Dkaraba Neijing Tcmwt Handout

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TCM Wisdom TubeTM

Acupuncture from the Neijing

byDavid Karaba, L.Ac., O.M.D.

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Acupuncture from the Huángdì Nèijī ng

( 黄经 )The origins of needling therapy

and Acupuncture

Remembering our Roots

Honoring our Tradition

by

David Karaba, O.M.D., L.Ac.

Purpose

This webinar is the provide insight andperspective to the upcoming class:"Acupuncture from the Neijing for Fantastic

Clinic Results,“ By Dr. Donald Kendall nextweekend, 6/26/10!

Reviewed will be:

Essential Concepts and

Why we should expand our understanding

of the Huángdì Nèij ī ng (黄内 )

Copyright

Pictures have been purposely removed from the

handout for copyright reasons

Overview

Keys to fully appreciate and grasp the subtleties ofthe Huángdì Nèij ī ng (黄内 ) are:

– The importance and need for IntegrativeConcepts (.i.e. Why scientific understanding isessential for consistent repeatable results)

– Nomenclature used (and why)

– Longitudinal Organization

Huángdì Nèijī ng ( 黄

经 )

Yellow Emperor’s Internal Classic(Huángdì Nèijī ng

黄内

经most

important text to evolve perhapsduring ca. 600 – 300BCE

Some evidence shows Neijing may havebeen compiled ca. 200 – 100BCE

The importance of the Huángdì Nèijī ng

( 黄经

) First comprehensive Medial Text

Is a compilation (c.200 BCE) of all knowledgerelated to Chinese medicine

Provides an amazing understanding of humananatomy, physiology, and pathology

Provides first complete description of bloodcirculation by cardiovascular system and alsothe lymphatic system

Neijing provides foundation of needlingtherapy including description of 9 needles





9 needles Used For:

– Needling - Blood letting - Minor surgery- Acupressure

Huángdì Nèijī ng ( 黄经

)

Notes that ancient Chinese physiciansperformed postmortem autopsies

First account of continuous blood circulation

and rudimentary immune system

Provided anatomical measurements of internalorgans and blood vessels

Mentioned neurovascular connections to heartand eyes

Observed propagated sensations (PS) alongvessel and muscle distribution pathways


) First medical text to correctly describe:

– Cardiovascular blood circulation consisting of:

Inhaled air

Nutrients absorbed by small intestine veins

Hormones

Immune substances (wèi卫) (can leave circulation anddrain into lymphatic system)

– Brain, spinal cord, and peripheral nerves

– Longitudinal body organization with segmentaldominance (fundamental to all vertebrates)

– Longitudinal distribution of muscles and vessels

giving rise to neurovascular nodes (acupoints)


)

First medical text to correctly describe (cont):

– Internal organs

– Did not differentiate the endocrine glands but includedtheir functions, vitalities, and emotional contributionswith specific viscera

– Rational concept of pathology involving the interplay ofphysiological balance, external environment, andemotional stress and strain

Provided treatment approaches using:

Treatment based on herbs and needling therapy

– The character of “Yi” 醫

Others: exercise, breathing exercise, moxa,

Somatovisceral relationships, organ referred pain &

Organ Vitalities and emotions mediated by refined substances

(shen jing)[

精 ] Organ referred pain, four hollows, vessel distributions

– Significance with regards to needling

Vitality, emotions, and endocrine glands

– Zhi– drive; will - adrenals

– Hun – Mood – pineal (controlled by eyes)

– Po – vigor – thyroid

– Yi – intent; desire – pancreas

– Shen – spirit – heart; pituitary

Organ referred pain

To increase the blood flow and innervationfeedback

Viscerosomatic effects (organ referred pain)

Somatovisceral effects (treating the extremities

to effect the organs – needling patches, etc.)





Fantastic Clinical Results

Some are due the results of unique

functions or capability of certainneurovascular nodes

Most are result of understanding uniqueview of body developed by the Chinese

Most important is longitudinal (经

) bodywith segmental nerve dominance

Western Exposure

Marco Polo (1275-1292),in a letter to the Doge ofVenice, mentioned“needles that cure”

Western Exposure

Jesuit Missionaries of the fifteenth centuryreported and practiced needling therapy

In the late 1600s Willem ten Rhijne was firstwestern trained physician to observe Chinesemedicine practice while serving the Dutch EastIndia Co. in Japan

He learned from practitioners that vessels involverelated nerves as well

Japanese physicians constructed hydraulic

machines to illustrate how blood continuallycirculates through the body

Western Exposure

Willem ten Rhijne also learned that branching ofvessels was a critical part of Chinese theory

He indicates that this branching was unknown inEurope at the time

He wrote a dissertation in 1683 on Chinese medicineand needling therapy

His report was used in early 1800 France, Italy, andUS to experiment with needling and electricstimulation to inserted needles

Western Exposure

During early 1900s a bank clerk from Francenamed Soulie de Morant spent several years inChina

Around 1930 he started teaching a few physiciansand lay people about his ideas of Chinese medicinein France

With no training in anatomy or physiology hemade several critical errors in his interpretation ofChinese medicine

Soulie de Morant

The most devastating error was to translate vitalbreath (qì气 [ ]) as “ ‘energy’ for lack of a betterword”

He then translated the longitudinal and collateralvessels (j ī ngluò经络) as meridian althoughmeridian is经线 j ī ngxiàn

He also then translated word for blood vessel (mài脉) as meridian as well





Original Chinese Discovery

Continuous circulation of blood to internal andsuperficial region by means of cardiovascularsystem

Branching of arteries into progressively smallervessels including capillaries which communicatewith return flowing veins

Vital breath circulated in blood along withnutrients, defensive substances, and biologicallyactive substances of vitality that mediate emotions

William Harvey

This developed the ideas of René Descartes who in hisDescription of the Human Body said that the arteriesand veins were pipes which carried nourishmentaround the body. Although Spanish physician MichaelServetus discovered circulation a quarter centurybefore Harvey was born, all but three copies of hismanuscript Christianismi Restitutio were destroyedand as a result, the secrets of circulation were lost untilHarvey rediscovered them nearly a century later.

Retrieved 1/1/19/07 @ http://en.wikipedia.org/wiki/William_Harvey

William Harvey (1578 -1657) was an English

medical doctor, who is credited with first

correctly describing, in exact detail, the

properties of blood being pumped around the

body by the heart.

In contrast – Four Great Inventions of China

History and origins

– Gunpowder was invented in China and is consideredone of the Four Great Inventions of ancient China.

The 'Four Great Inventions of ancient' China: the compass,gunpowder, papermaking, and printing.

The blood circulatory system is not included as anoriginal discovery (yet)….

From Wikipedia, the free encyclopedia

Integrating Medicine

Between the East and West

Bridging the Divide

A Need for Greater Understanding

Must be able to Communicate with allied

health providers – Standards of Care

Know the Self (i.e. know how the body works)

NIH 5 year plan

Things by mouth

Herbs botanicals

Diets Mind/Body (expectation / condition effecting any therapy)

Acupuncture, Chiro’s, Osteopathy

Energy Medicine – (Gov hasn’t invested much moneyin because it hasn’t been able to produce repeatablemodels) (lower Priority)

Whole medical systems – TCM, Native Americanhealthcare, Aryuveda, as opposed to the herb or the herbsor the modality used in the system (not reduce via an ultrareductionistic manner)





NIH 5 year plan

(Three new)

International collaboration – joint efforts toinvestigate: reproducibility, improving

training,

Cost Effectiveness (Show me the money)

Ethical, legal (malpractice), and socialramifications of making CAM therapiesaccessible, advising patients to use them oravoid them, training people of advisedconversations with patients

NIH 5 year plan

Summary: It emphasizes

Mechanism

Mechanism

Mechanism

NIH 5 year plan

Not so much that it works…

Show me how it works

NIH 5 year plan insufficiencies

In absence of scientific explanatory model noneof the treatments will be accepted by themedical elite

– Especially if it comes from outside the elite sphereof influence

– “we must understand or at least be able explainhow something works if we are going want thegreater healthcare system to accept it.”

Cost effectiveness – virtually absent

Practice based research – nonexistent

NIH 5 year plan insufficiencies

Systems reconciling complimentary and

conventional diagnosis do not exist – (acc. ToDr. Eisenberg)

However,

Donald Kendall has rediscovered basicOriental Medicine perspectives that allude toand link them to the standard world bodyknowledge of pathopysiological diagnosis.

“We are stuck in our tribal robes

without any written truce”

“We need people that are utterly comfortable inthe others domain.”





A look at Roots

Spire

A look at Roots

气 Qì

Cosmological Anatomical Order

Tai Yin = Moon(variable )

Shao Yin = Planets

(variable)

Jue Yin = The Spacebetween

(That whichsurrounds us;

the “gestalt”)

Yang Ming = Brightness(Morning Sunshine)

Tai Yang = Sun

(Hottest in the afternoon)

Shao Yang = Stars

(All around, shining atnight)

Anatomical CorrelationsYang = Lateral

Anterior Lateral Hand =

– Hand Yang Ming (LI) = ALH

Anterior Lateral Foot

– Foot Yang Ming (St) = ALF

Posterior Lateral Hand

– Hand Tai Yang (SI) = PLH

Posterior Lateral Foot

– Foot Tai Yang (UB) = PLF

Lateral Hand

– Hand Shao Yang (SJ/IM)=LH

Lateral Foot

– Foot Shao Yang (GB) = LF

Anatomical CorrelationsYin = Medial

Anterior Medial Hand

– Hand Tai Yin (Lu) = AMH

Anterior Medial Foot

– Foot Tai Yin (Sp) = AMF

Posterior Medial Hand

– Hand Shao Yin (Ht) = PMH

Posterior Medial Foot

– Foot Shao Yin (Kd) = PMF

Medial Hand

– Hand Jue Yin (PC) = MH

Medial Foot

– Foot Jue Yin (LR) = MF

Anatomical Correlations

(Lu) = AMH

(Sp) = AMF (Ht) = PMH

(Kd) = PMF

(PC) = MH

(LR) = MF

(LI) = ALH

(St) = ALF (SI) = PLH

(UB) = PLF

(SJ/IM)=LH

(GB) = LF





Chinese Arteries

FrenchMeridians

ChineseVeins

FrenchMeridians

AMH 1 to 11 Vs LU 1 to 11 ALH 1 to 20 Vs LI 1 to 20

ALF 1 to 45 Vs ST 1 to 45 AMF 1 to 21 Vs PN/SP 1 to 21

PMH 1 to 9 Vs HT 1 to 9 PLH 1 to 19 Vs SI 1 to 19

PLF 1 to 67 Vs BL 1 to 67 PMF 1 to 27 Vs KD 1 to 27

MH 1 to 9 Vs PC 1 to 9 LH 1 to 23 Vs IM1 1 to 23

LF 1 to 44 Vs GB 1 to 44 MF 1 to 14 Vs 1 to 14

Chinese anatomical division nomenclature for neurovascular

nodes (acupoints) versus Soulié de Morant’s usage

1. Internal Membrane System (sānjiāo三焦)

Internal Membrane (IM) System(San Jiao and Pericardium)

Dissection realities

Fu organ concepts

San Jiao functions

Internal membrane physiological features

Longitudinal Importance ( 经

)

Ancient Chinese system of vesselorganization based onlongitudinal distributions

Arteries and Veins identifiedand related to anatomicallocations, internal organs,muscles, referred pain patterns,and cutaneous nervedistributions

Longitudinal View of Body

Chinese observed longitudinal organization andsegmental influence on body

Major blood vessels, muscles, nerves, andpropagated sensation distribute longitudinally upand down body

Organ referred pain, somatovisceral relationships,and neurovascular nodes (acupoints)somatotopically organized

Provides systematic means to stimulate body toprovoke restorative processes

Treatment Approaches

Needling follows simple guidelines

– L A P D Local somato-somato

Adjacent somato-somato

Proximal Segmental innervation

Distal Somato-somato and somatovisceral /

Proprioceptive / Lonigitudinal organization

Visceral

Relationships

Recognized in terms of organ referred pain reflecting

in certain body regions

Also produce organ traction as noted during surgery

Viscerovisceral relationships occur as well where

function or treatment stimulation of one organ

produces autonomic reflexes in another organ





Uniqueness of Organization J ī ngluò经络

The grouping oflongitudinal (up &

down) vessels withrelated nerves,muscles and skinregions enabledneedling therapy toeffect distant parts ofthe body.

(proprioceptivenervous system)

Chinese Vessel Circulation

Chinese medicine theorydescribes the organizationof the blood vessels.

Early practitioners

described the dividing ofvessels into finer branches

Innervation of smoothmuscle is controlled by theANS

Where there are nerves,

there are blood vessels tosupply them

Needling Therapy

Needling therapy effects

the body first – at thecapillary / cellular level

(Sun Mai)

Second – sensory nervesthat affect the CNS

Chinese Vessel Circulation

(J ī ngluò经络 )

Ji Mai [寄脈]– Singular Vessels

– Chong Mai – Thoroughfare – (Aorta)

– Ren Mai – Conception - (Vena Cava)

– Du Mai – Governing – (Azygos, hemiazygos, ascending lumbar)

Shu Mai – Communication; transporation

Jing Mai – Longitudinal distribution vessels

Luo Mai – Collateral vessels

Sun Mai – fine vessels (arterioles, cappillaries,venules)





Right

Heart

Left

HeartLungs

InternalOrgans

SunLuo

Shu

Jing

Du RenChong

Jing

JingJing

Sun

Shu

Shu

Shu

ARTERIESVEINSLuo

O2CO2

Blood Circulation Direction

Luo

Luo

To: Lower Extremities and Trunk

To: Head, Neck, Brain, Upper Extremities, and Trunk

Dao of Chinese Medicine, Donald Kendall

© Lotus Institute of Integrative Medicine. Shall not be copied, duplicated, or

distributed in any format or be used for teaching without prior written consent from Lotus Institute.

26272829

30

31

32

3334

35

1234

109

8

7

6

5

12

11

17

18 19

2021

22232425

36

37

38

39

40

13

14

15

16

4142

43

45

44

Facial a.

Anugular a.

Superficial temporal a.

External carotid a.

Brachiocephalictr unk

Internal thoracic a.

Superior and inferior epigastricaa.

External iliac a.

Aorta

Femoral a.

Lateral superior and inferior aa.

Anterior tibial a.

Dorsalispedisa.

Dorsal metatarsal a.

Dorsal digital aa.1, 2

1. Medial aspect of the third toe and lateral side of the secondtoe

Arcuate a.

2. Lateral and medial dorsal digital arteries of the first toe andmedial aspect of the second toe

Celiac trunk

Right

gastric a.

Splenica.

Subclaviana.

Common carotid a.

Zygomaticoorbital a.

Dorsal nasaa.

Superior and inferior labial aa.

Arteri es suppli ngteeth are not shown

Left

gastric a.

Underlying Arteries that Supplythe Stomach Nodal Pathway andInternal Regions

Foot Yang-Ming Vessel (Stomach)

[Anterior Lateral Foot Vessel (ALF)]



Upper

Extremities

Head, Face,

Neck and Brain

Right

HeartLungs

Left

Heart

Liver

Stomach,

Spleen,

Pancreas,

Small Int.,

Large Int.

Kidney

Lower

Extremities

Urinary

Bladder

Gallbladder

P e r i p h e r a l V e i n s o f T r u n k

Hepatic v.

P o r t a l V e i n

R e n M a i - V e n a C a v a

External Iliac v.

Femoral v.

Renal v.

C h o n g M a i - A o r t a

Gastric a.

Mesenteric aa.

Inferior

Superior

Splenic a.

Celiac Trunk

P e r i p h e r a l A r t e r i e s o f T r u n k

Subclavian v. Subclavian a.

Common Carotid

and Vertebral aa.

Jugulars and

Vertebral v v.

Gastric v.

Mesenteric v v.

Inferior

Superior

Splenic v.

R. Coronary a. L. Coronary a.

Coronary Sinus

Coronary v v.

Pulm. aa.

External Iliac a.

Femoral a.

Renal a. D u M a i - A s c e n d i n g L u m b a r , A z y g o s & H e m i a z y g o s V e i n s

Pulm. v v.

Bronchial v v. Bronchial aa.

Hepatic a.

Cystic a.

Cystic v.

Vesical aa.Vesical v v.

Common Iliac a.Common Iliac v.

Internal Iliac a.Internal Iliac v.

Brachiocephalic v. Brachiocephalic a.

Dao of Chinese Medicine, Donald Kendall



Muscle distributions

© Dao of Chinese Medicine, Donald E. Kendall, Oxford University Press

FootYangming

Stomach

Anterior Lateral

Foot

足

陽

明


FootTaiyang

Urinary Bladder

Posterior Lateral

Foot

足

太

陽





©Daoo ChineseMedicine DonaldE Kendall OxordUniversi t Press

FootShaoyin

KidneyPosterior Medial

Foot

足少陰


FootShaoyang

Gallbladder

Mid Lateral

Foot

足

少

陽

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Multimedia images used in this presentation are obtained from various

internet sources. No infringement of copy right is intended in the usageof any multimedia images in this presentation. Any multimedia imagesused are purely for nonprofit, educational purposes by the Instructorand the Lotus Institute of Integrative Medicine. These multimediaimages used are not intended for commercial purposes nor for resale, tocomply with Fair Use Laws for multimedia usage from internet sources.

Pictures have been purposely removed from the handout

More info on the c lassic single herbs mentioned in thisseminar/webinar can be found in the Chinese Medical Herbology and Pharmacology

More info on the classic formulas can be found in the Chinese Herbal Formulas and Applications.

Collection formulas can be found in the Lotus Clinical Manual of Oriental Medicine

All the above texts are available through www.elotus.org

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Dkaraba Neijing Tcmwt Handout