End of Days (Buffy, Season 7, Episode 21)

The penultimate episode of the televised Buffy series!  ‘Always more’ is a phrase which jumped out at me while watching this episode again:  Chinese Medicine always has more to learn.  Whether it is learning to sense the flow of meridians in one’s own body through physical practices like Tai Ji, Qi Gong, or other martial arts, or how to prepare herbal medicines that you’ve grown yourself, or refining your needling and diagnostic techniques, Chinese Medicine — and the beautiful patients one encounters and treats — provides an endless series of challenges to deepen one’s skill and insight.    

In this episode, after Buffy saves Faith and the Potentials from death at the ends of the Turok-Han, Buffy reflects for a moment with two characters, Spike and Faith.  She tells Spike that the night they shared, with him just holding her, gave her the courage to go on.  With Faith, she discusses the mutual loneliness they each feel being Slayers.  In the instance with Spike, closeness was achieved through simply being present; in the other, closeness was cultivated through verbal expression.  Both are involved in the clinic, as a practitioner develops his or her bedside manner.  In many respects, that closeness with patients, is the single most important aspect of treatment, and is a skill which one must continually refine.  It must be continually refined in the sense that attentiveness is generated constantly in the present moment, in being present with the patient, and in drawing out the patient’s story, or ‘illness narrative’.

‘Does it have to mean anything?’ someone in this episode asked.  The same thing happens in the clinic.  Does an illness have to mean anything?  As practitioners of Chinese Medicine, we are adept at helping patients make sense of their illnesses, even drawing attention to the larger metaphors an illness or meridian disorder highlights.  But does it need to mean anything?  After all, illness is just the body’s physiology; it need not impinge on the character of the person.

Closeness is achieved through the meridian systems of Chinese Medicine in different ways.  In the primary meridian system, the Stomach meridian brings things internally, so they can be ‘digested’ and incorporated.  Pathologically, the ST meridian results transforming external wind-heat into internal heat.  Among the Channel Divergences, the San Jiao or Triple Warmer Channel Divergence brings things interiorly, to the heart.

In terms of its trajectory, the SJ CD moves from ‘100 meetings’ at the top of the head and enters interiorly at ST-12, from which it goes to the HT (and later CV-12, the mu point of the Stomach).  Thus it is the CD of bringing things closer, intimately.  Being a channel divergence, note that bringing things interiorly is not its function; rather, it shapes the form of things coming closer:  from meeting to ‘swallowing’ to the heart and the spirit’s curriculum in life, and then to integration in a person’s post-natal life.

The SJ CD treats skin issues of extreme dryness (Sjorgen’s syndrome, for example), as by this point, the body has lost most of its fluid in trying to keep a pathogen latent.   The dryness can include anything from ascites, celulitis, clove sores and psoriasis, to nodule and lymph node swellings.  fire toxins and wind coming out.  It can sometimes also include organ symptoms, as when endocrine and exocrine function have both ceased. 

The SJ CD trajectory is quite short.  As mentioned, it begins at Du20, the most yang point on the body in terms of being at the top of the head.  As such, it is one location at which wei qi converges.  Wei qi is yang in nature, and Yang qi rises to top.

From Du-20, the channel passes to the Window of the Sky point SJ16, ‘Celestial Orbit’.  All other WTS points evolve from this one (even if their collective name is taken from SI-17).  This means the point has an incredible capacity not only to release the neck, but also to open the portals of perception and connection between the observed external world and the internal world of the heart.  Through this opening, alchemically, the body’s qi and jingshen can move from the heart to the brain and form the celestial fetus. 

From SJ16, the path moves to ST12, the basin of clavicle which allows qi to enter interiorly, before linking up to the SJ channel itself.   In terms of points, CV17 diffuses into SanJiao in middle of chest and provides access to the Heart.  From here, CV12 is the next point, a converging of SJ, SI, and ST meridians.  These three organs are the organs of food transformation:  ST digests with aid of SP and KD, the SJ conducts KD yang to the ST to aid that transformation, and the SI separates the pure from the impure.  Because the SJ trajectory needs a point in the lower jiao, and because it has already linked to the SI through ST-12, soem commentators remark that the next point on its trajectory is CV-4, the mu point of the SI.  From here, the body could attempt to lodge the pathogen back in KD-11.  KD-11 is a doorway to the earth, known for its ability to release latent holding.  In this regard, the SJ CD can be used in reverse, to bring things deeper into the body as well as to release some deeply held pathogens.

In terms of herbal medicine, Zhi Zi containing medicinals tend to treat the San Jiao.  One way to test whether a zhi zi containing formula is appropriate for the person is to press on CV-17 or CV-15; if it is sore, the formula is appropriate.  A simple prescription would be Sang Xing Tang, with Sang Ji Sheng or Di Gu Pi added to direct the formula to the jing as well as the wei levels in the body.  Sang Xing Tang contains equal parts of sang ye, zhi zi, dan dou chi, zhi bei mu, and li pi; twice as much sha shen; and a middling dose of xing ren. 

If one wanted to compose a formula which goes to each of the points on the trajectory in turn, one could start with Gao Ben, which goes to Du-20; then Shi Chang Pu or Chuan Bei Mu to open the orifices of the neck; from there, a heavy descending herb with a Yang-Ming tropism could be selected — like Shi Gao (which also moistens).  The SJ meridian would be covered by Zhi Zi, while Qu Mai, Bai Mao Gen, Dong Gua Ren, Dong Kui Zi, or Deng Xing Cao could be used to drain the pathogen out via urine and tie the SJ relationship to the SI channel.  Sang Ji Sheng, Di Gu Pi, or Niu Xi could anchor the formula in the jing level of the hips.  Key to composing a formula for typical SJ CD pathologies is selecting herbs which also moisten. One resulting formula thus looks like this:

Gao Ben – Release exterior, alleviate pain, dispel wind-damp bi

Chuan Bei Mu – transform phlegm, stop cough, moisten Lungs, dissipate nodules in the neck

(Shi Chang Pu could be used in small amounts, as it is drying, but specifically opens the orifices)

Shi Gao – Drain fire, clear heat, alleviate thirst

Zhi Zi – Drain fire, clear heat, drain damp, cool blood, relieve toxicity

Dong Kui Zi – Promotes urination, relieves pain, moistens the intestines

Di Gu Pi – Cool blood, reduce deficient heat, moisten dryness

Finally, another formula which may be useful in cases of skin infections due to acne, folliculitis, or even diabetes, an internal formula which can be taken is Gua Lou Gui Zhi Tang:  Gui Zhi, Bai Shao, and Sheng Jiang at 9g; Gua Lou Gen and Gan Cao at 6g; 12 pieces of Da Zao.  Gua Lou Gen can be taken at higher dosages as appropriate.  This formula does not specifically target the SJ CD, but instead works on harmonising the interior-exterior relationship of humours in the body.  Gui zhi and sheng jiang release the exterior and relate to wei qi; shao yao and da zao relate to ying qi.  Together they harmonise the ying and the wei.  Gan Cao goes to all 12 meridians, and Gua Lou Gen nourishes the yin of the Stomach and Lungs.  As the root of a plant, it has a tropism for deeper levels of the body, and although it does not impact jing itself, it does benefit body fluid as a whole.  The formula generates fluid to nourish the ying, relaxes the Liver to smooth the flow of ying qi to all parts of the body, and unblocks wei qi so that it can be nourished by ying qi and defend the body appropriately. 

As always, these posts are for educational purposes only.  If you or a loved one have a hundred meetings which you are having difficulty making sense of, please see a qualified practitioner.  Happy Slayage!

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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.