Bad Girls (Buffy, Season Three, Ep 14)

The episode where the plot of season three really thickens with  betrayal, intrigue, and the comically new watcher Wesley.  We also meet Balthazar the edematous demon.

Everyone thought Balthazar had been destroyed, but it seems he had been able to survive.  It isn’t entirely obvious if his now bloated condition is a result of his near demise or if it was always part of his constitutional make-up.  Regardless, the fact that he now manifests severe edema is indicative of what his underlying constitutional proclivity is.  Therefore, rather than look at his condition simply as edema, I think this is a good opportunity to look at body types in Asian medicine.  Knowing the body type of a person can give the practitioner clues about what sorts of pathologies the person is likely to develop, and how the person’s physiology will react to pathogenic factors.

Personally, I never found the cosmologically-oriented five phase constitutional types particularly helpful in understanding patient physiology.  To be fair, neither did I spend much time trying to figure out how imbalances in each elemental phase could lead to different body types, either.  Even less helpful, particularly from a theoretical standpoint are the division of body and personality types into yin and yang.  Too often yin and yang as concepts get overlaid with cultural assumptions which are not of East Asian origin, and this sort of division doesn’t lead to clear treatment plans.

(For an example of cultural overlays:  if yin is feminine, then intuition must also be yin, because in Euro-American culture women are associated with intuitive, rather than manly scientific logical thought.  In China, however, as Thomas Cleary points out in his translation of the I Jing, intuitive thought is yang, because it is quick and light in comparison to logical thought, which is dense, slow — and yin in nature.  The difference is that traditionally, temperature, luminosity, and materiality are the base categories for dividing yin and yang into their complementary halves, not masculinity and femininity.  Cultures in which eunuchs are a part of everyday life don’t seem to have such a strong male-female dichotomy as their base pair of duality, and China was a culture in which eunuchs were not uncommon.)

To return to body or constitutional types.  What I have found helpful, both in terms of diagnostic utility and in terms of advancing an understanding of human physiology, is Kanpo’s division of body types by humour:  qi, blood, and water.  Each of these can be further subdivided into excess or empty types.

Qi types are volatile and quick.  They are typically fairly slim, although they can be muscular in a very dynamic and energetic sort of way.  Their muscles are not dense like blood types, but rather more wiry or sinewy.  Athletes whose sport involves quick movements — tennis, American football, swimming — are often qi types.  Qi empty types are quickly exhausted and need to take care to pace themselves, although they may also be wiry in musculature.  Actors, because of the dynamism that their craft entails, can often be qi empty types — even if they don’t have strong energy, they usually have a lively affect.  Physiologically, qi types tend to do well with formulas based on Gui Zhi, although they usually aren’t affected too much by external pathogens.  Typically, pathophysiology results from internal constraint, the qi not being able to get out and express itself.

Blood types, especially the full blood types, tend to be well-built, have dense muscles, good colour to their complexion, tough resilient types.  The peasant farmer is often considered a full blood type; nowadays, I would point to gay male models a typically demonstrating the blood full type.  Blood empty types have muscles which ought to be dense and full, but which have become flaccid and loose; their complexions have become dark and splotchy if stasis is present, or pale if blood deficiency is more pronounced; and they look fatigued.  Men who used to be bodybuilders, like Arnold Schwarzenegger or Sylvester Stallone, and whose blood and fluids have become stagnant or dry as they have aged, are examples of blood empty types.  Both blood full and blood empty body types typically have a high pain threshold and are rather stoic and calm.  Physiologically, blood types tend to be affected quickly by muscular symptoms, and gua sha and cupping are useful for these types.

Water types are like ‘water bags.’  The muscles, even when strong, have little definition — Sumo wrestlers are often water types.  So are women with soft rolls of flesh.  These body types are able to absorb a lot, both physically and emotionally.  Water empty types are typically skinny and often dry.  Their affect can have elements of fear, unrootedness, or timidity.  They can also give the impression that they are loosing a sense of their self, like they don’t have enough yin to stabilise what yang they do have.  Water types physiologically tend to develop water issues — full types tend to hold water, have trouble transforming it, have sluggish metabolisms.  All the water they carry can impede the flow of qi and its warming capabilities.  Water empty types have uneven water metabolism and are typically colder, weaker, and more empty of all humours to begin with.

Balthazar is obviously a water excess type.

Interestingly, he is both retaining water and insisting on being bathed in water.  This indicates that the water is not being transformed internally and not diffusing properly to the exterior.  In this instance, Wu Ling San is needed.

Ze Xie, Fu Ling and Zhu Ling all help remove excess water.  Ze Xie has a draining quality, which helps redirect water that has rebelled upwards causing symptoms of headaches and dizziness.  Fu Ling helps settle the agitation the heart and shen experience from this type of counterflow water.  Bai Zhu strengthens the Spleen in the presence of dampness (in this way it is different from tonifying the Spleen, which nourishes the Spleen organ itself in all its functions).  The Gui Zhi adds warmth to the formula to assist the qi in warming and transforming the excess fluid.  In terms of acupuncture, if Rou Gui were substituted, we would say Kidney yang is being strengthened to help Spleen yang in its transformational capability.  However, Gui Zhi is used to open the collaterals, to warm and penetrate the flesh.

Further information on Kanpo can be found in Nigel Dawes’ book Kampo:  A Clinical Guide to Theory and Practice.

Acupuncture may be difficult on this particular fellow, given his condition. Needles may not penetrate deeply enough. Therefore use either a JAS technique or a shallow-needle CAS protocol.  One could attempt to address the TaiYin sinew channel — TaiYin dealing with water metabolism, and adding the He-Sea points as part of the primary channel treatment at the end of the sinew treatment.  Alternately, since Balthazar’s wrists and ankles seem not to be swollen (if you’ve seen the out-takes, you’ve seen this demon’s skinny little feet), we could try the four gates as a way to bring the yang qi of the first yang channel in the primary channel sequence through all the remaining channels in order to reinvigorate the stillness of jueyin at LV-3.  This mimics the role of Zhu Ling and Gui Zhi in the Wu Ling San formula.

So:  LI-4, LV-3.  I often used the four gates in the clinic as a prelude to the core treatment as a way to open up all the other channels and make them receptive to the changes I diagnosed would be most helpful in each particular case.  I would leave the needles in for about five minutes, and then remove them.  The rest of the treatment — usually a primary channel treatment — would then follow, and typically would not use LI-4 or LV-3.

As always, this post is for theoretical and entertainment purposes only.  For further reference on Kanpo medicine, please see Otsuka (30 Years of Kanpo) and Dawes (A Clinical Guide).

Happy Slayage!


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