In response to Manuel’s question, I’ll elaborate a little on the disharmony between Ying and Wei qi, especially in relation to the Qi Jing Ba Mai.
Much of this material will be actually clear to Manuel, since he teaches this stuff over long time, but maybe some other students will benefit from it. I tried to illuminate it a little during the webinar, but due to lack of time and my disability to be clear , I thought it would be nice to write a little about it.
Disharmony between Ying and Wei has been discussed already elaborately in the classics. The Shang Han Lun, especially the Tai Yang chapter devotes a lot of discussion to this topic. Dan Bensky illustrated nicely the disharmony between Ying and Wei with three different (modified) Gui Zhi Tang formulas, all covering different aspects of Wei and Ying disharmony.
In the Shang Han Lun there are many examples of possible disharmonies, for example in the case of Zhong Feng (attack by wind cold), when wind is predominant we see that the pores of the skin are open and sweating appears. The defensive qi will rise against the wind cold and their appears stagnation on the body surface. It also fails to warm the skin and open the pores and protecting the nutritive qi, which results in aversion to cold, chills, body aches, fever and spontaneous sweating. All those symptoms compromise the communication between the Wei and Ying outside and inside the channels. This is one type of disharmony between Wei and Ying, which is called rong ruo wei qiang (see line 95 in Shang Han Lun), which means weakness of the ying qi and unreasonable strength of the wei qi. Here weakness doesn’t mean necessarily deficiency, but a leakage of the ying qi and unreasonable strength means here stagnation of the wei qi. ( Gui zhi Tang is used in this case of Zhong Feng)
Another example is when cold is predominant (Shang Han), and the pores of the skin are contracted. This will initiate a deeper and broader obstruction of the body surface which will result in obstruction of both the wei and ying qi, which will lead to symptoms like absence of sweating, general ache and pain, muscle and joint pain or even panting. This is another form of disharmony of Ying and Wei Qi. (In this case there is another strategy, using Ma Hua Tang).
These are just two examples of how disharmony between ying and wei qi can manifest, and to what kind of symptoms that can lead.
Ultimately in therapy we need to initiate the body’s ability to self-regulate and to help to dissolve these disharmonies. The beauty in for example a Gui zhi Tang formula is that it helps this self-regulatory effect. If we would translate that to acupuncture, we have no formulas to do that, but with all the skills we have, we could distinguish which points at that moment in time would be able to initiate that self-regulating effect.
We should be aware that disharmony between Ying and Wei can be caused by external pathogens as well as internal disturbances.
It is also good to keep in mind the original metaphors of Ying營 and Wei衛. Ying are the barracks, the Camp qi and the Wei is our defence, the soldiers. Ideally there should be a good transport and communication between the two. The Barracks also are responsible for the nutrition of the soldiers. If there is not enough nourishment, the soldiers might desert. The soldiers need also to be backed up, if you are the only soldier left on the wall without any protection you will either abandon the defence wall or be wiped away. If somehow the communication is compromised, if it is not Tong, then we can see disharmonies between the Ying and Wei.
There are different venues for the Ying and Wei qi to be distributed and regulated in the body and there are different ways to address issues of the Ying and Wei. One way to address them is also via the Qi Jing Ba Mai, since especially the Wei and Qiao vessels play an important role in the distribution of the Ying and Wei qi.
While the Chong, Du and Ren and probably also the Dai Mai are primary concerned with the transmittance of Primal or Yuan Qi元氣, the Wei and Qiao vessels are more in charge of the distribution and regulation of the Ying and Wei Qi. This is at least the opinion of one the most important physicians of the late Ming dynasty, and one of the most influential physicians in the history of medicine, Li Shizhen. He clearly exposes these ideas in the Qi Jing Ba Mai Kao. Li Shizhen was not so outspoken about the transmittance of the Yuan Qi in relation to the Ba Mai like some later physicians like Luo Dong Yi, but he clearly builded on the Neidan(Internal Alchemy) heritage in which the Ba Mai are seen closely connected with Yuan Qi.
There has been a lot of discussion in the past and different authors have different interpretations but many physicians agree with Li Shizhen that the Wei and Qiao vessels distribute and regulate the Ying and Wei. Some had slightly other opinions, like Luo Dong Yi , who states that the Wei are in charge of the nutritive and the Qiao are in charge of the defensive qi. But most scholar physicians of the late Imperial time agree with Li Shizen’s general idea and builded further on that.
If we would take that in account, we could elaborate a little bit on the functions of the Wei and Qiao in relation to the Ying and Wei qi and also the possible pathologies which could show up.
Yin and Yang Wei Mai
When we look to the function of the Yin Wei and Yang Wei Mai, we can state they have several important functions:
1) They hold the Yin and Yang functions of the body together.
This means the Yang Wei rules the exterior and the Yin Wei rules the interior. They can be seen as a binding network, the Yang Wei binds all the Yang, The Yin Wei binds all the Yin. According to Li Shizhen, the Yang Wei rises from the meeting of all the Yang and travels from the outer ankle in the protective aspect and the Yin Wei rises at the meeting of all the Yin and travels from the inner ankle in the nutritive aspect.
When the Yang and Yin Wei overflow from accumulation their contents stagnate and they are unable to circulate and irrigate all the other primary channels.
2) They master the Wei and Ying Qi
“The Yangwei is the defense, above it moves in the defence aspect. The Yinwei is the construction, above it moves in the construction aspect.” (Pulse Classic)
We can interpret Yin and Yang Wei on 3 different levels.
1- The Yin Wei connects the 3 Yin layers , Yang Wei connects 3 Yang layers
2- Yin Wei is internal , Yang Wie is external
3- Yang Wei – Wei qi 衛氣, Yin Wei – Ying Qi 營氣
1) In the Nan Jing is described how the Wei are related to irrigation.
If that is not enough, we can see it in the face, the lack of lustre. It is like a plant, if there is not enough nourishment, not enough moistening, then we can see it also in the lustre of the plant. The same for the body. If the nourishment fails, it will show in the lustre in the face.
The Yang Wei connects all the Yang, the Yin Wei connects all the Yin (all the network channels)
All the reticular circuits between Tai Yang/Shao Yang/Yang Ming, are connected with Yang Wei.
All the reticular circuits between Tai Yin/Shao Yin/Jue Yin, are connected with Yin Wei
So here it is clear that the Wei have an important role in connecting the Yang and the Yin. So this connection is very important for the irrigation. Only when they are open and connected the Qi can travel from outward to inward and the other way round.
2)The second way we can look at it, is that Yin Wei rules the internal and the Yang Wei rules the external. So in that sense the Wei rule the different domains respectively.
3) The third way is to see the Yang Wei responsible for the Wei qi and the Yin Wei for the Ying qi. We will zoom in little a while more deeply into that aspect.
Pathology of Wei and Ying
There can be many different ways the Wei and Ying pathologies can manifest. In the most narrow definition we could say:
If Wei qi 衛氣is not functioning it results in fever and chills (heat and cold)
If Ying qi 營氣is not functioning it results in pain (pain in heart, epigastrium )
This is the narrow definition. But if we we look broader we could say:
Heat and cold stand in a broader perspective for a lack of circulation on the Wei level.
Pain is symbol for stagnation in the inner (micro) circulation . Heart stays for Ying here, pain for lack of blood circulation. Heart is also related to blood, so therefore this metaphor.
We should keep in mind that Ying qi is closely related to the blood and the fluids. So if there is a disharmony between Ying and Wei it can manifest in ways as described above. We should be aware that Ying and Wei qi need to operate in tandem, if one of them is disrupted it will affect the other.
How can we differentiate Wei Mai pathologies from others?
Extraordinary Vessel pathologies, especially the Wei, will generally involve more than one channel or division. So If one has Tai Yang and Shao Yang signs for example it might be an extra vessel pathology, for example Yang Wei.
Or if one has Tai Yin and Shao Yin signs it might be Yin Wei for example.
Another way to interpret the Wei Vessels is along the 4 levels:
Differentiation according the 4 levels (Wen Bing):
Wei is Yang Wei Mai (Qi aspect is the primal channels )
Ying is Yin Wei Mai ( Blood aspect is , when blood is injured)
We can also see a combination of Yang and Yin Wei disorders, those can manifest physically and psychologically.
Joint Disorders (Yang and Yin Wei) :
Another option is that we see a combined disorder of Yang and Yin Wei. This can result in physical and also psychological issues. This is already mentioned in the Nan Jing.
“Yangwei binds to the yang, Yinwei binds to the yin. If yin and yang cannot bind with each other then one experiences such disappointment (changran) that one loses one’s sense of purpose (shi zhi). One is without strength and one no longer has a hold on oneself.” (Classic of Difficulties 29)
Li Shizhen elaborates on that notion and explains it in the following manner:
“When the protective qi is weak, this is called fearfulness; and when the constructive qi is weak this is called shameful timidity. When the fearful and the powerless combine, this is called detriment.” (LiShizhen)
“Fearfulness is a stirring of the mind characterized by oppressive timidity. The protective emerges from the upper burner. When it is weakened, the upper [burner] is deficient, and this causes the mind to stir, causing oppressive timidity. Powerlessness is in the mind characterized by an awareness of shame. The Needle Classic states: The blood is the spirit qi. When the blood is weakened the spirit is weakened, therefore one is ashamed of oneself. Detriment is a deficiency of both the five viscera and the six bowels.” (Cheng Wuji).
(Clarification on the meaning of detriment by Ye Tianshi:
Long time deficiency without recovery is called detriment, extreme detriment without recovery is called taxation. These three patterns, deficiency, taxation, and detriment develop in succession. )
According to Li Shizhen, when Wei and Ying are weak this produces heat and cold, being fearful and powerless are not only synonymous to deficiency of Wei and Ying but also refer to the signs and symptoms that express those deficiencies
There is no place here to discuss all the different possible pathologies, the goal here is to give you an idea of the dynamic.
There can be many different possibilities like fullness or emptiness of the Yang Wei Mai.
Examples of Yang Mai pathologies
An example of excess is an invasion by an external pathogen like cold, which is getting stuck. So, the cold remains. Especially when we see more than one level is involved like Tai Yang and Shao Yang for example, we could think about addressing the Yang Wei.
In terms of emptiness we can see different possibilities, one cause can be due to weakness of the Middle warmer, but another possibility is weakness of Ming Men. In that case we need to mobilise the soldiers from Ming Men. Here we have a difference from the Middle Warmer, where you just have to nourish the Middle Jiao, but here we need to create the soldiers from Ming Men.
Overall in Yang Wei patterns we see heat/cold symptoms, but here in emptiness patterns we see that the heat is not so acute as from an external pathogen, so we see deficiency signs as well. So the presentation is not acute . Other signs might be that it happens in the night and no sweating for example (or the sweating doesn’t improve the patient).
Example of Yin Wei pathologies
“The yin wei fastens to the yin. If the nutritive yin is depleted there will be heart pain with a red tongue.”
The main symptom of Yin Wei Mai is Heart pain
(we should realise that this is not Heart pain in Classical Chinese medicine – Zhen Xin Tong. 真心痛 which is a very acute life threatening pain – could be heart attack, this is not Yin Wei Mai heart pain)
But in Yin Wei cases, it is not heart pain like this, but it is more Xiong Bi 胷痺 , this is not direct heart pain ( like angina pectoris).
In this case the circulation in the breast is not good , in the case of Zhen Xin Tong 真心痛, it is really in the organ.
In the classics we see only cold attacking heart, attack from heat is relatively new in Chinese medicine, we see this concept arising in the Later Imperial times.
Yin Wei heart pain is clearly something different.
Li Shizen considered Yin Wei heart pain also possible caused by heat
We should be aware that the Yin Wei in relation to the Ying Qi has a lot to do with micro circulation. So the main issue of the Yin Wei is a lack of micro circulation. (At least this is a view that took hold in late imperial time)
Next to the Wei, the Qiao Vessels also play an important role in distributing the Wei and Ying Qi.
There is no place here to go into a detailed discussion of the physiology of the Qiao Mai, but the main points are:
Main Qiao physiology:
1.The qiaomaì keep the connections between yin and yang open, and balance left and
2. The qiaomai govern the opening and closing of the eyes (waking and sleeping, the
basic circadian rhythms of the human body)
3. The yinqiao is primary in women; the yangqiao in men
4. Establishing conscious control of yin and yang, being the pump of Yuan Qi (according to Neidan master Zhang Boduan, the Yin Qiao opens all Ba Mai)
To give an example of disharmonies between ying and wei in relation to the Qiao we can look to the second point, the opening and closing of the eyes.
Li Shizhen is saying the following about the disturbance of this physiology:
“When a patient’s eyes are shut and they cannot see……, this is due to protective qi being lodged in the yin and unable to travel to the yang. When it is lodged in the yin, then the yin qi is overly full, then the yin qiao is full.
(When protective qi) cannot enter the yang, then the yang is deficient and, hence, the eyes are shut.
When a patient’s eyes cannot close…., the protective qi cannot enter the yin and constantly lodges in the yang. If (the protective qi) lodges in the yang, then the yang qi is full. If the yang qi is full, then the yang qiao is overly full. (If protective qi) cannot enter the yin, then the yin qi is deficient, hence, the eyes cannot close. “
Li Shizhen (quote from the Systematic Classic of Acupuncture and Moxibustion, which is again a quote from Ling Shu 80)
“The Five grains enter the Stomach and are divided into three pathways of dregs, fluids and gathering qi. Thus, gathering qi accumulates in the chest and emerges in the throat to link with the heart and lungs and propel respiration there. The nutritive qi secretes the fluids and pours into the vessels. It transforms and becomes blood to nourish the four extremities. Internally, it pours into the five viscera and six receptables in accordance with the time of the day. Protective qi emerges with an impetuous ferocity, first in the four extremities in the partings between flesh and skin, and it does so in a ceaseless manner. During daytime, it circulates in the yang, and at night, it circulates in the yin from the level of the leg lesser yin, traveling to the five viscera and receptables.
When a reversal of qi visits the five viscera and six receptables, then the protective qi alone protects the outside. It travels in the yang but cannot enter the yin. By traveling (only) in the yang, the yang qi becomes overly full, and when the yang qi is overly full, then the yang qiao caves in. When (the yang qi) cannot enter the yin, then the yin is deficient and the eyes cannot not close.”
Li Shizhen (quote from the Divine Pivot Ch 71)
Li Shizhen has emphasized the meaning of the character “xian” 陷 in the third paragraph, which is by many annotators of the Neijing taken to be a transcription error and often read as “man” 满 .
But Li prefers the original reading of the character xian and reads it as follows “when the yang qi is exuberant, then the yang qiao caves in or collapses. (yang qi sheng ze yang xiao xian)”
This gives us insight how Li Shizhen looked at Qiao pathologies. In this context it can have different dynamics:
1 The Wei Qi is lodged in the yin and is not able to travel to the Yang. The Yin Qi is full and the Yin Qiao is full. When the the Wei Qi cannot enter the Yang, the Yang is deficient and the eyes are not able to open.
2. The Yang Qi is congested in the exterior, preventing entering even the Yang Qiao, even much less the Yin Qiao. The Yang Qiao becomes congested as a consequence of an exuberance of Wei Qi in the Yang Channels. The Yang Qiao is full and the Yin Qiao is deficient. This prevents a descent of the Yang Qi into the Yin Qiao.
Here the Yang Qi is so co congested in the exterior, that it is not even able to reach the Yang Qiao, the result will be a caving in or even collapse of the Yang Qiao. The Yang Qi will never reach into the Yin Qiao.
This second dynamic we see often in the case of insomnia.
The only herbal formula mentioned in Li Shizhen’s Qi Jing Ba Mai Kao for the Yang Qiao is the Pinellia and Sorghum Decoction (ban xia shu mi tang) , (one of the few herbal prescriptions in the Neijing), this formula works actually very well for this kind of insomnia.
These are examples of disharmony between Nutritive and Protective qi in relation to the Qiao vessels, described by Li Shizhen.
This notion from Li Shizhen can be very useful in the practice since it shows a dynamic which often underlies insomnia. We tend often to think in modern TCM , that insomnia has to do with a lack of quantity of the Yin and hyperactivity of the Yang, but in reality this dynamic of the Qiao is often at hand. It is my experience that this concept is very useful in certain forms of insomnia. If we would simplify this, we could say that the Yang doesn’t enter the Yin.
The Wei Qi goes inside in the night (inner journey), it is an active process, but if there is obstruction if there is no Tong (openness) it is blocked, that’s why the Yang doesn’t go into the Yin. So it is not so much weakness of the Yin, but a blockage problem (bu Tong). If we can’t sleep; Yang is not going in yin. If we have no Yin we have in the day dry eyes.
Here there is also a relation with the Stomach. The Stomach plays an important role in the movement of Qi , in the day and night cycle. There is a Chinese saying: “When the Stomach is not good, no good sleep” So when there is for example heat in Stomach, one can’t sleep. We have to realize that often the Stomach is involved in Insomnia.
If the Stomach is weak, it doesn’t nourish the Wei Qi. That is also the difference between the Qiao and the Wei. The Wei Mai are responsible for the circulation of Wei in the external, but the Qiao are responsible for connecting the stomach with the exterior, to nourish the Wei Qi, the soldiers. We could say that Qiao problems have more to do with essence .
So here in the Qiao we have another approach than with the other 8 Vessels. We have to arrange the inter penetration of Yin and Yang and Stomach.
I have given here just a few illustrations how disharmonies between the Ying and Wei can manifest in relation to the Wei and Qiao channels.
At the core we should realize that the concept of Tong 通, is once again very important here. As long as the vessels are open and communicating, as long as Ying and Wei are able to travel freely and are connected and interconnected, a healthy physiology takes place. As soon as this free passage and communication is becoming compromised, we can expect disharmony between the Ying and the Wei. Disharmonies between Ying and Wei can play out in many different ways and the Ba Mai are only one aspect. But we have to realise that great physicians from the later Imperial times, like Li Shizhen, Yu Chang, Ye Tianshi, Shen Jin’ao and Luo Dong Yi attached all importance to the Ba Mai in relation to the Ying and Wei, especially the Wei and Qiao Vessels, even though they might have had slightly different interpretations.
In terms of treatment, our strategies in acupuncture, they will be different from herbal medicine. In the case of herbal medicine we adjust herbal formulas to the pattern we discern , based on all our findings. In acupuncture we have to find the most opportune points, the right moment, the right place. If we needle the points which show up themselves after we did all our diagnostic palpation, we can initiate that self regulatory process.
Whether we use herbs or acupuncture, we always address this self-regulatory mechanism in the patient. We can address issues like disharmony between the Ying and Wei in many ways, all depending how the body presents itself at a certain instance. In many cases we can address them via the primary channels and in other cases we can reach them via the Ba Mai.
In Engaging Vitality we always treat what we find. We try not to have a fixed agenda or expectations. Often we find other things than we expect actually. Dan and Chip have so often told us that we have to try to prove ourselves wrong. So most important is that we are able to observe the propensity (Shi) and Dynamic (Ji). If we are able to discern that, we can respond correctly on what the body deserves at that moment.
In terms of the Ba Mai, the morphology and the inherent movement can be very useful l if there is any disturbance of the Ba Mai, it will show in those ways. Hara and sometimes the (Ba Mai) pulses can be used as confirmation. Whatever we do during a treatment, we should see an improvement in all the parameters we use, whether the Shape of Qi, MTE, Yang Rhythm, Fluids, Yin Tide and all the other markers we use.
I hope I have illuminated this topic a little for all of you.
(Part of this blog is derived from my lecture on the physiology and pathology of the Extraordinary Vessels, which I gave in March in The Netherlands, quoted translations of Chinese texts are translated by Volker Scheid. This presentation couldn’t be done without the clear exposition by Chip and Volker, who truly helped me to gain a deeper understanding of the Ba Mai physiology)
For further reading:
Qi Jing Ba Mai Kao – Li Shizhen – An Exposition of the Extraordinary Vessels –Acupuncture , Alchemy &Herbals Medicine – Charles Chace/ Miki Shima – Eastland Press
Shang Han Lun – Discussion of Cold Damage -Zhang Zhongjing- Commentaries and Clinical Applications- Guohui Liu – Singing Dragon
In this discussion I have focussed solely on the Wei and Qiao vessels , since Li Shizhen considered them the most important in relation to the distribution and regulation of the Ying and Wei.
Of course other Ba Mai are also involved, for example the Du Mai plays into the distribution of Wei Qi and the Chong plays also a role in the distribution of the Wei Qi according to some scholars. There is not enough space here now, but a more elaborated discussion on this topic is needed.