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Nan Jing: The Classic of Difficult Issues

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Abstract

This newly revised and updated edition of Paul U. Unschuld's original 1986 groundbreaking translation reflects the latest philological, methodological, and sinological standards of the past thirty years. The Nan Jing was compiled in China during the first century C.E., marking both an apex and a conclusion to the initial development stages of Chinese medicine. Based on the doctrines of the Five Phases and yinyang, the Nan Jing covers all aspects of theoretical and practical health care in an unusually systematic fashion. Most important is its innovative discussion of pulse diagnosis and needle treatment. This new edition also includes selected commentaries by twenty Chinese and Japanese authors from the past seventeen centuries. The commentaries provide insights into the processes of reception and transmission of ancient Chinese concepts from the Han era to the present time. Together with the Huang Di Nei Jing Su Wen and the Huang Di Nei Jing Ling Shu, this new translation of the Nan Jing constitutes a trilogy of writings offering scholars and practitioners today unprecedented insights into the beginnings of a two-millennium tradition of what was a revolutionary understanding of human physiology and pathology. © 2016 by The Regents of the University of California. All rights reserved.
... These theories and their role in diagnosis emerged in the Huangdi's Internal Classic and over time become more systematised. In acupuncture this systematisation becomes clear in the Classic of Difficult Issues (Nan Jing, circa 100 CE) [11], and for herbal medicine, in the Treatise on Cold Damage (Shang han lun, circa 210 CE) [5,12]. Throughout the practice of TEAM systems in East Asia, the role of identifying and treating patterns has had a complex history. ...
... These considerations raise questions about how systems are taught (7) Qi deficiency (11) Yin deficiency (7) Herbs + acupuncture [44] Meridian Therapy Non-symptom centred and how systems are practiced. There are insufficient studies in both these areas to have clear understanding of how practitioners arrive at their decisions on what to do and how to use PIs in their practice. ...
... Emerged in China in the mid-1950s in response to political and public health needs [11] Meridian Therapy (2) 12 channels; yin-yang theory; 5 phase theory; qi circulation Using especially pulse and abdominal palpation diagnosis, identify the primary five-phase deficiency pattern, among 6 yin meridians [17] 4 'primary' patterns with a small number of secondary patterns [17,26] Acupuncture treatment Practical interpretation of passages in the Nanjing. Emerged in Japan in the mid-1930s in response to Japanese government efforts to eliminate traditional medical thinking [1] Sasang -4 Constitutions (3) Classification of constitutional types according to a four-fold typography (tae-yang / so-yang / tae-eum / so-eum) Observation of body characteristics, personality traits and disease symptoms to identify the constitutional type (Sasangin) 4 basic patterns Herbal medicine prescriptions Began as a theoretical reconstruction of historical ideas and medical practice systems Emerged in Korea in the late 1890s ...
Article
Introduction In traditional East Asian Medicine (TEAM), various systems of practice exist that have used different theories to guide their practice. Although data gathering has been limited to what can be observed by the four examinations - si zhen, the different systems of practice have focused on different observational data to make diagnostic decisions and choose corresponding treatments. The organization of the data into patterns has led to what is called Pattern Identification based systems of practice (PIs). Methods The range of systems, theories, treatments and PIs were explored in order to highlight important issues for researchers to consider in performing PI based research Results Expert opinions, scholarly and clinical literature on the key issues which compose ‘pattern identification’ (PI) were identified with respect to the history, development, nature and the different strategies used by different PIs for diagnosing and treating patients. Conclusion It is important for researchers to understand these issues so as not to weaken their results and findings, whether conducting survey-based research, clinical trial research, laboratory studies or seeking to influence teaching and practice. This is the first in a series of papers by the international Pattern Identification Network Group (iPING) helping to clarify the area of research on PIs and which seek to expand lines of research on PIs so that teaching, practice, clinical and laboratory research can be more consequential.
... The root treatment focuses on correcting underlying disturbances of qi circulation among the twelve meridians regardless of the nature and location of symptoms. The theory of Nanjing sixty-nine states that one should always apply supplementation, bu [補] before draining, xie [寫] techniques [Fukushima 1991, Shudo 1991, Unschuld 1986:583], practically interpreted in Meridian Therapy to mean focus on finding what is xu [虛] or vacuous and take that as the primary target or first step of treatment. Nanjing sixty-nine also says 'for conditions of xu, vacuity, bu, supplement the mother. ...
... Today the more common understanding of deqi is that it refers to sensations that the person being needled might experience, such as 'throbbing, aching, tingling' etc [Anon 1980, Cheng 1987]. However the early descriptions of these two terms either explicitly refer to them as sensations that the practitioner feels (see Nanjing seventy-eight [Unschuld 1986:635] or require mastering skills in order for the qi to arrive that cannot locate the sensations in the patient, so that it is as much about the level of inner development of the practitioner as it is about the manipulations of the needle [Birch 2004, Birch in preparation, Chace 2006, Chace, Bensky 2009, Yang 2007]. TMT, like its progenitor Meridian Therapy, takes the idea from the Nanjing that it is the superior physician that feels the qi with their left hand as the standard to which the practitioner should aspire [Fukushima 1991, Shudo 1990]. ...
... ) were said to reflect the state of qi in the body and the theory of pulse diagnosis in the Nanjing informs that one can read the radial pulses to understand the condition of qi in the body and in the jingmai, meridians [Unschuld 1986] ...
... No correspondence is a sign of illness. ' NJ 13 18 The prognostic conclusions of these phasal relationships form general principles even to the point of predicting the demise of a patient on a given day according to the relationship of the stem of the day and the dominant phase of the pulse: 'If a Liver [movement] appears, [the patient will] die at Geng and Xin...' 19 9. Unschuld (1986) ...
... But this relationship is not a one to one fit, and though symptomatically it may bring results it can also result in a mistreatment of the root. For a fuller discussion see Todd (2021) 45. Unschuld (1986) p.250-51 46. Unschuld & Tessenow (2011) p.295-97 47. ...
Article
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Pulse is a key aspect of diagnosis in Chinese medicine. Chapter 1 of the Ling Shu describes health through the quality of the pulse for a given time of year. Through this lens of phasal congruence we can see health as a greater degree of order and integration of the parts of ourselves within the context of a greater whole. Pulse provides a means to see this and, in exploring its interrelated elements of relative strength and shape, both Nei Jing and Nan Jing models give us information on the nature of disease, prognosis and channel selection for needling. INTRODUCTION This article seeks to explore aspects of pulse and their relationship to health and disease as described in the Nei Jing and Nan Jing. Following the Yellow Emperor's description of health as a pulse that is aligned with the seasons, the Nei Jing and Nan Jing representations are presented through the lens of specific seasonal qualities that give prognostic indications, depending on the time of year of their manifestation. The congruence of different phasal aspects (pulse, complexion, etc.) with each other and with the time of year forms the idea of health, and underlies the principles of order and organisation in the human and in the world. The pulse is further explored in terms of relative strength at different locations as well as the specific quality or shape of the waveform. These two complementary aspects can be seen to give rise to different kinds of diagnosis. The former relates to the geographic distribution of strengths and weaknesses within the channel system, and so is closely aligned with needling protocols. The latter relates more to descriptions of disease and its prognosis, some of these pulse qualities being expressed in terms that lend themselves more to herbal intervention. This presentation of the pulse in terms of a yin/yang binary follows a theme outlined in a previous article 1 that explored relationships between organ/ channel, channel/point, acupuncture/herbs, external/internal physiology pairs. This article concludes by presenting horizontal and vertical levels of organisation of the body, and their expression in different aspects of the pulse.
... Warm disease theory was to cause many controversies; for instance, Qing dynasty scholars Ye Lin and Li Guanxian thought Wu may have confused his idea of warm disease with epidemic disease due to the phonetic similarity of their characters (温 warm and 瘟 epidemic -a character that did not exist in ancient Chinese). 15,16 However, 瘟 was not only shown as an entry in the Chinese rhyme dictionary Jiyun (1037) 17 but was also actually specifically identified and annotated by Wu in the chapter on Miscellaneous Qi in his text Wen yi lun (Treatise on Warm Epidemics) . 18 This warm versus cold controversy has still not been resolved, including Wu's conclusion that herbal medicine is the only cure for epidemic disease. ...
... Unfortunately, since the systematic development of Chinese medicine in the Han dynasty and the cultural revolutions in the 20th century, medical scholars began to avoid use of practices involving the term 'ghost' in order to distant themselves from shamanism. 15 Some modern authors believe that ghost points are actually related to the treatment of yin fire. 29 Obviously, when yin and yang separate, yang floats upwards and outwards; this creates a volatile, unbalanced state, which ferocious epidemic qi can easily take advantage of (and might explain why certain body types are infected more easily than others). ...
Article
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The coronavirus COVID-19 has presented a serious new threat to humans since the first case was reported in Wuhan, China on 31 December 2019. By the end of February 2020 the virus has spread to 57 countries with nearly 86,000 cases, and there is currently no effective vaccination available. Chinese herbal medicine has been used in this epidemic with encouraging results, but with concerns regarding disturbance of patients' digestive function. This study aims to explore the role of acupuncture in treating COVID-19 by investigating relevant current literature along with classical Chinese medicine texts on epidemics. Based on this analysis, acupuncture points and strategies are suggested for practitioners to use as a guide to treatment.
... The 50th issue of Nan-Ching explains the pathology of the Five Evils[15][16]and the 69th issue of Nan-Ching describes the treatment for these evils. This method consists of, in a broad sense, the method of " tonificationsedation between deficiency and excess " as well as the method of " tonification-sedation between coldness and heat ". ...
... Saam acupuncture makes use of the tonification and sedation points along the promotion cycle as well as points along the control cycle in cases of deficiency and excess; and along the fire and water Meridians in cases of heat and coldness. The basic rules, based on the writings of Nan-Ching[15][16], are those of the promotion and control cycle relationships. In the case of any Meridian's insufficiency (weakness), the points of its mother and its own Meridians should be tonified and the points of its governor and its own Meridians should be sedated. ...
... Each method yields a somewhat different set of information; however, the common outcome of all is to provide the practitioner with diagnostic clues that are relevant to the particular paradigm of practice. Amongst the more well-known methods of pulse diagnosis are those that use two depths to assess the radial artery and have their origins in the Nan Jing [7], such as the method documented by Wang Shu-He [8]. There are also methods that incorporate three depths and have their origins in the Neijing Suwen [9]. ...
... It is one of many pulse systems first mentioned in the Nan Jing classic (c. 200 CE) [7], including Wang Shu-He's lesser known elaboration of Chapter 5 that describes palpation of various depths measured by " beans of pressure " [14]. Undoubtedly, the most important concept transmitted by this manuscript that affected many subsequent pulse systems is its identification of the radial artery as the predominant site for assessing a patient's pulse. ...
Article
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Contemporary Chinese pulse diagnosis™ (CCPD) is a system of pulse diagnosis utilized by Dr. John He Feng Shen, OMD, and documented by Dr. Leon Hammer, MD, in the book Chinese Pulse Diagnosis, A Contemporary Approach. It is the traditional method of the Ding medical lineage from the Shanghai region and dates to the 15th century in Chinese language texts. The fundamentals of this system are, however, much older and can be directly traced to the Neijing Suwen. Having been passed from the last direct inheritor of Ding knowledge (Dr. Shen) to modern practitioners of Chinese medicine by way of Dr. Hammer and his students, it represents an important system of advanced diagnosis. Although modern diagnostic technology provides very sophisticated diagnoses, for these instruments to be effective, the disease process must already have a physical manifestation. CCPD, on the other hand, provides the earliest warnings of physiological processes, which if left unchecked may result in the subsequent appearance of a disease. This article describes the derivation and the principles of this system of pulse diagnosis and explores its successful integration into the modern practice of Chinese medicine.
... The acupoints in and around the local areas, special points such as connecting, cleft, and alarm points, could be used for interruptions in correlation to an acupoint's efficacy, but the Five Shu points, located below the elbow and knee joints, could be used corresponding to the Five Phases for imbalances in correlation to tonification and sedation [8]. The 50th issue of Nan-Ching explains the pathology of the Five Evils [9,10] and the 69th issue of Nan-Ching describes the treatment for these evils. Gao-Wu, during the Ming Dynasty (1519 AD), was the first and foremost medical acupuncturist to tonify deficiency and sedate excess on the basis of either depletion or repletion of the promotion cycle, which is explained in " The Four Needle method " by Ross [7,11]. ...
... The basic rules, based on the writings of Nan-Ching [9,10], are those of the creation (mother-son) and governor (destruction) relationships. In the case of any meridian's insufficiency (weakness), the points of its mother and its own meridians should be tonified and the points of its governor and its own meridians should be sedated. ...
Article
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This study aimed to review the clinical basis for Sa-Ahm Five Element acupuncture. This form of acupuncture uses the Five-Shu acupoints and the tonification-sedation treatments based on the creation and control cycles of the Five Elements. A total of 28 books and papers from the ancient "Nan-Ching" to the modern "Medical Acupuncture" were used to study clinical practices. Sa-Ahm Five Element acupuncture could be practiced in different ways depending upon differential diagnoses. These diagnoses include theories of excess and deficiency of Yin and Yang, seven emotions, ZangFu (organ, viscera), and comparing pulse diagnosis and meridian therapy to meridian palpation. Clinical trials and guidelines for the practice of Sa-Ahm acupuncture should be created to allow for a more evidence-based clinical approach to using this technique.
... The acupoints in and around the local areas, special points such as connecting, cleft, and alarm points, could be used for interruptions in correlation to an acupoint's efficacy, but the Five Shu points, located below the elbow and knee joints, could be used corresponding to the Five Phases for imbalances in correlation to tonification and sedation [8]. The 50th issue of Nan-Ching explains the pathology of the Five Evils [9,10] and the 69th issue of Nan-Ching describes the treatment for these evils. Gao-Wu, during the Ming Dynasty (1519 AD), was the first and foremost medical acupuncturist to tonify deficiency and sedate excess on the basis of either depletion or repletion of the promotion cycle, which is explained in " The Four Needle method " by Ross [7,11]. ...
... The basic rules, based on the writings of Nan-Ching [9,10], are those of the creation (mother-son) and governor (destruction) relationships. In the case of any meridian's insufficiency (weakness), the points of its mother and its own meridians should be tonified and the points of its governor and its own meridians should be sedated. ...
Article
Full-text available
This study is a review of the theoretical basis of Sa-Ahm Five Element acupuncture devised about 360 years ago. A total of 21 books and papers ranging from the ancient Huang Di Nei Jing to modern biomedical acupuncture for pain management were researched in relation to the Five Shu points. Gao-Wu, in the Chinese Ming Dynasty, used the Five Shu points for the first time based on the creation cycle as the tonification and sedation treatment, termed the "tonification and sedation treatment of self meridian". Since then, and for no particular reason, this method has been rarely used until Sa-Ahm's new doctrine, which includes the concept of the destruction cycle, was asserted. Sa-Ahm Five Element acupuncture is a method in which the Five Shu points are used from the viewpoints of the simultaneous tonification and sedation methods that are based on the promotion and control cycles. Although it is currently the most utilized method in accordance with the practitioner's points, this method is in need of designated guidelines by which Sa-Ahm acupuncture can be practiced effectively.
... Clinically the separation of PCT and CCT is not absolute. For example, having selected a channel using the CCT approach we can then take into account symptomatic presentations using a PCT approach; examples from the Nan Jing (Classic of Difficulties) 10 and Nei Jing Ling Shu (Inner Classic Divine Pivot) 11 can be seen in Table 1. Another example of integrating CCT and PCT is seen in Japanese Meridian Therapy, which has root patterns that include cold and heat as modifiers of point choice. ...
Article
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In the practice of traditional East Asian medicine there are many interlocking yinyang relationships that, although they cannot be entirely separated, are best understood on their own terms. This article explores some of these aspects, beginning by discussing acupuncture treatment based on point function versus balancing the channel system. Then the relationship of organs to channels is explored, and expanded to contrast the physiology of the body's interior-a multifaceted world of organs, substance and climates-with the relatively simpler channel physiology that is accessible via the body's exterior. The modalities of herbs and acupuncture are situated with respect to these regions, and the root and branch aspects of acupuncture treatment are clarified as a means to focus or dissipate the body's resources in order to create the conditions for better health.
... Regardless of which portion of the mesentery Aristotle referred to, both accounts assign the root to the lower diaphragm: the treatise Nature of Bones XIV to the genitals, and Humours XI and Nature of the Child XXVI to the belly. Therefore, in these particular accounts, if one end of the tree is below, the root in this case, 42 then the other end, the branches and leaves, must either be above or somewhere out towards the exterior of the body. These accounts already provide a strong indication that the liver, an organ that is situated in between the transition of nutriment from the mesentery towards the heart, would be the likely and logical conclusion for the trunk or substantial portion of the botanical analogy. ...
Article
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Chinese history contains an abundance of records discussing contact with the outside world. In the ever elusive search for the origin of the meridian theory, an extended investigation into the Hippocratic Corpus reveals parallels with the Huáng Dì Nèi Jīng (黃帝內經) medical text of the Chinese tradition that provide an alternative perspective into the origins of meridian channels theory. Though this topic has been discussed in the past, this paper provides new and developed insight into theories associated with the liver and gallbladder channel systems of each tradition. Condensing the scope of the analysis between the Huáng Dì Nèi Jīng and Hippocratic text traditions and focusing on the liver and gall bladder channels aids to expound on the theoretical background required to advance the comprehension and understanding regarding the origins of each tradition. This paper reveals content that further the relationship between the two traditions, including demonstrating the existence of theoretical parallels existing between the liver and gall bladder channels of these two texts.
... Paul U. Unschuld's format provides a content mode for TCM in the West, ie. original text, translation, comments and notes [2]. ...
... Probably compiled in the 1st or 2nd century ce. 3 Harper 1997, p. 210. 4 Ibid., p. 197. 5 Ibid., p. 220. 6 Unschuld, 1986, p. 3. 7 Unschuld, 1986 epidemic illnesses were too often unsuccessful, and the Imperial government was anxious to find ways to expand the scope of medical literature in the search for effective remedies. It established a new bureau, Jiaozheng yishu ju 校正醫 書局 (Bureau for Revising Medical Texts), which it charged with searching out, revising and publishing a selection of ancient and previously neglected classics that might prove useful in combating epidemic illnesses. ...
... A particularly intimate connection between therapeutic sensations and vital energy concepts can be found in traditional East Asian medicine, where most practitioners of acupuncture and moxibustion understand tingling, soreness, distension etc. as the physiologic equivalent of deqi ("attainment of qi") and qizhi ("arrival of qi"). Both expressions date back to the earliest classics, namely the Huang Di Nei Jing [90,91] and the Nan Jing [92]. They describe the moment, when qi, the vital energy, arrives at the point, where heat was applied or a needle inserted, and are considered essential for therapeutic success. ...
Article
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Physical sensations of tingling, warmth, dull pain, and heaviness are a common phenomenon in mind-body interventions, such as acupuncture, hypnotherapy, osteopathy, qigong, meditation, and progressive muscle relaxation. Even though there are striking parallels between sensations produced by many different interventions, no attempt has yet been made to understand them from a unifying perspective that combines information from different therapies and practices. Therefore, this narrative systematic review introduces the concept of therapeutic sensations and summarizes studies of their sensory quality, bodily topography, and the meaning that patients attach to them. Furthermore, it highlights the essential role of therapeutic sensations in the development of vital energy concepts, such as qi, prana, pneuma, and orgone, in various traditional medicine systems, body-oriented psychotherapy, and so-called energy medicine. Finally, the assessment of therapeutic sensations may help to gain a deeper understanding of such concepts, finding a common language between scientists, patients and practitioners, and bridging the wide gap between materialistic and vitalistic views.
... Thus, in acupuncture educational contexts, this is often not brought into discussion as it could undermine the ability of the beginner to perform. 120,121 However, in the acupuncture literature the important role of the practitioner is clearly articulated in the early literature, 38,121,122 especially in relation to how the practitioner touches the patient. 38,121,123,124 Is this a skill-based practical aspect of needling to trigger 'health improvement' effects? ...
Article
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Documented mechanisms of acupuncture suggest the possibility of whole body effects in addition to local and regional effects. Traditional theories of acupuncture predict whole body effects. Does this permit the possibility of applying treatment to target overall health improvement of the patient rather than the symptom? After introducing the term ‘health improvement’ this paper explores situations where it might be advantageous to do this, giving examples of how health authorities in some countries have proposed broader treatment approaches that focus on health improvement. It also discusses cases where acupuncture has been recommended as a treatment method in a number of these proposals and gives some clinical examples of this kind of whole body ‘health improvement’ targeted treatment effects. Given that health authorities have already recognised this potential for the application of acupuncture the author then explores evidence of more whole-body ‘health improvement’ effects from systematic reviews and examples of health experts recommending acupuncture to take advantage of them. Research strategies and foci are then proposed and explored to develop this evidence. What are the best treatment approaches to create these effects? By what mechanisms can ‘health improvement’ be produced? How can one measure these effects? It is likely that treatments based on ‘pattern identification’ (PI) may provide the best strategies for producing ‘health improvement’, thus PI-based acupuncture treatments are likely to be the best strategy for clinical research investigating these effects. Keywords: Acupuncture, Health, Pattern identification, Health improvement, Research
... In Egypt medicine knowledge was dated back to about 2900 BC and the information in our hands were recorded in the Ebers Papyrus (about 1550 BC, 9th year of Amenhotep 1 reign), which contains over 700 plant-based drugs (Borchardt 2002;Sneader 2005;Cragg and Newman 2013) ranging from gargles, pills, infusions and ointments. The Traditional Chinese Medicine (TCM) has been extensively documented over thousands of years (Unschuld 1986) and it is collected largely in the Chinese Materia Media (1100 BC) (Wu She Er Bing Fang, containing 52 prescriptions), the Shannong Herbal (around 100 BC, containing 365 drugs) and the Tang Herbal (659 AC, containing 850 drugs) (Cragg and Newman 2005). Documentation about the Ayurveda system dates back to the first millennium BC (Patwardhan 2005). ...
Article
Natural products (NPs) are secondary metabolites produced and used by organisms for defending or adapting purposes. These molecules were naturally selected during thousands of years to improve the specificity and cover a very wide range of functions, depending on the origin, the habitat and the specific activity carried out in the organism of origin. Due to these intrinsic features, NPs have been used as healing agents since thousands of years and still today continue to be the most important source of new potential therapeutic preparations.The purpose of this review is to provide information about the historical evolution of the NPs investigation methods, focusing attention on the relative benefit/problems emerged after the improvement of the scientific investigations about them, especially over the last two centuries. Taken together, the reported information lead to the central role of NPs in the future of drug development for human needs.
... These zàng-fȗ each have an associated channel that extends the energy of the organs along points across the body. As simple definition of the functions of the zàng -fȗ: the five yīn organs are said to 'store' and produce essential fluids, while the six yáng organs transform essences into production of movements/energy (Unschuld 1986). ...
Article
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This article introduces Pulse Project (2011–), a doctoral performance research project that engages in critical discourse between art and science through the creation of digital soundscapes that weave together artistic, medical, technological, ancient and modern methodologies. Pulse ‘reading’, case histories, notations of pulses and programming soundscape compositions are all used together as methods for exploring the cultural encounter between artist, participants and diverse medical practices. Pulse Project seeks to provide an examination of the means with which the temporal materiality of touch can be used together with audio programming to form a translation and synthesis of different ecologies and disciplines, e.g. medicine and art, Eastern and Western practices, touch and digitality, etc. Drawing upon my experience as a clinical acupuncturist (with training in biomedicine), I use Chinese pulse diagnostics together with SuperCollider (an audio synthesis programming language) to inform the composition process of each soundscape. In this way, Pulse Project interrogates the aesthetic and philosophical axioms underpinning contemporary medicine, technology and cognitive embodiment through the exploration of their corollary ‘others’—traditional Chinese medicine and music theory—in order to generate a fresh approach to embodiment and soundscape composition.
... According to The Pulse Classic (Mai Jing), the floating pulse is a pulse felt potent with no force applied on the fingertip but felt impotent with force applied, and the sunken pulse is a pulse felt impotent with no force applied on the fingertip but felt potent with force applied [3, 29]. The Difficult Classic (Nan Jing) states that the floating pulse flows above the muscle layer [30, 31]. According to The Lakeside Master's Study of the Pulse (Bin Hu Mai Xue), the floating pulse has power in the pulsation when fingertip touches lightly on the skin layer and is felt powerless when pressed down, and the sunken pulse is a pulse that can be felt when the fingertip is pressed down to the musculoskeletal level [32]. ...
Article
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An accurate assessment of the pulse depth in pulse diagnosis is vital to determine the floating and sunken pulse qualities (PQs), which are two of the four most basic PQs. In this work, we proposed a novel model of assessing the pulse depth based on sensor displacement (SD) normal to the skin surface and compared this model with two previous models which assessed the pulse depth using contact pressure (CP). In contrast to conventional stepwise CP variation tonometry, we applied a continuously evolving tonometric mechanism at a constant velocity and defined the pulse depth index as the optimal SD where the largest pulse amplitude was observed. By calculating the pulse depth index for 18 volunteers, we showed that the pulse was deepest at Cheok (significance level: P < 0.01), while no significant difference was found between Chon and Gwan. In contrast, the two CP-based models estimated that the pulse was shallowest at Gwan (P < 0.05). For the repeated measures, the new SD-based model showed a smaller coefficient of variation (CV ≈ 7.6%) than the two CP-based models (CV ≈ 13.5% and 12.3%, resp.). The SD-based pulse depth assessment is not sensitive to the complex geometry around the palpation locations and temperature variation of contact sensors, which allows cost-effective sensor technology.
... P ulse diagnosis has been an integral part of Traditional East Asian medical (TEAM) practice since the Han dynasty (206 bce-220 ce) developments in medicine in China. [1][2][3][4][5] While a widely used method in TEAM, pulse diagnosis has over time been described and used in many different ways. 6 A number of studies have examined the reliability of pulse diagnosis, [7][8][9][10][11][12][13] and some methods of instrumentation have been developed, [14][15][16] leading in some cases to clinical applications (for example, the ZM-IIIC TCM Pulse Pattern Diagnostic System). ...
Article
Background: Toyohari Meridian Therapy (TMT) is a Japanese system of acupuncture that utilizes radial pulse diagnosis to diagnose and guide acupuncture treatment, including ascertaining when the treatment has concluded. The "root" treatment involves manipulation of the body's Qi without penetration of the needle. There has been little research into the physiologic correlates of the changes detected through pulse diagnosis by Traditional East Asian Medicine practitioners practicing TMT. Objectives: The study objective was to investigate whether there were any concurrent changes in physiologic cardiovascular variables, specifically the Central (Buckberg) Sub Endocardial Viability Ratio (SEVR) or Heart Rate (HR) adjusted Augmentation Index (AI), with changes in the radial pulses produced by a TMT "root treatment." Materials and methods: A parallel, single-blind, randomized controlled design was utilized. Sixty-two (62) healthy volunteers were randomized to receive either a TMT root treatment or a sham-treatment. Two (2) TMT practitioners participated, with the same practitioner conducting the needling in each case. The SEVR and HR-adjusted AI were measured by a third researcher. Statistical analysis: Within-groups analysis (paired Student t-test) and between-groups analysis (analysis of covariance) were used; a p-value of 0.05 was designated as statistically significant. Results: SEVR improved significantly within the treatment group but not in the control group. Conclusions: Results indicate that changes detected in the pulse by the TMT practitioners were associated with a measurable improvement in the SEVR. The findings of this study offer the possibility for further investigation into radial pulse diagnosis practices in an effort to find a physiologic understanding or basis of TMT practice and the system of pulse diagnosis it uses.
Book
This Element first discusses the creation of transmitted medical canons that are generally dated from early imperial times through the medieval era and then, by way of contrast, provides translations and analyses of non-transmitted texts from the pre-imperial late Shang and Zhou eras, the early imperial Qin and Han eras, and then a brief discussion covering the period through the 11th-c. CE. The Element focuses on the evolution of concepts, illness categories, and diagnostic and treatment methodologies evident in the newly discovered material and reveals a side of medical practice not reflected in the canons. It is both traditions of healing, the canons and the currents of local practice revealed by these texts, that influenced the development of East Asian medicine more broadly. The local practices show there was no real evolution from magical to non-magical medicine. This title is also available as Open Access on Cambridge Core.
Article
Introduction: In recent years, a new form of health has emerged, namely philosophical health. This novel concept is part of the philosophical counseling movement and relies on the philosophical method called the SMILE-PH interview, which draws heavily from continental philosophy, including phenomenology. Reflecting on the link between health and philosophy brings us to an ancient healthcare tradition that actively relies on philosophy: Chinese healthcare and its founding wuxing, or five phases ontology. Objective: The aim of this study is to interpret philosophical health from the standpoint of wuxing ontology. Methods: We used the multiple meanings of the five phases to interpret the six concepts of SMILE-PH interview method. Then, we monitored how applying the SMILE-PH involves a parent phase triggering for the counselee. Last, we focused our analysis on the triggered phase and conceptualized them into philosophical health. Results: The SMILE-PH topics are located in a specific phase, namely the Metal phase (xin), which is described by the concepts of connection, existence, identity, meaning in one's life, and spirituality. The one-phase structure of SMILE-PH fosters the triggering of its parent phase: the predominant Metal phase character of the SMILE-PH interview will promote the appearance of Earth phase answers. Conceptualizing the Earth phase into philosophical health adds the following aspects to the latter: emotional stability, the feeling of plenitude, and sharing without a transactional mindset. Conclusion: We obtained a clear perspective of the place of SMILE-PH in wuxing ontology and added a new layer to philosophical health. The other phases of wuxing ontology remain to be tested and integrated into philosophical health.
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Purpose. Integrative treatments are growing among breast cancer survivors (BCS), and both acupuncture and Nordic walking (NW) are found particularly useful for them. Their positive effect on BCS health is partially due to their impact on bodily fluid balance. The study of bodily resistance and reactance is a practical method to monitor bodily fluid balance. The aims of our study were to investigate (a) the acute effects of acupuncture treatment on resistance and reactance in BCS who never had received acupuncture treatment before; (b) if BCS practising NW had better resistance and reactance than non-exercising BCS; and (c) if BCS practising NW presented a better response after acupuncture treatment than other conditions. Methods. A total of 80 BCS (53.24 ± 5.50 years), including 38 women not practising physical exercise and 42 Nordic walkers, were recruited and investigated for bodily resistance and reactance immediately before and after (a) acupuncture treatment; (b) supine rest without acupuncture. Results. Acupuncture seems to positively influence bodily resistance and reactance variation compared with supine rest. NW practice seems able to assure the best resistance and reactance basal values, and their best positive variation after supine rest and acupuncture alone. The observed results are amplified when NW and acupuncture are coupled. Conclusions. Both acupuncture and NW could be used to positively influence bodily fluids distribution, also considering that, when coupled, their positive effects are amplified. Therefore, NW should be prescribed to maintain the positive effect of acupuncture or to prepare the body for it. https://www.termedia.pl/Effects-of-acupuncture-and-Nordic-walking-practice-and-their-interaction-on-bodily-fluids-distribution-of-breast-cancer-survivors,129,47722,0,1.html
Thesis
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La progressiva globalizzazione della medicina cinese ha moltiplicato le questioni già numerose riguardanti la sua origine e la sua efficacia, mettendo in discussione il modo in cui essa crea la sua tradizione e mantiene la sua integrità e autenticità culturale. Porsi l’interrogativo di come la medicina cinese possa preservare la sua essenza, la sua identità, contribuisce alla reificazione di questo sapere, portando a concepirlo come una conoscenza tradizionale che proviene da un passato antico e lontano, passivamente trasformata e standardizzata nell'incontro con la modernità. Quella che chiamiamo medicina tradizionale cinese è il risultato di un processo in continua evoluzione che coinvolge attori, tempi e luoghi ben definiti. Per comprendere appieno le dinamiche che concorrono nel plasmare la medicina tradizionale cinese, ho frequentato un corso di studi semestrale per studenti internazionali presso la Beijing University of Chinese Medicine. Tramite un’analisi dei processi comunicativi, sia espliciti che impliciti, che stanno alla base della trasmissione della conoscenza, e delle opacità e delle discrepanze che vengono a crearsi, nel presente lavoro di tesi ho cercato di mettere in luce il ruolo dell’analogia e della metafora nel permettere il passaggio di determinati concetti teorici dal sistema di pensiero che sta alla base della medicina cinese e quello degli studenti internazionali con una formazione biomedica. In questa analisi intendo mostrare, inoltre, come il sapere venga a costruirsi all’interno del rapporto tra i due sistemi di pensiero in questione in un continuo rimando ai concetti di modernità e tradizione, permettendo così di sottolineare quali siano le continuità con il passato e le innovazioni.
Article
Resumen Existen diferentes interpretaciones sobre el deqi descrito en los textos de la Medicina Tradicional China, lo que ha generado controversia en cuanto a lo que es o debería constituir el deqi. Con base en el estudio de los caracteres tradicionales y de las evidencias experimentales recientes, el presente artículo propone un concepto integrador del deqi, como la suma de las respuestas psiconeurofisiológicas desencadenadas durante la intervención acupuntural y que pueden ser percibidas por el paciente y el acupunturista. Tales respuestas tienen una base anatómica, funcional y emergente que se integran en un biocircuito conformado por receptores, vías aferentes, centros de procesamiento, vías eferentes y efectores, los cuales son retroalimentados entre el paciente y el acupunturista.
Preprint
I am trying to do two things by posting this material from my book-in-progress titled Magic Matters: Science and Medicine in Chinese Popular Culture, 1600–1800. One is to invite constructive criticism 指正 (please respond directly to smithrj@rice.edu rather than to this website, unless you have something of general interest to say). And the other is to make my Asian-language and Western-language bibliographies available to anyone who might be interested. I have already imposed a draft preface and my preliminary bibliographies on a number of scholarly friends and colleagues, and have received valuable feedback. The preface is still no doubt incomplete (my fault, not theirs), but it should at least give an indication of what I am trying to do with my book. It also explains the title.
Article
It has been recognized that meaning of “難経(Nangyo, Nanjing)” is a scripture of difficult issues, or of the questionnaire for the term “難(nan)”. The author would like to propose that the real meaning of “難(nan)” in this scripture is not difficulty but immutability. “The Classic of Changes (易経)” deals with changes in the uni­verse, on the other hand Nangyo describe definitive and/or immutable evidences in the field of acupuncture. The author proposed that this epoch making scripture described in the purpose of make clear the concrete evi­dences of pulse diagnosis or manipulation of acupuncture, and relationship between the meridian routes with the five viscera and six entrails.
Preprint
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This paper explores the underlying information system of Chinese Feng Shui, translated literally as "wind and water," and compares and contrasts it with theories of complexity science, quantum mechanics, and systems science.
Chapter
In this chapter, I explore the notion of text segmentation from the viewpoint of discourse analysis. I examine the organization, in the particular context of Chinese medical texts, of the overall discursive tapestry, made up of a range of textual threads, including the author’s own discourse and that of others, in the form of citations and quotations. After a first overview on the practice of citation in a corpus made up of twenty-three medical texts produced between the beginning of the eighteenth century and the beginning of the twentieth century, I focus on how the marks of the heterogeneity implied by the overt incorporation of the words, the ideas or the work of others into the flow of a writer’s discourse appear in these texts. Paying attention to the syntax and the layout used by writers to interrupt their own discourse and to give the floor to others, I question whether the ways this heterogeneity is made visible can be a clue in distinguishing the different functions citations and quotations meet in Chinese medical literature. I also question whether using one way to cite or another can help in identifying different genres of medical writings at a time when writing in the medical field was not reserved to a professionalized social group.
Chapter
A great abundance of Chinese medical texts have come down to us since the mid seventeenth century. This is the combined result of the large number of texts written in this period and the fact that the texts were better preserved than earlier. As a matter of fact, the large number of medical texts, coming from various social settings, set historians the quite daunting challenge of understanding what the texts really were and how they should be classified. The idea underlying this article was to go beyond the various modern generic classifications used thus far (“learned”, “popular”, and the like) and to highlight, instead, how medical texts themselves differ from each other. In this aim, I chose to compare a number of excerpts of medical texts written from the eighteenth century to the beginning of the twentieth century in different geographical and social settings. And to compare them, I decided to use some tools created by linguists who have been particularly interested in the issues of genre, notably those used by speech act theoreticians. In this article thus, I analyze these excerpts by paying close attention to the five levels of any discourse act, summarized in the well known formula “Who (says) What (to) Whom (in) What Channel (with) What Effect”, following Harold D. Lasswell’s classic communication paradigm. In other words, I try to shed light on how each of these texts differs from the others from the semantic, syntactic and emotional angles and whether these differences can be linked to the authors’ social, geographical, chronological or intentional settings, and, finally, if we can speak of genres in Chinese medical literature.
Article
Abstract De qi is a concept most often associated with patient experiences during needling in acupuncture treatment. A review of the early historical literature on acupuncture shows that texts tended to describe de qi and its associated concept, qi zhi more in terms of practitioner-based phenomena and that this is something more in the realm of the experienced practitioner (i.e., it is skill based). Many modern authors in Asia and the West also describe the importance of practitioner-based experiences in the de qi of acupuncture, further implying that this may lie at the heart of the treatment effects of acupuncture. A review of scientific studies on de qi shows that qualitative studies have focused almost exclusively on patient-based aspects of de qi while quantitative studies have focused exclusively on them. There thus exists a gap in current research on the phenomenon of de qi that possibly reveals weakness in the wider study of acupuncture. It is important that precise qualitative studies of the practitioner-based aspects of de qi begin soon and as they become better understood, quantitative research also is initiated. This research will not only better inform clinical trials and physiologic research of acupuncture in general but could contribute significantly to rethinking of how to train practitioners.
Article
The Suàn shù shū is an ancient Chinese collection of writings on mathematics approximately 7000 characters in length, written on 190 bamboo strips, recovered from a tomb that appears to have been closed in 186 B.C. This anonymous collection is not a single coherent book, but is made up of approximately 69 independent sections of text, which appear to have been assembled from a variety of sources. Problems treated range from elementary calculations with fractions to applications of the Rule of False Position and finding the volumes of various solid shapes. The Suàn shù shū is now the earliest datable extensive Chinese material on mathematics. This paper discusses its relation to ancient works known through scribal transmission, such as the so-called “Nine Chapters,”Jiuˇ zhāng suàn shù, which is first mentioned in connection with events around A.D. 100, but may have been compiled about a century earlier. It is proposed that the evolution of Chinese mathematical literature in the centuries that separate these two texts may be understood through comparison with what is known to have taken place during that time in another area of Chinese technical literature, that of medicine.
Article
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In a simplistic way, the flow of qi resembles the passage of water through a series of twelve pipes. A blockage which occurs between two meridians in the sequential flow of qi is known as an "entry/exit" (E/E) block and may have implications for the functional balance of the entire energetic system.1 Clearing an E/E block may have profound effects on both the patient's pulse, overall presentation, and experience of his condition. It is therefore often necessary to prioritize "clearing" an E/E block before treatment at the constitutional or symptomatic level will "hold." It is the intention of this article to address the concept of the E/E block as it relates to pulse diagnosis, functional imbalances of the organ systems, and treatment strategies for clearing the imbalance.
Article
Im Verlauf der Ming- und anschließenden Qing-Dynastie stieg die Anzahl der im medizinischen Bereich tätigen Personen erheblich an. Und auch die Anzahl medizinischer Abhandlungen wuchs proportional zum Anstieg medizinischer Experten. In dieser Hochphase medizinischer Publikationen, in der das Fehlen eines institutionalisierten Zulassungssystems einem breiten Personenspektrum gestattete sowohl Medizin zu praktizieren als auch darüber zu schreiben, mussten sich die Autoren eine besondere Strategie zur Legitimierung und Aufwertung ihrer Bücher einfallen lassen, zumal seit dem 19. Jahrhundert Europäer mit der Verbreitung unterschiedlicher Techniken und Kenntnisse begonnen hatten und dadurch die ohnehin schon starke Konkurrenz noch weiter anstachelten. Einen wichtigen Faktor dieser Strategie bildete das Vorwort. Was ein Autor über sich selbst und seinen Text aussagte, wen er bat, sein Vorwort zu schreiben und was diese Leute wiederum als wichtig zur Empfehlung eines neuen Buches erachteten, ist Gegenstand des Artikels. Diese Aspekte sollen ein Bild davon vermitteln, worauf im späten chinesischen Kaiserreich medizinische Autorität und Legitimation beruhten.
Article
Previous work from our laboratory has demonstrated that the percentage differences of 2nd (C2) and 3rd (C3) pulse harmonics related to Kidney and Spleen were both increased toward another steady state in rats after acute hemorrhage. Therefore, it is suggested that changes in pulse spectra might represent the ability of animals to survive a model of progressive hemorrhage. In this study, the difference of the pulse spectra patterns between survivors and non-survivors after progressive hemorrhage (by loss of 5%, 10% or 20% of the estimated blood volume) in anesthetized rats is determined. Seven rats, dead within 2 hours after a loss of 20% of the estimated blood volume hemorrhage, were defined as 'non-survivors'. The other eleven rats, more than 2 hours after hemorrhage, were defined as 'survivors'. Pulse waves of arterial blood pressure before and after the hemorrhage were measured in parallel to the pulse spectrum analysis. Data among different phases were analyzed using one-way analysis of variance (ANOVA) with Duncan's test for pairwise comparisons. Differences between survivor and non-survivor groups at each phase were analyzed using Student's t-test. A mixed-effects linear regression model was applied to evaluate the relationship in harmonics, which significantly differed between the two groups. The study results showed that in rats, during progressive hemorrhage, the percentage differences of 2nd harmonic proportion increased significantly; however, the result failed to show any significant difference between survivors and non-survivors. After the third blood withdrawal process, the percentage differences of 3rd harmonic proportion increased more significantly in the survivors. In addition, the percentage differences of 1st harmonic proportion related to the Liver for the survivor group was significantly lower than that of the non-survivors. After analysis with the mixed linear regression model, C3 and C1 demonstrated a linear regression relationship, and there existed significant differences between survivors and non-survivors. These results suggest that C3 might play an important role in physiology regarding surviving capability after progressive hemorrhage.
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