PURPOSE, ELATION, AND THE PANCREAS

DAN BENSKY, D.O.

     There are many ways to look at the state of acupuncture in America and the progress that has been made over the last twenty years. In this article I would like to discuss some of the really basic terms and concepts of Oriental medicine that, even after "all these years", are still problematic. Looking critically and carefully at the past gives us many lessons for the present and future. This must be even more true for acupuncture than for other human endeavors. With this in mind, after each term is discussed, I will briefly touch upon some of the significance of this process to our patients and to us as a profession. I believe that thinking again about these terms (all of which are commonly used in everyone's practice), will help us understand something about both the medicine that we have been privileged to study and acupuncture in contemporary America.
     Starting is always the hardest. Where to begin and in what order? For this little study, 1 will start at the psychic level, move to the emotional, and end on the physical.

Psychic: Purpose, Will, Ambition - zhi
    The psychic or "supra-emotional" aspects of the five phase correspondences are a prime example of how much we do not understand about traditional Oriental medicine. The word that is translated variously as yin Organ, full Organ, depot, or viscera in English is zang. This character is made up of the classifier for flesh and the word that means to store. We have all heard the statement that the yin Organs store but do not drain. What exactly is that they store? One answer is in chapter 11 of the Basic Questions where it states they store the essential qi (jing qi). Chapter 42 of the Nan jing gives a slightly different answer. There, after a brief description of the structure of each Organ, it states what that Organ stores. In each case it is one of these psychic aspects of the soul (hun and po), our cognitive functions (shen), intention (yi), and will (zhi). All of these are fascinating concepts of great interest and import that require further exploration. It is the last that I would like to discuss here.
    The word zhi, will, is closely related (phonetically and graphically) to the modern Chinese word zhi, which means to go to a place. This word has a specific meaning and it stands in contradistinction to other words that mean traveling in general or just wandering along the road. In the pre-Han period, zhi "will" seemed to mean "that which one puts one's mind on". That is, one's purpose or ambition. For example, in the Analects of Confucius it most often refers to "high" ambitions such as studying, the Way, or being truly human. It also refers to a person's basic purpose or will. For example, Confucius is reported to have said, "a force of three armies can have its commander snatched away, but the common man cannot have his will snatched away".
     From reading these words and attempting to pay attention to my patients, I believe that as the psychic component of traditional Oriental medicine, this word zhi refers to a very important component of our higher life. It is that component that determines where we put our efforts, what we want, where we want to go. To me, this sense of purpose is one of the most basic aspects of what it is to be human. This may be part of the reason why the will is considered to be stored in the Kidneys that most basic or constitutional of the Organs.
     What is it that we think is important? Down the road what/who do we want to be? What is our purpose? What are our ambitions? This is major issue for many of our patients. Clinically, the tendency to achieve or become what we put our minds on can manifest in many ways. It can give us strength and also cause us problems. Treating the will often helps people to be more focused and healthier. Professions, like individuals, also have a tendency to become what they put their minds on. Confucius put his mind on studying and the Way. What about us?

Emotional, Elation, Euphoria, Exhilaration - xi
     When we come to the emotional level, most Americans feel more comfortable. After all, who spends more time and energy working on their emotions than Americans? Most American acupuncturists focus much of their treatments on their patient's emotions. Still even in this arena, we run across terms that appear to be misunderstood.
     Before getting to any specific emotion, I would first like to discuss the word that everyone translates as "emotion", that is qing. During the Warring States period, this word did not refer to emotions at all. What it meant was the genuine, real article. For example, in legal writing it referred to the hard facts of the case rather than any interpretation of them. While the usage of this term was changing in the Han dynasty, I believe that the term in the medical classics still definitely has this connotation. The five qing are not transient emotions, reactive emotions, nor even the expression of emotions. A qing is a deep down, genuine emotional state that determines how we see the world. It is something like an emotional predilection or even an emotional constitution. Perhaps "passion" is the most appropriate single-word translation. The passions so delineated in the classics are part of everyday life. However, when deeply held or driven to excess, they lead to different types of illnesses. These are the disease that are due to "internal injury".
     This understanding makes the passion that is related to Fire particularly problematic. How can xi, usually translated as joy or happiness, injure us? Is not joyful bliss the goal of many of the great religions and philosophies of the world? Does our own Declaration of Independence not guarantee us the right to the pursuit of happiness?
     The answer here is one of translation and history. While the word xi in modern Chinese means joy or happiness, in ancient Chinese it had quite a different meaning. At the time of the classics, xi meant the sense of elation or exultation, that is the sense of delight and triumph that comes with winning. As such it is a dispersing passion and can injure internally.
     We all have seen in our patients that when the emotional aspect of a problem is particularly significant, acupuncture can set off the passion in question. Patients with Liver problems become hostile, those with Lung problems sad, and so on. How about those with Heart problems? In my own experience, they can become giddy, restless and skittish. I believe that this giddiness is a mild form of the elation which as a deep down emotional constitution is so injurious.
     The Chinese have always had a tendency to use two-word phrases to stand for complex sets of objects or ideas. When talking about the various injurious passions, the most common phrase has been xi nu or "elation and anger". Why this particular combination? Why is it not "sadness and terror"?
     There is no answer to this type of question. Still I believe it is a useful starting point for an attempt at penetrating a little deeper into traditional Oriental medicine. As is usually the case, a glance at the Chinese tradition is beneficial. A very commonly given example of how elation and anger can be harmful comes from the Song dynasty. At that time, the native Chinese were fighting for control of northern China with Khitan Tartars. One particular general tried for years to defeat and capture one of the Tartar chieftains, but without success. After he died, his lieutenant was successful. Unfortunately, while he sat astride his captive, the prostrate chieftain, the lieutenant was so overcome with elation that he died. At the same time, the chieftain was so overcome with anger and frustration that he also died.
     To me this story gets to the heart of what internal injury from elation and anger is all about (as well as a sense of East-Asian tragedy). These are the primary passions of the victor (elation) and victim (anger and frustration). There are people who see the world as a set of adversarial encounters that they can only either win or lose. Perhaps our whole society, with its pervasive metaphor of sports and adversarial system of justice, is built around this emotional instability.
     Certainly this consciousness is the prevailing one in the acupuncture world. Every group wants to see itself as the victim of other groups. At the same time, it wants to win some sort of victory over them. The results include turf wars and the loss of focus on the work itself. I think that another collorary of this mindset is that people locked into adversarial relations focus on their enemies as the source of their own problems. All of us see this commonly in the clinic. It is also not rare in our profession, where each of the various groups of acupuncturists expend great efforts to criticize the training and practices of other groups while all but ignoring their own deficiencies and problems.
     I believe that there is a strong relation between our purpose (zhi) and the passions (qing). By this I mean that how we interpret and react to people and events is in large measure a result of what we set our minds on. If you set your mind on competition, you will experience life as a win or a loss. You will feel like a victor or a victim. This may be why in later Chinese medical texts the term wu zhi (literally "five purposes or wills" came to be a synonym for the five passions (wu qing).

Physical: Pancreas, Sweetbread - pi
     Finally, I would like to come down to the physical level. One of the more interesting questions for modern practitioners of traditional Oriental medicine is that of the relationship between the anatomical organs of biomedicine and the yin and yang Organs (zang fu) of traditional Oriental medicine. Many believe that any relation is coincidental and of little import. If this is true, then such relationships are arbitrary. As I begin to learn more and more about traditional Oriental medicine, it is harder and harder for me to believe that any significant part of it is arbitrary. Incorrect and incomplete, perhaps; but not arbitrary.
     In terms of the Organs, I have come to believe that they all have a direct connection to the anatomical structures whose name they bear. Of course the goal is not to make any simplistic one-to-one correlation between the anatomical organs as they are understood in conventional medicine and the zang fu. That would just be extending the paradigm of reductionism to traditional Oriental medicine. On the other hand, if we can connect the functional complexes that are the focus of the zang fu phenomena to the anatomical organs, we can show the descriptive and discriminating nature of the people who created traditional Oriental medicine. This kind of exploration reflects back on itself. Once we entertain the possibility that these descriptions are non-arbitrary, our whole view of traditional medicine must be different.
     With this concept in mind, it is obvious that which structures are attached to which zang fu is of some importance. It is well known that the ancient Chinese natural philosophers had a predilection to focus on function over structure. This has made attempts to clearly define what anatomical structures they meant by certain terms, difficult. Not much in the classics describes anatomical structure. Still, I believe, we can learn something from this approach.
     Let us take the pi as an example. This word is usually translated as "spleen". When we look at the ancient ritual texts, the pi that is mentioned in sacrifices, seem to be a type of sweetbread. As far as I know, the only description of the structure of the pi in the classics is in chapter 42 of the Classic of Difficulties (Nan jing) where, as Unschuld translates, "the pi weighs two catties and three ounces. Its flat width is three inches. Its length is five inches. It has a half catty of dispersed fat." This description, along with the ritual use, seem to me to fit the racemose pancreas better than the spleen. If we are looking for some overlap between the biomedical and traditional Oriental understandings of the organ, pancreas is also a better fit.
     This understanding of the pi is by no means a certainty. While there are a number of possible arguments against it, I have noted a peculiar reaction when I discuss this matter with other practitioners. They say, "if they meant pancreas, why didn't they say pancreas?" Of course, the ancient Chinese did not say pancreas nor did they say spleen. They said pi!
     To complete this study one would have to know how the word pi came to be translated as "spleen". It is a good guess that it was either done by Jesuit or medical missionaries in the eighteenth and nineteenth centuries. Why and what were their reasons is unknown to me. The main message here is that basic terminology needs to be constantly rethought. Why? Because often the limitations on our understanding are too great. A particular aspect of a term may appear to be unimportant and therefore ignored. By the time it becomes apparent that it has value, people are used to thinking in ways that preclude a good understanding of the medicine.
     Our aim is to see the world of acupuncture clearly. If we look at it through the lenses of biomedicine we are going to miss much of importance. While the technology and constructs of modern biomedicine can be helpful, using them in acupuncture requires translation into the framework of traditional Oriental medicine. It has been said that acupuncture is the practice of medicine. Of course this is true if what you mean by medicine is the science and art of dealing with the maintenance of health and the treatment of disease. It is even more obvious that this statement is untrue, if by medicine you mean conventional Western medicine. Acupuncture requires different knowledge, uses different thinking processes, and calls upon different talents. To state that a knowledge of conventional Western medicine uniquely qualifies one to do acupuncture is ethnocentric at best. This is like saying you need to know American English before you can speak Chinese or that one must be able to barbecue before learning how to cook Peking duck.
     I believe this ethnocentrism has a very deep place in our psyche. It influences all parts of us, including our purpose. It leads to a divisiveness that extends the victor/victim metaphor through our perception of acupuncture itself. For example, some label non-physician acupuncturists as "lay acupuncturists". Have all the great East Asian practitioners of Oriental medicine down through the ages (not to mention almost all of our own teachers) been "lay"? In the context of acupuncture, this divisive and demeaning attitude has no place.
     We have looked at the traditional Chinese concept of purpose or will and how that interacts with the passions. We have asked some questions about the impact of translations of the traditional concepts of psyche, passions, and anatomy on how we think about traditional Oriental medicine. I believe our attitude toward the ancient practitioners should seek a middle path between "Oh this is what those blockheads should have meant" and "The Sages knew everything then". Paying close attention to what we know and we do not know, what we learn and what we need to forget, can help us to understand something that otherwise was unintelligible and written off as useless.
     Taking this stance into our clinics and our professional meetings would help us transcend adversarial relations. Instead of looking for conflict and engaging in meaningless competition, we could seek a synergistic and cooperative view of all the healing arts. This by itself would make a deeper study of the tradition a worthwhile endeavor.

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