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A collection of notes on the topics of classical Chinese, medicine, and traditional culture.
 

This blog is a collection of ruminations, translations, and personal opinions by Sabine and some guest authors. Reflecting my own personality, some posts are academic, some clinical, and some personal, some are excerpts from existing books and some may become part of future books. Please leave a comment with feedback, questions, constructive criticism, and differences of opinion as long as you argue your reasons for disagreement logically. Any personal attacks, uncivil remarks, or self-promoting comments will be deleted.

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Rotem Rakovsky: A Short Glimpse Into the Concept of Anxiety in Ancient Chinese Writings

The following is a guest blog by Rotem Rakovsky, a classical CM practitioner from Israel, that was first published in the newsletter of the International Community of Chinese Medicine in Israel, http://www.iccm.org.il/en/a-short-glimpse/). I met Rotem in Tel Aviv last spring when we had a lively discussion about pediatrics and gynecology. I am so grateful for this writing of his, because in a way it's his elaboration or response to some of the issues raised in that conversation.

Anxiety is a fascinating term in Chinese medicine, although it is hardly ever studied and it appears in only few writings. This term describes a condition in which there is an involvement of the Upper Burner/ Shang Jiao and the Lower Burner/Xia Jiao in the body simultaneously, as the throbbing of the heart is accompanied by fear and a sense of quivering at the sides of the navel.

张景岳  Zhang Jing Yue, one of the greatest doctors and commentators of Chinese medicine, writes about this subject in his book Jing Yue Quan Shu, 景岳全书 "The Complete Document of Jing Yue" or " Jing Yue's Great Compnedium" :

心下跳動,怔忡不寧者,氣不歸精也
"Beating beneath the heart,
Fearful throbbing that is not abated,
Then the Qi does not return to the Essence/Jing"

We should ask which kind of Qi? Why is there throbbing involved? Zhang Jing Yue expands on this topic in this book, and in a specific discussion about fearful throbbing - Zheng Chong 怔忡:

論怔忡
怔忡之病,心胸築築振動,惶惶惕惕,無時得寧者是也。然古無是名,其在內經>則曰:胃之大絡,名曰虛里,出於左乳下,其動應衣,宗氣泄也。在越人,仲景則有動氣在上下左右之辨,云:諸動氣皆不可汗下也。凡此者,即皆怔忡之類。此證惟陰虛勞損之人乃有之。蓋陰虛於下,則宗氣無根,而氣不歸源,所以在上則浮憾于胸臆,在下則振動于臍旁。虛微者動亦微,虛甚者動亦甚
"The sickness of fearful throbbing, the heart and the chest beat and quiver in a condition of anxiety and caution, and the (heart) has no time in which it receives tranquility. In Ancient Times there was no name for this (Sickness). Thus the Inner Canon said: The large connection channel of the stomach is called Xu Li. It emerges underneath the left nipple and descends. The movement (in this channel) is reflected underneath the clothes, (which is caused by) secretion of Zong Qi. 
At the time of (the doctors) Yue Ren, Bian Que and Zhong Jing, this was diagnosed as a movement of the Qi up and down, from the right and from the left. It was said: In every (case of) movement of the Qi (that is felt), it is forbidden to cause perspiration or diarrhea*. All (the cases that are described) here are types ofFearful Throbbing.
This syndrome exists only in people with deficiency of Yin, which has been exhausted and damaged. The reason for this is that the Yin is absent below, and then the Zong QI has no root and the Qi has no source to return to. Thus, (if) it is above, it floods regret in the chest/depths of the heart. (If) it is below, then the quivering is at the sides of the navel. Light (Yin) deficiency, then the quivering is slight. Severe (Yin) deficiency, then the quivering is severe"

(* It is forbidden to cause perspiration or diarrhea due to deficiency of Yin)

Explanation:

It can be understood that this is a state of fear in which the Qi is in excess in the area of the heart, and does not descend to the essence in the kidneys. It is described how in the absence of Yin, the Ancestral Qi/Chest Qi/Zong Qi,  the Qi which is related to the path of the stomach's great connecting channel/Xu Li through the functioning of Circulating/Pushing of Qi and blood, cannot return to the source and anchor due to the deficiency of Yin. The Zong Qi/chest Qi is responsible for "pushing" and distributing the Qi and the blood. Thus, in this state of "Fearful Throbbing/Zheng Chong", the heart throbbing is regarded as a manifestation of excess Qi in the chest above, and a sensation of quivering at the sides of the navel is a manifestation of deficiency of Yin in the kidneys below.

I recommend that these should be taken into consideration together with pulse diagnosis. When a condition of excess above and deficiency below is identified in the clinic, the treatment should focus on descending movement, gathers and closes the Yang Qi, in relation to the Yang Ming Qi - Stomach and Colon: 

  • Through the path of the stomach's great connecting channel, Xu Li.
  • The anatomic and systemic connection of the stomach to the heart and lungs that distribute the Qi and the blood.
  • The ability of the Yang Ming organs to retrain and norish the kidneys with Yin and Yang Qi.
  • Great movement/Yun which is identical to the stomach and kidneys, as well as the tide and flow relations of the Terrestrial Branches of the colon with the kidneys, and of the stomach with the Pericardium.

All these will support the balance of the heart and kidneys, balance of the spirit and healing of the anxiety.

I want to thank my colleagues&friends, Nitzan Oren and Naomi Jacoby, for their comments.

Rotem Rakovsky,

Researches and teaches ancient Chinese writings, focusing on the ancient classic book, "Shang Han Lun-A Disscusion On Cold Damage" through the view of the Six Qi and Five Phases Theory, Wu Yun Liu Qi and on implementing and applying Acupuncture&Herbs through the use of pulse diagnosis, Nei Jing&Nan Jing Theories, Stems&Branches Doctrine and The "Opening Closing Pivot" Of the Six Qi. A new yearly course on those subjects will be open soon, together with Nitzan Oren

Co-owner of the "Refua-Shlema Clinic" in Tel Aviv, Israel