conduits of consciousness

7/27/2019 Conduits of Consciousness

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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

M aster of Science in Or iental M edicine

Stephen Higgins

Completed During the 2011-2012 Academic year


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Abstract:

This work creates a context for the concept of the orifices , qiao ( ), in

Chinese medicine. We present to our knowledge for the first time in English a

discourse on the various classical (and some modern) Chinese sources that discuss

this concept, and r eveal 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.


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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 homestead and relationship in 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 obsc ure, 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

laughing often at myself and have been like surrogate brothers to me during

our time together in school. Thank you for your inspiration, my friends.


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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

translat ed 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]

entity iii. 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 orifices and to awareness in

general might be elucidated. Furthermore, it is our hope that doing so might lead

to a deeper understanding of these concepts which in turn enables Chinese


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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 [an d] the

less the intervention is focused on the physical, the more crucial becomes the self-

understanding, insight, and inner resources of the healer. iv

An implicit goal of the thesis is to offer insights that have inspired uswhile 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


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that a ll 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 cl assical 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 Long whose combined clinical experience includes more

than eight decades of medical practice as 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


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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 tosome extent show the working of the Chinese mind. Therefore they interest uswho are students of Chinese thought. Moreover, they may only seem to befanciful 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 isdoubtful if we produce anything much less fanciful and we could produce nothingof such rich historic interest, as certainly invests the 3000 most primitivecharacters. 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


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indicates the nature of the thing being denoted viii (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. Thu s, we should notethat in

many phonetic combinations the phonetic part was chosen because its meaning

had some suggestion of the meaning of the character xi.

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


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times for being childishand fanciful xii, it also grants us information on a

symbolic level of understanding tha t 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 al so 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

withou t becoming too attached to our fanciful ideas.

II. The Character Qiao ( ):

Qiao : Releasing white from the cave Heiner Freuhauf xiii

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 cavity xiv,xv , and in the Shuowen jiezi (


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), 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] cav e-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 t o 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 radical telling us that orifices can contain

something and a character below pronounced jiao (which is phonetically similar

to qiao ), which means glittering or sparkling xviii . Thus here, when taken as

two radicals, we have a glittering cave, a sparkling container, or a hole

[that is] shined through xix.


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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 ( ),

empty xxi. 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 spirits how 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. Theart of the heart, which is a famous discipline in Chinese philosophy, is the way toobtain 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 radiance-

that emits from a healthy person s orifices. In other words, because the heart

stores the light of conscious awareness ( ) and the orifices are the portals


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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 parts xxiv . 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


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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 functions xxvi .

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 cosmos and 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


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When discussing Chinese medicine a medicine of systematic

correspondences xxix one 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; o n 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; [a nd] in the will ( zhi, ) it becomes anger...

In heaven it becomes heat; on earth, fire; in the body, the vessels ( mai ); withinthe zang , the heart; in hues, red; in the tones, jue ; in the voice, laughing; inmovements 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; inthe hues, yellow; in the tones, gong ; in the voice, singing; in the movements andchanges, hiccupping (or belching or vomiting); in the orifices, the mouth;within the flavors, sweet; within the will, thinking


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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 [ahuman being] is a rich paste, at two months it is a bulge, at three months it is afoetus, at four months it has flesh, at five months it has sinews, at six months ithas bones, at seven months it is complete, at eight months it moves, at ninemonths 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, thekidneys 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 beingssimilarly 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


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from Chapter 17 of the Lingshu xxxiii , 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 qicommunicates with the nose; when the lung is harmonious, the nose candistinguish rank and fragrant. Heart qi communicates with the tongue; when theheart is harmonious then the tongue can distinguish the five flavors. Liver qicommunicates with the eyes; when the liver is harmonious the eyes can

differentiate the five hues. Spleen qi communicates with the mouth; when thespleen is harmonious the mouth can distinguish the five grains. Kidney qicommunicates with the ears; when the kidney is harmonious the ears can hear thefive tones. If the five zang are disharmonious, then the seven orifices are not freeand 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 explains according to yin-yang theory the 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.


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mans seven orifices xxxviii . 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 respo nsible 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:


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The Chinese Heart has a hole in it, through which thinking and reasoning are

conducted, as ancients believed xli

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 spirit xlii , or the capacity for clear thinking xliii .

A Practical Dictionary of Chinese Medicine 2 nd 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 heart not the brain is 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


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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 thinking xlvi . Because the orifices act both as

conduits for sensory input into the body (or mind) and the spiritual light xlvii ,

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 intelligence xlviii .

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 tha t the Heart holds

the office of lord and sovereign; spiritual brightness( Shenming ) emanates from


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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 empire li,

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

heart lii. 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)


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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. A ccording 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


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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 andSlipperiness 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 widely-

known 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 phobia lx which, not incidentally, are two symptoms that


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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 prope rly 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 theears 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. (


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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( ). Themouth 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 theconvergence 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 thatwhich moisten the empty orifices through irrigation of the essences. Thus, if theupper 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 theessences; 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.


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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 zangflourish, the twelve channels maintain their [proper] position, the skin and bodyhair are thickened and consolidated, the tendons and bones are supple, the nineorifices 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 contactwith 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 thisobstructs 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


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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] entity lxxi

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 Chineseculture 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,


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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 emptyinside 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 Thefocus will be lost when reception of many things at the same time divides theattention-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 semi-mythological, 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 simple lxxv

text, attributed to the sage-author Laozi , is beyond requiring and introduction.

Although the Chinese character for orifice as such never appea rs 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


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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 a nd 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 ).


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After having come of age (and barring the slings and arrows of

outrageous fortune the heart -ache and the thousand natural shocks that flesh is

heir to lxxx ), 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 thesafest, 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 weighing with our heart the 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. (


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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 orifices an extension of the heart are 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


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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 diseases lxxxv ), 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 tostagnation 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


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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 funct ion. 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 hea rt lxxxviii ( )), 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 engenderedinternally 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 sev en 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


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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 heart suffering from exogenous pathogenic

influences itself instead of the heart just 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 network xciii . Moreover, because the

pericardium and the orifices can both be viewed as the means through which theheart maintains contact with the rest of the body internally and the rest of the

world externally they 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


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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. There upon, 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


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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 depressed c

V. Phlegm Misting the Orifices:

Described using a term first coined by the Ming dynasty physician Zhang

Zihe ci, 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 heart cii ( ). 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. Thiscounterflow drafts the phlegm upward where it confounds the orifices of theheart, thus causing consciousness to be impaired. The spleen vacuity is due to


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overeating uncooked, chilled foods or sweet, fatty, thick-flavored foods, over-thinking 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 losecontrol 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 slightlydifferent 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 existence physical, mental, emotional andspiritual. The qi of the heart retreats or closes off outside contact to variousdegrees and this may ultimately include blood as well as fluid. This retreat may beconceived as being a protective function of the Pericardium. Dr. Shen referred tothese conditions as `heart closed [a condition of qi stagnation, found with a Flator Inflated quality ] or `heart small [due to blood stagnation, and found with aChoppy quality]... Qi moves the blood and fluid. If the qi is deficient allsubstances within an organ become stagnant and the conditions in the Heart for the stagnation described above that leads to excess heat and damp [phlegmmisting the orifices] is present. This is increasingly more common today than thescenario involving the spleen and liver mentioned above [in the quote taken fromFlaws and Finney]. Since the movement of qi is essentially the definition of life,the organism experiences stagnation as dangerous and automatically acts toovercome it. The physiological mechanism begins by bringing metabolic [normal]heat to overcome the stagnation; If it succeeds, then there is no problem; If thestagnation is greater then the ability of the metabolic heat to move it, themetabolic heat starts accumulating and becomes `excess heat. The body


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Because we have only found one secondary source with information on

acupuncture treatment of the orifices cxvii (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 thinking cxix , 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 resuscitation cxx 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, theconcept 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.


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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 intreating 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


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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 jing cxxv 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 isacrid and warm. It primarily treats wind-cold-damp-bi [syndromes], cough and qiascending 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 issueforth. 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 substa nces 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 spir it and sensory orificescxxvii

. Indeed, the termaromatic 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


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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 t ending 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 spirit cxxviii , 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 , ),


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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 orifices cxxxvii . 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: Amethod of treatment used to address externally contracted febrile disease patterns,such as heat entering the pericardium, characterized by high fever with cloudedspirit and delirious speech, vexation and agitation, parched lips and dry teeth,titani c reversal, and convulsion, including child fright wind

bihui kaiqiao , repelling foulness and opening the orifices: Contractionof foul turbidity in hot weather, causing sudden oppression and distension in thechest and abdomen, ungratified urge to vomit and defecate, and, in serious cases,clouding reversal, phlegm-drool congestion and clenched jaw. It is treated by themethod of repelling foulness and opening the orifices [with such formulas as]: yu

shu dan, xing jun san, [and] su he xiang wan .cxxxviii


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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 pill cxl, 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:


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When a warm pathogen has transmitted abnormally cxliii or has sunken

deep into the nutritive or blood layers, the pericardium or orifices can

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 jiezi cxlv). However, it cannot be deni ed 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, illimit able medical

information which is the heritage of at least three thousand years of continuous

Chinese culture cxlvi .


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Further research is certainly needed in order to fully treat the topic of the

heart orifices, but as weve implied that 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


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Endnotes

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

Medicine ( ). (No city given. Publisher: .), 11iii Wiseman, Nigel, Feng Ye. A Practical Dictionary of Chinese Medicine, Second

Edition . (Brookline: Paradigm Publications), 421iv Hammer, Leon. Dragon Rises, Red Bird Flies (Seattle: Eastland Press), xxiv Barnes, Archie, et el. Dus Handbook of Classical Chinese Grammar (GreatBritain: WritersPrintShop), xvvi Wilder, G.D., and J.H. Ingram. Analyzing Chinese characters (Edinburgh:Dover Publications), iiivii Wilder, G.D., and J.H. Ingram. Analyzing Chinese characters (Edinburgh:Dover Publications), iiiviii Wiseman, Nigel and Feng, Ye. Chinese Medical Chinese: Grammar and Vocabulary . (Brookline: Paradigm Publications), 4ix Wiseman, Nigel and Feng, Ye. Chinese Medical Chinese: Grammar and Vocabulary . (Brookline: Paradigm Publications), 4x Wiseman, Nigel and Feng, Ye. Chinese Medical Chinese: Grammar and Vocabulary . (Brookline: Paradigm Publications), 4xi Wilder, G.D., and J.H. Ingram. Analyzing Chinese characters (Edinburgh:Dover Publications), vixii 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: anexploration into the meaning of Chinese acupuncture point names . (Brookline:Paradigm Publication), 386 xvi 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=Etymology&characterInput=
http://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etymology&characterInput=%8C%8Ahttp://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etymology&characterInput=%8C%8Ahttp://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etymology&characterInput=%8C%8Ahttp://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etymology&characterInput=%8C%8Ahttp://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etymology&characterInput=%E6%95%ABhttp://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etymology&characterInput=%E6%95%ABhttp://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etymology&characterInput=%E6%95%ABhttp://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etymology&characterInput=%E6%95%ABhttp://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etymology&characterInput=%E6%95%ABhttp://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etymology&characterInput=%E6%95%ABhttp://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etymology&characterInput=%8C%8Ahttp://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etymology&characterInput=%8C%8A


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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=Etymology&characterInput= xxi Shuowen jiezi.http://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etymology&characterInput= xxii Larre, Claude, and Elisabeth Rochat de la Vallee. Heart Master Triple Heater.(London: Monkey Press), 2xxiii Becker, Simon, et al. Translators preface. Yi Lin Gai Cuo: Correcting

Errors in the Forest of Medicine . Trans. Chung, Yuhsin, et al. (Boulder: BluePoppy Press), xvixxiv 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), xvixxvi Ibid. (???)xxvii Huangdi Neijing Suwen chapter 62 ( ).http://www.chant.org/prehan/frame.aspx?t=b&id=000951 xxviii Lingshu Chapter 17( ).http://www.chant.org/prehan/frame.aspx?t=b&id=000952 (Note: This sentence isfound in many chapters throughout the Neijing )xxix Unschuld, Paul U. Medicine in China: A History of Ideas. (Berkeley:University of California Press), 51xxx Suwen chapter 4 ( ).http://www.chant.org/prehan/frame.aspx?t=b&id=000951 xxxi 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 HuainanziChapter 7 . (London: Monkey Press),xxxiii Lingshu Chapter 17 ( ).http://www.chant.org/prehan/frame.aspx?t=b&id=000952 xxx iv

Hammer, Leon. A Discussion of Terrain, Stress, Root, and Vulnerability inChinese Medicine, . Chinese Medicine Times vol. 5, Issue 1, Spring 2011. xxxv Suwen Chapter 5 ( ).http://www.chant.org/prehan/frame.aspx?t=b&id=000951 xxxvi Zheng Xuan( ). A Han Dynasty Commentary [on the Rites of Zhou] by

Zheng Xuan( ). http://www.definition-of.net/ -
http://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etymology&characterInput=%C2%AChttp://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etymology&characterInput=%C2%AChttp://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etymology&characterInput=%C2%AChttp://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etymology&characterInput=%C2%AChttp://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etymology&characterInput=%E2%81http://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etymology&characterInput=%E2%81http://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etymology&characterInput=%E2%81http://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etymology&characterInput=%E2%81http://www.chant.org/prehan/frame.aspx?t=b&id=000951http://www.chant.org/prehan/frame.aspx?t=b&id=000951http://www.chant.org/prehan/frame.aspx?t=b&id=000952http://www.chant.org/prehan/frame.aspx?t=b&id=000952http://www.chant.org/prehan/frame.aspx?t=b&id=000951http://www.chant.org/prehan/frame.aspx?t=b&id=000951http://www.chant.org/prehan/frame.aspx?t=b&id=000951http://www.chant.org/prehan/frame.aspx?t=b&id=000951http://www.chant.org/prehan/frame.aspx?t=b&id=000952http://www.chant.org/prehan/frame.aspx?t=b&id=000952http://www.chant.org/prehan/frame.aspx?t=b&id=000951http://www.chant.org/prehan/frame.aspx?t=b&id=000951http://www.definition-of.net/%A9w%E4%B9%89-%B3%B1%C2%AChttp://www.definition-of.net/%A9w%E4%B9%89-%B3%B1%C2%AChttp://www.definition-of.net/%A9w%E4%B9%89-%B3%B1%C2%AChttp://www.definition-of.net/%A9w%E4%B9%89-%B3%B1%C2%AChttp://www.definition-of.net/%A9w%E4%B9%89-%B3%B1%C2%AChttp://www.definition-of.net/%A9w%E4%B9%89-%B3%B1%C2%AChttp://www.definition-of.net/%A9w%E4%B9%89-%B3%B1%C2%AChttp://www.chant.org/prehan/frame.aspx?t=b&id=000951http://www.chant.org/prehan/frame.aspx?t=b&id=000952http://www.chant.org/prehan/frame.aspx?t=b&id=000951http://www.chant.org/prehan/frame.aspx?t=b&id=000951http://www.chant.org/prehan/frame.aspx?t=b&id=000952http://www.chant.org/prehan/frame.aspx?t=b&id=000951http://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etymology&characterInput=%E2%81http://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etymology&characterInput=%E2%81http://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etymology&characterInput=%C2%AChttp://internationalscientific.org/CharacterEtymology.aspx?submitButton1=Etymology&characterInput=%C2%AC


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xxxvii Suwen Chapter 5 ( ).http://www.chant.org/prehan/frame.aspx?t=b&id=000951 xxxviii Lingshu Chapter 78 ( ).

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

Medicine. (Australia: Churchill Livingstone), 336xlix Yu, Ning. Application of Cognitive Linguistics 12: The Chinese HEART in aCognitive perspective . (Berlin: Mouton de Gruyter), 171l 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 theSpiritual Orchid (London: Monkey Press), 143 Larrelii Xunzi ( ). http://ctext.org/xunzi?searchu= liii Hanfeizi ). http://ctext.org/hanfeizi?searchu= liv Wang, Qing-Ren. Yi Lin Gai Cuo: Correcting Errors in the Forest of Medicine .Trans. Chung, Yuhsin, et al. (Boulder: Blue Poppy Press), xvilv Hammer, Leon. Chinese Pulse Diagnosis: A Contemporary Approach, Revised

Edition. (Seattle: Eastland Press), 23lvi Hammer, Leon. Chinese Pulse Diagnosis: A Contemporary Approach. (Seattle:Eastland Press),lvii Hammer, Leon. Chinese Pulse Diagnosis: A Contemporary Approach. (Seattle:Eastland Press), 401lviii Hammer, Leon. Chinese Pulse Diagnosis: A Contemporary Approach.(Seattle: Eastland Press), 73lix Hammer, Leon. Chinese Pulse Diagnosis: A Contemporary Approach. (Seattle:Eastland Press), 321
http://www.chant.org/prehan/frame.aspx?t=b&id=000951http://www.chant.org/prehan/frame.aspx?t=b&id=000951http://www.chant.org/prehan/frame.aspx?t=b&id=000952http://www.chant.org/prehan/frame.aspx?t=b&id=000952http://ctext.org/wenzi?searchu=%C2%AChttp://ctext.org/wenzi?searchu=%C2%AChttp://ctext.org/wenzi?searchu=%C2%AChttp://ctext.org/wenzi?searchu=%C2%AChttp://www.chant.org/prehan/frame.aspx?t=b&id=000952http://www.chant.org/prehan/frame.aspx?t=b&id=000952http://www.chant.org/prehan/frame.aspx?t=b&id=000951http://www.chant.org/prehan/frame.aspx?t=b&id=000951http://ctext.org/xunzi?searchu=%93%56%8A%AFhttp://ctext.org/xunzi?searchu=%93%56%8A%AFhttp://ctext.org/xunzi?searchu=%93%56%8A%AFhttp://ctext.org/xunzi?searchu=%93%56%8A%AFhttp://ctext.org/hanfeizi?searchu=%C2%AChttp://ctext.org/hanfeizi?searchu=%C2%AChttp://ctext.org/hanfeizi?searchu=%C2%AChttp://ctext.org/hanfeizi?searchu=%C2%AChttp://ctext.org/hanfeizi?searchu=%C2%AChttp://ctext.org/xunzi?searchu=%93%56%8A%AFhttp://www.chant.org/prehan/frame.aspx?t=b&id=000951http://www.chant.org/prehan/frame.aspx?t=b&id=000952http://ctext.org/wenzi?searchu=%C2%AChttp://www.chant.org/prehan/frame.aspx?t=b&id=000952http://www.chant.org/prehan/frame.aspx?t=b&id=000951


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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), 638lxxxiv Wiseman, Nigel, and Feng Ye. A Practical Dictionary of Chinese Medicine,

2nd

Ed . (Brookline: Paradigm Publications), 433lxxxv Clavey, Steven. Fluid Physiology and Pathology in Traditional Chinese Medicine, 2 nd Ed . (Edinburgh: Churchill Livingstone), 522lxxxvi 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), 7lxxxvii Pathomechanisms of the Heart, 7 lxxxviii Hammer, Leon I. Personal correspondence with the author, dated April 21,2012lxxxix Ye, Tianshi ( ). Discourse on warm- heat disease , Wenre lun (

). http://www.charleschace.com/pdfs/WenReLun_1.pdf xc Chapter 17 of the Lingshuhttp://www.chant.org/prehan/frame.aspx?t=b&id=000952 xci Chapter 28 of the Suwenhttp://www.chant.org/prehan/frame.aspx?t=b&id=000951 xcii 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), 95xcv 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 xcv iii Pathomechanisms of the Heart xcix Clavey, Steven. Fluid Physiology and Pathology in Traditional Chinese

Medicine, 2 nd Ed . (Edinburgh: Churchill Livingstone),c Pathomechanisms of the Heart, 15 ci Clavey, Steven. Fluid Physiology and Pathology in Traditional Chinese

Medicine, 2 nd Ed . (Edinburgh: Churchill Livingstone),cii

Wiseman, Nigel, and Feng Ye. A Practical Dictionary of Chinese Medicine, 2nd

Ed . (Brookline: Paradigm Publications), 433ciii Flaws, Bob, and Daniel Finney. A Compendium of TCM Patterns and Their Treatments . (Boulder: Blue Poppy Press), 43civ Flaws, Bob, and Daniel Finney. A Compendium of TCM Patterns and Their Treatments . (Boulder: Blue Poppy Press), 44cv Hammer, Leon I. Personal correspondence with the author, dated March, 2012cvi Hammer, Leon I. Personal correspondence with the author, dated June 2012
http://www.charleschace.com/pdfs/WenReLun_1.pdfhttp://www.charleschace.com/pdfs/WenReLun_1.pdfhttp://www.chant.org/prehan/frame.aspx?t=b&id=000952http://www.chant.org/prehan/frame.aspx?t=b&id=000952http://www.chant.org/prehan/frame.aspx?t=b&id=000951http://www.chant.org/prehan/frame.aspx?t=b&id=000951http://www.charleschace.com/pdfs/WenReLun_1.pdfhttp://www.charleschace.com/pdfs/WenReLun_1.pdfhttp://onlinebooks.library.upenn.edu/webbin/gutbook/lookup?num=25123http://onlinebooks.library.upenn.edu/webbin/gutbook/lookup?num=25123http://onlinebooks.library.upenn.edu/webbin/gutbook/lookup?num=25123http://onlinebooks.library.upenn.edu/webbin/gutbook/lookup?num=25123http://onlinebooks.library.upenn.edu/webbin/gutbook/lookup?num=25123http://onlinebooks.library.upenn.edu/webbin/gutbook/lookup?num=25123http://onlinebooks.library.upenn.edu/webbin/gutbook/lookup?num=25123http://onlinebooks.library.upenn.edu/webbin/gutbook/lookup?num=25123http://onlinebooks.library.upenn.edu/webbin/gutbook/lo

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