Ripples in the Flow: Nan Jing Pulse Teachings

By Z’ev Rosenberg, LAc

This excerpt from Z’ev Rosenberg’s upcoming book, Ripples in the Flow: Nan Jing Pulse Teachings, concerns the diagnostic and clinical strategies unique to the Nan Jing/Classic of Difficult Issues, and explains the concept of the ten variations/十變 shi bian, in the movement of the vessels when feeling different sections of the wrist associated with the specific 臟/zang organs.

十難曰：一脈為十變者，何謂也？

然：五邪剛柔相逢之意也。假令心脈急甚者，肝邪干心也；心脈微急者，膽邪干小腸也；心脈大甚者，心邪自干心也；心脈微大者，小腸邪自干小腸也；心脈緩甚者，脾邪干心也；心脈微緩者，胃邪干小腸也；心脈濇甚者，肺邪干心也；心脈微濇者，大腸邪干小腸也；心脈沉甚者，腎邪干心也；心脈微沉者，膀胱邪干小腸也。五藏各有剛柔邪，故令一脈輒變為十也。

“One pulse may undergo ten variations. What does this mean? It refers to the five evils, the mutual interference of softness (evils) and hardness (evils). For example, if the heart pulse is very tense, liver evils have entered the heart. If the heart pulse is slightly tense, gallbladder evils have entered the small intestine. If the heart pulse is very strong, heart evils have entered the heart (itself). If the heart pulse is slightly strong, small intestine evils have entered the small intestine (itself). If the heart pulse is very relaxed, evils from the spleen have attacked the heart. If the heart pulse is slightly relaxed, then evils from the stomach have attacked the small intestine. If the heart pulse is very rough, then evils from the lung have attacked the heart. If the heart pulse is slightly rough, evils from the large intestine have attacked the small intestine. If the heart pulse is very deep, evils from the kidney have attacked the heart. If the heart pulse is slightly deep, evils from the bladder have attacked the small intestine. The five yin viscera and their associated bowels have their hard or soft evils, and each pulse may have ten variations.”[1]

The Role of Evil Qi in Acupuncture and Chinese Medicine

In describing 邪氣 xie qi/evil qi in the Su Wen, Paul Unschuld writes that ‘evil qi’ can be understood as any phenomena that has violated its ‘correct’ location in the realm of nature. Acupuncture treatment was designed in the Su Wen to ‘repair the walls before the thief enters’, in other words, harmonizing and strengthening the 衛氣 wei qi/defense qi and 營氣 ying qi/construction/nutritive qi, mentioned multiple times in the Su Wen and Ling Shu. The Su Wen also states that ‘where evil qi collects, the correct qi must be depleted’. In Su Wen 68, it says “where there is 應 ying/correspondence, then there is 顺 shun/compliance. If not so, there is 逆ni/opposition. Where there is opposition, then this gives rise to 化 hua/changes. Where there are changes, then there is 病 bing/disease.”[2] In context of the Nan Jing, this means that the harmonious progression of qi via five phase 生 sheng/nourishing cycles and 克 ke/controlling cycles maintains the equilibrium and health of the viscera and bowels.

Nan Jing Difficulty 10 describes 五邪 wu xie/five evils that can afflict the 臟腑 zang-fu /viscera/bowels if they ‘violate’ each other. The first is 正邪 zheng xie/correct evil, where a viscera or bowel falls ill by itself. The next is 虛邪 xu xie/vacuity evil, where the mother phase attacks the child phase, as if from ‘behind’. Next is a 實邪 shi xie/repletion evil, where the child phase attacks the mother, from ahead. Next is 微邪 wei xie/weakness evil, when the evil is transmitted backwards from the controlled phase (for example, the lungs/metal are controlled by the heart/fire) by the controlling cycle that skips phases. Finally, is a 賊邪 zei/destroyer (thief) evil, where the controlling phase transmits the disease to the controlled phase (the heart/fire transmits the disease to the lung/metal). All of these are describing interrelationships of internal processes, which can lead to pathologies if not corrected through five phase acupuncture strategies. Many of these can be caused by excesses of the associated emotions with each of the 五臟 wu zang/five viscera (anger with wood, joy with fire, pondering with earth, grief with metal, fear with water).

Advanced Techniques in Nan Jing Pulse Diagnosis

One of the most interesting aspects of Nan Jing pulse diagnosis is feeling five phase relationships within the positions in terms of specific qualities, and then applying this to the interrelationships described in Nan Jing Difficulty 10. In other words, we may be able to feel wiry qualities in the metal/太陰 tai yin position (right cun), associated with the 厥陰 jue yin/少陽 shao yang pulse position (left guan), or hair-like qualities in the wood/厥陰 jue yin position, normally associated with the right cun and 太陰 tai yin/lung. The specific pulse qualities discussed in Nan Jing difficulties fifteen and sixteen are here connected to specific disease patterns, seasons, and behavior. Qualities associated with specific 經脈 jing mai/channels/network vessels and 臟腑 zang-fu/viscera/bowels are now seen to be signs of disease when appearing in positions associated with other channels, viscera/bowels and their associated qualities. It is a form of ‘dislocation’ of qualities appearing outside of their normal positioning in the mind/body dynamic. This is congruent with the general tendency in Chinese medicine for qualities to belong to certain phases and stages, in a certain progression through time and space. When these changes happen in an orderly manner, health and equilibrium are maintained. When the normal cycles of visceral function are disturbed, disease results.

The Nan Jing is based on a dynamic model that is appropriate for the complex illnesses we now confront in clinical practice. The ability to perceive, diagnose and treat subtle changes in the equilibrium of the bodily systems with subtle stimuli from filiform needles, moxa wool, or herbal medicines is a cutting-edge dynamic applied to the human body and mind. The text provides several conceptual models for observing the flow of 變 bian/changes in the human systems dynamic, and treatment strategies to correct the loss of equilibrium with the self, time, and the environment.

In the Nan Jing, evils are not necessarily seen as contracted from the exterior, but also from within the viscera and bowels themselves, and transmitted via the five-phase cycle between each other. The root concept here is that any excessive influence from a viscera or bowel that ‘overflows’ its area of influence, or any depletion of a viscera or bowel (or its associated channel) is ‘邪 xie/evil’ in and of itself. If the balanced, normal functioning of the visceral systems is disturbed, it may lead to systematic disharmonies or disease. As within families, or social groups, compensatory behaviors are common, where weak individuals, overbearing strong people, or highly dysfunctional people all adapt behavioral strategies in order to maintain a seeming harmony. As Kato Bankei, a Japanese commentator on the Nan Jing states, each section of the pulse (inch, bar, cubit) may show that the qi of one channel, viscera or bowel may ‘invade’ or enter another position, causing disease.

Abnormal pulses may indicate that the qi of one phase may ‘escape’ and appear in another phase. This means that one finds the quality (wiry, relaxed, replete, vacuous, soft) associated with a phase in a position associated with another phase. For example, sometimes the middle position on the right wrist will be wiry, while it will be relaxed on the left wrist in the middle position. This means that liver qi has violated the spleen, and has ‘vacated’ its normal position. If the left hand middle position is vacuous or soft, this is often a sign of liver disease. The practitioner needs to apply five-phase theory using the 五輸穴 wu shu xue/five transporting points, along with seasonal considerations, to ‘recover’ the qi and bring it back to its original position. This situation may also be affected by 時氣 shi qi/seasonal qi. In other words, liver qi tends to be more replete in the spring time, so a wiry pulse in summer time in the heart position means that evil qi from the liver has attacked the heart.

This chapter explains some of the sophisticated diagnostic and clinical strategies that are unique to the Nan Jing as THE classic of five phase acupuncture, based on a pulse system that is clearly explained and defined in the process. In further chapters, we will describe further dimensions that are available in Nan Jing pulse diagnosis as the foundation for treatment.