dificultate 3

ACU CENTRE www.acucentre.com.au (613) 9532 9602

ACU CENTRE, Suites 2 & 11, 219 Balaclava Rd., Caulfield North. Victoria. 3161.Australia 1

NAN-CHINGChapter One: Vessel Movements & Diagnostic Significance, cont’d.

(Difficult Issues 1-22, here, 14-16).

THE FOURTEENTH DIFFICULT ISSUE

Overview: Introduction of the concepts of "injured" (i.e., slower than usual) and "arriving" (i.e.,

faster than usual) movements in the vessels; also, discussion of the significance of the presence of a

movement in the vessels at the inch-section when no movement can be perceived at the foot-section,

and vice versa.

The fourteenth difficult issue: (1) The [movement in the] vessels may be "injured" or "arriving."

What does that mean?



(2) It is like this. An "arriving" [movement in the] vessel [implies the following. If during a period of]

one exhalation two [movements] arrive, that is called "normal. " (3) If three arrive, that is called

"departure from the regular." (4) If four arrive, that is called "loss of essence." (5) If five arrive, that

is called "death." (6) If six arrive, that is called "severance of fate." (7) These are the arriving1

[movements in the] vessels.

(8) What does "injured" [movement in the] vessels

mean?

(9) If one [movement] arrives [during the period of]

one exhalation, that is called "departure from the

regular." (10) One arrival during two exhalations is

called "loss of essence." (11) One arrival during three

exhalations is called "death." (12) One arrival during

four exhalations is called "severance of fate." (13)

These are injured [movements in the] vessels. (14) In

case of arriving [movements in the] vessels, [the

illness] proceeds from the lower [depots] to the upper

[depots]; in case of injured [movements in the]

vessels, [the illness] proceeds from the upper [depots]

to the lower [depots].

(15) What [course of an] illness is signalled by injured

[movements in the] vessels?

(16) It is like this. The first [stage of an] injured

[movement in the vessels corresponds to an] injury of

the skin [and of its] hair. The skin contracts and the

hair falls out. (17) The second [stage of an] injured

[movement in the vessels corresponds to an] injury of

the blood vessels. Hence, the blood vessels have little

or no contents which could circulate through the

[body's] five depots and six palaces. (18) The third

[stage of an] injured [movement in the vessels

corresponds to an] injury of the flesh. The flesh

grows lean; food and drink can no longer create flesh

and skin.

(19) The fourth [stage of an] injured [movement in the vessels corresponds to an] injury of the

muscles. The muscles relax and are unable to support one's stature. (20) The fifth [stage of an]

injured [movement in the vessels corresponds to an] injury of the bones. The bones become



powerless, and [one is] no longer able to rise from bed. (21) Opposite to this is the [course of an]

illness [corresponding to] arriving [movements in the vessels].2 (22) Thus, if [the illness, as happens

in case of an injured movement,] proceeds from the upper [depots] to the lower [depots, the patient

will] die when the bones have become powerless so that he is unable to rise from bed. (23) If,

however, [the illness] proceeds from the lower [depots] to the upper [depots, as happens in case of

an arriving movement in the vessels, the patient] will die when the skin contracts and when the hair

falls out.

(24) What methods exist to treat injury?

(25) It is like this. If the injury has affected the respective [patient's] lung, supplement his influences.

(26) If the injury has affected his heart, balance his protective and constructive [influences]. (27) If

the injury has affected his spleen, balance his food and drink, and see to it that [his exposure to] cold

and warmth is appropriate. (28) If the injury has affected his liver, relax his center. (29) If the injury

has affected his kidneys, supplement his essence. (30) These are the methods to treat injury.

(31) [Consider the following situations. The movement in the] vessels arrives twice during one

exhalation and twice during one inhalation; (32) it arrives three times during one exhalation and three

times during one inhalation; (33) it arrives four times during one exhalation and four times during one

inhalation; (34) it arrives five times during one exhalation and five times during one inhalation; (35) it

arrives six times during one exhalation and six times during one inhalation. (36) Or it arrives once

during one exhalation and once during one inhalation; (37) it arrives once during two exhalations and

once during two inhalations; (38) or it arrives twice during exhalation and inhalation. (39) If the

[movement in the] vessels comes like any of these [situations], how can the respective illnesses be

distinguished?

(40) It is like this. If the [movement in the] vessels comes in such a way that it arrives twice during

one exhalation and twice during one inhalation, and if it is neither strong nor minor, that is called

"normal." (41) Three arrivals during one exhalation and three arrivals during one inhalation indicate

that one just happens to contract an illness. (42) If the [movement in the vessels is felt to be] strong in

front [of the gate and] minor behind [the gate, that is accompanied by] headache and dizziness. (43) If

the [movement in the vessels is felt to be] minor in front [of the gate] and strong behind [the gate, that

is accompanied by a perception of] fullness in one's chest and by short breath. (44) Four arrivals

during one exhalation and four arrivals during one inhalation indicate that the illness tends to become

serious. (45) If the [movement in the] vessels is vast and strong, one suffers from uneasiness and has

[a perception of ] fullness [in one's chest]. (46) If the [movement in the] vessels is deep and fine, one

suffers from abdominal pain. (47) A smooth [movement indicates] harm due to heat. (48) A rough

[movement indicates] mist and dew in one's center. (49) Five arrivals during one exhalation and five

arrivals during one inhalation indicate that the [situation of that] person is critical. (50) If [in this case

the movement in the] vessels is deep, and fine, [the seriousness of the illness] will increase during the



night. (51) If it is at the surface and strong, [the seriousness of the illness] will increase during the

day. (52) If it is neither strong nor minor, [the illness] can be cured, although [the situation of the

patient] is critical. [If the movement is] either strong or minor, a cure will be difficult. (52) Six

arrivals during one exhalation and six arrivals during one inhalation indicate a deadly [movement in

the] vessels. (53) If it is deep and fine, death will occur during the night. (54) If it is at the surface

and strong, death will occur during the day. (55) One arrival during one exhalation and one arrival

during one inhalation is called "injury." (56) The [afflicted] person may still be able to walk, but

should stay in bed. (57) The reason for such [a condition] lies in a depletion of blood and of

[protective] influences. (58) One arrival during two exhalations [and one arrival during two

inhalations] or two arrivals during exhalation and inhalation are called "absence of hun."3 (59) If

one's hun is absent, one must die. (60) The [afflicted] person may still be able to walk, but one

speaks here of a "walking corpse." (61) If [a movement in the] vessels is [perceivable] in the upper

section, while no [movement in the] vessels is [perceivable] in the lower section, the respective

person should vomit; if he does not vomit, he will die. (62) If no [movement in the] vessels is

[perceivable] in the upper section, while [a movement in the vessels is perceivable] in the lower

section, the [respective person] will not suffer any harm, although [his situation] is critical. (63) The

reason for this lies in the fact that just as a person has feet, a tree has roots. Even though branches

and leaves may wither, the roots can lived by themselves. (64) [Similarly,] the vessels have their

root, [and that is where] man has his primordial influences. Hence, one knows that [the respective

patient] will not die.4

Unschuld’s Footnotes

1. The text says ssu mai ("deadly movement in the vessels"). All editions consulted, except for the

Nan-ching chi-chu, have replaced the character ssu, by chih ("arriving"). In analogy to sentence 13,

such a correction seems justified, so I have adopted it in my rendering.

2. The characters yü shou, appear to be superfluous here: see the commentaries.

3. The term hun, may have been used here in an ancient metaphysical sense, referring to a hun soul

which enters the body some time after its birth and leaves it upon its death (also during

unconsciousness). In the context of the medicine of systematic correspondence, this concept was

modified and the hun was considered to be one of several spirit-influences stored in the body's

depots.

4. The tenth difficult issue discussed the transmission of illnesses, (i.e. evil influences) from one

depot to the next in the context of the Five Phases doctrine. As outlined there, evil influences can

develop in a depot and cause it itself to be ill, or they may be transmitted—in accordance with the

orders of mutual generation and of mutual destruction—from child phase to mother phase, from

mother to child, from inferior phase to superior phase, and from superior phase to inferior phase.

Here in the fourteenth difficult issue, a different mode of transmission is introduced which is not

recorded in the Nei-ching, together with a method for diagnosing the resulting illnesses. The Nan-

ching points out that illnesses may descend from the lung—via the heart, spleen, and liver—to the

kidneys; or they may be transmitted from the kidneys upward—via the liver, spleen, and heart—to



the lung. The first of these two courses of transmission is considered to be paralleled by—and thus

perceivable through—a decreasing frequency of the movement in the vessels, while the second course

is supposed to be accompanied by an increasing frequency of this movement. The author(s) of this

difficult issue introduced two new terms to denote these innovative concepts—namely, "injury" for

the transmission downward, and "arrival" for the transmission upward. The discussion of this

difficult issue by the commentators followed the usual path; some adopted the new ideas and

attempted to reconcile them as best as they could with other concepts of systematic correspondence,

while the conservatives ridiculed any innovation and focused their comments on contradictions with

terms and concepts recorded by the Nei-ching.

THE FIFTEENTH DIFFICULT ISSUE

Overview: Elucidation of the changes in the movements in the vessels in accordance with the passing

of the four seasons.



The fifteenth difficult issue: (1) In spring the [movement in the] vessels is stringy; in summer the

[movement in the] vessels is hook-like; in autumn the [movement in the] vessels is hairy; in winter

the [movement in the] vessels is stony. Do these [movements in the] vessels [indicate the normal

presence of the] governing [influences of the respective seasons], or do these [movements in the]

vessels [indicate] illness?

(2) It is like this. Stringy, hook-like, hairy, and stony [movements in the] vessels are [those in

accordance with] the four seasons. (3) In spring [the movement in] the vessels is stringy because [it

corresponds to] the liver, the eastern region, [and to the phase of] wood. [During that season] all

things come to life; [trees] have no branches or leaves yet. Hence, the respective [movement in the]

vessels is soft, weak, and extended. Hence, it is called "stringy."

(4) In summer the [movement in

the] vessels is hook-like

because [it corresponds to] the

heart, the southern region, [and

to the phase of] fire. [During

that season] all things flourish;

the branches and the leaves are

spread out, and they all point

downward and are curved like

hooks. Hence, the [respective

movement in the] vessels comes

swiftly and goes slowly.

Hence, it is called "hook-like."

(5) In autumn [the movement

in] the vessels is hairy because

[it corresponds to] the lung, the

western region, [and to the

phase of ] metal. [During that

season] all things come to an

end. All the blossoms and

leaves of herbs and trees fall in

autumn. Only the branches

remain, resembling fine hair.

Hence, [the movement in] the

vessels comes light, depleted,

and is at the surface. Hence, it

is called "hairy."



(6) In winter [the movement in] the vessels is stony because [it corresponds to] the kidneys, the

northern region, [and to the phase of] water. [During that season] all things are stored. When winter

is at its peak, the water congeals to resemble stones. Hence, [the movement in] the vessels comes in

the depth, is soft, and smooth. Hence, it is called "stony." (7) These are the [movements in the]

vessels [in accordance with] the four seasons.

(8) What about variations?

(9) It is like this. In spring the [normal movement in the] vessels is stringy. [A movement] contrary

[to this] indicates illness.

(10) What does "contrary" mean?

(11) It is like this. If the influences come replete and vigorous, that is called "greatly excessive"; [in

this case] an illness is located in the external [sections of the organism]. (12) If the influences come

depleted and slight, that is called "insufficient"; [in this case] an illness is located in the internal

[sections of the organism]. (13) If the influences come serene and whispering, as if they followed

[the movement of] elm-leaves [in a spring breeze], that implies a normal state. (14) [If they come]

increasingly replete, as if they followed [the movement of] long canes, that implies illness. (15) [If

the influences come] tense and are unyielding and increasingly vigorous, like a new bowstring, that

implies death. (16) [If the movement in] the vessels in spring is slightly stringy, that implies a normal

state; if it is mostly stringy, and if few influences of the stomach are present, that implies illness. (17)

But if it is stringy in the absence of influences of the stomach, that implies death. (18) In spring [the

organism needs] the influences of the stomach as its basis.

(19) In summer the [normal movement in the] vessels is hook-like. [A movement] contrary [to this]

indicates illness. What does "contrary" mean [in this case]?




[sections of the organism]. (22) [If the influences in] the vessels come tied together like rings, or as if

they were following [in their movement a chain of] lang-kan stones, that implies a normal state. (23)

[If they come] in increasing frequency, resembling chickens lifting their feet, that implies illness. (24)

[If the movement is felt to be] curved in front [of the gate and] settled behind [the gate], like a hook

holding a belt, that means death. (25) [If the movement in] the vessels in summer is slightly

hook-like, that implies a normal state. (26) If it is mostly hook-like, and if few influences of the

stomach are present, that implies illness. (27) But if it is hook-like in the absence of influences of the

stomach, that implies death, [because in] summer [the organism needs] the influences of the stomach

as its basis.



(28) In autumn the [normal movement in the] vessels is hairy. [A movement] contrary [to this]





[sections of the organism]. (31) [If the influences in] the vessels come luxuriously, resembling the

canopy on a carriage, and if their strength increases under pressure, that implies a normal state. (32)

[If the influences remain] neither above nor below [the gate, but flap up and down] as if they

followed [the movement of ] chicken wings, that implies illness. (33) If under pressure [the

movement feels like] a loose rope, resembling hair blown by the wind, that implies death. (34) [If the

movement in] the vessels in autumn is slightly hairy, that implies a normal state. (35) If it is mostly

hairy, and if few influences of the stomach are present, that implies illness. (36) But if it is hairy in

the absence of influences of the stomach, that implies death, [because in] autumn [the organism

needs] the influences of the stomach as its basis.

(37) In winter the [normal movement in the] vessels is stony. [A movement] contrary [to this]





[sections of the organism]. (40) [If the influences in] the vessels come strongly above [the gate and]

sharply below [the gate], and if they are soft and smooth, resembling a bird's beak, that implies a

normal state. (41) [If the movement in the vessels resembles] continuous pecking, and if it is slightly

curved in between, that implies illness. (42) [If the movement in the vessels] comes like a loose rope,

and if it goes like a stone ball, that implies death. (43) [If the movement in] the vessels in winter is

slightly stony, that implies a normal state. (44) If it is mostly stony, and if few influences of the

stomach are present, that implies illness. (45) But if it is stony in the absence of influences of the

stomach, that implies death, [because in] winter [the organism needs] the influences of the stomach as

its basis. (46) The stomach is the sea of water and grains; it is responsible for supplying [the depots

during all] four seasons. Hence, the influences of the stomach constitute the basis for all [the depots].

(47) This is [what is] meant by variations [in the movements in the vessels] and by illnesses related to

the four seasons; these are the essential criteria [for recognizing a person's impending] death or

survival. (48) The spleen is the central region. Its balanced and normal state cannot be recognized

[through feeling the movement in the vessels. Only its] exhaustion can be recognized. [In this case,

the movement in the vessels] comes like the pecking of birds, like the dripping of water. This is how

one may recognize exhaustion of the spleen.1




1. In this difficult issue, the author of the Nan-ching once again modified the meaning of certain terms

and concepts of the Nei-ching in order to introduce innovative diagnostic criteria. As the

commentators pointed out, the Nei-ching treatises thus "misused" were the two Su-wen treatises,

"P'ing-jen ch'i-hsiang lun” and "Yu-chi chen-tsang lun". Two basic concepts are presented in this

difficult issue. The first is the idea of normal changes in the movement in the vessels in accordance

with the changing dominant influences during the four seasons, and the idea of the diagnostic

significance of aberrations from this pattern. This first concept was somewhat modified by a second,

which emphasized the importance of the stomach influences as accompanying the proper influences of

the respective depots. A diagnostic pattern is offered, outlining guidelines for diagnosing the partial or

complete absence of stomach influences and for drawing the appropriate prognostic conclusions. The

entire scheme is clear and logical if regarded in its own right, but conservative commentators

evaluated its contents against the contents of the Su-wen. They obviously failed to appreciate the

attempt of the Nan-ching author(s) to replace the often incoherent and contradictory presentation of

concepts in the Nei-ching with a set of ideas designed to serve as a concise and coherent guide to

practice (a function which the Nei-ching could hardly fulfil). The correspondences alluded to in this

difficult issue and by later commentators can be put into tabular form for easier reference as follows:



THE SIXTEENTH DIFFICULT ISSUE

Overview: Discussion of various methods to diagnose illnesses by taking internal and external

evidence into account.

The sixteenth difficult issue: (1) The [movement in

the] vessels can be [examined at the] three sections

and nine indicator [-levels], (2) as well as through

its yin or yang [nature]. (3) [One may, further,

examine it by exerting] light or heavy [pressure,

(4) or by taking into regard the] sixty informants,

(5) or one single [movement in the] vessels as it

varies in accordance with the four seasons. (6) The

distance from the sages is long and far. (7)

[Today,] everybody [selects but one of these

methods and] considers his [choice] to be correct.

How can one distinguish [what are correct and

incorrect diagnostic techniques]?

(8) It is like this. Any verification of an illness

should be based on the presence of certain internal

and external evidence.

(9) What kind of [evidence] do illnesses create?



(10) It is like this. Consider feeling a [movement in the] vessels [that is associated with an illness in

the] liver. (11) External evidence of such [an illness includes] a tendency towards tidy appearance, a

virid face, and an inclination to become angry. (12) Internal evidence of such [an illness is the

presence of] moving influences to the left of the navel which, if pressed, respond with firmness and

pain. (13) The illness, as perceived by the [patient], consists of swollen and stiff limbs, (14) dripping

urine and difficult stools, as well as twisted muscles. (15) If this [evidence] is present, the liver is

[afflicted]. If it is not present, [the liver] is not [afflicted]. (16) Consider feeling a [movement in the]

vessels [that is associated with an illness in the] heart. (17) External evidence of such [an illness

includes] a red face, a dry mouth, and a tendency to laugh. (18) Internal evidence of such [an illness

is the presence of] moving influences above the navel which, if pressed, respond with firmness and

pain. (19) The illness, as perceived by the [patient], consists of uneasiness of the heart and of

heartache. The center of the palms is hot, and dry vomiting occurs. (20) If this [evidence] is present,

the heart is [afflicted]. If it is not present, [the heart] is not [afflicted]. (21) Consider feeling a

[movement in the] vessels [that is associated with an illness in the] spleen. (22) External evidence of

such [an illness includes] a yellow face, a tendency to belch, a tendency to ponder, and a fondness of

tasty [food]. (23) Internal evidence of such [an illness is the presence of] moving influences right at

the navel which, if pressed, respond with firmness and pain. (24) The illness, as perceived by the

[patient], consists of a swollen and full abdomen; his food is not digested; his body feels heavy and

the joints ache. He is tired and weary, desires to lie down, and is unable to pull his four limbs

together. (25) If this [evidence] is present, the spleen is [afflicted]. If it is not present, [the spleen] is

not [afflicted]. (26) Consider feeling a [movement in the] vessels [that is associated with an illness in

the] lung. (27) External evidence of such [an illness includes] a white face, a tendency to sneeze,

grief without joy, and an inclination to cry. (28) Internal evidence of such [an illness is the presence

of] moving influences to the right of the navel which, if pressed, respond with firmness and pain.

(29) The illness, as perceived by the [patient], consists of panting and coughing, and of shivering

from [fits of ] cold and heat. (30) If this [evidence] is present, the lung is [afflicted]. If it is not

present, [the lung] is not [afflicted]. (31) Consider feeling a [movement in the] vessels [that is

associated with an illness in the] kidneys. (32) External evidence of such [an illness includes] a black

face and a tendency to be fearful, as well as yawning. (33) Internal evidence of such [an illness is the

presence of ] moving influences below the navel which, if pressed, respond with firmness and pain.

(34) The illness, as perceived by the [patient], consists of influences moving contrary to their proper

course, tensions and pain in the lower abdomen, and diarrhea [linked with a feeling] as if something

heavy was moving down, as well as [a feeling] of cold and reversed [moving influences] in the feet

and shinbones. (35) If this [evidence] is present, the kidneys are [afflicted]. If this [evidence] is not

present, [the kidneys] are not [afflicted].1


1. Various commentators have argued that the question voiced in sentences 1 through to 7 is unrelated

to the answer given in sentences 10 through 35, and they have reached the conclusion that the text of

this difficult issue is corrupt. This may be so, but one could also support a different interpretation. In



the preceding difficult issues, several diagnostic patterns have been outlined which, although based

on the same fundamental paradigms of yinyang and of the Five Phases, cannot be reconciled entirely

with each other. The quest for one general, coherent system, supposedly encompassing all

acknowledged facts and concepts, has characterized Western science for centuries. Yet such an all-

embracing system may be elusive to the human mind, at least for the time being. As developments in

modern physics demonstrate (for instance, the renewed recognition of cotemporaneous phenomena

and of the singularity of certain events), man's desire for knowledge may have to be satisfied with a

series of rather distinct explanatory models, often linked only by a common acknowledgment of some

basic paradigms of science. Such was also the case with the knowledge in the medicine of systematic

correspondence. Evidence obtained through experience and insights derived from theoretical

conclusions appear to have suggested various distinct explanatory models for an understanding of

illnesses and their symptoms. The question raised in sentences 1 through 7 may express the concern

that individuals would select one or another of these models and proclaim that their choice alone

represents the truth, while neglecting or even denouncing the other models. The response to this

complaint avoids a decision as to which of the diagnostic patterns mentioned is "correct," because

there is no point in making such a decision. Instead, a general survey is given which considers the

examination of the movement in the vessels—regardless of which pattern one relies on to determine

it—as but one facet of a comprehensive assessment of the patient's state. Such a comprehensive

assessment, it is pointed out, has to take into account much more than the condition of the influences

in the conduits. The "holistic" schema of diagnosis actually outlined in this difficult issue appears,

however, merely as a hint; the scope is pointed out, but only a few selected details are offered. For a

tabular illustration of this schema see the following table.

dificultate 3

Documents