Help (Buffy, Season 7, Episode 4)

Welcome to Buffy’s first week of actually interacting with the students! In this episode, we are treated to a variety of student problems, from the real and serious (a student whose older brother has joined the Marines during the US-led invasion of Iraq in 2002) to the surreptitious (a student who says he thinks he’s gay proposes that Buffy go on a date with him to disprove his feelings) and the amusing (Dawn sees her counsellor to complain how Dawn’s older sister steals her clothing). The principle focus, however, is on Cassie, a beautiful girl who writes poetry, creates art, speaks eloquently, and has a sincere presence. She also ‘knows’ things, and something she knows is that she will die the following Friday. The rest of the episode sees Buffy and the Scoobies trying to untangle the mystery of how she’ll die.

(Willow uses the term ‘pre-cog’ to describe Cassie, a reflection of high school and college abbreviation of terms like ‘pre-cal’ for pre-calculus, or here, ‘pre-cognitive’. However, I like to think of the term as being analogous to Pink Floyd’s ‘Brick in the Wall’ — a ‘cog in the machine’. Cassie is ‘pre-cog’ in that she hasn’t been molded to fit the machinery of society yet.)

Unfortunately, although Buffy manages to disrupt a demon-summoning group of students, and even catches a crossbow bold before it strikes Cassie, Cassie still dies. It turns out a heart condition ran in her family. The final scene shows the Scoobies on the couch, mourning the death of this beautiful girl. Buffy asks the question, ‘What do you do when you can’t help?’

That will be the topic of today’s post. How does Chinese medicine know when it cannot help, and what does the practitioner — or patient — do then?

First, I want to stress that this post is not about how Chinese medical practitioners know when to refer their patients to biomedical or other medicine practitioners for treatment.  Rather, the focus is just within the scope of the Chinese medical tradition’s diagnostic and prognostic paradigm.

In some medical traditions, learning how to identify what diseases and conditions can be treated and which are terminal is the first lesson a medical student studies.  The quintessence trantras of Tibetan Medicine, for example, put it as the second lesson, after a cosmological introduction to the medical tradition.  (‘The whole world is a garden of medicine if prepared properly’, is the short version of that cosmology.)  Chinese medicine, though, has its references to death as a prognosis scattered throughout its medical texts.  In general, however, the the patient’s pulse, hara, and shen tell the practitioner whether the patient will live or die.

The most commonly understood pulse pattern indicative of death is a separation of yin and yang.  This happens in terminally ill patients as they approach their final days.  However, Cassie would not have had such a pulse; rather, in her case, the Heart or Pericardium pulses would have felt different.  In Contemporary Chinese Pulse Diagnosis, an area on the wrist just to the side of the HT pulse is related to diagnosing the quality of the heart valves.  The practitioner in this case, could make note of it, send the patient for biomedical measurements, and then work as part of a team to address the underlying issue.

With hara diagnosis, even if a patient has stopped breathing or is turning blue, if a stirring near the umbilicus can still be felt, there is hope the patient will live.  The ‘moving qi’ between the kidneys is still active, and can still deliver the necessary qi to the organs and spirits of the patient.  If this moving qi is absent, the prognosis leans towards death.

The shen, or affect, is also a means for assessing whether a disease can be treated.  If the shen and qi does not correspond to the patient’s bodily form, the Jia Yi Jing states, the prognosis is death.

So what happens if the patient is going to die and medicine can not cure them?  Is there nothing medicine can offer besides pain-killers?  (As a side note, Chinese Medicine avoids the use of opiates as pain-killers, and instead relies on qi moving medicinals like Yan Hu Suo, Wu Ling Zhi, and San Qi, none of which impair mental functioning.)

In Cassie’s case, she is resigned to dying early; but this does not mean she gave up on living, nor did she try to rush her life experiences before their proper time.  In a moving monologue, Cassie tells Buffy that Cassie would like to fall in love, go backpacking, see the Mona Lisa… but she knows it will not happen.  She knows she must live her life as it comes to her, and right then, she was in high school, dividing her time between her parent’s houses.  She was cultivating the life she had then.  Her self-cultivation took the form of introspective poetry, expressive artwork, and an online gallery in which to feature it.  She cultivated a world that would outlive her.

As I’ve mentioned earlier in these posts, the highest calling of Chinese Medicine is on the cultivation of destiny.  If a technique allows a person to continue completing their relationship obligations to family, to themselves, and to the world; if it helps them honour or hone their talents, even when life is ebbing away, Medicine still has a place.  For many, that place is called hospice care.  Acupuncture has a place here.  Points used to comfort the dying include BL-62, CV-17, Yin Tang, and Du-23.  PC-6, HT-5, and LU-7 are also useful to open the heart and free the tongue, to work through grief into acceptance.  ST-25 (Heavenly Pivot) and various Kidney points are also commonly used to move the metal-qi of death into the stillness of water.

In the past, most people died through the metal meridian:  Lung conditions and Large Intestine (dysentery, cholera) conditions were rampant.  Now, people die through other meridians, often HT and PC for men; PC and LV for women.  Following five-phase and six-channel theory, expression through Tai Yang and out into the world (and proper closing off of some outer-worldy factors), or a movement to experience joy would be recommended for PC and LV cases (as, for example in various gynecological cancers).  A gathering to earth and society is the energetic movement to aim for in cardiac cases.  This was how Cassie herself achieved the serenity — a sad serenity, to be sure — that she did.  She focused on friends, even when she knew some, like Dawn, had initially become friends with her just to keep an eye out or get more information.

It is the role of the practitioner to know and understand when each of these movements is the next step on the patient’s path, and to arrange for support in guiding the patient there as necessary.

As always, these posts are for educational and entertainment purposes only.  If you or a loved one feel that Chinese Medicine may provide a means to helping make peace with life and death, please see a qualified practitioner.

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Flooded (Buffy, Season 6, Episode 4)

Buffy’s basement is flooding. Her pipes are leaking and need replacing. In the midst of such mundane terrors of everyday life, Warren, Jonathan, and Andrew are introduced as the villains of the season.  I might argue that Willow is the real ‘Big Bad’ of Season 6 (Magic as a general concept, or Amy as in instigator are close runners up), but the gang of three ‘supervillains’ makes a nice red herring.

Oh, and Buffy needs a job.  Having only a high school education and some kept-undercover Slayer skills, she’s having difficulty fitting into the world and finding her place.  I don’t quite understand why no one thought to suggest Buffy become a personal trainer. She’d make a great kickboxing coach, if she didn’t accidentally injure her clients.  The episode raises the question of how the internal vocation of the jing-shen meet the societal value of that vocation-service, as recognised through remuneration.  That is, what if your real work isn’t paid?  What then?

Among the extraordinary channels, the Yang Wei Mai control the integration of the surface with the interior.  Wei means ‘net’, and is similar to the network of pipes in her house which are bursting.  In Buffy’s case, her interior vocation isn’t being integrated with the external world, leading to an internal crisis of the net giving out — thus Buffy’s financial-vocational crisis as well as her flooding house.  (Houses in dreams are often metaphors for the body.)  Of course, usually, the Dai Mai is concerned with restraining leaking — but I’d rather treat the root of the problem, and thus the Yang Wei Mai will suffice.

So what points should be needled?  The Yang Wei Mai originates at the point UB 63 and ascends along the the GB meridian up the leg and sides of the body passing thru GB 35. It continues to UB 59 and up to the hip (GB 29). Then it continues along the lateral aspect of the body to LI 14 at the shoulder, to TH 13, TH 15 and to GB 21. It then travels down to SI 10, over to GV 15, GV 16 and then to GB 20. It continues downward along the GB meridian from GB 19 thru to GB 13 where it ends, fully traversing TaiYang, ShaoYang, and YangMing aspects of the body.

The most salient point on the vessel for us would be UB-63, which treats leaky bladder (think leaky pipes/ leaky bladder).  UB-63 also treats ShaoYang issues, like damp-heat pouring out of the body (again, Buffy’s leaky pipes).  I would add LI-14, which clears the vision, in the hope that Buffy can see her role in the world more clearly.  For the ShaoYang point, I would select TH13 NaoHui, and purposely mis-translate the point’s name as ‘Brain Meeting’ rather than ‘Upper Arm Meeting point’.  In other words, I would use the point to bring the mind’s attention from securing leakage to clarity of vision, to the union of jing and shen in the experience of the world.

A little too metaphorical?  Perhaps.  But try it and see what happens.  Relaxing tense shoulders will almost always induce a little clarity of thought.  Besides, if you want a more exacting correspondence between point names and the function I’m trying to elicit, you can always choose TH15, Tian Liao, ‘Heavenly Foramen’.  Buffy fell through a hole in heaven, and maybe there’s a blockage at that point.

Ye Tian-Shi lists several herbs useful for treating the Yang Wei Mai and integrating yang activity in body.  Xiao Hui Xiang, Bai Zi Ren, and Fu Ling all free the flow of the network vessels.  Bai Zi Ren in particular is good for calming the mind and harmonising the shen, hun, and po.  In the case of the Wei Mai however (according to Bob Flaws), Ye Tian-Shi recommends not just herbs, but a particular formula:  Dang Gui Gui Zhi Tang jia Lu Jiao Shuang.

As always, these posts are for entertainment and educational purposes only.  If you or a loved one have ‘leaky pipes’ or are trying to find your vocation, please see a qualified practitioner.

Happy Slayage!

Out of My Mind (Buffy, Season 5, Episode 4)

In this episode we learn about the seriousness of Joyce’s medical condition, as she collapses and is taken to the hospital for treatment.  We also see Spike’s quest to get the chip removed from his brain.  Riley’s doubt about being good enough for Buffy, and the legacy of his time in the Initiative, continue to develop.  Finally, this is the episode which ends with Spike’s nightmare about kissing Buffy.

In case you think this episode is pretty tame from the Chinese medical point of view (despite the brain surgery on Spike and Riley’s heart attack), I would disagree.  What a plethora of pathologies this episode presents!  Everything from nosebleed, syncope, tachycardia and “hyper-adrenal overload”, not to mention brain surgery with local anesthetic, and the rather rarely presented erotic dream.

Where shall we begin?

A simple remedy for nosebleed used in Chinese medicine is a fresh Perilla leaf — Zi Su Ye, also known as Shiso in Japanese — rolled up and inserted into nostril.  Quick and effective.  If anyone has ideas for acupuncture remedies for nosebleed, let me know.

Syncope, we treated in the first episode of this season with Dracula.  Syncope is a similar phenomena to absence seizures, from a TCM perspective.  So I would refer you to Season 5, Episode 1’s post.

Neurosurgery can be performed using acupuncture anesthesia.  In fact, it is this accomplishment which contributed to stimulating interest in acupuncture among the United States’ medical establishment.  The points are usually stimulated with electricity or a beam from a 2.8–6 mW helium-neon laser apparatus (Model CW-12, Chengdu Thermometer Factory) delivered and focused to a red spot on the selected skin point of the patient. In the absence of laser or electro-stimulation, strong de qi sensation from conventional acupuncture suffices.

For those interested in more in-depth reporting on acupuncture anesthesia, I would recommend:  http://jama.ama-assn.org/content/229/10/1317.full.pdf+html (page1320); and http://onlinelibrary.wiley.com/doi/10.1002/lsm.1900040311/abstract

The tachycardia and hyper-adrenal overload bit is more complex.  Usually, rapid heartbeat, assessed by a ‘hastened’ quality to the pulse more than through sheer numerical beats per minute, indicates heat in the system.  In Riley’s case, extreme heat would be present.  Hyper-adrenal overload could be translated into an ungrounded yang qi, perhaps floating kidney fire run amok.  However, the presentation Riley presents is great strength and stamina — thus, something is feeding the Liver’s sinews with plenty of blood and qi.  However, Riley’s presentation is clearly unsustainable, and therefore pathological.  He does not have the yin capability of reigning in the out-of-control hormones circulating through his body.  While hormones of various sorts are considered ye-thick fluids, and thus under the control of the Small Intestine — yin fluid controlled by a yang organ — something in the relation of the shaoyin-taiyang dynamic seems to be amiss.  In particular, I would focus on the Heart-Small Intestine connexion, even more than the Kidney-Heart (shaoyin) or the Triple Heater-Pericardium relationship.  How should this issue be treated?

The treatment goals are to clear fire from the small intestine and build yin fluids to anchor yang.  In particular, we want to assure that Heart yin can withstand the yang energy in the Fire element system of the body.  (Both the Heart and the Small Intestine are fire phase organs.)  Therefore, I would use something which builds Heart yin, such as Suan Zao Ren Tang, with a larger quantity of heat clearing herbs which go to the Small Intestine, like Qu Mai (dianthus amurensis — garden variety Chinese pinks) and Mu Tong (caulis akebia).  I would also add some Zhi Zi, which is very cold in nature, but with a focus on the Triple Heater, in an effort to draw off some heat from the Pericardium.  The Pericardium has the function of clearing heat from the Heart.  If this modified formula does not work (it should induce copious urination), I might consider switching my diagnosis to a Four Levels school of thought, and diagnose heat in the Blood level (moving to the Jing level).  I would give a pill traditionally containing Rhinoceros horn, but which now uses Water Buffalo horn instead (in at least a 10-fold increase in dosage).

In terms of acupuncture, I would regulate the PC meridian at PC-6, aiming to address the blood level first.  I would not treat the yang meridians first, although according to the Ling Shu, pathology enters there initially.  Next, I would bleed the luo point of the Small Intestine, SI-7, to release heat from that channel’s blood level.  If necessary, I might also needle SI-2, the ying-point on the channel, to treat fire conditions and address the fluid component of the channel.   Bloodletting TH-5 would be considered if necessary — that is, if cooling the SI channel enough so that the Pericardium could address the heat was not successful.  Success would be assessed by a decrease in pulse rate.  Note, I would not treat the Heart meridian in this more Japanese style of thinking with the meridians.  Cooling the SI meridian should help balance its relationship with the HT, while the PC-TH should begin to address the pathology of excess heat in the body.  I would follow up with treatment of KD yin and jing in an effort to secure whatever excess heat may still be in the body.  Riley might do well to refrain from losing any jing (i.e. ejaculating) until the heat is entirely cleared from his system.

Since interpersonal relationships and Chinese medicine is part of my clinical interests, I will also mention the question at the end of the last post.  In the previous post, I wondered about how to address the problem of ‘the one for you’ not loving you  back — here we see the response of ‘the one’:   if communication, opening up to someone and becoming vulnerable enough to let you know the ‘one’ more than any other person has already is not good enough, then no treatment will be effective.

As always, these posts are for entertainment and educational purposes only.  If you or a loved one is experiencing tachycardia or symptoms of mania, please see a qualified physician and ensure communication between your biomedical and complementary medicine practitioners. 


Happy Slayage!

Fear Itself (Buffy Season 4, Episode 4)

On the face of it, this is an episode about fear — or more precisely, a psychological study of each character’s own particular personal insecurities.  Buffy can’t protect the whole group, Oz fears the wolf inside him will overpower him, Xander feels invisible, Willow has her own fears about her ability to produce workable magic, and Anya is focused on Xander.  Like the fear demon who appears at the end of the episode, each person’s fear is only a small thing which gets magnified out of proportion when attention — in this episode, going around in circles in a labryinthine fraternity house; in real life, a perpetual mulling in the mind, heart, or soul — is fixed on it.  A closer look at the script reveals another theme emerging in bits and pieces throughout the episode:  a preoccupation with the face.  This post will therefore treat the topic of Chinese medical facial diagnosis.

(For those interested in fear and mulling, as separate phenomena, please see my earlier posts on Season 3, episodes 8 and 13, and Season 2, Episode 6.)

The episode begins with Xander’s attempt at creating a ferociously scary expression on his pumpkin ending up merely dryly sardonic.  Willow and Oz chip in by noting its mocking eyes and nose of self-loathing.  A perfectly systematic face reading, though geared strictly towards expressiveness, rather than medicine.  Meanwhile, Buffy is going through a post-Parker depression and ‘what’s wrong with me’ self-perception.  (My post on the Season 2 Halloween episode treats comfort with one’s self.)  Buffy’s pumpkin is left as a  “freak with no face”.  Later, Joyce gets “nostalgia face” in a mother-daughter encounter over Buffy’s Little Red Riding Hood costume.   Eyes come back into the picture when peeled grapes turn into literal eyeballs at the now haunted frat house.  After the gang arrives, Willow lashes out at Buffy, saying her face is 50/50.  Xander himself cannot be seen, due to his fear of his own invisibility to his friends, although he does note that bloody face in corner can see and speak to him.  Oz fears his wolf-face, although in this instance ‘face’ isn’t mentioned as such.  Finally, we note the illustration of the fear demon’s appearance (actual size) led Buffy not to want to fight it, if possible.  Of course, once they discovered the demon’s actual size, thoughts changed…

Facial Diagnosis in Chinese medicine consists of two aspects:  quality and quantity.  Quantity is governed by dividing up the face into sections which reflect parts of the body (or life). Several systems emerged during the course of Chinese history, the most popular of which superimposes a figure over the face so that its abdomen covers the nose, the arms wrap the eyes, the legs cross lotus-style around the mouth, and the head is at yin-tang or just above, in the centre of the forehead.  This system therefore treats the nose as the site at which the state of the viscera is ascertained, while the bowels or external areas are viewed along the edge of the nose.  The Lungs are uppermost, between the eyes, below which is the Upper Pivot, then the Heart (some texts place the Heart in between the eyes, and the Lungs in between the eyebrows), a place marked ‘On the Road’, the Liver, the Spleen, and the tip is called ‘wang mian’.  Beside the nose are the stomach; beside the corners of the mouth, the small intestine, and above that and towards the corner of the jaw is the large intestine.  The Kidneys are just in front of the ears, near the ‘Three Silly Geese’ acupuncture points (TH21, SI19, GB3).  Manuscript P. 3390, housed in the Biblioteque Nationale offers some illustrations of medieval physiognomy charts from Dun Huang, and are reproduced in Lo and Cullen’s book treating the Dun Huang medical texts, Medieval Chinese Medicine.

Quality is found by looking at lustre, colour, suppleness, blood (vessels), and blemishes with regard to the skin of the face. While lustre gives an indication of fluid balance in the body, and the presence of spider veins indicates pathology in a particular channel (e.g. along the zygoma would indicate a Small Intestine Luo Vessel issue, dealing with discomfort at or desire for attention from others), by far the most important aspect to look at is the overall colour of the complexion. The colours of the complexion differ from mere skin colour.  Just as the state of blood can be seen as if through the gauze of the skin, so also can the sort of colours described in the classics be seen ‘through’ or ‘reflecting out of’ the facial complexion.

The colours noted in the classics typically follow a five-phase pattern:  cyan indicates wood, red fire, yellow earth, white metal, and black water.  However, facial diagnosis also paid attention to prognosis, and these colours were distinguished into auspicious and inauspicious colours.  For example, if the complexion was black like double lacquered boxes or a crow’s feather, the patient would live; if it was a dull black like coal, the patient would die.  Likewise, cinnabar red or cockscomb red was positive; a complexion of ochre, coagulated blood, and dry red leaves foretold death.  Indigo indicated poor prognosis, but as did the colour of young or wet grass and lichen.  However, cyan like the wings of a mandarin duck, a wheat shoot, foliage, jade, or a blue-green wall were all positive signs of health.  White like quicklime and dried bone was inauspcious, while soft white like a goosefeather, or lustrous white like porkfat and precious jade signified recovery.  Yellow earth like the hearth was a poor prognosis, but that like silk thread or a crab’s belly was better.

Eyes are sometimes looked at, too, for their overall expression, catchlights, and sclera colour.  Glassy or shiny eyes indicate a shen disturbance, usually one needing to be anchored.  Dull eyes indicate that the Heart needs nourishment.  More detailed analysis of the eyes, or specifically the iris, falls into the realm of iridology.

Huang Fu Mi writes, “Complexion,pulse, and cubit skin correspond with one another… So it follows then that a cyan complexion will be accompanied by a wiry pulse; a red complexion by a hook-like pulse; a yellow complexion by an interrupted pulse; white by a hair pulse; and black by a stone-like pulse.  If one observes a certain complexion and it is not accompanied by its pulse but rather by the pulse of its restraining phase, then this portends death.  If by the engendering phase, recovery.”  (Jia Yi Jing Scroll 4, Chpater 2, Part 1, section 1.)

Taking the Jia Yi Jing approach, treatment would then follow a five-phase approach, in which the meridian to be treated corresponds to the facial complexion; points would be selected based on the pulse indications of generating or controlling cycle.  Alternately, a Ling Shu approach could follow the same method of diagnosing an elemental pair of meridians, but the points selected for needling would then nuance the treatment to address whether the illness varied by time of day, whether it was hot or cold, affected the meridian or organs, or was due to some form of blood stagnation.

As always, this post is for entertainment purposes only.  If you feel you could benefit from Chinese Medical approaches to health, please see a qualified practitioner.  Happy Slayage!