The Initiative (Buffy, Season 4, Episode 7)

This is the episode in which Spike, trapped in an Initiative-built glass prison cell and starved of blood, manages to escape.  Believing the Slayer to be behind the Initiative (and that Buffy actually got some funding for her slayage project), he decides to finish off Buffy once and for all.  Finding Buffy’s room number through the easily hacked UC Sunnydale student database, Spike goes to Buffy and Willow’s dorm.  Only Willow happened to be in the room at the time, and not finding Buffy, Spike settles for Willow… and then finds that for the first time in his unlife, he can’t perform.

Impotence. It can come as a shock when it suddenly happens.  We witness Spike’s confusion, as well as the efforts of his would-be participant to help assuage his feelings.  While Spike wonders at the sheer fact that things aren’t working, Willow tries to figure out why it might not be working, in the hopes that a solution could be found.

In Spike’s case, we later learn the chip in his brain is the source of the problem.  Since this is a pure mechanical action, the solution would seem easy enough:  remove the chip.  However, we can analyse the mechanism by which that chip affects his system in Chinese Medical terms.  After such an analysis, we could try to circumvent its actions through various herbal medicines and acupuncture protocols.

In order to do that, however, we must take a look at what collection of symptoms Spike is displaying.  Specifically, what are the changes we see in Spike’s physicality as a result of this chip?

Despite the best efforts of make-up artists to conceal the effects of imprisonment on Spike, his pale lips lips and grey complexion could not be hidden.  The greyness can be seen especially along the Small Intestine line as it crosses the zygoma.  These two factors present the first clues:  the SI channel is devoid of its red colour; and the pale lips indicate a lack of blood.  So we might look at how either the TaiYang (Small Intestine) or ShaoYin (the Small Intestine’s internal pair, the Heart) may be affected.

In addition to the visually observed symptoms, we also see Spike’s emotional swings, particularly an uprush of anger, or more specifically, of hot-headedness, despite his frailty from forced starvation in the prison.  Later we see that in addition to his impotence, he seems to suffer from sudden and acute neurogenic headaches.

In contrast to Buffy’s expressed stamina, Spike’s qi and yang is bottled up, possibly due to a lack of communication between the interior ShaoYin and exterior TaiYang.  In terms of herbal medicine, this qi inversion fits the pattern of the Shang Han Lun‘s formula, Si Ni San.

The formula name, which literally means ‘Four Inversions Powder’ is often called ‘Frigid Extremities Powder’ today.  Its indications include cold fingertips and toe tips, impotence (i.e. cold tip of the penis), neurogenic headache, LV-SP disharmony, and hot headedness, among other signs, including ‘rectal heaviness’ — presumably referring to certain types of hemorrhoids or piles.

In (Chinese) clinical practice, it increases blood pressure in patients with low blood pressure, and is given in Japan to patients with tight rectus abdominis muscles in the upper abdomen.  It also treats vexing heat in the heart and chest, including irritability.  Other signs include a red tongue with yellow coating, and if Spike had a pulse, a wiry presentation would complete his being a textbook case for this formula’s use.

Note this formula isn’t for cold or yin preventing diffusion of yang, nor for heat inversion preventing diffusion of yang (indicated by dark urine and symptoms more appropriate for Bai Hu Tang).  The sensation of cold is present only at the tips of extremities.  Rather, this formula is for the internal constraint of yang qi when the TaiYang-ShaoYin dynamic is upset.

Si Ni San is composed of  equal parts of the following powdered herbs:

Chai Hu (Radix Bupleuri); Gan Cao (Radix Glycyrrizae); Shao Yao/ Bai Shao (Radix Paeoniae Albae); and Zhi Shi (Fructus  Immaturus Citri Aurantii).

A debate exists over why this formula is classified as a ShaoYin formula, given its chief herb Chai Hu — a herb usually associated with the Liver and Gallbladder channels, or the ShaoYang channel system as a whole.  To enter that debate, let us examine each herb separately:

Chai Hu is the generally accepted ‘chief’ herb of the formula.  According to Dr Huang Huang, who specialises in Shang Han Lun formulas, people who benefit the most from this herb are easily affected by changes, whether of temperature, air pressure, emotional context, or environment; and their appetite is easily affected by emotions. Chai Hu is usually associated with the Liver and Gallbladder, as it treats the alternating cold and heat characteristic of ShaoYang (GB) patterns.  However, it also releases the exterior, and the Divine Farmer specifies that it treats bound qi in the Heart.  The Heart, of course, is one of two ShaoYin organs, the other being the Kidneys.  (Kidneys are often associated with male sexual function in Chinese medicine.)  The HT, though, is sovereign fire; Chai Hu is associated with ministerial fire.  We will return to this relationship in the context of Chai Hu in a moment.

Likewise, Bai Shao is usually associated with the LV, because of Bai Shao’s astringent and blood-nourishing properties.  Because the LV stores blood and Bai Shao nourishes and brings in the blood it forms, this association is easy enough to understand.  Yet it is specifically when dry fried that Bai Shao nourishes blood; when raw, it harmonises the Ying or nourishing qi.  One can argue that Bai Shao, in this formula gives substance for the HT’s role in pumping nourishment through the body by generating blood.  In other words, the HT needs something to pump, otherwise it gets vexed and exhausted; Bai Shao supplies that substance.  However, I would argue that the role of BaiShao is focused more specifically on smoothing out the Ying Qi carried within the vessels and under the control of the Heart.  Chai Hu releases bound qi in the Heart; Bai Shao allows it to become unknotted along its pathways.

In addition to the Heart, the SI is also involved in the process of blood formation; and as Tai Yang, is involved in opening and closing the pores.  Being the most superficial of the six channels, it is the ultimate goal of the formula, inasmuch as the TaiYang helps keep the body’s surface warm and comfortable.  When its qi is depleted — as can be seen in Spike’s grey cheeks — the SI cannot supply the HT with blood, and the ShaoYin dynamic is upset.  The disruption of the ShaoYin dynamic, involving both the HT and KD, thus prevents the sort of performance Spike has come to expect of himself.  (Climax, as a side note, is due to a discharge of fire from the HT to KD essence, giving it a motile force out of the body.  A patient with difficult ejaculation might benefit from looking at the shao-yin dynamic, with a treatment focused on nourishing of KD water and a diffusion of HT fire.)

Zhi Shi is a key herb to explore when the Tai Yang and SI are considered.  Although zhi shi is usually though of as a LV qi constraint relieving herb today, the Divine Farmer claims zhi shi treats ‘great wind in the skin’ (the sort of wind that causes itching ‘like hundreds of flax seeds’); it also treats cold and heat, and heat constraint.  The skin in this instance would be the domain of TaiYang, and because heat constraint is mentioned here one would be more prone to think of the skin’s relationship to TaiYang, rather than its association with the Lungs.  (If the skin were dry, rough, or flakey, I would be more prone to examine the Lung’s role in diffusing fluids, but I would not rule out an examination based on the six channels.)  As a side note, zhi shi also relieves heaviness of the rectum and treats hemmorhoids (wind in the intestines — not necessarily the large intestine only).  The herb also treats blockage of food and reduced appetite — and I would argue this reduced appetite isn’t the sort found in the upper abdomen, where the stomach just feels ‘blah’, but the deeper, more small intestine area, where one feels a desire not to involve oneself with food.  (Of course, Spike wasn’t interested in feeding off Willow or Buffy, so much as just killing them in a way that might give him some additional pleasure.  Whether this could be considered a lack of appetite or not is debatable.)  Interestingly, the sixteenth century physician Wang Qing-Ren associates the yuan-qi’s mansion with the mesentery of the SI, permitting a connexion between the SI and the KD, another TaiYang-ShaoYin interrelationship at work.

All that remains to be looked at now is Gan Cao.  Wang Ang (seventeenth century) said Gan Cao drains Heart fire and nourishes yin blood.  It also supplements the triple burner (minster fire) — and can thus draw off heat constrained in the heart by promoting the function of the san jiao mechanism.  In fact, it is my contention that Si Ni San is thus a formula to be used when the pathology is located in the ShaoYin qi dynamic but where the TaiYang is compromised (thus not allowing the use of such formulas as Dao Chi San, which guides out heat through the Small Intestine) or in which the heat doesn’t need to be guided out or vented outwards so much as released to the surface TaiYang.  As mentioned above, the TaiYang itself is not necessarily compromised by a blockage or ‘bi’ syndrome, but is perhaps slightly ’empty’ due to an interrupted connexion with the ShaoYin substances.  The mechanism which is harnessed for this effect is the ShaoYang system of the Triple Heater and Gallbladder.

Hence the presence of herbs usually associated with the LV, GB, and SJ; not because those systems are diseased, but because they are healthy and can support or mediate between the ShaoYin and TaiYang.  LV blood supports the Heart when the Small Intestine cannot transform Red to support blood (‘hua chi wei xue‘).  Meanwhile, Minister Fire vents heat away from the Heart and brings it to the surface, where the TaiYang then functions to ‘xu‘ or warm-comfort the body with warmth — like the sort of warm spring day (‘xu ri‘ in Mandarin) that many people find comfortable.  Thus Chai Hu unbinds the qi of the HT, the Gan Cao flushes that Heat away through the TW, and the Zhi Shi guides that heat outward towards Tai Yang, while the Bai Shao smoothes the ying qi that had been compromised on the interior.  (Zhi Shi and Bai Shao thus act to spread wei and ying qi, harmonising them in a different way from Gui Zhi and Bai Shao or Sheng Jiang and Da Zao.)

As for acupuncture, a simple unblocking of the qi dynamic should suffice.  For this, I would use points on both the ShaoYin and TaiYang channels. Specifically, I would focus on xi-cleft points, which treat counterflow qi and which relieve pain.  Pain, in general, is caused by a stagnation of qi, and thus xi-cleft points facilitate movement of qi along their particular paths.

Thus we have as options HT-6 (clears deficient Heart heat, which implies a lack of blood, or lack of blood going where it needs to go), KD-5 (used for delayed menstruation, thus clinically warrants exploration for delayed ejaculation or erection — i.e. blood and essence not descending), BL-63 (head pain, used in acupuncture anesthesia during cranial surgery), and SI-6.  SI-6 does not seem relevant for our purposes (‘supporting the aged’ is the name of the point), even if Spike is a century or so old…  BL-58 and SI-17 would also be useful.  The former has an alternate name with the character for ‘counterflow’ in it, and as the luo point, connects the TaiYang BL with the ShaoYin-KD.  SI-17 is a Window to the Sky point, and thus relates to the movement of the four limbs; in this case, it is also a point formerly on the GB channel — and thus may duplicate the action of Chai Hu in the sense of harnessing the ShaoYang to benefit TaiYang.

As always, these posts are for entertainment purposes only.  If you feel Chinese Medicine may benefit your own ability to perform, please see a qualified practitioner. 

Happy Slayage!


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