Neijing Studies Lecture #12 Twelve River Courses EDWARD NEAL, MD

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1 Neijing Studies Lecture #12 Twelve River Courses

2 PRIMARY INSTRUCTOR CONTACT INFORMATION Edward Neal, MD, LAc edwardnealmd.com (503) ALL TRANSLATIONS COPYRIGHT EDWARD NEAL, MD Course material may be used for personal study and research. Course material may not be shared without prior consent. For more information on course policies visit:

5 Neijing Studies Lecture #12 - Twelve River Courses Zhōng Shĭ 終始 - ends and beginnings The twelve mai river courses Classical text reading - Lingshu Chapter 2, 5 and 11

7 You now have official permission to forget TCM theory and Western medical knowledge and think about rivers 100% of the time

11 終始 zhōng shĭ - ends and beginnings

13 經脈 jīng mài - axial rivers of the body

14 絡脈 luò mài - radial rivers of the body

19 zhongshi 終始 (ends & beginnings) large intestine heart small intestine xinzhu sanjiao lung lung stomach spleen bladder kidney gallbladder liver mu 木 wood (ascent) yin 陰 jin 金金 metal (descent) mu 木 wood (ascent) jin 金金 metal (descent) mu 木 wood (ascent) jin 金金 metal (descent) mu 木 wood (ascent) yang 陽 yin 陰 yang 陽 yin 陰 yang 陽 yin 陰

21 Jing Mai - Section 1 Upper taiyin (lung) mai river Upper yangming (large intestine) mai river Lower yangming (stomach) mai river Lower taiyin (pancreas) mai river Equals one yin/yang motion Digestion and assimilation Renying/cunkou pattern 4:1

22 Jing Mai - Section 2 Upper shaoyin (heart) mai river Upper taiyang (small intestine) mai river Lower taiyang (bladder) mai river Lower shaoyin (kidney) mai river Equals one yin/yang motion Governance and axial integrity Renying/cunkou pattern 3:1

23 Jing Mai - Section 3 Upper jueyin (xinzhu) mai river Upper shaoyang (sanjiao) mai river Lower shaoyang (gallbladder) mai river Lower jueyin (liver) mai river Equals one yin/yang motion Maintenance and internal protection Renying/cunkou pattern 2:1

24 And now we are ready to begin!

26 始 shĭ - beginnings

27 始女 nǚ - woman

28 始台 tái - breath emerging from a mouth

29 Upper taiyin (lung) mai river

30 LS12. 太陰外合于河 shŏu tài yīn wài hé yú hé shuĭ externally the hand taiyin follows the patterns of the yellow river LS12. 內屬于肺 nèi shŭ yú fèi nèi shǔ páng guāng ér tōng shuǐ dào yān internally it joins with the lungs Lingshu Chapter 12 經

31 SW24. 太陰常多氣少 tài yīn cháng duō qì shăo xuè normally taiyin contains an abundance of qi and a lesser amount of blood Suwen Chapter 24 氣形志 LS65. 太陰常多少氣 tài yīn cháng duō xuè shăo qì normally taiyin contains an abundance of blood and a lesser amount of qi Lingshu Chapters 65 五五味

32 SW24. 刺太陰出氣惡 cì tài yīn chū qì è xuè when needling taiyin (it is permitted) to expel qi and pernicious blood Suwen Chapter 24 氣形志

33 LS10. 肺太陰之脈起于中焦 fèi shǒu tài yīn zhī mài qǐ yú zhōng jiāo the lung hand taiyin mai river arises from zhongjiao (the middle burner) LS10. 下絡腸 xià luò dà cháng descending it nets with the large intestine LS10. 還循胃 huán xún wèi kǒu turning back it crosses weikou (stomach mouth)

34 LS10. 上膈屬肺 shàng gé shǔ fèi ascending (through) the diaphragm it joins with the lungs LS10. 從肺系橫出腋下 cóng fèi xì héng chū yè xià from the system of the lungs it flows laterally to emerge from beneath the axilla LS10. 下循臑內少陰主之前 xià xún nào nèi xíng shǎo yīn xīn zhǔ zhī qián descending along the (upper) inner arm it passes in front of the shaoyin (heart) and xinzhu (heart ruler) (pathways)

35 LS10. 下肘中 xià zhǒu zhōng descending through the elbow LS10. 循臂內上骨下廉入 xún bì nèi shàng gú xià lián rù cùn kǒu it flows along the inner forearm and passes beneath the edge of shanggu (the upper bone) to enter cunkou (the inch mouth) LS10. 上循際出指之端 shàng yú xún yú jì chū dà zhǐ zhī duān ascending (along) yu (the fish) it crosses yuji (the fish border) and emerges from the tip of the thumb

36 LS10. 其者從腕後直出次指內廉出其端 qí zhī zhě cóng wàn hòu zhí chū cì zhǐ nèi lián chū qí duān a (second) branch arises from behind the wrist and (flows) directly to emerge at the inner aspect of the tip of the second finger

37 Upper yangming (large intestine) mai river

38 LS12. 陽明外合于江 shŏu yáng míng wài hé yú jiāng shuĭ externally the hand yangming follows the patterns of the yangtze river LS12. 內屬于腸 nèi shŭ yú dà cháng internally it joins with the large intestine Lingshu Chapter 12 經

39 SW24. 陽明常多氣多 yáng míng cháng duō qì duō xuè normally yangming contains an abundance of both qi and blood Suwen Chapter 24 氣形志 SW24. 刺陽明出氣 cì yáng míng chū xuè qì when needling yangming (it is permitted) to expel both blood and qi Suwen Chapter 24 氣形志

40 LS10. 腸陽明之脈起于指次指之端 dà cháng shŏu yáng míng zhī mài qĭ yú dà zhĭ cì zhĭ zhī duān the large intestine hand yangming mai river arises from the tip of the second finger LS10. 循指上廉 xún zhĭ shàng lián flowing along the (inner) border of the (second) finger LS10. 出合兩骨之間 chū hé gŭ liăng gú zhī jiān it emerges at hegu (converging valley) between the two bones

41 LS10. 上入兩筋之中 shàng rù liăng jīn zhī zhōng ascending it enters between the two tendons LS10. 循臂上廉 xún bèi shàng lián and then ascends along the border of the forearm LS10. 入肘外廉 rù zhŏu wài lián to enter the outer aspect of the elbow

42 LS10. 上臑外前廉 shàng rú wài qián lián ascending along the outer front aspect of the upper arm LS10. 上肩出骨之前廉 shàng jiān chū gú zhī qián lián it ascends to the shoulder and emerges at the front corner of the bone LS10. 上出于柱骨之會上 shàng chū yú zhù gú zhī huì ascending it emerges and then converges at the pillar bone

43 LS10. 下入缺盆 xià rù quē pén descending it enters quepen LS10. 絡肺 luò fèi and nets with the lungs LS10. 下膈屬腸 xià gé shŭ dà cháng it then descends through the diaphragm and joins with the large intestine

44 LS10. 其者從缺盆上頸 qí zhī zhĕ cóng quē pén shàng jĭng a (second) branch arises from quepen (open basin) and ascends to flow along the neck LS10. 貫頰入下齒 guàn jiá rù xià chĭ passing through the cheek it enters the lower teeth LS10. 中還出挾 zhōng huán chū xiá kŏu turning outward it emerges to flow along the sides of the mouth

45 LS10. 交中 jiāo rén zhōng it intersects with renzhong (person s center) LS10. 左之右 zuŏ zhī yòu (and here) left crosses right LS10. 右之左 yòu zhī zuŏ and right crosses left

46 LS10. 上挾孔 shàng xiá bí kŏng ascending it flows along the nostrils

47 Lower yangming (stomach) mai river

48 LS12. 陽明外合于海 shŏu yáng míng wài hé yú jiāng shuĭ externally the foot yangming follows the patterns of oceans and seas LS12. 內屬于胃 nèi shŭ yú dà cháng internally it joins with the stomach Lingshu Chapter 12 經

49 SW24. 陽明常多氣多 yáng míng cháng duō qì duō xuè normally yangming contains an abundance of both qi and blood Suwen Chapter 24 氣形志 SW24. 刺陽明出氣 cì yáng míng chū xuè qì when needling yangming (it is permitted) to expel both blood and qi Suwen Chapter 24 氣形志

50 LS10. 胃陽明之脈起於之交頞中旁納太陽之脈 wèi zú yáng míng zhī mài qǐ yú bí zhī jiāo è zhōng páng nà tài yáng zhī mài the stomach foot yangming mai river arises from the crossing region at the bridge of the nose near the taiyang mai river LS10. 下循外入上齒中 xià xún bí wài rù shàng chǐ zhōng descending it flows along the outer aspect of the nose and enters the upper teeth LS10. 還出挾環脣下交承漿 huán chū xié kǒu huán chún xià jiāo chéng jiāng turning back it emerges from the mouth, encircles the lips and descends to cross chengjiang (sauce container)

51 LS10. 卻循頤後下廉出迎 què xún yí hòu xià lián chū dà yíng following along the lower border of the cheek it emerges at daying (great welcoming) LS10. 循頰上前過客主 xún jiá chē shàng ěr qián guò kè zhǔ rén crossing jiache (jaw axle) it ascends in front of the ear and passes over kezhuren (guest's host) LS10. 循髮際至額顱 xún fà jì zhì é lú following the (anterior) hairline it arrives at the forehead

52 LS10. 其者從迎前下迎 qí zhī zhě cóng dà yíng qián xià rén yíng a (second) branch arises in front of daying (great welcoming) and descends to renying (man's welcoming) LS10. 循喉嚨入缺盆 xún hóu lóng rù quē pén flowing along the throat it enters quepen (open basin) LS10. 下膈屬胃絡脾 xià gé shǔ wèi luò pí descending through the diaphragm it joins with the stomach and nets with the pancreas

53 LS10. 其直者從缺盆下乳內 qí zhí zhě cóng quē pén xià rǔ nèi a (third) branch flows directly (down) from quepen (open basin) and enters the breast LS10. 廉下挾臍入氣街中 lián xià xié qí rù qì jiē zhōng descending along the sides of the umbilicus it enters qijie (the qi ravine) LS10. 其者起于胃下循腹裏下至氣街中 qí zhī zhě qǐ yú wèi kǒu xià xún fù lǐ xià zhì qì jiē zhōng a (fourth) branch arises from weikou (the stomach mouth) and descends to flow along the inner abdomen and arrive at qijie (the qi ravine)

54 LS10. 合以下髀關抵伏兔 ér hé yĭ xià bì guān dĭ fú tù here it merges with (the external branch) and together they descend to flow across biguan (the thigh pass) and arrive at futu (crouching rabbit) LS10. 下膝臏中 xià xī bìn zhōng it descends flowing through the knee LS10. 下循脛外廉下跗入中指內間 xià xún jìng wài lián xià zú fū rù zhōng zhǐ nèi jiān and then passes along the lateral shin to arrive at the top of the foot where it enters the inner (aspect) of the middle toe

55 LS10. 其者下廉三別下入中指外間 qí zhī zhě xià lián sān cùn ér bié xià rù zhōng zhǐ wài jiān a (fifth) branch divides three cun (below the knee) to flow along the (shin) and enter the lateral (aspect) of the middle toe LS10. 其者別跗上入指間出其端 qí zhī zhě bié fū shàng rù dà zhǐ jiān chū qí duān a (six) branch divides on top of the foot and flows into the space between the first and second toes and exits at the tip (of the big toe)

56 Lower taiyin (pancreas) mai river

57 LS12. 太陰外合于湖 shŏu yáng míng wài hé yú jiāng shuĭ externally the foot taiyin follows the patterns of lakes and marshes LS12. 內屬于脾 nèi shŭ yú dà cháng internally it joins with the pancreas Lingshu Chapter 12 經

58 SW24. 太陰常多氣少 tài yīn cháng duō qì shăo xuè normally taiyin contains an abundance of qi and a lesser amount of blood Suwen Chapter 24 氣形志 LS65. 太陰常多少氣 tài yīn cháng duō xuè shăo qì normally taiyin contains an abundance of blood and a lesser amount of qi Lingshu Chapters 65 五五味

59 SW24. 刺太陰出氣惡 cì tài yīn chū qì è xuè when needling taiyin (it is permitted) to expel qi and pernicious blood Suwen Chapter 24 氣形志

60 LS10. 脾太陰之脈起于指之端 pí zú tài yīn zhī mài qǐ yú dà zhǐ zhī duān the pancreas foot taiyin mai river arises from the tip of the large toe LS10. 循指內側際過核骨後 xún zhǐ nèi zè bái ròu jì guò hé gú hòu flowing along the inner aspect of the toe it passes along the white flesh border moving behind the nut bone LS10. 上內踝前廉 shàng nèi huái qián lián it ascends to flow across the front corner of the inner malleolus

61 LS10. 上踹內循脛骨後交出厥陰之前 shàng chuài nèi xún jìng gú hòu jiāo chū jué yīn zhī qián and then ascends along the inner calf passing behind the shin bone and emerging in front of the jueyin (pathway) LS10. 上膝股內前廉入腹屬脾絡胃 shàng xī gǔ nèi qián lián rù fù shǔ pí luò wèi ascending along the inner front border of the knee and thigh it enters the abdomen, joins with the pancreas and nets with the stomach LS10. 上膈挾咽連本散下 shàng gé xié yān lián shé běn sǎn shé xià ascending through the diaphragm it flows along the throat, connects with the tongue root and spreads beneath the tongue

62 LS10. 其者復從胃別上膈注中 qí zhī zhě fù cóng wèi bié shàng gé zhù xīn zhōng a (second) branch divides from the stomach and flows through the diaphragm to pour (into) the heart center

63 Upper shaoyin (heart) mai river

64 LS12. 少陰外合于濟 shŏu yáng míng wài hé yú jiāng shuĭ externally the hand shaoyin follows the patterns of the ji river LS12. 內屬于 nèi shŭ yú dà cháng internally it joins with the heart Lingshu Chapter 12 經

65 SW24. 少陰常少多氣 shăo yīn cháng shăo xuè duō qì normally shaoyin contains a lesser amount of blood and a greater amount of qi Suwen Chapter 24 氣形志 SW24. 刺少陰出氣惡 cì shăo yīn chū qì è xuè when needling shaoyin (it is permitted) to expel qi and pernicious blood Suwen Chapter 24 氣形志

66 LS10. 少陰之脈起于中 xīn shŏu shăo yīn zhī mài qĭ yú xīn zhōng the heart hand shaoyin mai river arises from xinzhong (the heart center) LS10. 出屬系下膈絡腸 chū shŭ xīn xì xià gé luò xiăo cháng emerging it joins with the system of the heart and descends to pass through the diaphragm and net with the small intestine LS10. 其者從系上挾咽繫系 qí zhī zhĕ cóng xīn xì shàng xiá yàn jì mù xì a (second) branch arises from the system of the heart and ascends to flow along the throat and join with the system of the eye

67 LS10. 其直者復從系卻上肺 qí zhí zhĕ fù cóng xīn xì què shàng fèi a (direct) branch then arises from the system of the heart and curves back to ascend to the lungs LS10. 下出腋下 xià chū yè xià it then descends to emerge beneath the axilla LS10. 下循臑內後廉太陰主之後 xià xún rú nèi hòu lián xíng tài yīn xīn zhŭ zhī hòu descending along the inner posterior border of the (upper) arm it flows behind the taiyin (lung) and xinzhu (heart ruler) pathways

68 LS10. 下肘內循臂內後廉抵掌後脫骨之端 xià zhŏu nèi xún bèi nèi hòu lián dĭ zhăng hòu tuō gú zhī duān descending across the inner border of the elbow it flows along the inner posterior border (of the forearm) and joins with the palm behind the tip of the pointed (ulna) bone LS10. 入掌內後廉循指之內出其端 rù zhăng nèi hòu lián xún xiăo zhĭ zhī nèi chū qí duān entering the inner rear aspect of the palm it flows along the inside border of the little finger and emerges at its tip

69 Upper taiyang (small intestine) mai river

70 LS12. 太陽外合淮 shŏu tài yáng wài hé huái shuĭ externally the hand taiyang follows the patterns of the huai river LS12. 內屬腸道出焉 nèi shŭ xiăo cháng ér shuĭ dào chū yān internally it joins with the small intestine and to the (regions) where the water passages emerge Lingshu Chapter 12 經

71 SW24. 太陽常多少氣 tài yáng cháng duō xuè shăo qì normally taiyang contains a greater amount of blood and a lesser amount of qi SW24. 刺太陽出惡氣 cì shăo yīn chū qì è xuè when needling taiyang (it is permitted) to expel blood and pernicious qi Suwen Chapter 24 氣形志

72 LS10. 腸太陽之脈起于指之端 xiăo cháng shŏu tài yáng zhī mài qĭ yú xiăo zhĭ zhī duān the small intestine hand taiyang mai river arises at the tip of the little finger LS10. 循外側上腕出踝中 xún shŏu wài cè shàng wàn chū huái zhōng flowing along the outer edge of the hand it ascends along the wrist and emerges from the wrist center LS10. 直上循臂骨下廉出肘內側兩筋之間 zhí shàng xún bèi gú xià lián chū zhŏu nèi cè liăng jīn zhī jiān it then directly ascends passing under the border of the forearm bone and emerges from the inner aspect of the elbow between the two sinews

73 LS10. 上循臑外後廉出肩解繞肩胛 shàng xún rú wài hòu lián chū jiān jiĕ rào jiān jiă ascending across the outer posterior border of the upper arm it emerges from the shoulder joint and wraps around the shoulder blade LS10. 交肩上入缺盆絡 jiāo jiān shàng rù quē pén luò xīn crossing and ascending over the shoulder it enters quepen (open basin) and (descends) to net with the heart LS10. 循咽下膈抵胃屬腸 xún yàn xià gé dĭ wèi shŭ xiăo cháng flowing along the esophagus it passes the diaphragm, meets with the stomach and joins with the small intestine

74 LS10. 其者從缺盆循頸上頰至銳眥 qí zhī zhĕ cóng quē pén xún jĭng shàng jiá zhì mù ruì zì a (second) branch arises from quepen (open basin), flows along the neck, ascends across the cheek and arrives at the (outer) corner of the eye LS10. 卻入中 què rù ĕr zhōng it then turns back to enter the center of the ear LS10. 其者別頰上抵至內眥斜絡于顴 qí zhī zhĕ bié jiá shàng dĭ bí zhì mù nèi zì xié luò yú quán a (third) branch ascends along the cheek, meets with the nose, arrives at the inner corner of the eye and slants (down) to net with the cheekbone

75 Lower taiyang (bladder) mai river

76 LS12. 太陽外合清 zú tài yáng wài hé qīng shuĭ externally the foot taiyang follows the patterns of the qing river LS12. 內屬膀胱通道焉 nèi shŭ băng guāng ér tōng shuĭ dào yān internally it joins with the bladder and communicates with the water passages Lingshu Chapter 12 經

77 SW24. 太陽常多少氣 tài yáng cháng duō xuè shăo qì normally taiyang contains a greater amount of blood and a lesser amount of qi SW24. 刺太陽出惡氣 cì shăo yīn chū qì è xuè when needling taiyang (it is permitted) to expel blood and pernicious qi Suwen Chapter 24 氣形志

78 LS10. 膀胱太陽之脈起于內眥 páng guāng zú tài yáng zhī mài qǐ yú mù nèi zì the bladder foot taiyang mai river arises at the inner corners of the eyes LS10. 上額交巔 shàng é jiāo diān ascending the forehead it crosses dian (the mountain summit) LS10. 其者從巔至上循角 qí zhī zhě cóng diān zhì ěr shàng xún jiǎo a (second) branch arises from dian (the mountain summit) and (descends) to the area above the ear

79 LS10. 其直者從巔入絡腦 qí zhí zhě cóng diān rù luò nǎo (from) dian (the mountain summit) the (main) branch then enters (the head) and nets with the brain LS10. 還出別下項 huán chū bié xià xiàng emerging outwards it divides and descends flowing down along the nape of neck LS10. 循肩髆內挾脊抵腰中 xún jiān bó nèi xié jǐ dǐ yāo zhōng passing along the inner border of the shoulder blade it follows the spine and meets with yaozhong (the waist center)

80 LS10. 入循膂絡腎屬膀胱 rù xún lǚ luò shèn shǔ páng guāng here it enters and following the spine nets with the kidneys and joins with the bladder LS10. 其者從腰中下挾脊貫臀入膕中 qí zhī zhě cóng yāo zhōng xià xié jǐ guàn tún rù guó zhōng a (third) branch arises from yaozhong (the waist center) and descends flowing along the spine, passing through the buttocks and entering the back of knee LS10. 其者從髆內左右別 qí zhī zhě cóng bó nèi zuǒ yòu bié (above) a (fourth) branch divides along the inner border of the shoulder blade on the left and right sides

81 LS10. 下貫胛挾脊內過髀樞 xià guàn jiǎ xié jǐ nèi guò bì shū descending, these (branches) pass through the (area of) the shoulder blades, flow along the spine and enter and pass through the (region of) bishu (the thigh pivot) LS10. 循髀外 xún bì wài flowing (down) along the outer thigh LS10. 從後廉下合膕中 cóng hòu lián xià hé guó zhōng it passes along the posterior border (of the thigh) and merges with (the third branch) at the back of the knee

82 LS10. 以下貫踹內 yǐ xià guàn chuài nèi the (combined rivers) then descend to enter the calf LS10. 出外踝之後 chū wài huái zhī hòu and emerge from behind the lateral malleolus LS10. 循京骨 xún jīng gú flowing across jinggu (capital bone)

83 LS10. 至指外側 zhì xiǎo zhǐ wài zè it arrives at the outer edge of the little toe

84 Lower shaoyin (kidney) mai river

85 LS12. 少陰外合于汝 zú shăo yīn wài hé yú rŭ shuĭ externally the foot shaoyin follows the patterns of the ru river LS12. 內屬于腎 nèi shŭ yú shèn internally it joins with the kidneys Lingshu Chapter 12 經

86 SW24. 少陰常少多氣 shăo yīn cháng shăo xuè duō qì normally shaoyin contains a lesser amount of blood and a greater amount of qi Suwen Chapter 24 氣形志 SW24. 刺少陰出氣惡 cì shăo yīn chū qì è xuè when needling shaoyin (it is permitted) to expel qi and pernicious blood Suwen Chapter 24 氣形志

87 LS10. 腎少陰之脈起于指之下 shèn zú shăo yīn zhī mài qĭ yú xiăo zhĭ zhī xià the kidney foot shaoyin mai river arises from beneath the little toe LS10. 邪 xié zŏu zú xīn it slants across zuxin (the foot heart) LS10. 出于然之下 chū yú rán gŭ zhī xià and then emerges beneath rangu (blazing valley)

88 LS10. 循內踝之後 xún nèi huái zhī hòu passing behind the inner malleolus LS10. 別入跟中 bié rù gēn zhōng it divides and enters the heel center LS10. 以上踹內 yĭ shàng chuài nèi from here it ascends flowing along the inner calf

89 LS10. 出膕內廉 chū guó nèi lián and emerges from the inner border of the back of knee LS10. 上股內後 shàng gŭ nèi hòu it then ascends along the inner posterior border of the thigh LS10. 廉貫脊 lián guàn jí and flows into the spine

90 LS10. 屬腎絡膀胱 shŭ shèn luò páng guāng it then joins with the kidneys and nets with the bladder LS10. 其直者從腎上貫肝膈 qí zhí zhĕ cóng shèn shàng guàn gān gé the (direct) branch then ascends from the kidney and flows through the livers and diaphragm LS10. 入肺中 rù fèi zhōng and enters the lungs

91 LS10. 循喉嚨 xún hóu lóng it flows along the throat LS10. 挾本 xiá shé bĕn and passes along the (sides of the) tongue root LS10. 其者從肺出絡注胸中 qí zhī zhĕ cóng fèi chū luò xīn zhù xiōng zhōng a (second) branch emerges from the lungs and nets with the xinzhu (the heart ruler) and pours into xiongzhong (chest center)

92 Upper jueyin (xinzhu) mai river

93 LS12. 主外合于漳 shŏu xīn zhŭ wài hé yú zhāng shuĭ externally the hand jueyin follows the patterns of the zhang river LS12. 內屬于包 nèi shŭ yú xīn bāo internally it joins with the xinbao (heart wrapper) Lingshu Chapter 12 經

94 SW24. 厥陰常多少氣 jué yīn cháng duō xuè shăo qì normally jueyin contains a greater amount of blood and a lesser amount of qi Suwen Chapter 24 氣形志 SW24. 刺厥陰出惡氣也 cì jué yīn chū xuè è qì yĕ when needling jueyin (it is permitted) to expel blood and pernicious qi Suwen Chapter 24 氣形志

95 LS10. 主厥陰包絡之脈起于胸中 xīn zhŭ shŏu jué yīn xīn bāo luò zhī mài qĭ yú xiōng zhōng the xinzhu (heart governing) hand jueyin xinbao (heart wrapping) luo mai river arises from xiongzhong (the chest center) LS10. 出屬包絡 chū shŭ xīn bāo luò emerging it joins with the xinbao (heart wrapping) luo (network) LS10. 下膈歷絡三膲 xià gé lì luò sān jiāo and then descends flowing through the diaphragm to net with the sanjiao (three warmers)

96 LS10. 其者循胸出脅下腋三 qí zhī zhĕ xún xiōng chū xié xià yè sān cùn a (second) branch flows out from the chest and emerges along the rib-sides three cun below the axilla LS10. 上抵腋 shàng dĭ yè ascending it meets with the axilla LS10. 下循臑內 xià xún rú nèi then descending it flows along the inner arm

97 LS10. 太陰少陰之間 xíng tài yīn shăo yīn zhī jiān circulating between the taiyin and shaoyin pathways LS10. 入肘中 rù zhŏu zhōng it then enters the elbow LS10. 下臂兩筋之間入掌中 xià bèi xíng liăng jīn zhī jiān rù zhăng zhōng and descends along the lower arm flowing between the two sinews and entering the palm center

98 LS10. 循中指出其端 xún zhōng zhĭ chū qí duān flowing along the middle finger it emerges at its tip LS10. 其者別掌中循指次指出其端 qí zhī zhĕ bié zhăng zhōng xún xiăo zhĭ cì zhĭ chū qí duān a (third) branch divides at the palm center and flows along the fourth finger emerging at its tip

99 Upper shaoyang (sanjiao) mai river

100 LS12. 少陽外合于漯 shŏu shăo yáng wài hé yú lĕi shuĭ externally the hand shaoyang follows the patterns of the lei river LS12. 內屬于三焦 nèi shŭ yú sān jiāo internally it joins with the sanjiao (three warmers) Lingshu Chapter 12 經

101 SW24. 少陽常少多氣 shăo yáng cháng shăo xuè duō qì normally shaoayang contains a lesser amount of blood and a greater amount of qi Suwen Chapter 24 氣形志 SW24. 刺少陽出氣惡 cì shăo yáng chū qì è xuè when needling shaoyang (it is permitted) to expel qi and pernicious blood Suwen Chapter 24 氣形志

102 LS10. 三焦少陽之脈起于指次指之端 sān jiāo shŏu shăo yáng zhī mài qĭ yú xiăo zhĭ cì zhĭ zhī duān the sanjiao (three warmers) hand shaoyang mai river arises from the tip of the fourth finger LS10. 上出兩指之間 shàng chū liăng zhĭ zhī jiān ascending it emerges between the (fourth and fifth) fingers LS10. 循表腕出臂外兩骨之間 xún shŏu biăo wàn chū bèi wài liăng gú zhī jiān following along the surface of the hand it emerges on the outside of the arm between the two bones

103 LS10. 上貫肘 shàng guàn zhŏu ascending it passes through the elbow LS10. 循臑外上肩交出少陽之後 xún rú wài shàng jiān ér jiāo chū zú shăo yáng zhī hòu flowing along the outer aspect of the (upper) arm it ascends to the shoulder to cross and emerge behind the foot shaoyang (gallbladder pathway) LS10. 入缺盆 rù quē pén it enters quepen (open basin)

104 LS10. 布膻中 bù dàn zhōng spreads through danzhong (the dan center) LS10. 散落包 săn luò xīn bāo and disperses through the xinbao (heart wrapper) LS10. 下膈 xià gé it descends through the diaphragm

105 LS10. 循屬三焦 xún shŭ sān jiāo and flows along and joins with the sanjiao (three warmers) LS10. 其者從膻中上出缺盆 qí zhī zhĕ cóng dàn zhōng shàng chū quē pén from danzhong a (second) branch ascends to emerge from quepen (open basin) LS10. 上項繫後 shàng xiàng jì ĕr hòu ascending it flows upward along the nape of the neck and joins with the region behind the ear

106 LS10. 直上出上角 zhí shàng chū ĕr shàng jiăo it then emerges directly from the ear ascending to the corner of the forehead LS10. 以屈下頰至 yĭ qū xià jiá zhì curving down it descends to the cheek LS10. 其者從後入中出前 qí zhī zhĕ cóng ĕr hòu rù ĕr zhōng chū zŏu ĕr qián a (third) branch arises behind the ear, enters the ear and then emerges in front of the ear

107 LS10. 過客主 guò kè zhŭ rén passing kezhuren (guest/host person) LS10. 前交頰至銳眥 qián jiāo jiá zhì mù ruì zì it crosses the cheek and arrives at the (outer) corner of the eye

108 Lower shaoyang (gallbladder) mai river

109 LS12. 少陽外合于渭 zú shăo yáng wài hé yú wèi shuĭ externally the foot shaoyang follows the patterns of the wei river LS12. 內屬于膽 nèi shŭ yú dăn internally it joins with the gallbladder Lingshu Chapter 12 經

110 SW24. 少陽常少多氣 shăo yáng cháng shăo xuè duō qì normally shaoyang contains a lesser amount of blood and a greater amount of qi Suwen Chapter 24 氣形志 SW24. 刺少陽出氣惡 cì shăo yáng chū qì è xuè when needling shaoyang (it is permitted) to expel qi and pernicious blood Suwen Chapter 24 氣形志

111 LS10. 膽少陽之脈起于銳眥 dăn zú shăo yáng zhī mài qĭ yú mù ruì zì the gallbladder foot shaoyang mai river arises at the (outer) corner of the eye LS10. 上抵頭角 shàng dĭ tóu jiăo ascending it meets the corner of the forehead LS10. 下後循頸少陽之前 xià ĕr hòu xún jĭng xíng shŏu shăo yáng zhī qián then descending to the area behind the ear it flows along the neck in front of the hand shaoyang

112 LS10. 至肩上卻交出少陽之後入缺盆 zhì jiān shàng què jiāo chū shŏu shăo yáng zhī hòu rù quē pén reaching the top of the shoulder it crosses and emerges behind the hand shaoyang (pathway) and enters quepen (open basin) LS10. 其者從後入中出前至銳眥後 qí zhī zhĕ cóng ĕr hòu rù ĕr zhōng chū zŏu ĕr qián zhì mù ruì zì hòu a (second) branch arises from behind the ear, enters the ear and emerges in front of the ear and arrives at the (outer) corner of the eye

113 LS10. 其者別銳眥下迎合于少陽 qí zhī zhĕ bié ruì zì xià dà yíng hé yú shŏu shăo yáng a (third) branch divides from the (outer) corner of the eye, descends to daying (great welcoming) and then merges with the hand shaoyang LS10. 抵于下加頰 dĭ yú xià jiā jiá chē below it arrives and joins with jiache (the jaw axle) LS10. 下頸合缺盆 xià jĭng hé quē pén descending along the neck it merges with quepen

114 LS10. 以下胸中貫膈絡肝屬膽 yĭ xià xiōng zhōng guàn gé luò gān shŭ dăn from here it descends to xiongzhong (chest center), passes through the diaphragm, nets the liver and joins with the gallbladder LS10. 循脅裏出氣街 xún xié lĭ chū qì jiē flowing along the sides of the inner (abdomen) it emerges at qijie (the qi ravine) LS10. 繞際橫入髀厭中 rào máo jì héng rù bì yàn zhōng winding around the border of the (pubic) hair border it flows laterally to enter the thigh (support) center

115 LS10. 其直者從缺盆下腋 qí zhí zhĕ cóng quē pén xià yè (above) a direct branch descends from quepen (open basin) down to the axilla LS10. 循胸過季脅下合髀厭中 xún xiōng guò jì xié xià hé bì yàn zhōng there it flows along the chest, crossing the lower ribs and merges with the thigh (support) center LS10. 以下循髀陽出膝外廉 yĭ xià xún bì yáng chū xī wài lián descending along the yang (outer side) of the thigh it emerges from the outer border of the knee

116 LS10. 下外輔骨之前 xià wài fŭ gú zhī qián it descends along the outer (shin) flowing in front of the axle bone (fibula) LS10. 直下抵絕骨之端 zhí xià dĭ jué gú zhī duān there it descends directly to arrive at the tip of juegu (the severed bone) LS10. 下出外踝之前 xià chū wài huái zhī qián descending it emerges in front of the lateral malleolus

117 LS10. 循跗上入指次指之間 xún zú fū shàng rù xiăo zhĭ cì zhĭ zhī jiān flowing along the top of the foot it enters the space between the fourth and fifth toes LS10. 其者別跗上 qí zhī zhĕ bié fū shàng a (fifth) branch divides from the arch of the foot LS10. 入指之間 rù dà zhĭ zhī jiān and enters the space beside the big toe

118 LS10. 循指歧骨內出其端 xún dà zhĭ qí gú nèi chū qí duān there it flows across the large toe passing the inner side of the fork bone and emerges at its tip LS10. 還貫甲 huán guàn zhuă jiă it then turns back and passes through the nail LS10. 出三 chū sān máo and emerges from within the three hairs

119 Lower jueyin (liver) mai river

120 LS12. 厥陰外合于澠 zú jué yīn wài hé yú mĭn shuĭ externally the foot jueyin follows the patterns of the min river LS12. 內屬于肝 nèi shŭ yú gān internally it joins with the liver (heart wrapper) Lingshu Chapter 12 經

121 SW24. 厥陰常多少氣 jué yīn cháng duō xuè shăo qì normally jueyin contains a greater amount of blood and a lesser amount of qi Suwen Chapter 24 氣形志 SW24. 刺厥陰出惡氣也 cì jué yīn chū xuè è qì yĕ when needling jueyin (it is permitted) to expel blood and pernicious qi Suwen Chapter 24 氣形志

122 LS10. 肝厥陰之脈起于指叢之際 gān zú jué yīn zhī mài qĭ yú dà zhĭ cóng máo zhī jì the liver foot jueyin mai river arises from the big toe in the border of the thicket of hairs LS10. 上循跗 shàng xún zú fū it ascends flowing along the (top) of the foot LS10. 上廉去內踝 shàng lián qù nèi huái yī cùn and then flows upward one cun from the (front) border of the inner malleolus

123 LS10. 上踝八交出太陰之後 shàng huái bā cùn jiāo chū tài yīn zhī hòu eight cun above the (inner) malleolus it crosses to emerge behind the taiyin (pathway) LS10. 上膕內廉 shàng guó nèi lián ascending it flows along the inner border of the back of the knee LS10. 循股陰 xún gŭ yīn and passes along the yin (aspect) of the thigh

124 LS10. 入中 rù máo zhōng it then enters the (pubic) hair LS10. 過陰器 guò yīn qì passes through the yin organs (genitals) LS10. 抵腹 dĭ xiăo fù and arrives within the lesser abdomen

125 LS10. 挾胃 xiá wèi (ascending) it passes along the sides of the stomach LS10. 屬肝 shŭ gān joins with the livers LS10. 絡膽 luò dăn and nets with the gallbladder

126 LS10. 上貫膈 shàng guàn gé then ascending through the diaphragm LS10. 布脅肋 bù xié lè it spreads along the (inside) of the rib sides LS10. 循喉嚨之後 xún hóu lóng zhī hòu flows behind the throat

127 LS10. 上入頏顙 shàng rù háng săng ascends to enter the palate LS10. 連系 lián mù xì and then flows (upward) to join with the system of the eye LS10. 上出額與督脈會于巔 shàng chū é yŭ dū mài huì yú diān ascending it emerges upon the forehead and merges with the dumai pathway at dian (the mountain summit)

128 LS10. 其者從系下頰裏環脣內 qí zhī zhĕ cóng mù xì xià jiá lĭ huán chún nèi from the system of the eye a (second) branch descends passing along the inside of the cheeks and encircles the inner lips LS10. 其者復從肝別貫膈上注肺 qí zhī zhĕ fù cóng gān bié guàn gé shàng zhù fèi a (third) branch divides from the liver to pass through the diaphragm and pour into the lungs

129 終 zhōng - endings

130 終糸 sī - silk

131 終冬 dōng

132 冬冬 dōng - winter

133 Classical text reading

134 LS11. 夫經脈者 fū shí èr jīng mài zhĕ it is from the twelve jingmai LS11. 之所以 rén zhī suŏ yĭ shēng that humankind is born LS11. 病之所以成 bìng zhī suŏ yĭ chéng and illnesses arise

135 LS11. 之所以治 rén zhī suŏ yĭ zhì from them humankind is cured from disease LS11. 病之所以起 bìng zhī suŏ yĭ qĭ and illnesses advance LS11. 學之所始 xué zhī suŏ shĭ when beginning the study of (jing luo)

136 LS11. 之所也 gōng zhī suŏ zhĭ yĕ the mid-level (physician believes this knowledge) to be something attainable (with study) LS11. 麤之所易 cū zhī suŏ yì the lower level (physician believes this knowledge) to be something easily (acquired) LS11. 上之所難也 shàng zhī suŏ nán yĕ it is the superior (physician alone) who understands the true difficulties of its study. - Lingshu, Chapter 11

137 LS2. 帝問於歧伯曰 huáng dì wèn yú qí bó yuē the yellow emperor asked to qi bo saying LS2. 凡刺之道 fán cì zhī dào in regards to the way of acupuncture LS2. 必通經絡之所終始 bì tōng shí èr jīng luò zhī suŏ zhōng shĭ it is essential to open the communications between the ends and beginning of the jing luo (pathways)

138 LS2. 絡脈之所別處 luò mài zhī suŏ bié chŭ in those places where the luo mai divide LS2. 五輸之所留 wŭ shū zhī suŏ liú in those places where the five (ben) shu reside LS2. 六府之所與合 liù fŭ zhī suŏ yŭ hé in those places where the six fu merge

139 LS2. 四時之所出入 sì shí zhī suŏ chū rù in those places where the four seasons emerge and enter LS2. 五藏之所溜 wŭ cáng zhī suŏ liū in those places where the five zang circulate LS2. 處闊數之度淺深之狀下所至 chŭ kuò shù zhī dù qiăn shēn zhī zhuàng gāo xià suŏ zhì and (to know) the degree and quality of all these pathways whether they are shallow or deep, high or low Lingshu Chapter 2 本輸

140 LS5. 邪離經不可勝數 xié lí jīng bù kĕ shèng shù when xie (pernicious energies) enter the jing (channels) the (problems they may cause) are countless LS5. 不知根結五藏六府 bù zhī gēn jié wŭ cáng liù fŭ if (one) does not know the (arrangements of) the roots and fruitions and the five zang and six fu organs LS5. 折關敗樞開闔 zhé guān bài shū kāi hé ér zŏu then the (bodies) ability to close and pivot is lost, and the capacity to open and close departs

141 LS5. 陰陽失 yīn yáng dà shī then (the great balance) of yin and yang is lost LS5. 不可復取 bù kĕ fù qŭ and cannot be recovered LS5. 九鍼之玄要在終始 jiŭ zhēn zhī xuán yào zài zhōng shĭ in using the mysterious method of the nine needles the essential (thing) is (to know the entire circulation) of the (channels and vessels) from end to beginning

142 LS5. 故能知終始畢 gù néng zhī zhōng shĭ yī yán ér bì to those who know these things the essential principles of acupuncture may be spoken in a word LS5. 不知終始鍼道咸絕 bù zhī zhōng shĭ zhēn dào xián jué to those who do not understand these matters no understanding of the art of acupuncture is possible Lingshu Chapter 5 根結

143 Question time

144 Adriano Taricani November 22 at 4:33am Hi Ed and class. I have a close friends son suffering from myoadenylate deaminase deficiency. Which would be the presenting direction? As there seems to be a genetic (self) component I am thinking Northern and eastern. Thanks

145 Adenosine monophosphate deaminase deficiency type 1, also called myoadenylate deaminase deficiency (MADD), is a recessive genetic metabolic disorder that affects approximately 1 2% of populations of European descent. It appears to be considerably rarer in Asian populations. The genetic form is caused by a defect in the gene for AMP deaminase though there is also an acquired form of AMP deficiency.amp deaminase is an enzyme that converts adenosine monophosphate (AMP) to inosine monophosphate (IMP), freeing an ammonia molecule in the process. It is a part of the metabolic process that converts sugar, fat, and protein into cellular energy. In order to use energy, a cell converts one of the above fuels into adenosine triphosphate (ATP) via the mitochondria. Cellular processes, especially muscles, then convert the ATP into adenosine diphosphate (ADP), freeing the energy to do work. -Wikipedia

146 Symptoms: Fatigue - MADD lowers aerobic power output, so increased anaerobic power is needed to perform the same amount of work. Without myoadenlyate deaminase, heavy activity causes adenosine to be released into the cell or perfused into the surrounding tissues. Fatigue and sedation after heavy exertion can be caused by excess adenosine in the cells which signals muscle fiber to feel fatigued. In the brain, excess adenosine decreases alertness and causes sleepiness. Recovery from over-exertion can be hours, days or even months. In cases of rhabdomyolysis, which is the rapid breakdown of muscle fibers, time to recovery is dependent on duration and intensity of original activity plus any excess activity during the recovery period.

147 Muscle pain - Muscle pain from MADD is not well understood, but is partially due to high levels of lactate. Increased levels of free adenosine temporarily decrease pain, allowing over-exertion without awareness. The over exertion can cause mild to severe cases of rhabdomyolysis, which is painful. Muscle cramping - The cause of cramping is unknown, but may be related to elevated lactate, increased calcium signaling across the sarcoplasmic reticulum caused by membrane instability from reduced levels of ATP, or increased levels of free adenosine. Muscle weakness - Muscle weakness is not a major symptom, though the progressive effects of chronic muscle damage from rhabdomyolysis will eventually cause significant weakness. Similarly, the long-term metabolic effects may result in nerve damage. -Wikipedia

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149

8 Pieces of Brocade. 1. Two hands lifting up the sky with finger interlocked to harmonize the triple Burners.

8 Pieces of Brocade. 1. Two hands lifting up the sky with finger interlocked to harmonize the triple Burners. 8 Pieces of Brocade Preparing/standing form: Move left feet one step to the left side, feet with shoulder width, relax and bend knee slightly, stand straight, tongue touch the upper jaw, close lower jaw,