axis of efficacy part 1 (charles chace)

7/28/2019 Axis of Efficacy Part 1 (Charles Chace)

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by Charles Chace and Dan Bensky

In this frst o a two-part article, the authors analyse the frst section o

chapter one o the Ling Shu as the oundation or understanding ap-

proaches to needling. The authors begin their discussion by frst ori-

enting the book within the Nei Jingand outlining the structure o the

text. This is ollowed by translations and commentaries o the text itsel.

Preceding the translation is an interesting in-depth examination o theconcept o ji and its central relevance or understanding the Ling Shu.

Any serious effort to understandthe approaches to needling described inthe Huang Di Nei Jing (Yellow Emperors In-ner Classic, 3rd2nd century BCE), demandsa close examination o the rst chapter o oneo its component texts, the Ling Shu (DivinePivot).1 A book devoted largely to the practi-

calities o acupuncture practice, the rst chap-ter o the Ling Shu outlines the undamentalprinciples o needling that are developed and

The Ling Shu Prcisfrom chapter one of the Ling Shu

Please tell me of the way [of needling].The essentials of the small needle areeasy to explain but difficult to engage.

The crude attend to the form, thesuperior attend to the spirit.

Spirit oh spirit! There is a guest at thedoor.

Without observing the disease, howcan one know its origin?

The subtleties of needling lie in itsspeed.

The crude attend to the junctures andthe superior attend to the dynamic.

The movement in the dynamic is notseparate from its empty spaces;

The dynamic within this empty spaceis clear, still and subtle.

Its coming cannot be met and itsgoing cannot be pursued.

Those who understand the way of thedynamic, will not impede it and thus itmanifests.

Not understanding the way of thedynamic, one detains it and thus itfails to show itself.

To understand its goings and comings,emphasise its periodicity.

The crude are in the dark about this;sublime! Only practitioners have it.

Going away from it is contrary,promoting its arrival is goingwith the flow.

If one clearly understands the contrary

and normal [flow of qi], then you canact correctly and without doubt orquestion.

By meeting it and taking it away, howcould one not achieve depletion [ofthe qi]?

By pursuing and assisting it, howcould one not achieve repletion [ofthe qi]?

Whether meeting it or following it,by means of ones attention, oneharmonises it.

This is all there is to say with regard tothe way of needling.

An axis oefcacy

The range of meaning in the Ling Shu chapter one


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applied in dierent contexts throughoutthe text. Following an introductory pream-ble that establishes the chapter as part othe Huang Di lineage o medical texts,2 this

rst chapter presents a short passage thatstands by itsel as an introductory overviewo the most basic principles o needling. Itis the oundation o all urther discussionon needling within the chapter and argu-ably within the entire Nei Jing. This paperis an analysis o the rst section o chapterone o the Ling Shu and an assessment o itsramications or understanding the needletechniques presented in that book. To makesense o how the passage in question relatesto the rest o the treatise, it is helpul to un-

derstand something about the structureand organisation o the Nei Jing.

Ancestral texts

The two books o the Nei Jing, the Su Wen(Basic Questions) and the Ling Shu (DivinePivot) are by no means a homogenousor consistent text. They constitute ananthology o many independent writingsby many dierent authors that may or may

not have any relation to one another. Eachchapter may contain multiple subsectionsthat constitute complete texts in their ownright. For instance, the rst two thirds oLing Shu chapter one, reerred to here as LingShu-1.1, constitute a discrete text knownvariously as the Jiu Zhen (Nine Needles),the Xiao Zhen (Small Needles) or simplythe Zhen (Needles). This text is consideredan ancestral text in that it most likelypredates other texts in the Nei Jing that areeectively commentaries on it.3 These later

texts, known as descendent texts, includebut are not limited to the last section o therst chapter o the Ling Shu, reerred to hereas Ling Shu-1.3, or rst section o the 54thchapter o the Su Wen, reerred to here as SuWen-54.1

Dierent descendent texts requentlyposit dierent interpretations o anancestral text.4 For instance, the linexu er jize shi in Ling Shu-1.1 is interpreted in LingShu-1.3 as When one slowly inserts andquickly removes the needle this will make

the qi replete.5Su Wen-54.1 interprets the

a.

line dierently. When one slowly removesthe needle and quickly presses the point[to prevent bleeding], this will make the qireplete.6

Other writings within the Nei Jing arealso eectively commentaries on the JiuZhen (Nine Needles). Descendent texts mayappear in close proximity to their ancestraltexts as does Ling Shu-1.3, or they may bescattered in apparent random throughoutthe Nei Jing as is the case with Su Wen-54.1.This raises a relevant point regarding thedating to the various texts within the NeiJing. It is commonly believed that the LingShu postdates the Su Wen but in act neitherone, as a whole, is earlier or later than the

other. Su Wen-54.1 is clearly a descendent oLing Shu-1.3, and Ling Shu-3, a distinct textin its own right known as the Explanationo the Small Needles is also a descendent oLing Shu-1.3.7 From all o this it is evidentthat even at the time o its compilationthere were multiple lines o interpretationassociated with the Nei Jing.

It is debatable whether this initial passagein the rst chapter o thethe rst chapter o therst chapter o the Ling Shu can beconsidered an independent text in its own

right. Nevertheless, it is unquestionablya succinct prcis o the core conceptsthat are subsequently developed later inLing Shu-1 and throughout the Ling Shu.However one chooses to label this passage,hereater reerred to as the Ling Shu r-r-cis, it is worthy o critical examination. Itscontent bears directly on our undamentalunderstanding o what it means to perormacupuncture and the interpretation o thispassage inevitably infuences ones readings readings readingo the rest o the Ling Shu.

The most common interpretations othe Ling Shu rcis, although plausible,coherent and inormative, are not entirelysatisactory. A number o intriguing state-ments that orm the core o the passage areeither reduced to triviality by these standardinterpretations or ignored entirely. We willexamine this prcis in detail and considerits possible range o meaning. In the process,we will demonstrate that the text containsat least two intertwined interpretive threadsor layers, one o which has been largely

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overlooked in the commentary literature.The basis or this neglected interpretivethread is the texts use o the concept ji( ). We will examine this concept in some

detail and consider its ramications orour understanding o the passage and thechapter as a whole.

A pivotal concept

The interpretation o the Ling Shu rcishinges on the word ji ( ) and what itmeans that the superior attend toji. Mostcommentators take ji in Ling Shu-1 tomean the qi mechanism or qi dynamic.

This, o course, begs the question o what

precisely a qi mechanism or dynamic is andhow it pertains to the rest o this passage.The Ling Shu suggests two interpretations,one narrow, and one broad.

1) Ling Shu-3 is among the mostcomprehensive and least ambiguouscommentaries on Ling Shu-1, and itexemplies the most common reading oji ( ). The qi mechanism is the interactiverelationship between the correct and

pathogenic qi. In practical terms, it is ourawareness o and interaction with thatdynamic that determines whether onewill administer tonication or drainagetechniques. This interpretation will bediscussed in greater detail below. Forthe present it is sucient to say thatthis straightorward explanation allowsthe Ling Shu rcis to be read as a basicdiscussion o excess and deciency, correctand pathogenic qi, and tonication anddrainage. That said, i one reads the text

with an open mind, this simple equivalencyleads to many questions. In this it is similarto another common interpretation thatji isa simple reerence to the channel qi.8

2) The Ling Shu rcis itsel describesthe qi mechanism as an expression o thepacing o the qi, its goings and comings. Itstresses the importance o ones awarenesso the spaces or intervals o stillnesswithin the ji. From this perspective, onesattention to the relationship between the

c. shang shou ji

d. qi ji

e. wang lai

correct and pathogenic qi is the tip o aniceberg, a relatively minor aspect o a muchlarger scope o awareness that is essential toeective needling.

The trigger o activity

The wordji ( ) is an ancient term or thering mechanism o a crossbow,9 and byextension, it is the crux or hinge o a thing.This root meaning oji is especially apt whenthe word is used in the early acupunctureliterature, which oten makes use o archeryimagery. For instance Ling Shu-1 counselsthat at the moment the qi arrives, one mustwithdraw [the needle] like [loosing an

arrow] rom a bowstring.,10Ji exerts itsinfuence by virtue o its position at thebeginning o things. For this reason,ji maybe the trigger or cause o a disease as in SuWen-74, which states: Careully examinethe appropriateness o the [seasonal] qi,and do not lose [sight] o the trigger [ji] odisease., 11

Ji also reers to the articulations (guanji ) and may reer specically to theacupuncture hole Circular Jump (Huantiao

GB-30). Su Wen-60 states: What cleavesclose to the hip is the ji.,12 The hip is, ocourse, a major hinge or pivot point in thebody but it is also the initiator o movementthrough the lower extremities, harkeningback to a more undamental meaning othe word.

Incipiencecipienceipience

Ji is cognate with incipience (ji ), theheavenly mechanism (tian ji ), the

divine mechanism (shen ji ). TheClassic o Change uses the word incipience(ji ) to denote an initial tendency towardchange that is more minute than andprecedes active transormation.,13 Accordingto the Great Commentary in the Classic oChange: The Changes are the means bywhich the sages search the proound andexamine incipience. Only by the prooundcan one penetrate to the purpose under the

. qu ru xuan jue

g.jin hou qi yi, wu shi bing jih.

i. Yi Jing 9-7th centur ies BCE.

j.hua

It stresses the importanceo ones awareness o

the spaces or intervals

o stillness within the ji.

From this perspective,

ones attention to the

relationship between the

correct and pathogenic

qi is the tip o an iceberg,

a relatively minor aspect

o a much larger scope o

awareness that is essential

to eective needling.

Errata: i Vl. 5:3 (sp.08) The Lantern, a d- wa mg m hacl Clg bld adlvg xc b Ga

yg J D, ag hah ca d lcad pag 26-27 w cdm Shaanxi Zhong Yi1995

Vl 16: (4) b L L r Gagx L Zh sh Zhgy ya (545000) .

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heaven; only by incipience can one perectthe tasks under heaven., 14

The Great Commentary also states:also states:also states:

The Master said: Ah, to know theincipience, how divine! The gentleman indealing with his betters does not atter, indealing with his ineriors is not rude, ordoes he not know incipience? Incipience isthe most minute aspect o movement andthe frst appearance o good ortune, thegentleman sees incipience and inaugurates;he does not wait until the ending o theday. , 15

The expression o natural endowment

Ones ji ( ) is linked, at least to someextent, to ones relationship with the worldat large. In the Zhuang Zi, tian ji is anatural endowment or disposition, and acapacity to be in accord with the universe.Those whose desires are deep-seated willhave a shallow natural endowment, 16 Inthe Huai Nan Zi the divine mechanism ishidden and closed. Its marks and imprintslack all trace, and it is the subtlety behind

human ingenuity.

, 17

Where shen andji appear together in theNei Jing it is oten a general term or the lieorce, but Su Wen-70 understands them asseparate though inextricably related things.

Qi Bo said: The root at the centre is calledthe spirit dynamic. When the spirit leavesthen the dynamic ceases. 18

The wellspring at the centre o things

Ji lies not only at the beginning o actionsbut at their centre (shu ji ) insoar as itis the crux o a thing. This use o the wordappears in Ling Shu-69.1 which states: thetongue is the key to speech., 19and Ling Shu-75.5 which states: the penis and testicles are

k.

l.

m.

n. .

o. Huai Nan Zi (79-8 BCE)p.

q.

r.

the hinge o the body centre., 20Ji may alsodenote a specic situation or state o aairs(ji shi ), and by extension it denotesthe opportunity inherent in a situation or

disposition. Similarly, ji may be both anindicator o change and a source o changewithin something. According to the GreatLearning in the Han dynasty Record o Rites:

From the benevolent example o one amilyan entire state becomes benevolent, androm its courtesies an entire state becomescourteous, while rom the ambition andperverseness o one man, an entire Statemay be led into rebellious disorder; itsdynamic is such as this., 21

The Zhuang Zi expresses a similarsentiment. The ten thousand things allcome out rom the wellsprings and all re-enter the wellsprings., 22

This translation by Victor Mair highlightsthe aspect oji that lies at the source and isthe wellspring o things.Just as ji is situated at the centre o events,

Isabelle Robinet notes that: Physiologi-Physiologi-cally,,ji is located in the centre o the bodyin the centre o the bodycentre o the bodythe bodybody

which is in turn related to yi intention andto the Spleen, or it can be identied withor it can be identied withthe interval between breathing in and out,corresponding with the closing and openingo the world in the instant that preceded themovement o breath.

In this it is evident that even in its mostmaterial maniestations ji is associatedwith the empty spaces or intervals betweenphases o activity. Robinet also notes thatji is synonymous with the heart-mind (xin

) and the spirit or spirit (shen ). This

association is central to the interpretationo the Ling Shu rcis where they are linkedby the parallelism o its sentence structure.According to Robinet, those involved ininternal cultivation aim at uniting theirhumanji with heavenlyji. 23

An axis o quiescence

As a hinge or pivot, ji reers to a point ostillness around which eective intervention

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turns. It is equated with the unboundedinnite, and the great ultimate. It isthe wondrous movement that unitesmovement and quiescence, the true spring

that moves spontaneously by itsel

andwithout intention and acts without actionand intererence., 24 In light o this, it isworth mentioning that the book we arediscussing is entitled the Divine ivot. Atleast by the Tang dynasty when the text wasgiven this title, it was clearly acknowledgedthat the needle itsel is the pivot or axis ohealing. The task o the acupuncturist is tomake maximal use o this pivot orji.

Synthesising these layers o meaning,Robinet describes ji as the spring o the

world, its activating orce the extremedegree o quiescence and purity which ison the verge o changing into movement.25The wealth o meanings associated withji in the early literature o China suggeststhat whatever it is that the superiorpractitioner must attend to, it both includesand transcends the relatively mundanerelationship between the correct andpathogenic qi, the state o qi in the channels.Ji is a refection o the overall health or

disposition o the patient; it determineswhatever opportunities that might beavailable or improving the situation, itis closely associated with the spirit andaccording to Robinet, it subsequently cameto be associated with source qi in the senseo a primordial breath., 26

From the discussion above it is apparentthat no single English word does justice tojis ull scope o its meaning. For the present,however, we have provisionally translatedjias dynamic to ampliy its undamental

characteristic as the impetus o eectiveaction, movement and transormation.That said, it is most productive to keepits ull range o meanings in mind whencontemplating the Ling Shu rcis. Whenapproached rom this perspective the ocuso this passage shits signicantly. Onesengagement with ji is clearly the overalltopic o the passage. It is through theji that

v. wu ji

w. tai ji

x. zi ran

y. wu xin. wu wei

aa. shen

ab.yuan qi

one harmonises the excesses or decienciesin the states o the correct and pathogenic

qi, and it rames the way in which oneapproaches tonication and drainage.

What ollows is a translation o the LingShu rcisrcis accompanied by an overviewo representative commentaries includingthose appearing within the descendenttexts o the Nei Jing itsel.

This essay will illustrate how the concept oji as described above establishes a coherenttrain o meaning throughout entire passagethat both complements and deepens theimport o the established commentaries. Itis not so much an alternative interpretationo the material as a subtle but signicant

shit in emphasis. We have omitted theintroductory paragraphs to Ling Shu-1.1.1that do not bear directly on the content othe chapter and numbered the lines or easyreerence.

The Ling Shu rcirciTranslation and commentaries

. [1][1]

P [ ].T 27 f .What are the essentials o needling? Theyare apparently easy enough to describe, asimple idea that is dicult to implement.According to Ling Shu-3.1, what is reerredto as easy to explain, means that it is easyto talk about, and dicult to engagemeans dicult to apply to people., 28

Whatever this means, it is unlikely thatit is a mere needle technique. As Ma Shi

articulates in his Commenting on theEvidence and Explicating the Details in theYellow Emperors Inner Classic Divine ivot,mere needle techniques are an expressiono the crude attending to the orm.29

. [2][2]T , , , , . . ...The word shou means to guard or protect,and by extension, to attend to. Its use here

ac. zhengad.xie

ae.

a.

It was clearlyacknowledged that the

needle itsel is the pivot or

axis o healing. The task

o the acupuncturist is to

make maximal use o this

pivot or ji.


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suggests that the physician must notjust protect the integrity o the ormand the spirit, but must also attend toand somehow engage it.

The crude and superior

The distinction between the crude andthe superior is central to the structureo the passage. Appearing again in linesix, the crude and the superior ramestwo sets o related ideas, and theparallelism it creates links the notionso orm (xing ) to the junctures(guan ), and the spirit (shen ) tothe dynamic (ji ). It will become

apparent that the essentials o needlingtranscend the mechanics o its orms.

According to Ling Shu-3.1, Thatthe crude attend to the orm meansthat they attend to the methods oneedling., 30 Zhang Zhi-CongsCollected Commentaries on the Ling Shu(1670) interprets orm not in terms oneedle technique but as the corporealbody o the patient. He explains that:When needling, the crude attend

to the skin, vessels, fesh, sinew, andbone.,31

Shen as qi and blood

Most commentators and thedescendent texts within the Nei Jingitsel interpret spirit in terms o the qiand blood or the correct qi. Ling Shu-3.1 states That the superior attend tothe spirit means that they attend toa patients surplus or insuciency o

qi and blood, and this enables themto toniy or drain., 32 It goes on toexplain that, at least in this context,the spirit is correct qi., 33 WhereLing Shu-3.1 identies the spirit as thecorrect qi,34Ling Shu-18 links the spiritto the blood. The blood is the spiritqi., 35 This is conrmed in Su Wen-26which says: Blood and qi make up a

ag.

ah.

ai. zheng qiaj.

ak.

al.

persons spirit, and must be careullynourished.

The descendent texts within the LingShu inorm us that needle techniques

are useless without an appreciationo the state o the qi and blood. Yet,i we take Ling Shu-3, and Ling Shu-18seriously, then spirit in this context isnothing more than the qi and blooditsel, or more specically, the overallstate o excess or deciency o the qiand blood. From this perspective, themessage o line two is that one musttwo is that one mustis that one mustattend to the state o qi and bloodrather than the physical orm or themechanics o needle technique.

Shen and the ocus o ones mind

The rather circumscribed interpretationo spirit propounded in Ling Shu-3.1 and Ling Shu-18 is by no meansdefnitive. The ollowing lines romlater in Ling Shu-1.1 itsel clearly adopta broader understanding o the spirit.The spirit resides in an autumnhair.,36 Autumn hairs or down are

extremely fne, so this means thatthe spirit resides in paying attentionto the smallest details. In anotherinterpretation, the term autumn hairis also thought to reer to ocusing onthe tip o the needle. The successivelines in Ling Shu-1.1 clariy the role othe practitioners spirit at least to theextent that one must be highly ocusedand concentrated. Those who wouldexamine disease must calm theirminds when gaing upon a patient,

looking neither let nor right.,37

Thisocused and concentrated state allowsthe practitioner to comprehend thespirit within the patient and make adiagnostic assessment. According toZhang Zhi-Cong, I when needling,one attains it [spirit] in the heart-mind,then when the spirit connects to thosewho are sick, one will know whether

am.

an.

ao.

the patient will survive or perish., 38

The spirit here includes, but clearly, but clearlybut clearlytranscends, a simple awareness o the, a simple awareness o thea simple awareness o thestate o a patients qi and blood. It iss qi and blood. It iss qi and blood. It is

the way in which one is aware o thepatients condition.s condition.s condition.

Line two can then be summarisedtwo can then be summarisedn then be summarisedas meaning that while the ineriorpractitioner attends to the externalmechanics o his/her needle technique,the superior practitioner quite literallyattends to the spirit within themselvesas well as that o the patient. It willbecome apparent in the lines belowthat spirit in this sense is intimatelyspirit in this sense is intimatelypirit in this sense is intimatelyrelated to ones appreciation o ands appreciation o ands appreciation o and

interaction with the ji-dynamic thatwill be introduced in line eight.eight..

Shen as a knack or capacity or efcacy

Finally, shen may reer to something orsomeone with a remarkable capacityor ecacy. Its dening characteristicis that it is somehow more than sim-ply an expression o consummate skill.One story in Fan Yes Histories o the

Latter Han

illustrates this use o thethetheword specically as it relates to acu-puncture. When Emperor He calledupon the physician Guo Yuthe physician Guo Yu to de-to de-scribe his approach to needling, Guoexplained:

As for doctors talking about intention, theinterstices and pores have extremelysubtle divisions, so to follow the qirequires skill. When inserting needlesand the stone [probes] between

them, being a hair off means failure.The knack exists in the connectionbetween the heart-mind and hand. Itcan be understood, but it cannot bespoken of., 39

The language o this passage bears

a p .

aq. (398-455), Hou Han-Shu .

ar. Emperor He (f. 89-105), Physician Guo Yu

.as.


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some remarkable similarities to that usedin the Ling Shu, and it makes a crucial pointregarding the nature o needling. Shen hereresides in the subtle relationship between

the mind and the hand, which both includesand transcends mere skill and technique. Itis a knack insoar as it is particular skillthat can be learned but is oten innate orintuitive. That is why it can be understoodbut not spoken o. In line [2], the crudeattend to the orms o needle technique butthe superior go beyond this to make use oa subtle knack that is necessarily groundedin technique.

This understanding o shen ampliesthe shadings o the word discussed above.

The knack or needling that is so dicultto talk o hinges on the quality o ones at-tention and ones capacity to utilise it whenneedling. This is something one must ulti-mately discover and develop or onesel.

. [3][3]S , , , , , .Most commentaries read this line asa statement regarding the correct and

pathogenic qi. Ling Shu-3 contains threestatements to this eect.The spirit and guest is the conjoining o

the correct and pathogenic qi.

The spirit is the correct qi. The guest isthe pathogenic qi.

At the door means that the pathogenic[qi] travels along the exits and entries o thecorrect qi., 40

Ling Shu-32 corroborates this inter-32 corroborates this inter-pretation o spirit, emphasising itsspirit, emphasising itspirit, emphasising itsphysiological basis.

Thereore, the spirit, is the essence qi othe water and grains.41 Ma Shi adoptsa similar perspective, dening the dooras an aficted channel. An afiction bypathogenic qi is at times like the periodiccoming and going o a guest, so it is calledby the name guest. The guest at the door isthe pathogenic guest [qi] at the gate o eachchannel.

at.

au.

av.aw.

ax.

Yet, Su Wen-26 uses the phrase Spirit ohSpirit ohpirit ohspirit,in quite a dierentcontext that againpirit,in quite a dierentcontext that againin quite a dierentcontext that againin quite a dierent context that againsuggests it is something more and perhapsmore subtle than simply the correct qi.

Spirit oh spirit! Although my ears cannothear it, i my eyes are keen, the heart-mind open and the will luminous, then Iwill be the only one to be conscious o it.The mouth cannot speak o it, and manylook at it, but I alone perceive it. Althoughit is appropriately obscure, it is clear to mealone, like the wind blowing the clouds.For this reason it is called the spirit., 42

As mentioned above,ji and shen are nearly

synonymous in many contexts. Centralin many contexts. Central. CentralCentralCentralto the appreciation o both is a state oopen awarenessa presencethat is itsela presencethat is itsela presencethat is itselpresencethat is itselis itselspirit. It is this state o awareness that isemphasised in line three.three..

Where line two contrasts a spirit o two contrasts a spirit o contrasts a spirit oattention witha preoccupation withexternalwith a preoccupation with externala preoccupation with externalorms, line three may be understood asthree may be understood asmay be understood asemphasising the importance o a certainquality o attention in assessing states ohealth and disease.

.[4][4]W , ?In interpreting this line, Ling Shu-3.1emphasises the importance o examiningthe state o correct and pathogenic qi withinthe channels prior to treatment. Withoutobserving the disease means that one mustrst know about the pathogenic and correctand in which channels there is disease how can one know its origins, means that

one must rst know how to identiy thelocation o the diseased channels., 43

Following this interpretive thread throughthese rst our lines we learn that one mustassess the state o the qi and blood prior toactually needling. This is ne as ar as it goes,however, we have already established thatthere is another layer o meaning embeddedin this rather sel-evident message. Thepreceding lines o the Ling Shu rcis rstclariy that not only must one observe a

ay.

a.

The knack or needlingthat is so difcult to talk

o hinges on the quality o

ones attention and ones

capacity to utilise it when

needling.


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