Acupuncture and Diaphragm

Short notes on Acupuncture and Diaphragm

Diaphragm

The ancient character for 鬲

The ancient character for 鬲

The diaphragm and its constriction caught my attention some years ago as I noticed that most of the patients coming to the “infertility” treatments had their diaphragm constricted, coldness of abdomen, cold womb and many of them had acid reflux.

Physically the diaphragm is a sheet of muscle separating thoracic cavity and abdominal cavity. The diaphragm plays important role in respiration, and is also involved in vomiting, expelling feces and urine. The pressure from diaphragm helps esophageal hiatus to preventing acid reflux. The muscular structure is also connected to ligaments of vertebral column.  The diaphragm is innervated by phrenic nerve formed from nerves coming from C3-C5.

In Chinese medicine

In classic medical texts the problems of diaphragm are usually seen more as symptoms of disease than the source of the problem. Most of the classics speaks of heated, cold, full or distended diaphragm. The symptoms mentioned in connection are mostly of vomiting, constipation/diarrhea, food retention, qì rebellion and breathing difficulties.

However the problem is much deeper. For example physician named Yùchāng (喻昌) wrote in 1645 in Yùyìcǎo (寓意草) how the dàlùo of Stomach and the qì of Lung go through the diaphragm. Because of moving and transformations of jīng, blood and qì the constricted diaphragm is seen to cause serious problems as it is “Not only the womens disease but also the child [in womb and while breatfeeding] loses it nourishment”.

When we look at the channel pathways we can see something very interesting:

  1. The Stomach channel coming downwards from the throat goes downwards and goes through the diaphragm area. The dàlùo of stomach goes from stomach to lungs passing the through the diaphragm as it goes.
  2. The Spleen channel likewise go through the diaphragm as it ascends. One branch that enters the spleen and stomach rise from stomach through the diaphragm and enters the Heart.
  3. The Lung channel beginning from the middle burner descends to the lower burner and ascends again passing the diaphragm before entering the lungs.
  4. The Large intestine channel after ascending the arm goes from Li15 to Du14 and goes to qūepén area where it branches. The descending branch enters the lungs and penetrates the diaphragm before entering the colon.
  5. The Heart Channel starts from the Heart and descends through the diaphragm to small intestine. The Heart also has network of connection to every Zàng-organs and most of these connections has to go through the diaphragm.
  6. The Small intestine channel after rising the arm branches at the qūepén area. The descending branch goes to Heart and descends further through the diaphragm to small intestine.
  7. The Kidney channel goes through diaphragm area while ascending before it dives to the Lungs and Heart.
  8. The liver channel after ascending from toes to abdomen enters the liver and gallbladder and continues to ascend through the diaphragm to costal region and finally to throat.
  9. The Gallbladder channel descends from qūepén area down the chest passing the diaphragm and enters the gallbladder and liver.
  10. The Sānjiāo channel branches after reaching qūepén area and the one part of it goes down to chest connecting Xīnbāo and descending trough the diaphragm to connect all the three burners.
  11. The Xīnbāolùo Channel starts from the chest and descends through the diaphragm to join the three burners.
  12. The Rènmài  pass through the diaphragm and the rènmài 15 is seen as a lùo-point of Rèn as from there the channel branches and the branch disperses to diaphragm.
  13. Chòngmài as it rises from womb it passes through the diaphragm. Chòngmài is responsible of red blood transforming to white milk during the breastfeeding.

There are also numerous other connections from different branches of the main channels. And as the diaphragm is a muscle it is very important to note that the Stomach, Spleen, Heart and Xīnbāo muscle channels all connect to the diaphragm.

From this it becomes clearly understandable why the diaphragm plays such important role upon all the ascending and descending within the energy system.

In alchemy

The diaphragm in Chinese language is 膈 (gě). Today the character for diaphragm is written with flesh radical (月 + 鬲) and the whole character is translated as diaphragm. The older form of character omits the flesh radical and the simple 鬲 translates as iron cauldron or earthen pot. This older name reveals much clearly the function of the whole diaphragm.

All the six fǔ-organs and three of the five zàng-organs reside below the diaphragm. Only the Heart and Lungs reside above it. The diaphragm stands between the upper and lower, separating them. The qì and jīng are below and the source of blood (Heart) is above. Water (Kǎn) below and Fire (Lí) above. In cultivation practices the diaphragm is very important as it controls the rising and descending of fire and water. It mixes the yuan qì and post heaven qì. The earthen pot is the whole abdominal area where the cooking of alchemical herbs is done.

In inner alchemy the diaphragm is connected to following “parts of the body”:

  1. Squeeze the spine pass (夾脊關 – Jiājǐguān) in the back
  2. Doves tail (鳩尾 – Jiūwěi) and Crimson palace (Jiànggōng) in the front
  3. The Great gate tower (巨闕 – Jùquè) within.

In emotional level the diaphragm works as an emotional shield and bridge between the unconscious and conscious emotions. It can block the emotions stored in the lower abdomen from over-flooding the Heart and consciousness. Its functioning can be easily observed in children. When the emotions are too hard to deal with the diaphragm becomes tense and whole upper stomach get tense. The sobbing, crying or vomiting are biological ways of relieving the formed tensions. Quite common result of diaphragmatic tension is digestion problems or diminished appetite. One very common manifestation of this blockage is that there is cold and possibly qì masses or even blood stagnation masses below while there are heat and fullness above manifesting as symptoms like feeling of stuffiness at the chest and throat, nausea and acid reflux.

It also seems that many common anti depression medicines block the diaphragm. This also might explain some of the most common side effects like nausea and heart-burn. Sometimes you can see how medicated bodies express strange division where rest of the body still show the emotional strain while the facial expressions seem tranquil and rationally distant. In these cases the certain caution is in place while treating the area.

Acupuncture and diaphragm

One commonly used acupuncture point is called 膈俞 (Bl 17 – gěshū).  In Nánjīng reads “血會鬲俞”, meaning that the Blood meets or collects in Gěshū. The point is seen as “master of blood” as the Heart above produces the blood and the liver below stores it. This point is commonly used in many Blood related diseases and it is great for moving blood and qì. Shū point are places from where channel branches to fill places/organs with qì. The great meaning of point is revealed while applying moxa here as it results in warming the whole abdomen or the cauldron for alchemical cookings.

The point lateral to Gěshū is much less used point called 膈關 (Bl 46 – Gěguān). It is a great point to open the diaphragm and open the lid upon the cauldron. This point is better for opening the diaphragm than the Gěshū.

In front we have Ren 14 Jùquè (巨闕). The name means the great gate tower. It is the mù (募) point of the Heart. It is the watchtower to protect the imperial city. At the back there is also hidden points called 巨闕俞, the shū point for this watchtower.

In emotional problems with constricted cauldron one of my favorite ways of opening the diaphragm is to first needle Gěshū and Gěguān in intention of first stirring the cauldron and opening the lid. Then using qìgōng at Jùquè to very genty open the gates to the Crimson palace of Heart.

One good point for very prolonged blockage is Ren 15 – Jiūwěi (鳩尾). Jiūwěi means Doves tail. It is also called  Shéns treasury (Shénfǔ 神府). The point is yuán point for gāo (膏) and the point has a great effect to all the Zàng-organs. This point is also the lùo-point of Rènmài. The lùo merges to the diaphragm. It is said that when one descends from here he/she becomes tangled in emotions and thoughts of later heaven and when one ascends from here one returns to the Palace of Shén.

These are just a few points affecting the diaphragm. Other common points include other local points (mostly stomach and kidney channel points). Also because the fact that diaphragm is a muscle and the courses of muscle channel pathways the distal points of Spleen, Stomach, Heart and Xīnbāo channels are also effective.

It is very important to be very gentle while trying to open the diaphragm. Any tension or forcing will easily prevent the opening from happening. The opening is sometimes accompanied with involuntary laughter, crying, sobbing and/or shaking. Care must be taken that the emotions have time to settle down before leaving the patient.

Do you have a great Gallbladder?

Gallbladder in classics

In acupuncture the Gallbladder channel is used frequently for wide variety of symptoms. The most common mental association are with anger in case of excess or timidity and indecisiveness in case of deficiency. These ideas of Gallbladder (mental) pathologies originate from Sùwèn and Língshū.

Sùwèn explains that Gallbladder is linked to anger (ch. 23) and also explains how a hot gall and indecisiveness are linked to throat and bitter taste in mouth (ch.47).

Língshū tells that weak, dull and fearful mind are part of Gallbladder pathologies (ch. 4). In dreams the Gallbladder can produces themes of fighting, blaming and self cutting (ch. 43: “則夢鬥訟自刳”). The chapter 50 explains how courage of soldier is linked with abundance of Gallbladder qì, strength of liver, heart and Sānjiāo.

But why Gallbladder is associated with decision and judgement? Why does the big gall mean great courage?

The Sùwèn 8 says: “The Gallbladder is official of exact and correct, decision and judgement stem from it.” (膽者中正之官決斷出焉)

中 means center, central, exact and for example in archery hit to the center.
正 means just, correct, upright and correct
決 means to decide, conclude and judge. It also means to execute a person.
斷 means to cut apart, sever and to decide. It also means to put an end to something.

The Gallbaldder is a fǔ organ and its zàng pair is liver. The liver is said to be the general of the imperial army, who is responsible for plans and vision of the situation. But even its decision depends on the gall. In fact Sùwèn 9 states that “All 11 organs obtain their judgement from Gallbladder”.

One of the easiest ways to understand this is by meridians. The gall belongs to Shǎoyáng. The Shǎoyáng is composed of two meridians, one being the gall and other being Sānjiāo. The Sānjiāo (as three burners/jiāo and not just the channel) has its beginning in the space between kidneys or Mìngmén. The much debated Nánjīng chapter 66 explains how the influence of the Sānjiāo stems forth and forms the source of all meridians. Its influence can be found from source or yuán (原) points of every meridian. The Sānjiāo is sometimes thought as a prime mover and a link between the earthly manifestation (of elements/organs and meridians) and the formless Heaven.

The Gallbladder is also one of the six extraordinary fǔ, others being brain, marrow, bones, channels/blood vessels and womb. These extraordinary fǔ are formed of Earthly qì and they function like Earth by storing the essences. The Sānjiāo and these extraordinary fǔ-organs form the structure of essence cultivation and transformation. The Gallbladder has close relation to other extraordinary fǔ-organs. Therefore it is said “the qì that is born within the Gallbladder is the source of 10 000 transformations”. (膽中生氣為萬化之元也)

Gallbladder Shén

The Gallbladder once also had its own Shén called Blaze of the Dragon or Lóngyào (龍耀).

In Xīuzhēntú there is a paragraph about Gallbladder:

膽者金之精水之氣其色青附肝短葉下膽者敢也膽大者必不驚神名龍耀字威明形如龜蛇混形其象如懸袋重三兩三銖為肝之腑若據膽當不在五臟之數應歸於六腑因膽亦受水氣與坎同道又不可同於六腑故別立膽臟合於膀胱亦主毛髮黃庭經曰主諸氣力攝虎兵外應眼瞳鼻柱間腦髮相扶亦俱鮮九色錦衣綠華裙

The Gallbladder is the essence (jīng) of Metal and Qì of the Water
Its color is blue-green (Qīng)
As small sack it is attached under the Liver
Gallbladder is the courage and sureness
When Gallbladder is big one does not fear or be frightened
Its Shén is called Blaze of the Dragon (Lóngyào)
Its function is to be Majestic Brightness (Wēimíng)
Its form is like mixture of the turtle and snake
Gallbladder looks like a hanging sack
It weights three liǎng and three zhū (about 115g)
It is the Fǔ and is like it were grabbed by liver
Gallbladder should not be counted to five Zàng, it belongs to six Fǔ
Gallbladder receives Qì of Water and with Kǎn (坎 ☵) it collects the Tao
So it is not similar as others of the six Fǔ
And it could therefore be counted as Zàng
Together with the Urinary bladder it governs the hair
Huáng Tíng Jīng says:
(Gallbladder) governs all the Qì and strength (Lì)
It directs the strategy of attacking tigers
It has outer relationship to gazing, pupils
And the root of the nose between the eyes
It supports the brains, hair and also everything that is bright
(Its Shén has) nine colored bright cloak and green glorious hems

The quote in the end is from Huángtíngjīng. In Huángtíngjīng just before the quote reads that:

膽部之宮六腑精,中有童子曜威明。

“Within the palace of Gallbladder is the essence of six fu.
At the center is Young child (like) glorious Majestic Brightness.”

The text later continues:

能存威明乘慶雲,役使萬神朝三元。

[Gallbladder] is able to store Majestic Brightness and ascend with the blessed cloud.
Serving as delegation between 10 000 shén and three origins (sānyuán or three pure ones).

With these pieces of information it becomes clear that the courage is born out of qualities associated with clarity and brightness. With Sānjiāo the Gallbladder is connected to Heaven and Tao and can bring down their perspective and clarity to other Shéns. With this clarity and vision the plans (Liver) can be made, the decisions of heart can be firm and found, the fear of kidneys transform to alertness and reaction speed, 7 pòs remain lightened and yì is steady. This is when the true courage is born.

These mental aspects of Gallbladder are treated in classics with GB 40 Qiūxū (丘墟) as it is the yuán (原) point of Gallbladder. Many modern authors seems to use more GB 13 Běnshén (本神). Běnshén being also excellent because it has connection to root of all shéns, Yuánshén (元神) residing in the brains. It also gathers all the shéns and rises the essence to fill the brain.

Following points are have also proven clinically excellent even as they are less known and used in modern practice:

GB 18 – Chéng líng (承靈)

Gallballder in communication with Líng or Heaven.

GB 23 – Zhéjīn (輒筋)

This point was once called 神光 (shén guāng – Shéns brightness) and  膽募 (dǎn mù). It was considered mù point of Gallbladder. Currently the following point rì yuè (日月) is held as mù-point.

GB 27 – Wǔshū (五樞)

The name could be translated as the Axis of five (shéns). It also has connection to Girdle vessel.

GB 28 – Wéidào  (維道)

This point reflects the function of Gallbladder to store and collect Tao with the lower jiāo (坎 ☵).

GB 42 – Dìwǔhuì (地五會)

This is the point of Earthly meeting of five shén. The Heavenly meeting is at St 9.