Cold Yang Constraint

Cold Yang Constraint here is a term I use not to describe a particular pattern but a particular pathological phenomena that occurs within the bodily mechanism. It, in fact, is not Cold Yang or Yang that is Cold, it is Yang confined, fastened, or trapped by Cold. Cold 寒 damages various levels of patterned movement depending on whether it resides inside or outside the vessels 脈. If external of the vessels, namely affecting the vessel terrain, even then due to this environmental change the "vessels become cold. When the vessels are cold, then they contract and curl, when they contract 縮 and curl 踡 then the vessels are curved and tense (Ji 急)." (Suwen 39 舉痛論). Here the latter "vessels" are referring to not only the Mai that the are containers of moving substance and Shen 神, but also what one may palpate at the site of Qikou 氣口 at the wrist. Ji, a tense pulse is an indication of exactly that: "trapped Yang". Suwen 3 states "Because of Cold, (Yang 陽) tends to resemble a moving pivot. Rising and resting as if frightened, the Shen qi floats." As many will see in the commentary there is great discourse and discussion regarding the proper intention of this passage - however, the concept of Shen as Yang becoming agitated due to constraint is absolute and clear. Shen / Yang needs space, as the preceding passage in SW3 states "the movements of Tian 天 require the sun to be lustrous and brilliant". So how then, does this translate clinically, how can we observe this change and how can we appropriately intervene? As previously mentioned there is a distinct defining indicator that occurs when Yang becomes trapped: Ji Mai 急脈, often described as a tense, impatient vessel presentation and as Lingshu 4 states, "All kinds of Ji Mai indicate Cold". Here the vessel is responding in the same way that the body is (exact location is determined by what pulse at what site - we often talk of the Qikou pulse, however, this of course can occur at any of the pulse palpation sites around the body). Yang is being held captive by the cold, it has little space to move - but this is the key, it still has some space in most cases. Much like the description from Suwen 3, the Yang itself is "frightened" or better yet, panicked and impatient, like a claustrophobic individual stuck in an elevator the Yang qi is constantly looking for a weakness within the impending full constraint of the cold in order to escape. And this is where we as physicians must step in, we must intercept this Cold before it completely traps and consumes the Yang, leading to more serious, chronic, and difficult to treat illness. Our tools or our teas do the work. As we are Neijing / Yijingpai focused at the INR we will be discussing acupuncture here, however, there are certainly methods within the Jingfangpai that will yield similar results via a different means. Trapped Yang, Cold Yang, can manifest at any of the varying levels of the compass of the Jingluo. Depending on the level, depending on the terrain, anatomical correlation, and possibly specific pathway will determine what method is used. If cold has constrained the Yang of an organ, then yes, these methods can be utilised to influence the geography of that particular organ, however, often additions are employed (and will likely be discussed at a later time). How we needle Cold is determined by how that Cold manifests and where. If, for example, the Cold is palpable, that is, there is a feeling of Cold (discussed shortly) that the physician can feel (regardless of whether the patient can feel anything) and the edges of that Cold are clear and the depth and shape of those edges are defined then Qi Ci 薺刺 or Yang Ci 揚刺 are the primary techniques. Palpable Cold does not need to be actual temperature based Cold. Remember this is a pathology based on constraint there is a contraction, there is a blockage, so under our fingers we may feel tightness, a lump of sorts, or there may be pain upon pressure etc. The cold may be confined to something as small as a pea or could cover the entire back of an individual - it doesn't matter, what determines the use of the needling methods is depth and tissue, we find the edge of the Cold, we feel the depth of that edge and we needle either shallow (Yang Ci) or deep (Qi Ci). If the Cold is trapped within the longitudinal patterned pathways of the Jin 筋 then our methods will revolves around the 3 Jin techniques of Cui Ci 焠刺, Hui Ci 恢刺, and Guan Ci 關刺. Cui Ci is the exception here, but all these methods require patience and time - sneak up on the cold, slowly and surely break down the edges of that cold, flank it, and shrink it to allow the body to recognise that the Yang is trapped but help is on the way - then, and only then, will the Shen properly be able to engage and the facilitation of healing will have started. This is just a short note on constrained Yang caused by Cold, in future posts will discuss more on specific types of constraint within the Zang organs and channel complexes. For further information and seminars on the methods discussed above please see the online talks by Dr. White at www.instituteofneijingresearch.com. David White - INR