Doomed (Buffy Season 4, Episode 11)

This is the episode where Buffy tells Riley she’s the Slayer (“Look it up:  ‘Slayer, the.'”), and where Buffy pieces together that Riley is part of the Initiative.  It also happens to be another Close Apocalypse, as a group of demons try to re-open the Hellmouth, heralded by an earthquake.  The last time an earthquake occurred in Sunnydale was in Season 1, right before Buffy died (the first time), and because the Hellmouth was located in the High School library, the demons provide us with a glimpse of the charred and ruined post-Mayorial Close Apocalyptic Sunnydale High.

In order to reopen the Hellmouth, the demons need the blood of a man, a child’s bones, and a talisman.  They also sacrifice themselves for the greater goal of unleashing destruction on earth.  One must admire the dedication of some demons to their ideals.

All in all, not much to treat, unless we are to pull out obscure point names to aid the demons in reopening the Hellmouth — but then, we’d be helping the ‘other side’, and we are supposed to see how Chinese Medicine can help Buffy and the Scooby gang.  So what shall we diagnose?

A clear and unmistakable symptom was observed by Forrest, when he get’s fed up with Riley’s constant chatter about Buffy:  “She’s hot Buffy, she’s cool Buffy, she’s tepid Buffy: She’s every temperature Buffy!”

Body temperature is one important diagnostic feature in Chinese medicine.  Generally, when a Chinese medicine practitioner asks about body temperature, what he or she is asking about is the patient’s subjective sense of warmth or coldness.  A sense of heat, or an aversion to heat can indicate a hot disorder, while conversely an aversion to wind or cold points in the direction of cold disorders.  In the former case, heat tends to be an internal phenomenon, while aversion to cold and wind indicate external factors (e.g. wind-cold invasion).  Internal cold does not necessarily lead to an aversion to cold; rather it leads to an inability to warm up and stay warm.

Of course, fluctuating body temperature in women is often associated with peri-menopausal symptoms, though this is not the case with women in Japan.  Medical anthropologists Lock and Kaufert pointed out this discrepancy in a their now oft-cited 2001 article, ‘Menopause, Local Biologies, and Cultures of Ageing’, outlining a theory of ‘local biologies’ in which purportedly universal physiological changes are modified by the particulars of sociocultural environments and expectations.  (From the point of view of Eastern medicine, the women in Japan mentioned in the article tended to suffer more from blood-deficiency syndromes, while women in Canada and the US manifested more yin-deficient patterns; ‘menopausal syndrome’ as such does not exist in the classical literature of Chinese Medicine.)  Although the predominant association of temperature fluctuation is with menopausal hot or cold flashes,  pathological temperature variation occurs in both men and women at all ages.  What is the mechanism?

The following case is illustrative, despite the fact that the patient in question was, as it turns out, perimenopausal.  At one point in my career, I focused on using diagnostic protocols drawn from the Ling Shu, and I clearly recall treating one woman for night sweats and temperature fluctuations during that time.  In this system, the pulse at ST-9, renying, is compared to that at LU-9, cunkou.  The resulting ratio tells the practitioner which channels are unregulated and in need of treatment.  Thus, a 4:1 ratio indicates Yang Ming needs to be addressed by dispersing two yang points and tonifying one yin point on the tai yin channel, while a 1:4 pulse ratio is indicative of a tai yin disorder requiring the tonification of two yang points and the dispersal of one yin point.  (A restless pulse indicates that one should choose an arm channel; otherwise, the leg channels are used.)

In this particular case, the unregulated channel was TaiYang, Bladder.  Because the fluctuations varied by time of day, we used shu-stream points as one of the primary points to treat; in this case BL-65.    The disregulation of TaiYang, however, raises questions, since ordinarily in TCM menopausal syndromes are associated with deficiency of the Liver and Kidney systems.  Why then was Tai Yang appearing, rather than jueyin or shaoyin?

The TaiYang system opens to the exterior and regulates the wei qi.  We could note also Buffy’s reluctance to open herself up to a new relationship with Riley, a very psychological comment on the role of BL Tai Yang — opening oneself up to the exterior (in a different sense from SJ-5, Wai Guan), or withdrawing because of the emotion associated with the water phase, fear.  Of course, wisdom is also associated with the water phase, as is propriety.  The TaiYang system would thus encompass the wisdom of combining of propriety and openness — precisely the same combination which informs SJ-5 and PC-6, the ‘outer gate’ and ‘inner gate’, respectively.  (San Jiao is also a fire-water combination channel.)  Functionally, the TaiYang system warms and moistens the skin and releases the exterior.  It is therefore ultimately bound up with wei qi and jin-thin fluids.

But why would it disregulate around menopause?  One could approach the question of why TaiYang would get disrupted particularly at menopause from a hybrid or translation of physiology perspective, too.  The Small Intestine (hand Tai Yang channel) is associated with the ye-thick fluids.  Ye fluids are frequently correlated with endocrine secretions and hormonal levels.  While the Ling Shu indicates that the BL channel should be used to treat problems with the jin-tendons, clinical experience notes its luo point, BL-58, nonetheless augments jin-fluids, which circulate with the wei qi on the exterior of the body.  Together, the two Tai Yang channels have a similar relationship in their use of jin-ye as the entire body has to the relationship of wei qi and ying qi.

Wei qi, after all, is what keeps the surface of the body warm.  When the skin is hot, this is often wei qi battling against an invading pathogen; when the skin is cool, it is because wei qi is either deficient, or the Tai Yang channel has opened the interstices and pores to allow heat to drain off.  The opening and closing of the pores is regulated by wei qi (Huang Qi is an appropriate herb to mention here, both tonifying qi and closing the pores.)  What keeps the body warm on the inside is yang qi, and this is more often thought of as the ming men fire stored in the Kidneys.  Since Buffy does not seem to be deficient in yang qi (witness her ‘not holding back’ when sparring with Riley), Every Temperature Buffy must therefore have trouble regulating the relationship of wei qi and ying qi.

The classical herbal formula to regulate the exterior and interior is Gui Zhi Tang.  Gui Zhi and Bai Shao harmonise ying and wei by stimulating the Bladder’s transformative capacity; while Sheng Jiang and Da Zao harmonise wei and ying by addressing the interior tai yin aspects of the SP and LU.

Interestingly, from the perspective of the Tang Ye Jing Fang, an early herbal work predating the Shang Han Lun, the combination of the two pairs works with the LV, which in its capacity of ‘smoothing the qi’.  In other words, the Liver is responsible for harmonising the relationship between wei qi (LU) and ying qi (SP).

The principle of formula composition in the Tang Ye is simple:  based on flavour, take two herbs to tonify one of the five phases and one herb to disperse that element, if tonification of a phase is desired, and the reverse proportions if dispersal is warranted.  Thus, the acrid flavour tonifies the LV and disperses the SP.  Gui Zhi and Sheng Jiang tonify the LV, while sweet Da Zao tonifies the SP (and disperses the KD).  Sour Shao Yao, on the other hand, disperses the LV (and tonifies the LU).  Gan Cao also tonfies the SP.

Gui Zhi (acrid), Sheng Jiang (acrid), and Shao Yao (sour) thus form a set designed to tonify the Liver, while  Gui Zhi (acrid), Sheng Jiang (acrid), and Da Zao (sweet) are a three herb formula to drain the Spleen.  The addition of Gan Cao, however, alters the formula slightly, and Sheng Jiang (acrid), Da Zao (sweet), and Gan Cao (sweet) together serve to tonify the Spleen.  The five-herb formula thus continues to tonify the Liver while preserving the Spleen.  Because the Spleen is said to store the ying qi, it is important to ensure its stability and continued ability to nourish the wei qi.

From a five phase perspective, the LV is part of a triad involving itself, the Lungs and the Spleen.  The Lungs are associated with wei qi, and the SP with ying qi.  The LV is thus in a position to mediate the relationship between the two — quite apart from the obvious mother-child relationship between SP-ying qi and LU-wei qi.  In terms of acupuncture, we could regulate Spleen excess by dispersing the Lungs, but some traditions don’t like dispersing qi at all.  On the other hand, nourishing the SP could lead to increased stagnation in the body, if ying qi and wei qi were not in proper relationship to begin with.  Thus, the LV’s role in the ke-control cycle is invoked.

(In the Gui Zhi Tang formula, because the LV controls the SP, tonifying the LV at the expense of the SP might lead to a state of ‘LV invading SP’; therefore extra care was taken to ensure the SP remain healthy.)

How does the Liver harmonise ying and wei qi?  Quite apart from the axiomatic definition of the organ’s role, how can we explain this?  A clue comes from a different formula, one I don’t often see used:  Ren Shen Yang Rong Tang, “Ginseng Decoction to Nourish Luxuriance”.  Explaining the origin of its name, Bensky (et al) cite Fei Bo-Xiong, a Qing dynasty physician who clarified the relationship between the terms rong, xue-blood, and ying-nutritive qi.  Only the latter two are important for our purposes:

“Without blood, there is nothing to moisten the yin and yang organs, irrigate the channels and vessels, and nourish the hundred bones.  All of this embodies the meaning:  enriches growth.  The second is ying — barracks and their enclosing walls.  Without blood, there is nothing to fill the form, firm the interstices and pores, and secure the hundred vessels.  All this embodies the meaning:  guards from the inside.”  (Bensky et al, Formulas and Strategies, 2nd Edition, p351; edited to be closer to Chinese grammar.)

In this quote, we see that the Liver’s ability to harmonise ying and wei is dependent on its ability to store blood.  Blood ‘firms the pores’ — that is, it nourishes the function of wei qi.  It also ‘fills the form’ (in other texts, the form emerges from the SP; thus blood allows the SP to function properly).   As Bensky et al comment, “Ying… refers to blood’s active funciton of securing the body by providing it with substance:  a yin place to which yang qi can attach itself.  For that reason, the term ying invariably invokes as its counterpart wei, or protective yang, whereas xue invokes qi.”

No wonder the jueyin level is so fundamental among the six channels!  Where jing provides the template for structure, blood allows for its filling, execution, and movement.  Blood, it appears, allows for the functioning of the entire system of physiology.  Herbal systems which pull out the three humours and focus principally on blood, qi, and body-fluids can thus be quite versatile in their scope of treatment.

Theoretically, then, the proper nourishment and regulation of blood should be key to maintaining the harmony of the body.  It should come as no surprise that in Kanpo (Japanese Herbal Medicine, based on CHM) will use Gui Zhi Tang as a general tonifying formula.  Likewise, if blood carries the emotions, then regulation of the emotions is also key in ensuring the proper balance between nourishment and defence of the body, both from external and internal disruption.

Such an approach would serve to answer another question of mine, namely,  how do the hun-ethereal souls play into such harmonisation, the hun being stored in the LV and subsisting in the blood? (Note: the shen emerges from the union of qi and blood, and is housed in the Heart and mai-vessel pulses.)  The hun are associated with the personality, which is frequently known by the associated emotive character of people.  Thus, allowing the hun to delight in itself — the property fostered by the herb Dang Gui, according to Ted Kaptchuk, author of The Web that has No Weaver, should help regulate the entire system.  That Dang Gui goes to the qi level of the blood, and works on both levels, would seem to support such a claim.

However, the blood also contains and constrains the three worms, as explained by Jeffrey Yuen in his description of the character xue-blood.  These worms, representing desire-lust, anger-gluttony, and ignorance-refinement, must also be kept well governed by the blood.  Mi Wu (the herbal portion  of the plant whose root is called Chuan Xiong) and Yi Yi Ren are two herbs which, according to the Shen Nong Ben Cao, precipitate the three worms.  Yi Yi Ren, interestingly enough, goes to the SP-ST, LV, and LU.

So, to summarise, the recommended herbal treatment for Buffy is Gui Zhi Tang, to regulate the TaiYang and wei-ying qi physiology.  From a five-phase perspective, we could needle just one point — the source point LV-3, perhaps in combination with SP-3 and LU-9 — to regulate wei and ying.  But if we wanted to stick to a diagnosis of a TaiYang disorder, apart from the initially mentioned BL-65, a shu-stream point, what is the second point on the Bladder channel in need of dispersal?

Soon after the earthquake, we see Buffy at Gile’s place, anxious over what may foretell her possible death.  While Giles seeks to comfort Buffy with words, I might try some acupuncture points traditionally used to make patients comfortable with their approaching death.  (Oddly, most people I’ve known who have died and come back through medical miracles seem to be quite comfortable with the thought of death.  “I’ve been there before” as someone I once knew put it, shrugging.  “It’s not a bad place.”  Therefore, Buffy’s anxiety seems particularly out of place and ‘pathological’.)

The Kunlun moutains are the abode of spirits and the Garden of Immortality in Daoist cosmology.  It is the realm of the Queen Mother of the West and is often described in poetic terms as a paradise.  BL-60, KunLun is named after this abode, and would be my second point to needle on the Tai Yang channel.  Coincidentally enough, another point bears the same name:  CV-4, the mu point of the Tai Yang Small Intestine.  CV-4 also happens to be on the KD shaoyin channel, and thus makes a nice pairing as the yin point to tonify in combination with the dispersal of the two Tai Yang points.

So the herbal treatment for ‘Every Temperature Buffy’ is Gui Zhi Tang, and the acupuncture treatment is a simple three point, five needle prescription of BL-65 (use a short needle and quick insertion — this point is sensitive!), BL-60, and CV-4.

As always, these posts are for educational and entertainment purposes only.  If you feel you could benefit from the experience of Chinese Medicine, please see a qualified practitioner.  Happy Slayage!


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