Some thoughts on the last part of Ling Shu chapt. 3 and the direction of energy in acupuncture treat
The direction of energy during treatment is a major issue, whether you are treating patients with herbs or with acupuncture: as the Ling Shu states, inducing the patient’s energy to flow in the wrong direction will definitely worsen their condition.
So how can we address this interior 内 vs. exterior外issue? In other words, when treating a patient, should we open the periphery to help the yang circulate, which eventually will tonify the interior, or should we gather at the deep level, to tonify the yin, which will eventually reach the periphery?
Whereas the answer to this question is fairly obvious in some patients when their condition is clear (extremes, like strong Tai Yang types or weak Shao Yin types), it can be a bit of a conundrum with “in between” patients, for example in Tai Yin types: Spleen Tai Yin types tend to be blocked but have more strength then Lung Tai Yin types. If they are a bit on the heavy side, do they have the appropriate Jing and Qi to move on to Shao Yang or Yang Ming, in which case you can open, or are they heavy and depleted, in which case you need to gather for them to gain strength first, etc.
An efficient way of dealing with this interior vs. exterior issue with acupuncture is to use the 8 extraordinary channels. If you consider the Ba Mai not as the few points attributed to them in acupuncture charts (e.g. Chong Mai from Qi Chong to Heng Gu to You Men), as that is only their most superficial aspect, but as the main axes of the body along which energy is distributed (as in top/down, left/right, front/back and inside/outside), then Chong Mai and Dai Mai represent the内and外aspects of the body.
Chong Mai is the Sea of blood which feeds all the organs. When it is blocked, the whole body is depleted (if yin / Zang are depleted, the yang / Fu are most probably not doing too well either). Pulses then tend to be hard and very thin, wiry, because not much blood/yin is coming out of the Chong Mai (which is very close to the description of the Chong Mai pulse in the Mai Jing). In extreme cases, the pulses are even absent or hardly noticeable. The blockage could be due to anything: cold, improper diet, toxins (some vaccines, or medicines) and of course emotional stress (that’s where Yin Wei Mai and Pericardium come in). This is frequently seen in Tai Yin types (but not exclusively) due to the proximity between Chong Mai and spleen channel, and at any rate is most often the sign of a measure of yin deficiency. In this case, opening the Chong Mai means that you are releasing or opening the flow of yin at the deepest level, irrigating the organs with yin and blood. If you try to open at the yang then at best you will get no results (yang comes from yin, which is not “open”) or the patient will be even more depleted.
Dai Mai is the 外most superficial aspect of the body. When it is blocked, the yang of the body is not circulating, and the left superficial Guan pulse (link to GB through Zu Lin Qi) is affected (usually vibrating, but could be missing), which is again quite similar to the description of the Mai Jing. Opening or circulating the Dai Mai enables the flow of qi towards the periphery. Once the yang superficial level is open and circulating, qi can reverse course and gather again at the deep level. Such patients will tell you they are exhausted though their physical constitution is fairly good (often a bit plump). Once the yang Ba Mai are open and the superficial yang qi can flow out and back to gather in the yin again, the patient’s energy levels will go up. In this case, if you tonify the organs directly at the yin level instead of opening or circulating the yang level, you are just adding pressure to a blocked system, making things worse.
It can sometimes be difficult to tell these two kinds of patients apart, so it helps to combine observation, pulse, symptoms, etc. Besides their obvious physical constitution (heavy with or without strength, thin with or without strength, etc.), these 2 types of patients have slightly different pulses, as their yin and yang levels are different. In most people with a blocked Chong Mai, the pulse is generally thinner and harder than with a blocked Dai Mai (blocked Chong Mai = less yin, the blood doesn’t flow out, doesn’t reach the Mai Kou). In extreme cases, the pulse is thin to a point where you can’t really feel the three distinctive layers of the pulse. With Chong Mai, the spleen pulse is usually weak, or even missing altogether, whereas with Dai Mai the GB pulse is affected. With marked kidney deficiency (e.g. 5 elements, with a floating or large kidney pulse), the Chong Mai is more likely to be affected than the Dai Mai.
You can also check for symptoms: for Chong Mai, stabbing abdominal pain, Jue syndrome (cold extremities or limbs, with no strength), etc. For Dai Mai: bloating, slow digestion, headaches, discharge, lumbar pain, and often also wind/cold attacks, as the superficial yang is depleted and not protecting the body, etc.
Treating with the extraordinary vessels though very powerful, must of course be supported by the production of adequate blood and energy by the San Jiao, etc.: acupuncture is not about learning a series of techniques to address symptoms or syndromes, but about using a global and holistic understanding of the body to restore the proper flow of energy Qi Ji and the body’s balance. We are dealing with processes and dynamics, not with fixed states.