan, Korea, Vietnam, Laos, and Cambodia evolved a Chinese medicine distinctly different from those even nearby [and, moreover, the term Chinese medicine can be used to include] all of the rich, illimitable medical information which is the heritage of at least three thousand years of continuous Chinese culturecxlvi.

52 Associations involving the orifices are no exception to this pluralism of thought. Throughout the Neijing and other classics of Chinese medicine and philosophy the attribution of the sensory orifices to the zang organs appear not to be fixed, and likely this lack of agreement is closer to both clinical reality (for disease of a particular organ can affect various sensory orifices) and the underlying philosophy of Chinese medicine in which each body part- and all of nature- is inextricably linked. Physiology in Chinese medicine encompasses the human being, his relationship to the cosmos, and his consciousness, because these phenomena are to the ancient Chinese just as much a part of the embodied human as are the qi and blood. From this holistic perspective, personal evolution is also the purview of medicine, and the path of self-cultivation is an important part of the path of health. Indeed, a quote above from the Hanfeizi refers to a competent rulers orifices being maintained in emptiness, and this aspect of self-cultivation is merely that in which a person rids himself of those things that stand in the way of the full flowering of his awareness. While we (very) briefly addressed the topic self-awareness and cultivation in the section dealing with pathology according to the philosophical classics, we cannot but also assert here that cognition and awarenessand, consequently, the topic of cultivated awarenessare part and parcel to the functional physiology of Chinese medicine to the same extent that any material aspect of the body might also be. To the extent that the orifices are conduits of consciousness, the topic of consciousness has been germane to our discussion.

53 Further research is certainly needed in order to fully treat the topic of the heart orifices, butas weve impliedthat research must continue in the clinic as well as amongst the annals of Chinese medical literature. What we can say definitively is this: the orifices, an extension of the heart, must be maintained in emptiness in order to function properly; because they are the portals through which the heart connects with the body and the world (and because the heart is the ruler of consciousness), they play a role in the acquisition of information, in thought and communication, and in consciousness. We depart with one final thought. In hearkening back to a turn of phrase found in the Daode jing, we proclaim: would that all our hearts could be empty and yet our stomachs still be full!cxlvii

54 Endnotes

Liu Xiang (). Garden of Stories (). From: Paul Rouzer, A New Practical Primer of Literary Chinese (Cambridge: Harvard University Press), 4.
i ii

Wiseman, Nigel (). Introduction to English Terminology of Chinese

Medicine (). (No city given. Publisher: .), 11 iii Wiseman, Nigel, Feng Ye. A Practical Dictionary of Chinese Medicine, Second Edition. (Brookline: Paradigm Publications), 421 iv Hammer, Leon. Dragon Rises, Red Bird Flies (Seattle: Eastland Press), xxi v Barnes, Archie, et el. Dus Handbook of Classical Chinese Grammar (Great Britain: WritersPrintShop), xv vi Wilder, G.D., and J.H. Ingram. Analyzing Chinese characters (Edinburgh: Dover Publications), iii vii Wilder, G.D., and J.H. Ingram. Analyzing Chinese characters (Edinburgh: Dover Publications), iii viii Wiseman, Nigel and Feng, Ye. Chinese Medical Chinese: Grammar and Vocabulary. (Brookline: Paradigm Publications), 4 ix Wiseman, Nigel and Feng, Ye. Chinese Medical Chinese: Grammar and Vocabulary. (Brookline: Paradigm Publications), 4 x Wiseman, Nigel and Feng, Ye. Chinese Medical Chinese: Grammar and Vocabulary. (Brookline: Paradigm Publications), 4 xi Wilder, G.D., and J.H. Ingram. Analyzing Chinese characters (Edinburgh: Dover Publications), vi xii Wilder, G.D., and J.H. Ingram. Analyzing Chinese characters (Edinburgh: Dover Publications), PAGE??? xiii Freuhauf, Heiner. Advanced Cosmology III, Spring 2011. National College of Natural Medicine.
xiv

309 xv Ellis, Andrew, Nigel Wiseman, and Ken Boss. Grasping the wind: an exploration into the meaning of Chinese acupuncture point names. (Brookline: Paradigm Publication), 386 Shuowen jiezi () http://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etym ology&characterInput= xvii Freuhauf, Heiner. Advanced Cosmology III, Spring 2011. National College of Natural Medicine. xviii Shuowen jiezi. http://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etym ology&characterInput=
xvi

55

xix

Harbaugh, Rick(). Chinese Characters: A Genealogy and Dictionary (

). (Taipei: Han Lu Book and Publishing company), 269.

xx

Shuowen jiezi. http://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etym ology&characterInput= xxi Shuowen jiezi. http://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etym ology&characterInput= xxii Larre, Claude, and Elisabeth Rochat de la Vallee. Heart Master Triple Heater. (London: Monkey Press), 2 xxiii Becker, Simon, et al. Translators preface. Yi Lin Gai Cuo: Correcting Errors in the Forest of Medicine. Trans. Chung, Yuhsin, et al. (Boulder: Blue Poppy Press), xvi xxiv New Oxford American Dictionary (digital version 2.3.1 (80.4) ). Entry for Anatomy. xxv Wang, Qing-Ren. Yi Lin Gai Cuo: Correcting Errors in the Forest of Medicine. Trans. Chung, Yuhsin, et al. (Boulder: Blue Poppy Press), xvi xxvi Ibid. (???) Huangdi Neijing Suwen chapter 62 (). http://www.chant.org/prehan/frame.aspx?t=b&id=000951
xxvii

Lingshu Chapter 17(). http://www.chant.org/prehan/frame.aspx?t=b&id=000952 (Note: This sentence is found in many chapters throughout the Neijing) xxix Unschuld, Paul U. Medicine in China: A History of Ideas. (Berkeley: University of California Press), 51
xxviii

Suwen chapter 4 (). http://www.chant.org/prehan/frame.aspx?t=b&id=000951

xxx

Suwen chapter 4 (). http://www.chant.org/prehan/frame.aspx?t=b&id=000951 xxxii Rochat de la Vallee, Elisabeth, et al. JingShen: A Translation of Huainanzi Chapter 7. (London: Monkey Press),
xxxi

Lingshu Chapter 17 (). http://www.chant.org/prehan/frame.aspx?t=b&id=000952 xxxiv Hammer, Leon. A Discussion of Terrain, Stress, Root, and Vulnerability in Chinese Medicine,. Chinese Medicine Times vol. 5, Issue 1, Spring 2011.
xxxiii

Suwen Chapter 5 (). http://www.chant.org/prehan/frame.aspx?t=b&id=000951

xxxv xxxvi

Zheng Xuan(). A Han Dynasty Commentary [on the Rites of Zhou] by

Zheng Xuan(). http://www.definition-of.net/-

56

Suwen Chapter 5 (). http://www.chant.org/prehan/frame.aspx?t=b&id=000951

xxxvii

Lingshu Chapter 78 (). http://www.chant.org/prehan/frame.aspx?t=b&id=000952

xxxviii

Jiu shou(), Wenzi. http://ctext.org/wenzi?searchu= Lingshu Chapter 71 ( ). http://www.chant.org/prehan/frame.aspx?t=b&id=000952 xli Yu, Ning. Application of Cognitive Linguistics 12: The Chinese HEART in a Cognitive perspective. (Berlin: Mouton de Gruyter), 171 xlii Wiseman, Nigel, and Feng Ye. A Practical Dictionary of Chinese Medicine, nd 2 Ed. (Brookline: Paradigm Publications), 421 xliii Yu, Ning. Application of Cognitive Linguistics 12: The Chinese HEART in a Cognitive perspective. (Berlin: Mouton de Gruyter), 171 xliv A Practical Dictionary of Chinese Medicine 2nd Ed xlv Yu, Ning. Application of Cognitive Linguistics 12: The Chinese HEART in a Cognitive perspective. (Berlin: Mouton de Gruyter), 2 xlvi Yu, Ning. Application of Cognitive Linguistics 12: The Chinese HEART in a Cognitive perspective. (Berlin: Mouton de Gruyter),171 xlvii Yu, Ning. Application of Cognitive Linguistics 12: The Chinese HEART in a Cognitive perspective. (Berlin: Mouton de Gruyter), 130 xlviii Clavey, Steven. Fluid Physiology and Pathology in Traditional Chinese Medicine. (Australia: Churchill Livingstone), 336 xlix Yu, Ning. Application of Cognitive Linguistics 12: The Chinese HEART in a Cognitive perspective. (Berlin: Mouton de Gruyter), 171
xxxix xl

Suwen Chapter 8 (). http://www.chant.org/prehan/frame.aspx?t=b&id=000951 li Larre, Claude, and Elisabeth Rochat de la Vallee. The Secret Treatise of the Spiritual Orchid (London: Monkey Press), 143 Larre
l lii liii liv

Xunzi (). http://ctext.org/xunzi?searchu=

Hanfeizi ). http://ctext.org/hanfeizi?searchu= Wang, Qing-Ren. Yi Lin Gai Cuo: Correcting Errors in the Forest of Medicine. Trans. Chung, Yuhsin, et al. (Boulder: Blue Poppy Press), xvi lv Hammer, Leon. Chinese Pulse Diagnosis: A Contemporary Approach, Revised Edition. (Seattle: Eastland Press), 23 lvi Hammer, Leon. Chinese Pulse Diagnosis: A Contemporary Approach. (Seattle: Eastland Press), lvii Hammer, Leon. Chinese Pulse Diagnosis: A Contemporary Approach. (Seattle: Eastland Press), 401 lviii Hammer, Leon. Chinese Pulse Diagnosis: A Contemporary Approach. (Seattle: Eastland Press), 73 lix Hammer, Leon. Chinese Pulse Diagnosis: A Contemporary Approach. (Seattle: Eastland Press), 321

57

lx

Hammer, Leon. Email correspondence with the author. April, 2012. Hammer, Leon. Chinese Pulse Diagnosis: A Contemporary Approach, Revised Edition. (Seattle: Eastland Press), 73 lxii Hammer, Leon. Chinese Pulse Diagnosis: A Contemporary Approach, Revised Edition. (Seattle: Eastland Press), 73 lxiii Hammer, Leon I. Personal correspondence with the author (dated March, 2012). lxiv Lingshu Chapter 4 ( ?????). http://www.chant.org/prehan/frame.aspx?t=b&id=000952
lxi

Suwen Chapter ??? (). http://www.chant.org/prehan/frame.aspx?t=b&id=000951 lxvi Lingshu Chapter 28 (??????? ). http://www.chant.org/prehan/frame.aspx?t=b&id=000952
lxv

Gao, Li ().Piwei lun(). http://onlinebooks.library.upenn.edu/webbin/gutbook/lookup?num=25123 lxviii Gao, Li. Piwei lun. http://onlinebooks.library.upenn.edu/webbin/gutbook/lookup?num=25123 lxix Gao, Li. Piwei lun. http://onlinebooks.library.upenn.edu/webbin/gutbook/lookup?num=25123 lxx Larre, Claude, and Elisabeth Rochat de la Vallee. Heart Master Triple Heater. (London: Monkey Press), 15 lxxi Wiseman, Nigel, and Feng Ye. A Practical Dictionary of Chinese Medicine, 2nd Ed. (Brookline: Paradigm Publications), 421 lxxii Larre, Claude, and Elisabeth Rochat de la Vallee. Heart Master Triple Heater. (London: Monkey Press), 1 lxxiii Yu, Ning. Application of Cognitive Linguistics 12: The Chinese HEART in a Cognitive perspective. (Berlin: Mouton de Gruyter), 98 lxxiv Mair, Victor H. Tao Te Ching: The Classic of Virtue and the Way. (New York: Bantam Books), xi lxxv Mair, Victor H. Tao Te Ching: The Classic of Virtue and the Way. (New York: Bantam Books), xi lxxvi Hammer, Leon I. Dragon Rises, Red Bird Flies, Revised Edition. (Seattle: Eastland Press), xlii
lxvii lxxvii lxxviii

Laozi (). Daode jing (). As quoted in The Chinese Heart, 65 Huang Di (). Yinfu jing (). As quoted in The Chinese Heart,

60
lxxix lxxx lxxxi

Long, Rihui. Personal correspondence with the author dated March, 2012. Shakespeare, William. Hamlet, Act III

Shizi (). As Quoted in The Chinese Heart, 64 Csikszentmihalyi, Mark. Readings in Han Chinese Thought. (Indianapolis: Hackett Publishing Co), 3
lxxxii

58

lxxxiii

Maclean, Will, and Jane Lyttleton. Clinical Handbook of Internal Medicine: The treatment of Disease with Traditional Chinese Medicine ,Volume 1. (Macarthur: University of Western Sydney), 638 lxxxiv Wiseman, Nigel, and Feng Ye. A Practical Dictionary of Chinese Medicine, 2nd Ed. (Brookline: Paradigm Publications), 433 lxxxv Clavey, Steven. Fluid Physiology and Pathology in Traditional Chinese Medicine, 2nd Ed. (Edinburgh: Churchill Livingstone), 522 lxxxvi Yan, Shi-Lin , and Zheng-Hua Li. Pathomechanisms of the Heart: Xin Bing Zhi Bing Ji. Ed. Brand, Eric and Zhang Yuhuan, Trans. Sabine Wilms, et al. (Taos: Paradigm publications), 7 lxxxvii Pathomechanisms of the Heart, 7 lxxxviii Hammer, Leon I. Personal correspondence with the author, dated April 21, 2012
lxxxix

Ye, Tianshi (). Discourse on warm-heat disease, Wenre lun (

). http://www.charleschace.com/pdfs/WenReLun_1.pdf
xc

Chapter 17 of the Lingshu http://www.chant.org/prehan/frame.aspx?t=b&id=000952 xci Chapter 28 of the Suwen http://www.chant.org/prehan/frame.aspx?t=b&id=000951 Ye, Tianshi (). Discourse on warm-heat disease http://www.charleschace.com/pdfs/WenReLun_1.pdf xciii Pathomechanisms of the Heart, 7 xciv Xie, Zhufan. On the Standard Nomenclature of Traditional Chinese Medicine. (Beijing: Foreign Languages Press), 95 xcv Gao, Li. Piwei lun. http://onlinebooks.library.upenn.edu/webbin/gutbook/lookup?num=25123 xcvi xcvi Gao, Li. Piwei lun. http://onlinebooks.library.upenn.edu/webbin/gutbook/lookup?num=25123 xcvii xcvii Gao, Li. Piwei lun. http://onlinebooks.library.upenn.edu/webbin/gutbook/lookup?num=25123 xcviii Pathomechanisms of the Heart xcix Clavey, Steven. Fluid Physiology and Pathology in Traditional Chinese Medicine, 2nd Ed. (Edinburgh: Churchill Livingstone), c Pathomechanisms of the Heart, 15 ci Clavey, Steven. Fluid Physiology and Pathology in Traditional Chinese Medicine, 2nd Ed. (Edinburgh: Churchill Livingstone), cii Wiseman, Nigel, and Feng Ye. A Practical Dictionary of Chinese Medicine, 2nd Ed. (Brookline: Paradigm Publications), 433 ciii Flaws, Bob, and Daniel Finney. A Compendium of TCM Patterns and Their Treatments. (Boulder: Blue Poppy Press), 43 civ Flaws, Bob, and Daniel Finney. A Compendium of TCM Patterns and Their Treatments. (Boulder: Blue Poppy Press), 44 cv Hammer, Leon I. Personal correspondence with the author, dated March, 2012 cvi Hammer, Leon I. Personal correspondence with the author, dated June 2012
xcii

59

cvii

Hammer, Leon I. Personal correspondence with the author, dated April 21, 2012 cviii Hammer, Leon I. Personal correspondence with the author, dated April 21, 2012 cix Long, Rihui. Personal correspondence with the author, dated March 2012 cx Hammer, Leon I. Personal correspondence with the author, dated April 21, 2012 cxi Hammer, Leon I. Personal correspondence with the author, dated April 21, 2012 cxii Hammer, Leon. Chinese Pulse Diagnosis: A Contemporary Approach, Revised Edition. (Seattle: Eastland Press), 570-571 cxiii Hammer, Leon. Chinese Pulse Diagnosis: A Contemporary Approach, Revised Edition. (Seattle: Eastland Press), 571 cxiv Hammer, Leon. Chinese Pulse Diagnosis: A Contemporary Approach, Revised Edition. (Seattle: Eastland Press), 571 cxv Long, Rihui. Personal correspondence with the author, dated May 2012 cxvi Bensky, Dan, and Randall Barolet. Chinese Herbal Medicine: Formulas and Strategies. (Seattle: Eastland Press), 415 cxvii Maciocia, Giovanni. The Psyche in Chinese Medicine: Treatment of Emotional and Mental Disharmonies with Acupuncture and Chinese Medicine. (Edinburgh: Churchill Livingstone Elsevier), 208, etc. cxviii Bensky, Dan, and Randall Barolet. Chinese Herbal Medicine: Formulas and Strategies. (Seattle: Eastland Press), 415 cxix Yu, Ning. Application of Cognitive Linguistics 12: The Chinese HEART in a Cognitive perspective. (Berlin: Mouton de Gruyter), 171 cxx Xie, Zhufan. On the Standard Nomenclature of Traditional Chinese Medicine. (Beijing: Foreign Languages Press), 237 Shennong (). Shennong bencao jing (). http://www.chant.org/sixdyn/frame.aspx?t=b&id=000839
cxxi

Shennong (). Shennong bencao jing (). http://www.chant.org/sixdyn/frame.aspx?t=b&id=000839

cxxii

Shennong (). Shennong bencao jing (). http://www.chant.org/sixdyn/frame.aspx?t=b&id=000839

cxxiii

Shennong (). Shennong bencao jing (). http://www.chant.org/sixdyn/frame.aspx?t=b&id=000839

cxxiv

Shennong (). Shennong bencao jing (). http://www.chant.org/sixdyn/frame.aspx?t=b&id=000839

cxxv

Shennong (). Shennong bencao jing (). http://www.chant.org/sixdyn/frame.aspx?t=b&id=000839 cxxvii Bensky, Dan, Steven Clavey, Erich Stoger, and Andrew Gamble, Illus. Lillian Lai Bensky. Chinese Herbal Medicine: Materia Medica, 3rd Edition. (Seattle: Eastland Press), xvi
cxxvi

60

Jiao, Shu-De() , trans. Mitchell, et al. Ed. Wiseman, Nigel and Andrew Ellis. Ten lectures on the use of Medicinals from the personal experience of Jiao Shu-De. (Brookline: Paradigm publications), 22
cxxviii

The Rites of Zhou (). http://ctext.org/rites-of-zhou/zh Long, Rihui. Personal correspondence with the author, dated May, 2012 cxxxi Chinese Herbal Medicine: Materia Medica by Bensky et al cxxxii Maciocia, Giovanni. The Psyche in Chinese Medicine: Treatment of Emotional and Mental Disharmonies with Acupuncture and Chinese Medicine. (Edinburgh: Churchill Livingstone Elsevier) cxxxiii Clavey, Steven. Fluid Physiology and Pathology in Traditional Chinese Medicine, 2nd Ed. (Edinburgh: Churchill Livingstone), 314 cxxxiv Clavey, Steven. Fluid Physiology and Pathology in Traditional Chinese Medicine, 2nd Ed. (Edinburgh: Churchill Livingstone), 313 cxxxv Clavey, Steven. Fluid Physiology and Pathology in Traditional Chinese Medicine, 2nd Ed. (Edinburgh: Churchill Livingstone), 485
cxxix cxxx cxxxvi cxxxvii

p. 62 Wiseman, Nigel (). Introduction to English Terminology of Chinese

Medicine (). (No city given. Publisher: .), 188

cxxxviii

Wiseman, Nigel (). Introduction to English Terminology of Chinese

Medicine (). (No city given. Publisher: .), 187-188 cxxxix Bensky, Dan, and Randall Barolet. Chinese Herbal Medicine: Formulas and Strategies. Seattle: Eastland Press, 485 cxl Bensky, Dan, and Randall Barolet. Chinese Herbal Medicine: Formulas and Strategies. Seattle: Eastland Press,
cxli

Wiseman, Nigel (). Introduction to English Terminology of Chinese Wiseman, Nigel (). Introduction to English Terminology of Chinese

Medicine (). (No city given. Publisher: .),

cxlii

Medicin(). (No city given. Publisher: .), 44 Ye, Tianshi (). Discourse on warm-heat disease http://www.charleschace.com/pdfs/WenReLun_1.pdf cxliv Bensky, Dan, and Randall Barolet. Chinese Herbal Medicine: Formulas and Strategies. Seattle: Eastland Press, 416-422 cxlv Shuowen jiezi. http://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etym ology&characterInput= cxlvi Dragon Rises, Red Bird Flies, 2
cxliii cxlvii

Laozi (). Daode jing (). http://ctext.org/dao-de-jing