Anyone that’s spent more than an hour with me knows that Ling Shu study (and usage) is one of my primary passions in Chinese medicine. What follows are two comments by Dr. Edward Neal (presumably of NCNM in Portland, Oregon) ripped in their entirety from the Ling Shu forum on Arnaud Versluys’ site and put together into one post here for comprehensions sake. This illustrates in excellent and eloquent detail why I have thrown away TCM (other than temporary retention of what’s required of me for tests) and furthermore how Ling Shu acupuncture looks at things and is used in much much better fashion than I, a beginner, possibly could.  My favorite line of Dr. Neal’s response is “There is no ‘protocol’ for these problems only an understanding of these basic patterns of Nature.”

This is also verification and validation I think for Dr. Tran Viet Dzung’s practice of using ONLY acupuncture and moxibustion to treat (Dr. Tran insists that he wanted to utterly master acupuncture so he decided that he would only use acupuncture to treat). I hope some TCM folks see this and realize how much they’re missing out on.

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My own experience is that acupuncture is very good modality for treating Cancer. Of course there are some cancers that are always difficult to treat with any system but I have had good reuslts treating many cancers with acupuncture. Early stage cancers for example, are usually relatively straight forward thing to reverse if caught in time. Acupuncture is also very good at preventing relapses of metastatic disease. I have seen many patients with a variety of these conditions. I am remember patient I saw last year who had Familial Polyposis, a condition in which both the small intestine and large intestine become lined with hundreds of pre-cancerous polys that then transform into cancer. On her inital endoscopy and imaging studies she had literally hundreds of these polyps scattered throughout her digestive tract. After 6 months of acupuncture treatment alone, repeat studies showed no polyps left. Thyroid tumors and early stage breast tumors, for example, in my experience are treated more strongly with acupuncture than with herbs becasue they primarily represent disorders of Jing Luo pathology. On the other hand I would say that what acupuncture ‘was in the past’ and ‘what it is now’ are two quite different things. Acupuncture suffered to a much greater degree in the post-1949 reformulation of ‘TCM’ than did herbal medicine (although it certainly suffered too). To find someone who does the stronger interventions of times past is now certainly a rarity both in China and in the West.

Classical Chinese Medicine differs from modern TCM syndrome differentiation by an almost complete focus on the ideas of space, time and direction. Physicians of previous generations studied the movements and generation of ‘Energy and Form’ by studying how these things expressed themselves in Nature. They concerned themselves with the expansion and contraction of the seasonal breath (變化), the fullness and emptiness contained within these cycles (盛衰), and the cyclic movement of energy (五行). They studied the origins of these things so they would know how they came into being. Issues of pathology were seen as conditions of ‘flowing with’ (順) or’flowing against’ (逆) these basic patterns. They knew when these patterns were disturbed the body was susceptible to pathogenic factors (邪) and that ‘illnesse’ could be seen as a struggle between what is ‘correct’ within the body (正）and what is pathogenic (邪). They saw that these same patterns of Nature also occur within the human body. The physicians role was to study these things and know how they are generated and moved. Understanding them in Nature they also knew how they expressed themselves within the body. They were expected to know how to treat illness primarily through adjusting (調), the ‘directionality’ (方) of these forces. From these core ideas Chinese medicine evolved many different schools of thought, including the system of Zang Fu syndrome diagnosis. Historically, these different schools of thought were never seperated from their intellectual origins. This was the case until the middle and later half of the last century. At that time when this knowledge was passed to the West (ignoring for the moment earlier transmissions through Europe), what was received a system of ‘pattern recognition’ that was somewhat removed from its classical origins.
If we take a ‘classical’ approach to acupuncture, it means that we treat the patient by going back to these basic ideas. In terms of ’space, time and direction’, space means the location of the illness within the Jing Luo and Zang Fu system, time means the ‘timeline’ of the illness and the nature of the ‘ground’ in which the illness develops,’direction’ means which aspect of the seasonal ‘breath’ is impaired. In terms of this patient, we know the location of the patients illness to be the small network vessels of the Fu organs of the Small and Large intestines. In the West, most people know the Luo channels only as the ‘primary’ luo channels that are learned in acupuncture school but there are also luo systems that connect with the Xuan Fu (玄腑 ) (the water passages under the skin) that connect both sides of the body and there are also network vessel that coonect with the Zang Fu organs internally. In this case we knew from the biopsy slides and endoscopy that there were polyps (i.e. mostly phlegm accumulations) scattered throughout the network vessels of the small intestine and large intestine Fu organs. We know that in terms of the ‘timeline’ of the illness, that it was a congenital disease passed within the family line so it represented a disturbance within the Jing passed down from the parents. Why did it only come out in middle age? The life cycle also represents different aspects of the Five Element cycle. We begin our life in Water move into Wood in childhood and adolesence, into Fire in our younger adult life, into Earth in middle age, into Metal as we age and ultimately return back to the source of Water when we die. So we know that this illness represents a congenital disorder within the Jing that manifests as a disorder of Earth within the specific locality of the network vessels of the SI and LI Fu organs. When they are functioning correctly, the earth organs are supposed to be balanced in their functions of ‘taking in’ and ‘giving away’, When balanced they work in the service of the ‘nourishment and support’ of the body. Therefore the two main types of pathologies seen clinically with the Earth organs are diseases of ‘taking in too much’ (accumulations, obesity etc) and ‘giving too much away’ (e.g. malnourishment, anorexia). One disroder is more Yin the other is more Yang. In this case we know there is a disorder of ‘accumulation’ within a specific location within the Jing Luo system. The problem is one of relative ‘Yin accumulation’ and ‘Yang deficiency’. This is also the ‘ground situation’ in which the ’seed’ of the illness grows. We know from an examination of the case that the Zheng Qi within this area is relatively weak (it allows for excessive accumlation of pathogenic phlegm) and that the Xie Qi is also relatively weak (persists for a long time before causing problems). This is reinforced by the fact that there are no signs of an ‘active battle’ on the pictures from endoscopy (i.e. inflammation and redness). This is a much less dangerous battle to fight than the situation that exists when the Xie is strong (i.e. aggressive tumor) and the Zheng Qi is weak.This situation can be addressed by draining the Xie and tonifying the Zheng and in this case these things can be done simultaneously without danger. In addition in this case there was an associated problem of weakness within the Kidney fire leading to an insufficient generation of Ministerial fire and cold stagnation within the Triple Heater and Wood organs. There was also exogenous Cold lodged within the stomach and intestines from several previous external invasions. This resulted in a decrease in the bodies ability to transform Shui Gu (food and liquids), which resulted in increased phlegm production and retention. In this patient, there was also a relative deficiency of Lung Qi which impaired the entire bodies ability to circulate Qi and lead to an increased tendency for tumor formation. In the clinic, all these issues were treated in a sequential manner and fortunately the illness resolved. Because the patient did not want to take herbs her condition was treated entirely with acupuncture and moxibustion.
This represents a fairly typical ‘classical approach’. There is no ‘protocol’ for these problems only an undertanding of these basic patterns of Nature. This approach is based primarily on an understanding of the ‘movments’ and ‘directionality’ of Nature. This allows for a more detailed case analysis and in my experience also a better treatment result. I would doubt for example that ‘treating Sp-9 and St-40 for phlegm’ would likely give the same results. Nor, did I mean to say in my previous comment that all cases are treatable. There are definitely cases of illness where the progression is too far and the body to weak to effect a cure. In terms of your other question, tumors of the breast and thyroid (for example) are examples of ‘Jing-Luo pathology’ because they occur ‘within the channels’. That is the definition of Jing Luo pathology. Likewise, primary Liver cancer is an example of ‘Zang-Fu pathology’ because it occurs within the organs.
I also wanted to say that when I looked over my last comment, I may have been a little off the mark by suggesting one system is better than another for a given problem. My true belief is that we see only a fraction of the true power of Chinese medicine in the clinic. It is actually somewhat of a mystery to me why we get results as good as we do in the clinic when there are so many basic issues we do not understand. Although it is true that some conditions are typically treated better with one technique or another, I think more important is the experience and knowledge of the practitioner, if one is experienced they can get results with either acupuncture or herbs. My acupuncture teacher for example treated deep seated Yin and Blood deficiencies (conditions traditionally treated with herbs) with acupuncture alone by using a detailed knowledge of how these things form within the body. Perhaps a good herbalist may have treated this condition in only 3 months. I am sure if we had combined acupuncture and herbal medicine the results would have been even better and quicker.
Edward Neal, MD

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