Earshot (Buffy, Season Three, Ep 18)

After a very long break, I am finally back to posting.  Due to my long absence, a more lengthy post is warranted.

A quick review Earshot:  Buffy’s skin gets brushed by a demon she fights in a park.  The area the demon touched begins to itch.  Eventually, Buffy discovers she can hear other people’s thoughts.  (I’m particularly fond of Oz’s thought process.)  Ultimately, while Buffy is able to prevent both Jonathan from killing himself and the Cafeteria lady from killing half the students at Sunnydale High, the intrusion of so many external thoughts into her own mind begins to drive Buffy mad.  She becomes incapacitated at her home until Angel kills the offending demon and feeds Buffy its heart.

This episode provides several interesting points to consider from the perspective of Chinese medicine.  First, and most clinically relevant would be to tease out the mechanism by which contact dermatitis could lead to acute hearing.  The second point to consider is the chosen treatment within the episode itself.  Rather than teach Buffy how to detach herself from everyone else’s thoughts, the Scoobies opt to simply end her access to other people’s minds.  I suppose that particular treatment choice was determined on a triage basis:  Buffy’s sensitivity was growing at a rate too quickly for her to sustain through training.  This phenomenon can also sometimes seen in qi gong disease (assuming one treats qi gong disease as a physiologically defined, rather than a politically defined disease).

To address the first point, what could be the possible mechanisms of acute hearing following contact dermatitis?

I would begin with the skin, which was the point of origin for the disease.  If we take a five-element approach first, we can say that the skin is associated with the Lungs, and thus with metal.  Hearing is associated with the Kidneys, and the element water.  Something which affects the skin and leads to acute hearing would indicate that the generative relationship between metal and water has been disrupted.  In this case, I would argue that the child is taking too much from the mother (or that the mother is feeding too much to the child):  water is draining metal.  Therefore, the acupuncture treatment is quite clear-cut:  disperse water and control metal.

The treatment could disperse water and control metal using either the elmentally associated points on the metal and water meridians themselves, or it could opt to address a fire meridian (or point), fire being the phase associated with both water and metal through the control cycle.  In the former situation, we would disperse LU-3 (water point on metal meridian) or KD-10 (water point on water meridian), and augment KD-7 (metal point on water meridian) or LU-8 (metal point on metal meridian).  Practitioners who dislike dispersing techniques might opt to simply augment metal by using the point combination SP-3 and LU-9 (earth nourishing metal).

However, as the episode itself demonstrates, one could opt to view fire as the key element mediating water and metal through the control cycle.  Since the heart is the organ associated with the fire element, why not literally feed a demon heart to the patient?  Taking the fire approach from a meridian perspective, one could try to sedate the fire point on the metal channel (i.e. LU-10) and tonify the fire point on the water channel (i.e. KD-2).  The rationale behind this tonification-sedation choice is that dermatitis is inflammation or heat, a manifestation of fire over-acting on metal.  Therefore it needs to be sedated.  Tonifying the fire point on the water channel would help reign in water, which seems to be going out of control.  This reckless water will eventually affect the sea of marrow, controlled by the water-element kidneys.  Marrow is the vehicle for the jing-shen, the union of water and fire.  Therefore, one must protect those physiological elements by not allowing yin (jing, the element water, or even phlegm) to overwhelm shen (fire).

The other option is to treat the fire meridians directly, and sedate the water point (SI-8) and tonify the metal point (SI-1).  I hae chosen to use the yang pair for two reasons.  The first is to avoid treating the Heart meridian directly, which some traditions forbid.  (The Heart should be empty, and manipulating it directly clouds the emptiness of the Heart).  The second reason is due to the association the Small Intestine has with ye-thick fluids, which nourish the spine, marrow, and brain.  If we wish to protect those organs from the pathology, then bringing the Small Intestine’s attention to the problem would in theory be effective.  Additionally, the SI’s ability to separate the clear and the turbid could play a part in regulating the disrupted fluid metabolism we’re seeing with the itchy rash and increased hearing abilities.

In the same vein, one could try a Luo vessel protocol, picking up on the indications of SI Luo pathology (recognition from others).  In this case, Buffy is receiving too much recognition from others, but this recognition is strictly internal (and thus associated with blood, not qi; if blood, then the luo vessels).  The TW luo’s pathophysiology (rigidity of the sense organs) also seems applicable here.  Interestingly, both these meridians luo points happen to be near where Buffy’s dermatitis began.

The above approaches focuses more on a five-element understanding of physiological dynamics.  What about a more humoural approach, one which may more easily lead to a herbal treatment plan?

The approach I will take to parsing out the humoural dynamics builds on my understanding of qi gong disease.  My perspective on qi gong  disease (or many other diseases resulting from improper meditation) is that sensitivity or perception (a yang process) develops at a faster rate than the ability of the yin to anchor it.  In other words, shen or yang increases at the expense of  jing or yin. While we could further parse this out into the relationship between the Po and the Bones (or qi) on the one hand, and the Hun and the Blood on the other, I don’t feel such a detailed analysis is entirely helpful for the case at hand.  For an actual case of someone with hyper-perception then deciding whether it is the Po or the Hun which is most affected is entirely acceptable.

On the surface, the idea that yang is increasing at the expense of yin seems like the complete opposite of the five element treatment approach outlined above.  I would argue that while it is true that the two are opposite in treatment plan, this does not mean the theory itself is contradictory.  Five element theory works as a system of correspondences.  Humoural theory operates more along the lines of mutual transformation and interaction, much like basic yin-yang theory.  While the two can and do overlap to a certain degree, this need not always be the case.  From the perspective of acupuncture and herbal medicine as a craft, what matters is the correspondence between chosen theoretical approach and actual treatment.  From the perspective of the clinician, what matters is less the theoretical-treatment approach chosen, and more whether the patient gets better or not.

In the particular example of Buffy, the upper orifices are not being supplied with enough jin-thin fluids to buffer the yang energy being received by them from the exterior.  The solution, then, is to increase the fluids going to the ears.  This would naturally occur in the body through the production of wax, which in Chinese medicine can be considered a form of phlegm.  Phlegm, however, is often the body’s sign of trying to hold on to whatever yin fluids it has at its disposal.  In other words, it is a sign that a pathology has already progressed quite far.  The herbal treatment I would suggest co-opts the process.

The herbal treatment must increase thin fluids and guide them to the orifices without opening them.  What herbs go to the ears?

The Shen Nong Ben Cao notes several herbs which sharpen hearing or open the ears:  Chang Pu, Yuan Zhi, Ze Xie, Shan Yao, Bai Hao (Artemesia Argyi, i.e. moxa), Shi Long Chu, Di Fu Zi, Xiang Pu, Qing Xiang, Cang Er Zi, Shan Zhu Yu.  Some herbs open the orifices directly (Chang Pu, Yuan Zhi); others clear fluid from the ears (Ze Xie, Cang Er Zi); while the remaining nourish the ears through astringing fluids (Shan Yao, Shan Zhu Yu).

My favourite herb for nourishing jin fluids is Sang Ye, present in several formulas addressing cool cry and warm dry conditions.  To augment yin,  I would choose to combine the simple formula Sang Ma Wan (Sang Ye, Hei Zhi Ma, and honey) with Shan Yao.  Shan Yao is binding, preserves pure fluids while ridding the body of dampness, and is said to sharpen the ears with protracted taking.  Together with Sang Ye and Hei Zhi Ma (and the associated herb Qing Xiang, sesame leaves, which also open to the ears), the yin, and specifically the jin-fluid, is nourished.  Sang ye also has the property of releasing the exterior, which will treat the rash and perhaps guide the wind-phlegm absorbed from the demon out of Buffy’s body.

The herbal treatment is in line with the physiology of the Channel Divergences.  I would think of using channel divergences because the symptoms Buffy presents involve wei qi (skin, inflammation) and yuan qi (hearing, KD).  The divergences to be chosen could be the ST (upper orifice issues) or the HT (brain, speech).

While I might consider the same herbal treatment in the case of tinnitus, I am not confident I would treat tinnitus with Channel Divergences in quite the same way.  I see the locus of tinnitus not in the organ (bones, membranes, etc) of the ear, but in the brain itself.  In the case of tinnitus, whether low (KD related) or high (LV-yang related) pitched, I would choose a treatment which affects the Du Mai, and its regulation of the KD and yang of the body.
As always, these posts are for entertainment purposes only.  If you feel you could benefit from the Chinese Medicine, please seek a qualified practitioner.


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