Phlegm obstructing the Heart

Phlegm (tan), thin mucus (yin) and water (shui) are all products of disruption to normal food and fluid transformation, a phenomenon that has been termed ‘one root and three branches’. But the sheer variety of locations and symptoms for phlegm cannot be matched by either thin mucus or water, and so clinical differentiation of these three pathogens is essential, because a treatment designed for one will not necessarily be effective for another.

However, broadly defined phlegm presents such complex symptomatology in the clinic that it can be difficult for beginners to recognize, differentiate and treat. The ancients often noted that "strange afflictions are usually phlegm", even to the extent that Zhu Dan-Xi remarked: "[These phlegm] illnesses appear [the result of] an evil spirit; only when obstructed phlegm is expelled will the illness be allayed".

 

Phlegm obstructing the Heart may arise in one of the following ways: 

A- Excess of any of the seven emotions results in stagnation of qi which hinders the smooth circulation of body fluids, and by transforming into fire, further condenses the stagnant body fluids to form phlegm;

B -  Stagnation of Liver qi impairs the Spleen’s function of transforming and transporting fluids which form phlegm and rise with stagnant qi to disturb the Heart; 

C - High fever condenses the body fluids into phlegm, in which case Chinese medicine convention ascribes the disorder to the Pericardium; 

D - Fright generates phlegm, a concept expounded by Gong Juzhong:

“Phlegm is produced by fright. The spirit leaves its residence, and

when the residence is empty, the fluids will form phlegm”.

When phlegm or phlegm-fire obstruct and agitate the portals of the Heart, the spirit will be disturbed to varying degrees. There may be milder symptoms such as agitation, apprehension, propensity to fright, poor memory, restlessness and being easily startled, or more severe

symptoms such as mania, manic raving, epilepsy and what was known as ‘ghost evil’, a disorder probably attributed to demonic possession.

Shang Han - Wen Bing

In the 3rd century CE, the Shang Han Lun (Treatise on Injury by Cold) by Zhang Zhong Jing classified fevers according to their progression through the six channels (taiyang, yangming,

shaoyang, taiyin, shaoyin and jueyin). This theory, according

to which pathogenic cold attacked and penetrated the body via the skin, dominated Chinese medicine until the early 17th century when the ‘wen bing’ (warm disease) theory was developed (predominantly by Wu You He, Ye Tian Shi and Wu Ju Tong). 

The warm disease school placed the emphasis on febrile diseases due to injury by heat which penetrates the body via the nose and mouth, and classified fevers according to four levels of depth: the defensive level (wei fen), the qi level (qi fen), the nutritive level (ying fen) and the blood level (xue fen). 

The defensive and qi levels correspond broadly to the taiyang and

yangming stages respectively of the Shang Han Lun. 

When pathogenic heat penetrates further to the deeper levels of the body, it first enters the nutritive level, scorching the body fluids and the yin and disturbing the Pericardium and spirit, and then enters the blood level, giving rise to reckless bleeding.

Ling Shu (Spiritual Pivot) “Taiyang is the opening, yangming is the closing and shaoyang is the pivot”.

YIn e Yang do Rim

According to the Jing Yue Quan Shu (Complete Works of Jing Yue):

  “Yin and yang are of the same origin ... fire is the ruler of water, water is the source of fire ...”.  

Neither deficiency of Kidney yin nor Kidney yang exist in isolation.

Yin Qiao e Yang Qiao - awake or sleeping

The Ling Shu (Spiritual Pivot) states:

 “When the taiyang (bladder)

channel enters the brain it is divided into the Yin Motility (yin qiao mai) and the Yang Motility (yang qiao mai); it is here that the yin and yang meet; yang enters the yin and yin moves outwards to the

yang, meeting at the inner corner of the eye. When the

yang is abundant, the eyes are staring open; when the yinis abundant, the eyes will be closed shut” 

 “[When] defensive qi does not enter into the yin it will frequently

remain at the yang. [When] it remains at the yang then

yang qi will be full, [when] yang qi is full, the Yang

Motility vessel [will become] abundant, [when] it does

not enter the yin, then yin qi will become deficient and

therefore the eyes will not close”

 

Po Hu (BL 42) - Door of The Po

Po Hu (BL 42) - Door of The Po

The name of this point (Door of the Corporeal Soul) suggests that it is effective in treating disorders of the corporeal soul (po) and emotional disorders related to Lung disharmony. In fact, with the exception of "three corpse possession disorder", the classical indications of this point predominantly reflect its use in nourishing and tonifying the Lung. 

"Three corpse possession disorder" is a Daoist concept that refers to some form of ‘possession‘ and is divided into "upper corpse" which

attacks the eyes, "middle corpse" which attacks the five

zang, and ‘lower corpse’ which attacks human life itself.

The predominant clinical picture expressed by the classical indications for this point is one of severe exhaustion of the Lung. It is indicated for Lung atrophy, Lung consumption, deficiency-taxation, taxation cough with heat in the body etc. 

In its ability to strengthen the Lung at the deepest level it is similar to Gaohuangshu BL-43, although less renowned.

According to the "Essential Questions 60" (Nan Jing) the five outer

Bladder points level with the five zang back-shu points (i.e. Pohu BL-42, Shentang BL-44, Hunmen BL-47, Yishe BL-49 and Zhishi BL-52) drain heat from the five zang, an action shared by the back-shu points of the five zang.