The classics can be obscure, and may appear to have little clinical relevance. However, useful interventions can be discovered through study and contemplation. The question is not whether the resulting application is what the ancients intended, but whether the resulting clinical application is useful and can make a contribution to the field.
This paper discusses some practical applications of chapter five of the Nan Jing as found in Tu Ju Wang Shuhe Mai Jue Ba Shi Yi Nan Jing Bien Zhen (Pictorial Notes on the Pulse Songs of Wang Shuhe).1 The five-depth system is also discussed in other important texts of Chinese traditional medicine, including the Mai Jing (Pulse Classic)2 and Li Zhi Shen’s Pulse Diagnosis.3 While each text discusses the method of pressure to assess the five depths, none of these sources discuss the practical application of the method. The Nei Jing and Nan Jing both describe three-dimensional models for pulse diagnosis. Each position represents a burner, as does each depth. The trick is making sense of this set of possibilities; the solution is to focus on each aspect, one at a time. For instance, if the distal positions are weak, this suggests depletion in the upper burner. (The nature of the depletion will depend on other signs and symptoms.)
In chapter five, beans are used to signify the depth of pressure. “With a very light hand press superficially and then press harder; 1st depth is 3 beans pressure to the lungs and skin, 2nd depth is 6 beans to the heart and the vessels, 3rd depth is nine beans to the spleen and flesh, 4th depth is 12 beans to the liver and sinews, 5th depth is 15 beans to touch the kidney and bones.”4 Please note: depth is based on light pressure at the skin and deep pressure close to the bone, rather than using the vessel as the starting and ending point. For instance, the fingers are not merely pressing at six beans of pressure to examine the heart; one is pressing with an intention to examine the vessels.
The table in Pictorial Notes on the Pulse Songs of Wang Shuhe from the Qing dynasty includes only the organ, weight, and tissue level. This table adds other correspondences such as the phase and the corresponding perception.
|Table 1: Systematic Correspondences|
|Table 2: Three Depths and Five Depths Correspondences|
|3 beans pressure||Heaven or qi depth||Upper Burner||Skin|
|6 beans pressure||Vessels|
|9 beans pressure||Human or qi depth||Middle Burner||Flesh|
|12 beans pressure||Earth or organ depth||Lower Burner||Sinews|
|To the bone and lift||Bone|
This method can be reduced and made simple. Divide the region between the skin and the bone into three areas. This is the heaven-human-earth method. Then, the qi depth (heaven) is divided into Metal and Fire, while the organ depth is divided into Wood and Water.
Application The ability of an organ to control the tissues is another indirect suggestion that occurs in chapter five of the Nan Jing. For instance, the spleen’s capacity to control the flesh is evaluated at the middle depth. To examine the biceps, explore the middle depth in the right distal position. This provides information about the muscles and flesh along the trajectory of the lung vessel. As an alternative, use the middle depth (earth and spleen sector) in the proximal position to examine the musculature of the lower back.
There may be either excess or deficient signs at any depth. Even technique on the corresponding transport point will generally cause the anomaly to self-correct.
The operating premise is predicated upon fractal and holographic thinking. That is, a correction in a part will reflect corrections in the whole.
Applications of the Five-Depth Model
- Point selection
- Needle depth and breadth placement within a point
Diagnosis: A pulse with the Metal and Fire areas absent (qi depth) suggests a qi depletion pattern. It can also suggest that the capacity of the upper burner is diminished. The treatment is to select points, herbs and qigong to increase qi in the upper burner. Acupuncture could include tonification of back-shu or front-mu points; medicinals that supplement the qi of the heart and lungs are another possibility. Qigong methods include those that stretch the heart and lung vessels such as expanding the arms laterally so the angle of stretch is along the vessel. Cardiovascular exercise maybe recommended if appropriate.
Point selection: The depth where a depleted sensation or replete sensation is identified suggests a corresponding transport point on a channel. For instance, the left middle position corresponds to the liver orb of influence. If the pulse is floating and there is no root, needling the Water point on the Liver channel usually causes the root at the liver position to fill in.
Needle depth: The standard needle depth can be divided into five regions, and the region corresponding to the tissue layer is needled. The pulse can be palpated while the needle depth is adjusted to refine the depth of insertion. The distance within the point range can be divided into five sectors. The area closest to the bony landmark is the Water area – look for the most tender spot or palpate for the spot that corrects the pulse depth.
Case Example The patient is a 54-year-old female undergoing chemotherapy for breast cancer. Her pulse is thin and weak. (It was also absent at the Water depth in the left middle position.) The tongue is pink and thin; this is due to a qi and yin depletion pattern. She has fatigue, leukopenia, no appetite, and nausea. In addition, when she received typical TCM-style point selections such as Sp 10, St 36, Sp 6, Lu 9, and K 6 for a standard amount of time, she would experience a collapse of energy and remain in bed the whole next day. When the strategy of supplementing the liver Water point and supporting that treatment through the biao-li interior-exterior channel method, including Lr 8, GB 44 and SJ 5, was combined with corresponding mu points Ren 5, Lr 14 and GB 24, she felt relief, increased energy and diminished nausea. In addition, her leukopenia went from a count of 2,600 to 3,800 cells/µL/cu mm over the period of one week, with two treatments based on balancing the five depths of the liver position.
I would like to thank Christine Chang, a licensed acupuncturist and pharmacist at Emperor’s College of Traditional Oriental Medicine, for her assistance in translating chapter five of the Tu Ju Wang Shuhe Mai Jue Ba Shi Yi Nan Jing Bien Zhen.
- Aing Y. Tu Ju Wang Shuhe Mai Jue Ba Shi Yi Nan Jing Bien Zhen (Pictorial Notes on the Pulse Songs of Wang Shuhe). Yi An Tong, Shu Lin, Qing dynasty.
- Wang S. The Pulse Classic: A Translation of the Mai Jing. Blue Poppy Press, 1997.
- Zhen LS. Pulse Diagnosis. Brookline, MA: Paradigm Press, 1981.
- He WS. Wang Shu Tu Zhu Nan Jing Mai Jue (Wang Shu He Picture Chart Markings of the Nan Jing and Mai Jue). Jin Lun Tang, Qing dynasty.