Whatever Happened to Neijing?

There are MANY ways to study Chinese medicine. The practical desire to assure adequate training in China early in the Song (960-279) led to the standardization of the basic modern clinical doctrine. Many clinical differentiations had already been ‘worked out’ by that time, and they were organized into the familiar syndromes of the 藏府 (zàngfǔ). This process of standardization certainly accelerated with the advent of mechanical printing about a thousand years ago, which allowed relatively wide distribution of the vast textbooks of the Ming (1368-1644) and even simpler handbooks of the Qing (1644-1911). We now have SO MUCH information to learn, and students of Chinese medicine are generally expected to memorize many disparate ‘facts.’ There is little appreciation for clinical thinking to discern the dynamic responsive nature of an individual’s pathology, because there is so much emphasis on accurately classifying its manifestations.

While the most recent round of modernization during the second half of the 20th century stressed consistent and coherent theory, it did not completely eliminate the inherently heterogeneous nature of Chinese medical theory. We all learn differential diagnosis, according to the zàngfǔ, which has been standard for the past thousand years, yet many individuals continue to supplement that basic theory with other systems such as the ‘six stages’ of Shanghanlun. Indeed, throughout the history of Chinese medicine there have been MANY schools of thought that have accentuated various aspects of Chinese medical theory. While we have seen the effort to integrate ‘the best’ of many disparate historical ideas into the contemporary clinical doctrine (‘TCM’), that process has neither completely integrated those historical ideas nor always preserved them with perfect fidelity.

The process of modernization and standardization began MANY centuries before Chinese medicine was imported to the West, so a very large portion of ‘historical texts’ implement that program. Certainly, these included the The Best of Acupuncture and Moxibustion, by Gao Wu (1523) The Great Accomplishments of Acupuncture and Moxibustion, by Yang Jizhou (1601), many other texts of the Ming and Qing Dynasties (1368-1911), and the more recent Chinese Acupuncture, by George Soulie de Morant (translated into English by Grinnell, et. al.). Many scholarly practitioners dive into this nearly limitless sea of information, seeking specific options for treating patients who have not responded well to their initial treatments. While this is laudable research, as many historical texts provide more detailed information than the standard texts of “TCM,” these texts do not substantially broaden the modern doctrine’s clinical theory. Emphasis on information, including specific differentiations and treatment strategies, brings most focus to clearly discerning the expression of distress, rather than the complex process of ‘sorting out’ the individual’s dynamic process.

In response to being overwhelmed by information, many acupuncturists choose to learn ’empirical’ systems of evaluation and treatment, ranging from a wide variety of Japanese approaches to the lineage of Master Tung. While learning the craft of acupuncture can certainly make one a more effective practitioner, these teachings generally work around TCM acupuncture, rather than helping one understand how to resolve the contemporary doctrine’s shortcomings. Virtually all of the empirical teachings highlighted by various teachers have their theoretical foundations in Neijing, though this broader theory is not clearly elucidated — neither in the texts of the classics themselves, nor by the teachers. Empirical schools are generally much more about ‘how to do it,’ rather than ‘how to think about it.’

All students and practitioners of acupuncture and Chinese herbal medicine learn these are ancient arts/sciences, based on a pair of fundamental classic texts — Suwen (Simple Questions) and Lingshu (The Spiritual Pivot), which together are called Neijing (The Inner Classic [of Medicine]). This invocation is repeated so often; it has become a mantra and an article of faith. Often, it is one of the main reasons people — both within and outside the profession — are inclined to believe in our work. And, it is only partially true!

So, what is true about the relationship between modern TCM and Neijing? Well, most of the basic theory of contemporary Chinese medicine can be found in specific chapters of Neijing. For instance:

  • Many of the Five Phase associations we all learn are delineated in Suwen, chapter 5
  • Much of the basic theory of zàngfǔ (sometimes translated as “viscera and bowels”) comes from Suwen, chapter 8
  • The idea that we can treat a primary channel to effect the zàng or  for which it is named is implied by from Lingshu, chapter 2

Isn’t that enough? The ‘TCM’ we learn in acupuncture school comes from Neijing. Well…it’s not that simple. Each of the two texts of Neijing consists of eighty-one (81) chapters, and almost all of them are relatively short snippets of dialogue between the Yellow Emperor and one of his advisers (medicine teachers). Each of these short dialogues centers around a few themes; the entire texts of Suwen and Lingshu are each like tapestries of these dialogues. Each text exhibits MANY themes, and their information is NOT logically consistent. Indeed, they are both are riddled with discrepancies and apparent contradictions, and that creates their beauty and depth.

Suwen and Lingshu are NOT textbooks or handbooks!

The classic texts of Neijing are filled with a wide variety of thought provoking conundrums. They are designed to stimulate inquiry — into the nature of life in general, and the subtle dynamics of each individual’s struggles with it. They focus a reader’s attention on many aspects of life,  some being rather obvious, and they lead to some startling conclusions, especially for people trained in the modern clinical doctrine of Chinese medicine. The suggest a profound transformation in our perception of life, including a framework for understanding the nature of transformational healing for people with chronic degenerative diseases.

How does one resolve the apparent contradictions and mysteries in the texts? Working with patients allows practitioners to delve into the subtle and responsive dynamics of the individually embodied spirit. Contemplation on one’s experience as a practitioner is the ultimate teacher, as it informs one’s ability to probe the depths of the text.

Why were the classics written in conundrums? Seems like a great topic for another blog posting

 

Working with Sabine to Decipher Neijing

Classical Chinese is a difficult language, and I’ve been lucky enough to find the perfect person to help me undertake direct study of Neijing (The Inner Classic [of Medicine]) with all its beauty and challenges in classical Chinese. I wrote a little about Sabine and her background in a previous posting, but that brief review focused primarily on her external qualifications. Far more important than her literacy in classical Chinese, and even the specific usages of classical medical writings, Sabine has been willing to support me in finding my own reading of the text. While her reading of chapters of Neijing is informed by her long term work with classical Chinese medical writings, she is not a practitioner. While she shares the benefits of her  ‘literary’ reading, she does not impose it onto my process. Instead, Sabine challenges me to clarify my reading as a practitioner.

When I started working with Sabine last summer, I was nearly illiterate. Oh, I had been using a wonderful software Chinese dictionary for well more than a year, including to re-translate about eighty pages of excerpts from Neijing that Ed Neal had given as handouts for his series on “Neijing Acupuncture.” Although I had reworked his translations to correct many mistakes and misconceptions, and had grown familiar with a much larger vocabulary of Chinese characters, my knowledge of classical grammar remained rudimentary. None the less, that early work with the Chinese text convinced me to focus on translating whole chapters of Neijing, which allows any statements drawn from the classic to be understood in context. Almost ANY idea, including some very bizarre ones, can be supported by pulling specific lines out of context. It’s a bad idea, and fraught with dangers! I will only do so AFTER translating the entire chapter, which at this point includes going over it with Sabine (at least for me). Sometimes, scholarly discourse requires discussion of specific passages, such as comparing and contrasting different readings of a passage, as I’ve done below with Paul Unschuld’s translation of a short passage. However, I believe study of the text should focus on entire chapters, and consider the placement and role of each chapter within the text as a whole.

Most chapters of both Suwen (Simple Questions) and Lingshu (The Spiritual Axis) are snippets of dialogue, generally between the legendary Yellow Emperor and one (or in a few instances more) of his advisers. Context is everything! Yet, translating and studying whole chapters requires much more focus and intention than pulling out short excerpts to translate, and then using them as the basis for study. Working with entire chapters seemed to me the only responsible course, so while taking a year long series of seminars from Elisabeth Rochat, I started with a couple dozen of them. Elisabeth graciously spent a whole afternoon with me near the end of that series, as a sort of classical Chinese ‘boot camp,’ which convinced me that I needed to learn A LOT more classical Chinese syntax and semantics in order to do a credible translation of Neijing. I bought a couple books at her suggestion, and that recognition also led me to Sabine (who also encouraged me to expand my library).

Many chapters of Neijing (especially Suwen) are VERY challenging, even for someone well trained in classical Chinese language. A couple months ago, Sabine wrote back to me with some exasperation after working for an entire day on one short chapter I’d sent to her; she declared that I must be interested in only the hardest chapters! Well, I admit I’m particularly interested in the myriad conundrums presented by the classic texts, though only one type exhibits language that is particularly difficult for Sabine.

The three types of ‘conundrum’ one faces in studying Neijing:

  1. the grammar and/or usage is very obscure or complex; these passages are easily misunderstood, even for readers with good classical Chinese language skills
  2. the language seems fairly clear, but its ‘literary’ meaning makes little or no sense; a practitioner must find meaning based in his or her experience and understanding of the medical theory
  3. the language seems straight-forward, but the ‘obvious’ interpretation (of a literate reader) is limited or even misleading

The first of these requires someone with A LOT of experience with classical Chinese. Sabine has led me through several of these, and gradually I’m learning some of the many ‘quirks’ found in the classical language of Neijing. However, I can’t simply hire Sabine or any other academic sinologist to translate these texts. No matter how open they may be toward Chinese medicine, the last two types of conundrum are far too common. A practitioner’s reading, when informed by classical Chinese literacy, is qualitatively different from an academic’s reading.

While Sabine is highly skilled in reading classical Chinese, she is also refreshingly humble about Chinese medicine. Unlike some other sinologists who concentrate on historical Chinese medical texts, she recognizes that literary reading of Neijing by itself is incomplete. When she comes across a passage she doesn’t understand clearly, she simply says so. On a few occasions she has said, “the language of this passage literally means…; you’re going to have to use your clinical experience to understand what it signifies.” One of these in Lingshu 1, which I had not gotten by myself, astounded me — it was so specific and clear. I’d not realized the classic’s discussion of the theory of wei qi was SO explicit. As soon as Sabine gave me a clear literal rendition, I recognized the meaning of the statement in my clinical understanding, but without that experience the statement had little meaning.

I’ve found the third type of ‘conundrum’ even more interesting, and have already found a couple dozen of them. They are particularly interesting because they provide a wonderful way to obscure profound Chinese medical theory ‘in plain sight’ in the text. That is, ideas discussed this way are available to those who already understand them to some extent — at least well enough to look for them effectively, but are glossed over by most readers. Wow! Can this be real? Why would the authors do such a thing? Well, the ancient Chinese had already discussed the issue of transmitting medical teachings, which highlighted the central role of experience rooted in direct study with a teacher, who understands how to apply the subtle complexities of the texts, as the foundation for understanding.

The Benefits of Illiteracy

So, how does this third type of conundrum obscure the deeper meanings within the texts? While each case is individual, most have a rather obvious literary reading for those who is literate, which also misses some important piece of Chinese medical theory. One good example, which occurs many times in Suwen, involves the expression 時之序 (shí zhī xù). This is a VERY common expression used in a wide range of Chinese writings, where it refers to the intrinsic ordering or rhythm () of the timing (shí) of the four seasons — the 四時. This is the ‘literary’ reading of this phrase, which is generally understood ONLY in the macrocosm. The potential meaning of this expression within the microcosm are particularly interesting to the practitioner, who is constantly focused on the nature of life process within individuals — the Dao in microcosm. We are studying, after all, the Neijing — the Inner Classic. Might one consider (even give priority to) other internal aspects of studying Neijing?

My work with the text is very different from that of a literate reader. I’ve been working with interpreting and applying ideas from the classic for twenty years, yet am only now learning the language well enough to study the text. My limited literacy has forced me to devote a couple hundred hours to each short chapter I’ve studied carefully, so I’ve grown very familiar with their language and content. I’ve begun to discern an ‘inner’ network among chapters, where one chapter comments on another, sometimes where a chapter in Lingshu expands on an idea first mentioned in Suwen.

While I ponder the meaning of any passage, I think about my understanding of the medicine as well as the language. While 時之序 (shí zhī xù) SOMETIMES refers to the usual ‘sequence of the seasons’ in the “Inner Classic” (Neijing), it frequently refers to the “the rhythm of the timing [of wei qi ].” This ‘alternate interpretation’ considers 時之序 (shí zhī xù) within the microcosm of an individual’s life, rather than the literary interpretation in the macrocosm. The text gives only subtle clues of this ‘inner’ interpretation, including a few lines later in the chapter of Suwen discussed below, but it does not clearly indicate when to choose between these two fundamental interpretations.

Perhaps the best clue that one should consider this ‘inner’ interpretation is that the usual ‘outer’ one doesn’t make much sense. One example can be found in Suwen 3, lines 2.1 and 2.2 (of my translation):

蒼天之氣清淨,則志意治,順之則陽氣固,
雖有賊邪,弗能害也,此因時之序。

Professor Unschuld’s translation (volume 1, p. 60-1; his rendering devotes a new line at each comma, and places the first comma after 氣 rather than two characters later as in the text above):

The qi of the hoary heaven,
it is clear and pure, and as a result the mind is in order.
If one lives in accordance with it, then the yang qi is strong.
Even if there is a robber wind,
it cannot bring any harm.
This [is so because one] follows the sequence of the seasons.

My translation:

When the qì of deep dark Heaven is clear and clean, then the purposeful intent governs [well]; when one aligns with it, then yáng qì consolidates.
Although one is exposed to the thieving wind, it cannot harm, due to the rhythm of the timing [of wèiqì].

While this short passage demonstrates a few divergences in our translations, I’ll focus here on the meaning (in context) of the last three characters “時之序.” While Professor Unschuld and I render the first line somewhat differently, we agree that is describes the conditions that make a person’s yáng qì consolidated or strong (則陽氣固). Then, he renders the text to claim that when there is a robber wind, that is doesn’t harm such a person because he or she follows the sequence of the seasons. Really? That’s utter nonsense! There is no reason to switch scale in this passage from the microcosm to the macrocosm, and that change suggested by the ‘literary reading’ of this phrase simply introduces confusion and makes the classic appear incoherent. This is clearly an instance where 時之序 (shí zhī xù) should be interpreted within the microcosm of individual life as the “rhythm of the timing [of wèiqì].”

[Note: My translation of this short passage differs from Professor Unschuld’s in several other ways. One concerns the meaning and significance of 志意 (zhìyì). My translation of Lingshu 47 discusses the meaning 志意 (zhìyì), which I translated here as “purposeful intent,” with 魂魄 (hún-pò) and 精神 (jīngshén). These are the three complexes of 神 (shén-spirits) that animate the Three Qi.]

While Unschuld is a famous sinologist with unquestioned literacy in classical Chinese, he failed to recognize this ‘inner’ interpretation, and consequently his rendition of this passage is quite limited. By making the classic appear only oriented to the environment, rather than discussing the individual’s responsiveness to the environment, he missed important theory and a deeper stream of meaning. Alas, I’ve found too many such misunderstandings among the chapters of Suwen I’ve studied carefully, and I have A LOT more work to do with both that text and Lingshu. Collected together, professor Unschuld’s interpretations produce a literary translation that misses much of the incisive power of Neijing. While he and his team have done Herculean work in producing his two volume translation of Suwen, many of the historical comments he included were written by editors who were not primarily practitioners. Thus, their comments were limited to their own ‘literary reading,’ which didn’t substantially challenge or deepen the translator’s own reading.

On the first page of his Prolegomena, Professor Unschuld noted, “this translation was not prepared primarily with an eye on the contemporary clinical applicability of its physiological and pathological views, as well as the text’s therapeutic advice, provided by the authors of the Suwen…” Well, he got that right! Unfortunately, Professor Unschuld’s translation conveys his misconceptions concerning the content and meaning of the classic, misses its deeper logic, and consequently leaves the reader little opportunity to find its clinical value. Of course, that doesn’t matter to him. I understand Professor Unschuld considers the very concept, that we may diligently study today to practice ‘classical Chinese medicine,’ absurd. Might his translations not be our best possible resource for the Chinese medicine classics, especially when we are seeking clinical insight and inspiration?

Professor Unschuld also noted in his Prolegomena that Neijing is heterogeneous, while Nanjing is homogeneous. I agree completely, though he misinterprets the significance of that perception. He considers the tangled collection of contrary information in Neijing a sign it was still immature and confused, and that the later Nanjing clarifies Chinese medical theory and makes in coherent. On the other hand, I consider Neijing a complex tapestry of ideas and perspectives, which weave together into a profound investigation of life in health and disease. It is far more subtle and complex than the author(s) of the received version of Nanjing recognized. Unschuld believes Nanjing completes the evolution of Chinese medicine as a ‘medicine of correspondences;’ instead, perhaps it merely simplifies Neijing into a medicine of correspondences. He assumes the ‘progress of history’ brought clarification; I understand Neijing is much more subtle and profound than Nanjing, which exhibits only one approach in conceptualizing classical Chinese medicine.

While Nanjing presents one relatively accessible conceptual model for understanding and practicing Chinese medicine, doctors throughout history have returned to Neijing, for its ‘heterogeneous’ theory, when seeking clinical inspiration. In many circles of Chinese medical practice in the contemporary world, there is an emphasis on detailed discussions of theory and practice from the (relatively) modern Qing and Ming Dynasties (1368-1911). While those authors provide some detailed guidance, they lack the breadth and depth of insight available through studying Neijing.

The pervasive influence of Unschuld’s misunderstandings on the professional practice of Chinese medicine arise from our weakness, rather than his mistaken assertions, no matter how egregious. Can’t someone produce a careful translation of the Neijing based in practical understanding of the practice of Chinese medicine? [Everyone takes three steps backwards.] While academics scoff at Wu Jing-nuan’s translation of Lingshu, I used it for many years, and now that I’m working on chapters myself find that it portrays the meaning and import of the text with more fidelity than Unschuld’s translation of Suwen, which was produced according to his academic ‘rigorous philological principles.’ Yet, Wu’s work certainly lacks notes to help the reader explore the text’s textured meanings, he inserts some of his own interpretations into his translation, and it misses some subtle points; so, his work needs careful updating.

Maoshing Ni’s rendition of Suwen was published nearly twenty years ago. It seamlessly includes his interpretations and clarifications of the often challenging text. While it has made the classic much more accessible to an entire generation of practitioners and students, it has done so only through his interpretations, which were not clearly differentiated from the text itself. This is light reading.

The Yellow Emperor’s Canon of Internal Medicine, translated by Wu Liansheng and Wu Qi, benefits through including the Chinese text with the English translation. However, their English is poor, which severely limits their ability to convey the subtle meanings woven into the text. They insert their own interpretations fairly liberally, which limits the value of their translation, even if one wishes to weed through their obvious problems with English.

I look around, and it seems everyone has withdrawn from my imploring request for a ‘clean’ translation of Neijing that arises from a practitioner’s sensibilities, which thereby can convey the beauty and power of classical Chinese medical thinking. I seem to be standing by myself. Uhm…Oh my! I seem to have volunteered. Oops! How did that happen? What the…

Well, working with Sabine is a great help! I couldn’t do this without her support. She is stringent with me and insists on clarity and accuracy, yet she also supports my efforts to find wisdom for myself in the texts of Neijing, based in my experience and/or lineage training. As I struggle to understand the text’s syntax and semantics, I’m contemplating my nearly twenty years experience working with my lineage’s interpretations, and several years teaching the content and dynamic thinking process of our approach. Sometimes, I believe a certain passage in Neijing has multiple readings, where one is the ‘literary’ (or obvious) reading, and others share deeper ‘coded’ ideas or theory. I consider these ‘alternate’ readings little messages to the initiated — those who  understand medicine well enough to find and understand them. I’m discussing the ‘messages’ I find in my commentaries for the chapters I’m translating. It’s a BIG project.

Stay tuned for more news concerning my work on “An Acupuncturist’s Neijing.”

I’m already working on a posting focused on another ‘type 3 conundrum’ from the opening lines of Lingshu 52. The literary reading of that one is SO obvious it even ‘took me in’ for almost two weeks early last month. Shocking! Well, I hope I don’t grow too literate.

When is a “Cold” not Just a Cold?

Ms. C. is a thirty-seven year old woman, who called me about four months ago seeking relief from persistent pain and dysfunction of her right hand, which made her work difficult. She came for an appointment, and reported having received treatment for neck pain and nerve root impingement causing pain and dysfunction of the arm (radiculopathy). Her neck and arm symptoms had improved after three months of physical therapy and chiropractic treatments, yet her hand stiffness and pain remained. Ms. C. worked as an R.N., and said that she considered her hand symptoms residual from her neck ailment because they had started at the same time.

I examined Ms. C’s hand and neck, and inquired about other pains. I learned that she had knee and hip pain — especially on the left, which had grown rather severe during the past several months. I read her pulses and palpated some points. I looked up at her from where I sat at her feet, and told her that I didn’t think her current hand pain came from her recent history of neck pain. My diagnostic efforts led me to suspect arthritis of inflammatory cause, such as rheumatoid arthritis. Ms. C. finally allowed that her physician had done a special blood test (rheumatoid factor) that showed a mild positive. Was this a test?

The tests practitioners get from the Dao are much larger than any we may get from people!

What were her embodied spirit’s blocks that had allowed the accumulation of pathogenic factors, which had eventually emerged in this condition? Practitioners of classical Chinese medicine ask this question of the Dao as it works within the microcosm of an individual’s physiology, and probe the embodied spirit to stimulate transformation. After more examination, I discerned accumulation in the yangming zone channel divergence, and devised an acupuncture treatment to address that blockage.

Two weeks later Ms. C. returned for a follow-up session, and reported only mild “nuisance” pain in her right hand. Indeed, she noted that all of her joint pains were much improved. I questioned her more carefully, and learned that she’d had what she considered a “bad flu” a couple days after her first treatment. She noted, “It was strange because my joints didn’t hurt at all when I was sick.”

Strange, indeed. Ms. C. received a total of five treatments during a period of slightly more than two months. Each treatment was conceived to probe and stimulate her embodied spirit to address a slightly different aspect of her physiological blocks, and I suggested she make some changes in her relationship with food based on my evaluation. To her credit, Ms. C. recognized the exacerbating influence of certain foods after I pointed out what to look out for, and she made the necessary changes. By the time of her last treatment nearly two months ago, Ms. C. felt no pain.

We discussed her indicator symptoms, how they could help her maintain this degree of wellness, and she discontinued coming for acupuncture treatments. Easy as I’ve grown with the familiarity of such results, even I found the following synchronicity a little surprising:

The day after I started writing this posting, and completely out of the blue other than my  curiosity about how she was doing, Ms. C. called me to report on her good fortune. She reported being completely pain-free without taking any anti-inflammatory medicines or pain relievers. She even rejoiced in being able to run around playing soccer with her children. We briefly discussed her indicator symptoms, and she reported have no difficulty maintaining the lifestyle (dietary) changes she had made while she was receiving treatments.

Passive Health Care Breeds Dependence

Passive care is ANY form of health care where the patient is a passive consumer of a good or service. That might be a pharmaceutical medicine, surgery, joint or other physical manipulation, dietary supplement, or any other consumption-based attempt to improve your health. Let me be very clear: I don’t consider this a problem with any particular therapy, but a failure in how many use the technologies that humankind has developed.

Modern clinical theory teaches acupuncturists to practice according to the passive care model. It match the commonly held standards of modern medicine, and treat their patients to manage the intensity of symptoms. While this allows patients to maintain their diseases without having to expose themselves to the potentially toxic “side-effects” of pharmaceuticals, it’s not the highest use of acupuncture. That’s why many acupuncturists seek other training — to increase the long-term value of their work.

Within the current health care arena, many patients comply with the passive care agenda, and grow dependent on their therapies. However, when you buy into that:

You’re not a Patient, You’re an Annuity!

While passive care (regardless of the specific modality) is a great economic model for the people and especially the corporations that provide it, it has much less value for patients. Passive health care reinforces the idea that the patient’s body is “broken” and needs to be fixed. Yet, the human body is made to heal! That is its NATURAL tendency. When the embodied spirit fails to restore health, we can conclude that SOMETHING is blocking its natural and intrinsic movement.

When used incisively, acupuncture and Chinese herbal medicine stimulate the embodied spirit to release its blocks to facilitate healing. When an individual’s entire being is focused on the healing process, when both the personality’s conscious choices and the embodied spirit’s automatic function are aligned, the possibilities are limitless. We’ve all heard of people that have healed themselves of cancer; those aren’t random events, but the natural result of the embodied spirit unblocking its natural potential.

Take the initiative; find ways to heal your life. Don’t just be a passive consumer of health care!