Of MfDI(INt (HIN£~f UNOfRHANOIN~ AN ANCifNl HfAliN~ ARl Dr. Donald (Deke) Kendall first became involved with Chinese medicine after graduating from the University of Illinois with a degree in engineering, when he adopted the use of Chinese herbs as his primary health care strategy. This led to the study of physiology and Chinese medicine, culminating in a degree from the California Acupuncture College as Doctor of Oriental Medicine (O.M.D.) He has since fully incorporated the principles and practices of this ancient healing art into his life. He is now considered one of America's leading experts on Chinese medicine, with more than twenty years of private clinical experience, including acupuncture research at the UCLA dental school and as a staff member at the UCLA's Center for East-West Medicine. Dr. Kendall has also served on the boards of several state and national professional organizations for acupuncture and Oriental medicine. He has developed and taught acupuncture orthopedics and dental acupuncture certification courses, and has participated in veterinary medical acupuncture training programs. He lectures extensively around the United States, as well as internationally, and has published a number of articles on various aspects of Chinese medicine, with an emphasis on how acupuncture works. This book represents a large part of his experience, expertise, and enthusiasm. Jacket design by Lea & Ink Design £. DON~LD l(fND~L L / Of MfDI(INf (HINf~f UNDfR~l~NDING ~N ~NCifNl Hf~liNG ~Rl OXFORD UNIVERSITY PRESS OXFORD UNIVERSITY PRESS Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide in Oxford New York Auckland Bangkok Buenos Aires Cape Town Chennai Dares Salaam Delhi Hong Kong Istanbul Karachi Kolkata Kuala Lumpur Madrid Melbourne Mexico City Mumbai Nairobi Sao Paulo Shanghai Singapore Taipei Tokyo Toronto and an associated company in Berlin Oxford is a registered trade mark of Oxford University Press Published in the United States by Oxford University Press Inc., New York ©Oxford University Press 2002 First published 2002 This impression (lowest digit) 1 3 5 7 9 10 8 6 4 2 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford Uniyersity Press, or as expressly permitted by Law, or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address below You must not circulate this book in any other binding or cover and you must impose the same condition on any acquirer British Library Cataloguing in Publication Data available Library of Congress Cataloging-in-Publication Data available ISBN 0-19-592104-6 Printed in Hong Kong Published by Oxford University Press (China) Ltd 18th Floor, Warwick House East, Taikoo Place, 979 King's Road, Quarry Bay Hong Kong Dedicated to the ancient Chinese physicians, and subsequent practitioners, whose genius gave the world the great treasure of Chinese medicine. Contents Preface xi 1 In Search of the Dao 1 Early Western Exposure Authenticity of Chinese Medicine Toward Understanding 2 Ancient Beginnings 16 Out of the Stone Age Emergence of the Zhou Dynasty Early Medical Concepts Medicine as a Rational System Celebrated Texts 3 Early Understanding of Physiology 30 Postmortem Studies Skeletal and Body Measurements Function and Classification of Internal Organs Anatomical Information on Internal Organs Physiological Relationships Nerves in Ancient Times 4 Qualities of Opposition 56 Classification of All Things Anatomical Notation in the Yin-Yang System View of Internal Organs Dynamic Interplay between Yin and Yang 5 Need for Medicine 73 Cause and Treatment of Disease Development of Therapeutic Approaches Medicines for Internal and External Use Needling Therapy (Acupuncture) Heating Therapy Physical Medicine Prevention and Rehabilitation 6 Interaction of Sky and Earth 89 Dynamic Forces of Evolution Interaction of Earth Phases Products of the Soil Flavors in Health and Disease Herbal and Dietary Therapies viii CONTENTS 7 Spirit, Vitality, and Emotions 111 Role and Meaning of Spirit Origin of the Spirit Organ Vitalities and Emotions Organ Vitalities and Endocrine Glands 8 Basic Substances and Metabolism 128 Vital Substances Body Fluids Role and Function of Blood Key Metabolic Features Overall Metabolic-Processes 9 Vessels and Collaterals 144 Vessel Organization Singular Distribution Vessels: jimai Communication Vessels: Shumai Main Distribution Vessels: jingmai Collateral Vessels: Luomai Fine Vessels: Sunmai 10 Blood Circulation 167 Role of the Heart in Circulation Nutrient Circulation Cycles Circulation of Defensive Substances 11 Distribution Vessels and Nodal Pathways 182 Anterior Vessel and Nodal Pathways Vessels of Anterior Medial Hand: Lungs Vessels of Anterior Lateral Hand: Large Intestine Vessels of Anterior Lateral Foot: Stomach Vessels of Anterior Medial Foot: Spleen Posterior Vessel and Nodal Pathways Vessels of Posterior Medial Hand: Heart Vessels of Posterior Lateral Hand: Small Intestine Vessels of Posterior Lateral Foot: Bladder Vessels of Posterior Medial Foot: Kidneys Medial and Lateral Vessel and Nodal Pathways Vessels of Medial Hand: Pericardium Vessels of Lateral Hand: Internal Membrane Vessels of Lateral Foot: Gallbladder Vessels of Medial Foot: Liver Deep Singular Vessel Nodal Pathways CONTENTS ix 12 Muscle Distributions 214 Features of the Muscular System Longitudinal Distribution of Muscles Muscles of Posterior Lateral Foot: Bladder Muscles of Lateral Foot: Gallbladder Muscles of Anterior Lateral Foot: Stomach Muscles of Anterior Medial Foot: Spleen Muscles of Posterior Medial Foot: Kidneys Muscles of Medial Foot: Liver Muscles of Posterior Lateral Hand: Small Intestine Muscles of Lateral Hand: Internal Membrane Muscles of Anterior Lateral Hand: Large Intestine Muscles of Anterior Medial Hand: Lungs Muscles of Medial Hand: Pericardium Muscles of Posterior Medial Hand: Heart 13 View of Health and Disease 239 Physiological Balance and Homeostasis External and Internal Assault Environmental Pathogenic Routes Manifestations of Disease Clinical Presentation Differentiation of Syndromes 14 Mechanisms of Action 256 Tissue Response to Needling Nociceptive Activation Propriospinal Participation Somatovisceral Relationships Controlling Pathways 15 Treatment Approaches 286 Principles of Treatment Prima1y and Seconda1y Manifestations Therapeutic Methods Needling Therapy Use of Critical Nodes in Treatment Strategies Frequency and Number of Treatments Standards of Practice Notes 309 List of Tables 313 References 317 Index 336 Index to Neijing Citations 351 xii PREFACE Western interest in Chinese medicine and acupuncture has increased steadily since the 1960s and 1970s; some countries now license practitioners specifically trained in this medical art. In the year 2001, while some areas of the United States do not yet permit its practice except by conventionally trained medical doctors- most states do allow independent practitioners. A great debate has ensued over the past decade in the United States whether Chinese medicine, or at least acupuncture, needs to be recognized as a valid medical procedure. In 1997, some 175 years after acupuncture was first introduced in America, the NIH issued a Consensus Statement (No. 107; 1997 Nov 3-5; 15 (5): 1-34), which recognizes acupuncture as a useful therapeutic intervention for a wide range of conditions. However, it also notes that there are many inconsistencies in the research design of acupuncture studies, revealing the major problem that has plagued Chinese medicine since its inception in the West four hundred to five hundred years ago. Incomplete source material and poor translations have muddled the st01y of Chinese medicine since it was first introduced in the West. Accurately translating Chinese into Western languages, including Latin, was and still is a challenge because the context of spoken and written Chinese, especially that of the ancient written form, is often misunderstood. Chinese is more context-sensitive than most other languages. For this reason many early and present translations are flawed. If the reader understands the context of the sentence, paragraph, or chapter, or understands the context of the subject presented-even though an abbreviated form or a substitution for the Chinese term in question may be used subsequent to its first full reference-the true meaning can be discerned. The critical point is to understand in what context the key terms are used; without this, there is little chance of translating Chinese correctly or consistently. Jesuit missionaries in the fifteenth century were the first to bring Chinese medicine, including acupuncture, to Europe. The first text on the subject was written in Italy in the 1500s, based on information gathered from people who had traveled to the Orient. The earliest first-hand Western account of Chinese medicine was provided by the Dutch physician Willem ten Rhijne in 1683, based on his two-year stay in Japan. He reported that the Chinese emphasized the circulation of blood and vital air (qi, 9:) through the vascular system, and that Chinese physiology involved blood vessels and netves. Ten Rhijne interpreted the Chinese concept of environmental or pathogenic factors (xie, $) that affect the internal body as "airs" penetrating the body. From this he incorrectly concluded that Chinese medicine was essentially the same as the empirical ancient Greek concepts of Hippocrates and Galen that were held in disrepute c.luring his time. Equating Chinese medicine with the outdated Greek ideas persisted in the West until the 1930s. Then in the 1930s and 1940s the Chinese character for air (qi), or vital air, was inaccurately interpreted as "energy," while the Chinese vascular system was replaced with "meridians." These interpretations led to a whole new concept of Chinese medicine. These fundamental errors have been responsible for much misdirection in trying to understand the reality of Chinese medicine, and in the setting of design research protocol to verify its basic theories. After the energy-meridian idea was popularized, ten Rhijne's report about the involvement of nerves and blood vessels in Chinese physiology was considered erroneous, and little thought was given to the physiological basis of Chinese medicine. The great discoveries of the ancient Chinese physicians, including blood circulation, organization of the cardiovascular system, somatovisceral relationships (communication between the external body and the internal organs), internal organ systems, immune system function, and the organization of the musculoskeletal system, were obscured. Once modern research was applied to understanding