TRADITIONAL VERSUS MODERN ACUPUNCTURE

Part 1
Philip A.M. Rogers MRCVS
e-mail : progers@grange.teagasc.ie
1980, updated 1990, 1996
Postgraduate Course in Veterinary AP, Sydney, 1991

SUMMARY

Traditional Chinese Medicine (TCM) is based on ancient Chinese concepts of health and disease, including the theories of Yin-Yang, Qi, Change, Five Phases, the Six Evils, oriental diagnostic methods and the necessity for balance/control in all aspects of life. Some of these concepts are considered irrelevant to western-trained professionals. Others are highly relevant.

Acupuncture (AP) is part of TCM. It is based primarily on a knowledge of the location and function of AP points . In western concepts, AP is based on a knowledge of the input/output terminals of a two-way system of data transmission between superficial reflex (reactive) points and the organs or parts which are related to these points via the neuro-endocrine system.

AP diagnosis and therapy depend in part on TCM concepts. Mastery of traditional AP (TAP) demands years of study under expert teachers. Most western professionals will not invest the time and effort needed for that.

The basics of AP and Cookbook methods can be learned in 40-120 hours of concentrated course-work and 6-12 months part-time home-study. That training (combined with western medical knowledge) can produce excellent clinical results in properly selected cases.

Success with AP therapy demands a knowledge of medicine and basic AP. Those who have not studied or will not study the basics of both systems delude themselves and their clients/patients if they try to use AP in any but the simplest of cases. The more a clinician knows of TCM and western medicine, the greater the probability of being able to select an effective regime of therapy for the patient.

INTRODUCTION

The Guide to Professional Behaviour (page 22), issued by the Veterinary Council of Ireland in April 1988, states:

"19. Meeting an unqualified person in consultation
By this is meant the meeting for the purpose of consultation, with an unqualified person such as an acupuncturist, osteopath, bone setter, chiro-practitioner etc. Such a consultation is unethical and would be construed as conduct disgraceful in a professional respect...".

On being found guilty of that charge, the penalty may be removal of the veterinarian's name from the Veterinary Register of Ireland. He or she would be unable to practice veterinary medicine legally in Ireland or in any other country which recognises the Irish veterinary qualification.

Before and since the advent of western medicine, TCM and TAP have stood the test of time. They serve more of the world's population than our medicine and it will not go away because some westerners scoff at it. Among professionals and the public in the west, there is also growing awareness that holistic medicine must involve the study of many modalities, including western and eastern. Today, a small but slowly growing number of medical, dental, physiotherapy and veterinary graduates in almost every country in the developed world use acupuncture (AP) routinely. However, AP is practised at levels of proficiency ranging from grossly incompetent (by professionally qualified people who may have attended an expensive but worthless weekend AP crash-course) to highly skilled (by people fully trained in Classical AP but deemed to be professionally "unqualified").

Orthodox colleagues of "professionally qualified" acupuncturists have mixed reaction to their use of AP, ranging from encouragement, to disinterest (due to complacency with the status quo or intellectual laziness), to honest scepticism (based on genuine criticism of the poor standard of science/statistics behind many of the published claims for AP, or based on ignorance of the body of solid research and clinical results from well conducted AP trials), to antagonism (based on prejudice, if not malign intent in the face of knowledge that AP has a useful role in medicine).

Three main factors limit the more widespread use of AP and allied methods in "western medicine":

This paper compares and contrasts aspects of the two main schools of AP: the Classical and the Cookbook. It concludes that both systems have strengths and weaknesses and that the minimum requirement is a working knowledge of the basic principles of AP theory and a good knowledge of the main AP points. Neither the Traditional nor the Cookbook system (alone or combined) is effective as a therapy for all types of disease. Therefore a complete approach to professional therapy requires more than proficiency in AP.

The ideal for western societies is an orthodox professional training, combined with a mixture of classical and modern AP, to say nothing of integration of other complementary therapies (homoeopathy, manipulative therapy, etc). Ideals are difficult to attain. A good compromise solution would:

Without such a compromise, acupuncturists (even those with recognised qualifications within the medical and paramedical professions) are likely to remain "out in the cold" for the foreseeable future in most western countries.

AP SYSTEMS

Historically AP developed from applications of Tibetan/Chinese thought. Today there are many variants of AP. The two main ones are the Traditional (Classical) school and the Modern (western-oriented school). The latter is based on a limited study of what westerners consider to be the relevant classical principles, combined with Cookbook (prescription) AP and western concepts of physiology and medicine. Both systems demand knowledge of the AP points and Channels.

There were/are major differences (cultural, philosophical, political, sociological, economic and environmental) between our world and that of the Chinese, ancient and modern. Difficulties in communication, not least of which are language and conceptual differences between eastern and western minds, can be traced to that fact. Even highly educated Chinese scholars have difficulty in interpreting the meanings hidden in the ancient Chinese texts. The ideograms and their context have subtleties of meaning which can be distorted or lost in "technical" translations.

Conceptual differences are also barriers to understanding. Concepts of Yin-Yang, Five Phases, the Emotional Causes of disease, the Six Evils, direction and flow of Qi (life energy), the Qi body clock, pulse diagnosis etc have no parallel in western thought. The closest we can come to them is by analogy and by some specific examples. But, in spite of years of exposure to these concepts, many western students of AP still regard them as "foreign, Chinese or traditional", e.g. "non-self", not part of "our" world-view. But, if we are to improve our clinical results, we must be prepared to learn from other effective medical systems, including TCM.

TRADITIONAL AP (TAP)

TAP is based on ancient Chinese concepts, which will be discussed:

These concepts are discussed in more detail in other papers and in texts on TCM (Austin 1974; Connolly 1979; Kaptchuk 1983; Mann 1973; Porkert 1983; Wu Wei Ping 1973; van Nghi 1971).

The western student who wants to make rapid progress in the study of TAP must "forget" western ideas for a time. He or she must approach the study of AP as a child approaches a wise teacher- in a spirit of openness, total ignorance, tranquillity and trust.

The teacher is there to teach and the student is there to learn. There is little value in questioning each step of the lessons from a critical, analytical western viewpoint. From western viewpoints there are no satisfactory answers to many valid questions. At best, such questions impede the student's progress and, at worst, may discourage him or her from continuing the study. Because of unsatisfactory answers, many western "scientific" research workers reject the entire system, throwing the baby out with the bath water.

1. AP POINTS AND CHANNELS

AP POINTS
The diagnostic, therapeutic and preventative value of AP depends totally on a knowledge of the AP points, the Channels and their functional and anatomical relationships with each other.

Characteristics of AP points There are two main types of AP points: (a) Ahshi points and (b) codified AP points. Most AP points of type (b) are reactive electro-permeable points (REPP) relative to nearby skin areas. Hyper-reactive AP points, whether of type (a) or (b) are hypersensitive to pressure-palpation, electric current or heat. Hypo-reactive AP points, usually type (b) only, are hypo-sensitive to pressure-palpation, electric current or heat.

a. Ahshi points Ahshi points are abnormally tender to palpation pressure. The patient may be unaware of their presence until they are pressed. When Ahshi points are pressed, the human patient usually grunts, groans, swears or jerks (AH = Ah! SHI = Yes !; Ahshi = "Ouch!"). In animals, pressure on Ahshi points elicits definite defensive or aversive behaviour (movement, dipping, swishing of the tail, attempts to kick or escape in horses; movement, bellowing or attempts to kick in cattle; attempts to bite, howling, whining, attempts to escape in dogs).

Some Ahshi points are just painful locally, corresponding with "fibrositic nodules", "motor points" and other irritable foci in muscle and fasciae.

These are not as important in therapy as those which are painful locally and refer pain to the area in which the patient reports the clinical pain. The latter type of Ahshi points are the Trigger Points (TPs) of "Western Medicine", as they trigger pain to the referred area of pain. For instance, many headaches may be caused by TPs points in the trapezius, neck or temporal muscles; shoulder pain may be due to TPs in the infraspinatus or supraspinatus muscles. (See Travell and Simons 1984).

Ahshi points may occur anywhere in the body but are usually in muscle. Many (up to 70%) occur at codified AP points but others occur at positions not codified in AP texts. They are usually present in myofascial syndromes and are very useful in diagnosis and prognosis. In the absence of signs of other pathology, they confirm that muscular spasm is the main problem and that the prognosis is very good if they can be eliminated successfully.

Ahshi points may also occur in disorders of internal organs (especially at the Shu (paravertebral reflex) and Mu (front alarm) points). For instance, in heart/pericardial disease, pressure along T4,5,6 (BL14,15,16) or from under the xiphoid cartilage to a point between the nipples (CV14-17) may be painful. These points are the Shu and Mu points for HT and PC (see section (a) under MASTER POINTS below).

Apart from diagnostic value, Ahshi points have great therapeutic value. They are always treated as part of AP therapy.

So far, it would appear that treatment of tender points (Ahshi, Shu and Mu points) is all that is needed for successful AP therapy. Unfortunately, that is not sufficient. Point tenderness does not always occur in clinical disease. In the absence of point tenderness, the therapist can not begin to use the AP system unless he/she knows the position and uses of the codified AP points.

b. Codified AP points
There are over 1000 codified AP points. Apart from the 361 classical Channel Points, there are over 639 other points described in this century, mainly outside the Channels. These are the "New", "Strange", "Hand", "Ear", "Foot", "Scalp", "Face", "Nose", "Red Doctor Zone" points etc.

Each point has a Chinese name and an alpha-numeric code (e.g. ST36 is the 36th point on the ST Channel). The Chinese name describes its function, location or other detail of use to those who know the language, for example Tsu San Li (ST36) translates as Foot Three Li (3 Li = 1 mile), a point for tired legs and also 3 TSUN below the patella; Fei Shu (BL13) is the reflex point for Lung; Hsin Shu (BL15) is the reflex point for the Heart etc). As few westerners know Chinese, much valuable "automatic information" is hidden from them by not knowing what the point name means. They must learn the points the hard way- by alphanumeric code and functions, as most texts do not translate the point name for western readers.

Each AP point is described anatomically, in relation to easily visible or palpable body landmarks; joints, tendons, body creases, intercostal spaces, vertebrae, umbilicus, xiphoid, nipples, mouth, ear, eye etc. Some of the better texts also describe the location of the point in relation to nearby blood vessels and nerves.

AP point location: The "body inch" or TSUN is the standard way of locating points in relation to each other (See Anon 1980: "Essentials of Chinese AP"). The average TSUN in humans is the width of the joint of phalanx 1-2 of the patient's index finger. 3 TSUN is approximately the width of the patient's hand (thumb excluded) at the level of phalanges 1-2. However, the length of the TSUN varies slightly with the part of the body being searched. The body is divided into a number of TSUN between fixed landmarks:

Points on the Head and Neck are located as follows:

  • from anterior to posterior hairline (midline) is 12 TSUN
  • from anterior hairline to spine of C 7 (midline) is 15 TSUN
  • from anterior hairline to midpoint of eyebrows (midline) is 3 TSUN
  • from midpoint of eyebrows to spine of C 7 (midline) is 18 TSUN
  • from anterior hairline to cleft of chin (midline) is 10 TSUN
  • between the left and right mastoid processes is 9 TSUN
  • between the highest points of left and right cheekbone is 7 TSUN
  • Points on the Trunk are located as follows:

  • from left to right nipple (male) is 8 TSUN
  • from midline of spine to upper angle of scapula is 3 TSUN
  • from upper angle of axillary crease to free end of 11th rib is 12 TSUN
  • from xiphisternum to umbilicus is 8 TSUN
  • from umbilicus to upper edge of pubis is 5 TSUN
  • from xiphisternum to upper edge of pubis is 13 TSUN
  • Points on the Thoracic limb are located as follows:

  • from upper angle of anterior axillary crease to elbow crease is 9 TSUN
  • from elbow crease to distal wrist crease (medial or lateral) is 12 TSUN
  • Points on the Pelvic limb are located as follows:

  • from tip of great trochanter of femur to lateral edge of popliteal fossa is 19 TSUN
  • from lateral edge of popliteal crease to external malleolus of tibia is 16 TSUN
  • from upper edge of pubis to medial epicondyle of femur is 18 TSUN
  • from medial condyle of femur to medial malleolus of tibia is 13 TSUN.
  • Thus, point KI27 (2 TSUN from the midline, below the clavicle), can be located easily in a child or in a huge man. The TSUN is a ratio system, as applicable in mice or elephants as it is in humans.

    AP POINT FUNCTIONS
    Apart from functions specified for each point in standard texts, AP points also influence:

  • a. the Channel and associated functions of its Organ (e.g. points on the ST Channel influence ST function and the stomach);
  • b. the Channel and areas anatomically close to it (e.g. ST points influence pain and dysfunction along the superficial and deep paths of the ST Channel;
  • c. local tissue and functions (e.g. GB34 (on the lateral leg, in the notch between the upper head of the fibula and the tibia) influences the knee, the upper lateral leg and its structures and functions);
  • d. thoracic and abdominal points, including paravertebral points, influence organs anatomically close to them.
  • For example, the GB Channel begins at the lateral canthus of the eye (GB01), travels upwards and backwards over the head, down the neck dorsomedial to the mastoid process (GB20), over the highest point of the trapezius (GB21), down the lateral thorax past the tip of the last rib (GB25), behind the femoral trochanter (GB30), down the lateral thigh to the fibular-tibial notch (GB34), down the lateral leg, to end on the 4th toe. GB34 (apart from functions specified in the textbooks) influences GB function and disorders (cholecystitis, cholelithiasis etc); pain and dysfunction along the course of the Channel from eye, to lateral headache, to neck/shoulder area pain, to lateral thoracic/abdominal pain, to hip, lateral thigh, knee, lateral leg, ankle, to 4th toe pain/sprain/paralysis etc.

    Apart from specified and additional functions (above), certain points on the Channels are more powerful than others, even for local effects. For instance, GB34 is more often used than GB33 in knee problems, even though GB33 is near the knee. For other details, see the papers on the "Choice of Points for Particular Conditions" and "The Study of Points and Channels"). MASTER POINTS
    (See paper on "The Study of Points and Channels"). Each of the 12 main Channels has a number of MASTER points, which are used in TAP:

  • a. Shu and Mu Points
  • b. Five Phase Points
  • c. Luo (Passage) Points
  • d. Yuan (Source), Xi (Cleft), Tonification, Sedation, Hour Points etc.
  • Point types b, c, d (above) are powerful Energetic Points of AP. Their use needs a study of the principles of TAP.

    As a knowledge of point location and functions is essential to the use of AP, beginners may feel daunted by the large number of points. Please take courage from the fact that most western AP experts are familiar with as few as 50-150 points ! If beginners grasp the principles of basic AP, they can consult AP textbooks for details of the less commonly used points, as the need arises.

    The Channel-Organ Systems (COSs) of AP
    When the Chinese use the term Hsin (Heart, HT), Pi (Spleen-pancreas, SP), Fei (Lung, LU), Shen (Kidney, KI), Kan (Liver, LV) etc, they imply much more than the physical organs (heart, spleen-pancreas etc). They include the nature, structure and functions of the organs and many other attributes, as well as the superficial, collateral and deep paths of the Channels. Thus, it is better to think of the Twelve COSs (each with many specific attributes) rather than to anatomical pathways or localised physical organs. The extended COS (Channel-Organ System) concept is most important in diagnosis and therapy by TAP.

    TAP is a system of Energetics and Correspondences. Classical practitioners are interested in symptomatology, only in so far as it indicates WHICH COS(s) has/have energy (Qi) imbalance. By correcting the Qi imbalances, all amenable symptoms and signs are expected to regress rapidly. For example, Hsin (HT) is of the Fire Phase. It controls the heart, tongue and psyche. Thus, neurasthenia, restlessness, insomnia, excitability, rapid speech, angina pectoris, red complexion, dislike of summer weather or heat etc indicate a disorder in Fire, manifest in a disturbance in Heart function. (In that case, ECG and heart muscle enzymes etc may be normal but treatment of the HT Channel can eliminate most or all of the symptoms).

    There are twelve main Channel-Organ Systems, which either begin or end on a finger or toe. The superficial paths of the 12 main Channels have bilateral symmetry: Lung (LU); Large Intestine (LI, colon); Stomach (ST); Spleen-Pancreas (SP); Heart (HT); Small Intestine (SI); Bladder (BL); Kidney (KI); Pericardium (PC, Circulation-Sex, Heart Constrictor); Triple Heater (TH, Endocrine, (Respiration, Digestion, Reproduction)); GallBladder (GB); Liver (LV). The superficial paths of the Channels are longitudinal lines of low electrical resistance (high conductivity) which connect AP points of similar function. The deep paths are planes of low electrical resistance (high conductivity) which connect the superficial path to their related organs.

    Each Channel passes through an arm or leg, has a polarity (negative (Yin) or positive (Yang)), belongs to one of the Five Phases and has a specific number of AP points:

    Limb ARM LEG ARM LEG ARM LEG
    Polarity - + + - + - - + - + + -
    Meridian LU LI ST SP HT SI BL KI HC TH GB LV
    Phase Metal Earth Fire Water Fire Wood
    Number of points 11 20 45 21 9 19 67 27 9 23 44 14

    The arm Yin Channels (LU, HT, PC) begin in their organs, become superficial on the chest and end at the fingers;
    The arm Yang Channels (LI, SI, TH) begin on the fingers and end on the face but send a deep branch to their organs;
    The leg Yang Channels (ST, BL, GB) begin near the eye and end on a toe but send a deep branch to their organs;
    The leg Yin Channels (SP, KI, LV) begin on a toe and end on the chest but send a deep branch to their organs.

    Channel circuits: In TAP, vital energy (Qi) flows in a specific daily circuit through the Channel network and in a fixed time sequence. It circulates throughout the body, reaching all parts and all organs. The Qi peaks in each COS at a fixed time each day. The peak times for the Channels are:

    - + + - - + + - - + + -
    LU » LI » ST » SP » HT » SI » BL » KI » PC » TH » GB » LV » LU
    0400 0600 0800 1000 1200 1400 1600 1800 2000 2200 0000 0200

    The daily Qi Cycle ends in LV at 0300h, the "dead hour of night". A new cycle begins in LU at 0300h, peaks there at 0400h and passes to the LI at 0500h etc. In the daily Qi Cycle, LU is the Son of LV (LU receives Qi from LV) and LU is the Mother of LI (LU feeds Qi to LI). LI is the Son of LU and the Mother of ST etc.

    Within each Phase, the Yin partner is the Wife and the Yang partner the Husband, e.g. in Metal (LU, LI), LU is the Wife of LI; LI is the Husband of LU. This pairing is important in Energetic AP, as Qi can be shunted from Husband to Wife (or vice-versa) via the Luo (Passage) point of the Deficient partner. This shunt (via Luo of Deficient partner) is also used in balancing disturbed Qi in the Five Phase Cycle (see below). Also, the pairings indicate that LU points can be used in LI diseases and vice-versa.

    In addition to the 12 main Channels, there are Eight Mai (Vessels or Extra Channels). These intersect with some of the main Channels and act as Qi reservoirs for them. The Eight Mai are: Du Mai (Governing Vessel, (GV), in the dorsal midline, 28 points); Ren Mai (Conception Vessel, (CV), in the ventral midline, 24 points) ; Chong Mai; Dai Mai; Yang Chiao Mai; Yin Chiao Mai; Yang Wei Mai; Yin Wei Mai. There are 361 AP points on the 14 Channels (the 12 main Channels + GV + CV).

    2. QI AND YIN-YANG (DUALITY)
    Qi is the general Chinese name for energy. Qi is immaterial and is neither created nor destroyed; it just changes form. Qi and substance interchange. Every thing in the universe, organic/inorganic, material/solid, immaterial/intangible, hot/cold depends on, or is a manifestation of Qi. Life and death, health and disease, growth and senility, composition and decomposition is caused by changes in the proportions and types of Yin and Yang Qi.

    There are many types and expressions of Qi, creative and destructive. Qi can manifest in Yin and Yang forms, in the Five Phases, in a flower, the wind, a laugh and in empty space, nothingness.

    Yin-Yang: Thousands of years before the Bible spoke of Good and Evil, the Chinese developed the concepts of duality and relativity. To them, nothing was absolute, but was a mixture of opposing forces, Yin (the passive or negative force) and Yang (the active or positive force).

    "Yin and Yang are the source of creation and the cause of destruction of all things": Chinese concepts of Yin and Yang were essential, fundamental parts of this world view. The Yin-Yang principle refers to opposites. Everything in creation has its opposite number. Yin-Yang referred to female/male, below/above, Earth/heaven, passive/active, front/back, dark/bright, etc.

    This concept of Yin-Yang was applied to everything in life: art, politics, philosophy, medicine, architecture, etc. Everything in nature can be characterised by its proportions of Yin and Yang Qi.

    In medicine, Yin-Yang referred to hypo/hyper states, solid organs/hollow organs, female genitalia/male genitalia etc. Chronic dis-eases were Yin, acute dis-eases were Yang, etc. Table 1 shows some other examples of Yin-Yang.

    TABLE 1. Examples of Yin-Yang (states of relative opposition)

    YinWaterIceColdFemale PassiveDark MaterialSolid
    YangFireSteamHotMaleActiveBrightImmaterialGas
    YinSlowCentripetalPrecipitationWinterNightDownwardsInner
    YangFastCentrifugalEvaporationSummerDayUpwardsOuter
    YinSolid organs LU SP HT KI PC LV CVBelow waist DorsalMedialLower
    YangHollow organs LI ST SI BL TH GB GVAbove waist VentralLateralUpper
    Yin
    InhibitionRelaxation
    Hypo- (Xu, Deficient)
    Chronic
    Cold
    Moon
    YangExcitationContractionHyper- (Shi, Excess ) AcuteHot Sun
    YinParasympatheticDiastole FlaccidConservativeBlack hole
    YangSympatheticSystoleErectRadicalBig bang

    3. CHANGE (transformation, rhythms, cycles, relativity, balance)
    Change: Everything in existence must change in a ceaseless cycle of anabolism (building up) and catabolism (breaking down). Change reverses to the original state, in time. Nothing is permanent. Everything changes.

    All great civilizations were aware of the rhythms and cycles in nature:

  • a. the seasonal cycle
  • b. the lunar and tidal cycle
  • c. the mating-birth-growth-death cycle
  • d. the sexual (menstrual and male) cycles.
  • We have the activity/rest, the day/night cycles, sunspot cycles, political cycles. Internal (diurnal) cycles include the cardiac cycle (systole/diastole), the respiratory cycle (inspiration/expiration), the hormone secretion cycle (tropins/inhibitors) etc. All of life and nature follows cyclic patterns.

    The Wheel symbolises change/transformation in a cycle of endless and beginningless revolution. The Monad, symbolises the Yin-Yang, and within the Yin is some Yang and vice-versa. Diagram of the Wheel and Monad:

    
        EVERYTHING CHANGES 	                             THE MONAD
    
    
    
    
    
    							Yang				Yin
    
    
    
    
    
    JOY      WHEEL     SORROW                     
    
    
    
    
    
    							Yin				Yang
    
    
    
                                        		          MOUNTAIN <=====> VALLEY
    
         NOTHING CHANGES                       	   ROCK <=========> SAND
    
    	              				          BIRTH <========> DEATH
    
           			                      		HEALTH <=======> DISEASE
    
    
    
    

    Yin and Yang are opposite, essential but complementary parts of the same whole. Yin (dark area) changes to Yang (bright area) and Yang changes to Yin in a changing, yet changeless cycle. Thus, mountains become flat land and flat land becomes mountains. Rock becomes sand and sand becomes rock. Thus, tears and laughter are opposite yet essential parts of the same whole. Birth/death, day/night, potency/impotence, fertility/sterility, joy/sorrow are the lot of nature.

    Yin-Yang concepts imply continuous Change, movement and transformation. Nothing is static. Day must become night. Change occurs because of the interplay of Yang Qi and Yin Qi. Winter becomes Summer as Yin Qi weakens and Yang Qi strengthens. Summer becomes Winter because of a reverse change. Thus Winter must become Summer when Yin reaches its LIMIT (mid-winter solstice) and transforms into Yang. Summer must become Winter when Yang reaches its LIMIT (Mid-summer solstice) and transforms into Yin.

    Different Syndromes are categorised into Yin and Yang types. For example, chronic diarrhoea, with cold extremities and abdomen is Yin Syndrome and an acute febrile disease with raging thirst is a Yang Syndrome. But Yin disease can become Yang and vice-versa.

    The change from Yin to Yang to Yin has many other analogies: In childhood, the male (Yang) may have predominantly Yin characteristics (soprano voice, no body hair, tendency to cry if hurt etc). Between puberty and old age, the Yang characteristics develop and the Yin characteristics decay. In old age, the male may revert to predominantly Yin characteristics again (quav-ering voice, breast enlargement etc). The opposite may occur in female (Yin) from childhood (tomboy = Yang characteristics) to fertile womanhood (Yin) to post-menopausal old age (many Yang characteristics).

    Substance (Yin) transforms into function (Yang) and function transforms into substance. In the most profound sense, in the midst of frenetic change, nothing changes. Energy is merely transferred elsewhere in the total system.

    RELATIVITY: Nothing is created or destroyed, it only changes form. Structure/mass (Yin) and blueprint/energy (Yang) transmute. That is all. The concept predated Einstein's equation (e = mc2) by thousands of years.

    There was no "Instant of Creation" in which "Something" was created from "Nothing". Nor can there be an "Instant of Annihilation", in which "Something" can become "Nothing".

    Nothing is absolute and all things must exist in relation to each other. Yin and Yang are RELATIVE states. The head is Yang relative to the chest (Yin), but the chest is Yang relative to the feet (Yin) and is Yin relative to the back (Yang). The front and inside are Yin, the back and outside are Yang etc. But the outside can become the inside (the neural tube becoming the brain and spinal cord) and the inside (emotions, organs) can become externalised (see correspondences in the paper on the Five Phases).

    A man is predominantly Yang (aggressive, strong, phallus etc) but may have some Yin characteristics also (gentleness, laziness, compassion, sensitiv-ity). A woman is predominantly Yin (pacifying, gentle, compassionate, sensitive) but may have some Yang characteristics also (creativity, perseverance, courage, extroversion etc). In the family there must also be Yin and Yang. If both Husband and Wife are Yang (active, bossy) there are family arguments, and if both are Yin (passive, inactive the marriage will be dull, apathetic and uncreative. Either way, the lack of balance (antagonism between Yin and Yang) leads to poor family life. If the Yin-Yang balance is maintained, the marriage (unity) can be very stable.

    BALANCE: The totally balanced system has equal amounts or Yin and Yang. Yin and Yang are necessary for the other (interdependence) yet each opposes the other (inter-opposition). Balance or equilibrium is maintained by the mutual antagonism, yet mutual dependence of opposing forces. For example, for life to exist (as we know it on our planet) we need a balance of sunlight and darkness. If there was perpetual sunlight or perpetual darkness, life on the planet would cease.

    Yin or Yang can not exist in isolation. If there is no day, there is no night. If there is no excitation, there is no inhibition. The balance of Yin-Yang is a dynamic, changing state. There is seldom exact balance, with equal amounts of Yin and Yang. For instance in Summer, daylight exceeds darkness (Yang is predominant) but in Winter, darkness exceeds daylight (Yin is predominant). Equal amounts of Yin and Yang (night/day occurs only at the equinoxes (March 2lst and September 23rd). The limits of Yin and Yang are seen, for example at the Winter solstice (December 2lst) when Yin is maximal (relative to Yang) and Summer solstice (June 2lst) when Yang is maximal. This transformation of Yin to Yang and Yang to Yin is a natural, universal phenomenon. It is natural for Yin to predominate at certain times and Yang to predominate at other times, in dynamic cycles. Allowing for the transformation of energy within the system, the overall state is one of balance.

    The concept of balance is very important in Oriental philosophy, including TCM/TAP concepts of health and disease. The balanced body has a time for work and a time for rest (physical and mental). Deficient (depleted) energy must be conserved or renewed; Excessive energy must be drained or released.

    Overactivity or underactivity in any facet of life causes Qi imbalance. Too much work (overexertion) or underactivity (laziness); too much sexual activity (loss of KI Qi) or inability to release sexual energy in some constructive way (frustration); overindulgence in food or drink, or undernutrition etc can have adverse effects. For example, too much sex (Water) can weaken the Water organs (KI, BL), resulting in lumbago, sciatica (controlled by BL, KI Channels), as well as throwing strain on HT, PC (heart, circulation) via the Ko Cycle (Deficient Water allows Excess Fire (HT, PC)). Inability to release sexual energy can cause Excess Qi in KI, causing Deficient HT Qi (Excess Water Qi causes Deficient Fire). Apart from cardiac problems and hypertension, this may cause, frustration, lack of drive, spirit and mental energy).

    Balance also extends to food: too much (or too little) bitter food (Fire), sweet food (Earth), acrid/pungent food (Metal), salty food (Water) or sour food (Wood) can damage the corresponding COS in the Five Phase Cycle (see next section). Balance of the taste and food types helps to maintain good health. Over-cooking of food can destroy some of the good Qi in food. Under-cooking of food can cause indigestion or food-poisoning.

    Similarly, the emotions are associated with the Five Phases (see section 5c). Control of the emotions to maintain a good balance is important.

    4. FIVE PHASE THEORY
    As well as a binary classification (Yin-Yang), the Chinese classified natural phenomena into five archetypes, translated as the Five Phases, once called the Five Elements. The word "Phase" is more appropriate, as it signifies that the five classifications are relative and it infers the idea of change between the phases. The Five Phases are Fire type, Earth type, Metal type, Water type and Wood type. The Five Phases stand together as a mutually nourishing (anabolic) and controlling (catabolic) whole, as in the diagram (below):

    The outer clockwise circle ( ---> ) is the Sheng, creative or nourishing cycle. Things of a Fire nature nourish ( --> ) things of an Earth nature in the Sheng Cycle: Fire --> Earth --> Metal --> Water --> Wood --> Fire. In the Sheng Cycle, Fire is the Mother on Earth; Metal is the Son of Earth.

    THE SHENG AND KO CYCLE OF THE FIVE PHASES

    
    
    
    
    
                                        Fire
    
    
    
    
    
                              Wood                Earth
    
    
    
    
    
    
    
                                  Water       Metal
    
    
    
    
    
    

    The inner clockwise star ( > ) is the Ko, controlling cycle. Things of a Fire nature control or weaken ( X ) things of a Metal nature in the Ko Cycle: Fire X Metal X Wood X Earth X Water X Fire.

    Each Phase also contains Yin and Yang attributes or correspondences (see paper on the Five Phases). Each Phase also relates to a specific Yin-Yang pair of COSs and Fire relates to 4 COSs (HT, SI, PC, TH). For instance Wood Yin relates to Liver and Wood Yang relates to Gallbladder function, as in the diagram (below).

    The Yin-Yang pairs in each Phase are called Husband-Wife pairs. For instance ST (Yang) is the Husband of SP (Yin). Each Channel has a special AP point (the Luo (Passage) point). The Luo points are used to shunt Qi between Husband and Wife.

    Each Phase also has relationships to a specific season, food, emotion, sound, body tissue, secretion etc. (See details in the paper on the Five Phases). Any imbalance of Qi in the Five Phase system can affect the balance in the whole system. For instance, Deficient KI (Water) Qi can cause Deficient LV Qi (the Mother can not feed the Son in the Sheng Cycle), or it can cause Excess HT (Fire) Qi (via the Ko Cycle, Deficient Water allows Excess Fire). Excess KI Qi would have the opposite effect.

    Five Phase Theory has very practical use in TAP therapy. For instance, if there is a Qi Deficiency in one Channel and an Excess in another, the Qi can be balanced very easily by needling special points (selected from the Five Phase Points and/or the Luo (Passage) points). Each Channel has a special point which relates to each Phase (5 x 12 points = Sixty Phase Points). These points are used to shunt Qi between the Phases.

    One stimulates the appropriate TAP point on the Deficient Channel (always the Deficient Channel!) to draw the Excess Qi directly into it (or indirectly via other Channels), thereby balancing the whole system.

    In the Five Phase relationships (below), the Yang organs (SI, TH, ST, LI, BL, GB) are those on the outside of the diagram and the Yin organs (HT, PC, SP, LU, KI, LV) on the inside.

    CHANNEL RELATIONSHIPS VIA THE SHENG AND KO CYCLES

    
    
    
                                      SI   TH
    
    
    
                                      HT   PC
    
    
    
    
    
                                        Fire
    
                    GB                                           ST
    
                        LV                                   SP
    
                              Wood                Earth
    
    
    
    
    
    
    
                                 Water       Metal
    
                        KI                                  LU
    
                    BL                                           LI
    
    
    
    

    Five Phase Theory teaches that disorder in any one COS can directly or indirectly cause disorder in any other COS via Sheng, Ko or other energetic transfer routes. It is essential to the understanding of disease interactions in TCM and in the selection of the primary sites of disease.

    It also teaches that if the primary disorder is corrected, the secondary disorders may self-correct rapidly.

    A detailed study of Five Phase relationships and the uses of the Phase and Luo Points is essential to the therapeutic use of energetic TAP. The system can give dramatic clinical results in complex Syndromes but few western acupuncturists have the patience to study the system properly.

    ...CONTINUE...