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Exploring The Triple Burner (San Jiao) by Bob Damone, M.S., L.Ac. A confusing aspect of the Chinese medical concept of the “triple burner” is that it has different meanings depending on the context in which it appears. For example, it may be used to refer to the sixth bowel (fu), but it may also be used for: (1) denoting the location of a disease or an evil in the body; (2) referring to the channel connected to the triple burner as the sixth bowel, and (3) diagnosing diseases and determining their treatments. Therefore, when discussing the triple burner, it is best to first clarify which of these contexts is most relevant. In this essay, I will briefly approach the triple burner purely as the sixth bowel and will most specifically explore the question of whether or not it possesses its own individual morphological structure. The question of whether the triple burner has its own distinct morphology has been one of the most actively debated issues in the history of Chinese medicine. Much of this debate can be traced to the 25th and the 38th chapters of the Nan4 Jing1 (“Classic of Difficult Issues,” 1st century C.E.) which state that the triple burner has “a name, [but] no form.” This assertion represents a deviation from statements about the triple burner found in the Nei4 Jing1 (“Inner Canon,” 1st century C.E.), which endow the triple burner with its own individual morphological structure like that possessed by other viscera and bowels. That the Nan4 Jing1 authors should deny the triple burner its own physical form is particularly interesting in light of the fact that they meticulously recorded the weights and measurements of each of the other viscera and bowels which they apparently obtained through human dissection. This question of whether the triple burner has “form,” initiated in the Nan4 Jing1, has since attracted the attention of many famous Chinese physicians and scholars throughout history. The extant body of Chinese medical literature reveals these debates in which Chinese medical scholars and doctors wrestle with their perceptions of the triple burner. There are many examples of statements from pre-modern Chinese medical texts which argue that the triple burner has its own morphological structure. For example, Yu2 Tuan2, in Yi1 Xue2 Zheng4 Zhuan4 (“The Orthodox Tradition of Medicine,” 1515 C.E.), said: “Regarding [the] triple burner as [occupying] a body cavity, it is the commander contained within the stomach and intestines. [That which is] above the huang membrane (huang1 mo2) within the chest is called the upper burner. [That which is] below the huang membrane but above the umbilicus is called the middle burner. [That which is] below the umbilicus is called the lower burner; collectively, they are called the triple burner.” Zhang1 Huang2 Zai4 wrote: “The triple burner has a covering like that of the bladder which enables it to store and connect [to other viscera and bowels]. If it did not have form, how could it store and connect [to other viscera and bowels?]” He also quite remarkably stated: “Below the right kidney there is a fatty membrane [that looks] like a large hand, directly opposite to the bladder. There are two white vessels that come out of it in the direction of the spine and [extend] upward to connect with the brain. This means that what Daoist breathing adepts say about this connection to the spine has a double meaning; they were not aware that this fatty membrane [that looks] like a large hand is indeed the triple burner.” Zhang1 Jie4 Bin4, in the Lei4 Jing1 (“The Classified Canon,” 1604 C.E.) postulated that the triple burner is a cavity inside the body that covers or embraces all the other organs within one large bowel. He said, “Among all the twelve organs, only the triple burner is alone and large. [Since] it is not paired with any other organs, it is called the solitary bowel. It is a covering on the outside of all the other viscera and bowels; [it is] a cavity inside the body [and] covers all the other organs. [Therefore, it is like a] a large bowel.” Of course, there were also those who argued that the triple burner does not have its own morphological structure. As mentioned above, this idea was originally expressed in the 25th Difficulty of the Nan4 Jing1 which states: “The heart governor and the triple burner [constitute] an interior-exterior pair. Both have a name [but] no form.” Moreover, the 38th Difficulty states: “[The triple burner] governs all qi4; it has a name [but] no form. Its channel is ascribed to hand lesser yang2. It is an exterior bowel.” Later, in the Zhong1 Zang4 Jing1 (“Central Treasury Canon,” 2ndcentury C.E.), we find the following statement: “The triple burner, the three origins of humans’ qi4…has a name, [but] no form.” In the Tang2 Dynasty, Sun1 Si1 Miao3, in Qian1 Jin1 Yao4 Fang1 (“Thousand Gold Pieces Prescriptions”) states: “[The] triple burner [has] one name, [but] three gates. The upper burner is called ‘three managers of return and discharge’; the middle burner is called ‘sudden turmoil,’ and the lower burner is called ‘traveling chewed-up food.’ [In] combination, they are one. [The triple burner] has a name [but] lacks form. [It] governs the five viscera and the six bowels, and [makes] contact with the divine dao4. [It] links the whole body together [as one] system. It can be spoken of, but it cannot be seen.” In the Ming2 Dynasty, in Yi1 Xue2 Ru4 Men2, (“The Gateway to Medicine,” 1515 C.E.), Li3 Chan1 states: “[The] three burners are like a mist, foam, and a sluice [respectively]. Although [the triple burner] has a name, it has no form. It governs qi4 [i.e., breath], eating, and excretion [of stool and urine]. Although it has no form, it [does] perform [these various] functions.” In addition to those who advanced polarized views on the topic of the triple burner, there were also many who very reasonably attempted to blend both perspectives. Zhang1 Zhi4 Cong1, in 1670 C.E. said: “[The opinions asserting that the triple burner either] has form or does not have form are both biased [in their own way]; therefore, [one cannot] accept [all that is] heard [on the topic!]” In the Tang2 Dynasty, Liu2 Yu3-Xi1 said: “[In] Ancient [times], it was said that [the triple burner] has no form, perhaps [because] it has a changeable form.” Some other doctors felt that the triple burner “does not have its own autonomous individual form and body as the other five viscera do; therefore, one cannot be sure of its appearance.” In modern Chinese medical literature, when doctors attempt to relate the ancient concept of the triple burner to the modern Western medical body, they invariably begin pointing to anatomical structures which they believe to be closely related to it. In this context, it is common to find discussions which relate the triple burner to the lymphatic system, the nervous system, the pancreas, the omentum, and the spinal nerves. This approach seems to presuppose that the triple burner does have some “form,” or at least that it requires interaction with physical structures in order to function normally. In modern Chinese language textbooks on Chinese medical theory, most authors do not interpret the classical statement “the triple burner has no form” too literally. Rather, they more commonly frame the triple burner as a collective analogy for the functions of all the other viscera and bowels specifically in terms of the free passage of original qi4, water and grain, and fluids; as such, the triple burner functions by virtue of its interactions with known morphological structures within the body. In this view, the triple burner lacks its own distinct and dissectible anatomical “form” separate from all other viscera, bowels, and tissues, but functions only through the coordinated efforts of all the other viscera and bowels. It is interesting to explore some of these arguments because to expose ourselves to the broader perspectives they embody is to view Chinese medicine as a phenomenon that has always included and continues to allow for a reasonable measure of diversity. However, note that the flavor of these comments reveal that literate Chinese medical scholar-doctors do hold themselves accountable for mastering a formidable amount of classical literature as prerequisite to formulating their own opinions. While some in the West may find fault with this rather conservative approach to medical progress, it does serve to maintain a certain pedigree and authenticity in Chinese medicine by preventing immediate acceptance of novel assertions that lack historical precedent. The clinician in me knows that my main goal is to relieve my patient’s suffering and that I should be open to new ideas and perspectives which improve my ability to do so. I assert that the existing body of East Asian medical literature already holds a great deal of diverse perspectives that we in the West have yet to gain access to; from reading the quotes in this essay, I hope this is apparent at least in the context of the triple burner. Accessing this literature empowers us to wield the tools of our chosen art with greater skill and with a greater degree of solidarity with our predecessors. In terms of the triple burner, the more we understand its significance to different doctors at different periods in history, the more conceptual basis we have for creatively applying existing Chinese medical insight on the triple burner to productive use in the clinic.
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