Recently I found myself “eavesdropping” on an online conversation between two professors at NCNM, namely Roger Batchelor and Ed Neal, on the subject of the Pericardium in the Classics. What came out of it was more than a little enlightening and inspired me to talk about the Pericardium a bit this week.
The essential point of the discussion was as follows: what we call Pericardium in the modern Chinese medicine disciplines is referred to as (quoting Ed’s translation here) “Mai vessel of the heart encircling luo vessel (network), following the hand (upper) Jue Yin six confirmation terrain, relating to the function whose (domain of responsibility) is the heart.” Usually this is shortened to Xin Bao, or Heart Wrapper or Heart Encirclement. Usually this is assumed to equal the Western anatomical structure of the pericardium, the membrane that protects the heart. However, what Roger and Ed pointed out is that in it’s discussion of the function of the Xin Bao, which is always the important thing to the Classical Chinese mind, it has almost nothing to do with the pericardium whatsoever and instead equates much more closely to the coronary artery network. This, to my mind, answers a boatload of questions about what the Hand Jueyin (and the not-particularly-easy-to-understand Jueyin as a whole) actually does.
First, for our TCM readers, let me clarify a misconception that seems to be prevalent: contrary to what we learn in school, Jueyin does not refer to a seldom seen and horrifying state where the patient is vomiting roundworms (something that the average Westerner can’t fathom) and occurring just before spectacular death. Rather, Jueyin, which deals with-amongst other things-the Heart and Pericardium organs, is the “closure” of Yin, the function that causes Yin to shrink and decrease so that it may change properly into Yang. The Liver stores the Blood and supplies said Blood throughout the body. The Heart moves the Blood, but how does the Blood get there? Via the Jueyin network. The Liver feeds blood to the Heart via the Pericardium/Xin Bao. How much more sense does this process make if the Xin Bao is really the coronary artery network?
Also notice that the representative true Jueyin formula, Dang Gui Si Ni Tang, is a Blood-oriented formula. If Dang Gui is the Emperor herb, you can bet the house that Blood is the primary issue at stake, especially given the construction of the rest of the formula: Gui Zhi to invigorate the Blood, Tong Cao to decrease vascular rigidity, Xi Xin to warm the Blood as it reaches the Lungs, Sheng Jiang to bolster Taiyin function in the construction of Blood and Da Zao and Zhi Gan Cao to supply material to the Blood and Yang to the Heart when used with Gui Zhi and Sheng Jiang. Blood, Blood, and more Blood. If the Xin Bao was just the wrapper of the Heart (something that always mystified me) this wouldn’t make a great deal of sense. However, if it instead is equated with a) the coronary artery system that is responsible for feeding Blood directly to the heart and b) a more formless and function-oriented idea of the system of channels, Luo networks, etc. that encircle the Heart and supply it with Yin and material fuel, suddenly both Xin Bao and Jueyin make a lot more sense. Also if you consider that the Kidneys have to provide the ultimate Yin Water that nourish and protect everything in the upper Jiao from the overwhelming Imperial Fire of the Heart, it makes complete sense that this Yin would travel up through its child Wood (meaning the Yin Wood network of the Liver, but which the Chong Mai adds its influence to) and onto Wood’s child Fire (being the Xin Bao and Heart).
Let’s also look at the Xin Bao/Pericardium from psychological perspectives. The Pericardium is normally seen as the Heart protector, a point of view I agree with fully. However, I think in the context of viewing Xin Bao as a network instead of reducing it to just one physical entity (as is our modern wont) the protective membrane of the pericardium is only a small part of the story. In the primary lineage I have been trained in (Leon Hammer’s Contemporary Oriental Medicine which, despite the name, is actually very classically informed) as the Heart pulse begins to tighten there is both a restriction of circulation into the Heart proper as well as a decrease in communication with the outside world. The patient is often quite far into nervous exhaustion and is beginning to close off and isolate himself emotionally from society, loved ones, possibly also even himself, especially if a Slippery quality is also found. The tighter the pulse gets the more the constriction develops on every plane, introducing emotional rigidity (frequently accompanied by the “character armor” of muscular rigidity) and impeded circulation in the chest, frequently with sharp pains over the heart. It’s much easier to see this constriction mirrored by a constriction of the arteries that feed the Heart rather than what amounts to a lubricated bag somehow constricting.
I would also add in a comment from Arnaud Versluys on this subject in a lecture where he stated that the Heart’s job is to primarily serve as a container for the Shen and that in fact the Pericardium-which is also represented by the entirety of the vascular network-does the actual beating, “squeezing the heart” as it were. Again, the coronary artery network theory really works well.
So what does this mean practically? To begin with, this really clarifies the (manifold) uses for the Pericardium channel in acupuncture. Given the usage of Pc-4 for treating acute myocardial infarction, we can see its power over the physical structure of the Heart and its Vessels. However, we can also see the benefits of providing nourishment to the Heart via the combination of K-22, Pc-1, and Pc-2 using the Exit and Entry points of the Kidney and Pericardium channels to bring the Yin influence of Water to the Fire networks, essentially mimicking the natural activity of the Jueyin. This combination is very useful for patients whose Imperial Fire is beginning to run amok causing insomnia, flight of thought, anxiety, and other symptoms.
This does however raise interesting questions about the true function of Pericardium-oriented herbs such as Zhi Mu, which is frequently used to cool down and protect the Heart and Pericardium, relieving cases of delerium as well as less serious psychological difficulties along the same spectrum.
I would love to hear from our more experienced practitioners on this subject in the comments section.
Tags: pericardium, Chinese medicine, AcupunctureRelated articles
Filed under Alternative Medicine, Holistic Healing, Natural Health Care by on Aug 11th, 2010. Comment. 
If there’s one lesson that everyone learns very quickly once they start treating, it’s that modern patients have complex conditions that don’t readily fit into any of the ready-made boxes we have formed for them, whether from a Classical or TCM standpoint. Patients usually have multiple ailments all stacked on top of each other like a messy garage. Like said messy garage, some things are new, some things have been there a long time, some things no one knows where they came from, and sometimes there are even animals and insects hiding out. All of this is what you have on your plate the second a patient comes into your clinic, sits in front of you and says “my shoulder hurts” (the ubiquitous ailment).
We’re all familiar with that momentary surge of apprehension (or outright panic) that wells up in this situation, especially if the patient has a Western diagnosis with a scary name like cancer, Lyme disease, autism, etc. However our tools are absolutely equal to the task of even the most complex cases. As the Ling Shu says, “Thorns can be pulled out, even those embedded for a long time; stains can be cleaned, even old ones; knots can be undone, even those formed long ago; accumulation can be demolished, though it be very old.”
One of the keys to successfully treating complex conditions is to be able to competently combine already-extant herbal formulas into a single prescription to match the situation. More accurately, the trick is to use the best tools to perform the right actions at the right times continuously (a subject which I will discuss further in my column on Friday). Over the next few weeks I hope to help those having trouble with formula combining to get a better grasp on it.
So, let’s begin at the beginning.
Reynolds’ First Maxim
There’s one thing that trips up everyone at the beginning (and some folks forever), which is the basis of what I like to call “Reynolds’ First Maxim.” The joke is that I only answer any question my students ask with about five possible responses, so to save time they can be referred to by number. What typically happens is this: a student gets a patient in clinic who comes in with three different “named” diseases like, say, Crohn’s disease, PCOS, and Fibromyalgia. The student gets intimidated, panics, runs through their mandatory battery of questions, needles the Four Gates per supervisor, then calls or emails me with “I have a Crohn’s disease patient. Can you tell me what formula is for that?”
To this I always have the same response:
What are the symptoms?
It’s very easy to get bogged down in the details of what someone else has decided about a patient, whether they are from your side of the healthcare fence or not. We have to be very very careful to not slap names on conditions and try to treat those, whether we are discussing biomedical diagnoses or Zang Fu patterns. Any case that you see is only going to open up to you (like the proverbial flower to the bee) once you start diagnosing, which means using the tools at your disposal to find out what’s really going and making your own judgment. Remember the Four Pillars of Diagnosis? Asking, Looking, Listening, and Touching. These are absolute necessities for any type of case, no matter how easy or difficult. It’s no good just saying “I’m watching this patient for Bob who is on vacation and he says she has Spleen Qi Deficiency so I’m gonna give her Si Jun Zi Tang.” That absolutely won’t cut it. It also won’t do to say “Well, I saw on the internet a study that says Huang Qi is good for autoimmune conditions and since Crohn’s is an autoimmune condition I’ll give her that Huang Qi-based patent we have in the pharmacy.”
You absolutely must do your due diagnostic diligence and find out specifically and systemically what is going on with the patient. Then you can begin to make choices. As long as you are confined to throwing herbs and points at a name, you won’t see results and the patient won’t be sticking with you for very long.
The next step is to make sure that you are using a diagnostic model that is going to steer you in the right direction and provide useful information about what to actually do about the problem, which is what we will discuss next week. For now, remember that the first thing you absolutely must do is find out what is going on with the patient in order to have something to work with.
In other words, what are the symptoms?
Combining Chinese Herbal Formulas, pt. 1: Reynolds’ First Maxim
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Jaseng Center for Alternative Medicine’s primary philosophy is to provide non-surgical treatment from pre-diagnosis to post-treatment for various spine and joint conditions. Jaseng integrates traditional medicine with modern medicine to offer a wealth of various naturopathic healing modalities such as Chuna (Korean Spine Manipulation), acupuncture, chiropractic, physiotherapy, and herbal medicine. In addition, our facility is fully equipped with state-of-the art diagnostic systems, which provide high quality images and precise analysis for each patient’s conditions. The quality and expertise of our specialists and staff are dedicated to excellent service ensuring that every patient of ours receives individually tailored diagnosis and treatment plan by providing exceptional and proficient care. Jaseng is a service oriented medical office that offers full care, full value, and effective treatment.
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