Styles of Touching: Pulses

1. Expressiveness of the Human Body: Shigehesi Kuriyama Styles of Touching: Pulses GREEKS Hippocrates: (460 BCE) no "pulse taking". continuum from palpitation to tremor to spasm. multiple pulses Aristotle (384 BCE): separate heart pulsation and palpitation, but didn’t use pulse in diagnosis. Didn’t separate arteries form veins Herophilus(335 BCE) show pulse only in arteries and heart, palpitation, spasms, tremors in muscles and nerves. Pulse: speed, strength, rhythm, order/disorder, regularity (time/space),; size Galen: (129 ACE) great corpus on pulse-taking., one pulse. Anatomy shaped how and what fingers felt. Arteries visible but pulse felt. How: Picture tubular artery rising and falling. . CHINESE Get info on all organs from mo? Infer anatomy deceive. Mo was not pulse. Mawangdui (2nd cent BCE): mo neither arise or return to heart. Mo not correspond to specific veins or arteries Neijing (Suwen and Lingshu) variety of pulse taking. Feel on wrist one way. Nanjing : replace words like upper, middle, with gun, guan, Qi, floating, sunken. Chinese circulation no start or center point. Local differences critically important 18th cent:: 8 ways to feel wrist. Qiemo not single timeless system but congery of approaches. .

3. CHINESE • Mo - In diagnosis, it is the pulse. • Nanjing : • tracts linked into circulation. • wrist points: cun, guan, chi (3 realms of yin/yang • judge 5 zang and fu organs • . • multiplicity of mo. • no split of structure/fn (artery vs pulse). neither vessel or pulse • long, short, rapid, large, thin, excess, intermittent,– sounds like pulse. • slippery/rough and floating/sinking most important; • Slippery – comes/goes, rolling rapidly; rough – thin and slow, rough flow. • Analogy btw earths rivers, not conduits; No rise and fall of arteries. • Slippery and rough like flowing and resisting – mirror belief that life flowed.

4. Styles of Touching: Pulses 2 GREEKS • To teach, learn need clear words in region of multiple languages and in debate • Galen terms: size, speed, rhythm and modulators: large/small, fast/slow, frequent/rare (like 4 humor diagram). • Artery has l, w, and h so 27 size differences. Additional: strong/weak, full/empty, hard/soft CHINESE • Qiemo: vocabulary, stable for 1000s yr no problem. • Mo ineffable. Complete clarity not possible. Figurative speech (similes and metaphors that describes how feel mo not what it is. No objective state. • no parallel concept of rhythm since mo not systole/diastole. • Mo was manifestation of blood and Qi. Sensitive to change in blood and Qi. Nature manifested in mo. But Qi perceptive from outside. • Subjective like emotions: Neijing - rising in anger, sinking in fear, • Mencius: Differentiate btw hearing and listening: Effect depend on how they are uttered. (Read emotional states in people).

5. East Vs West • pulsing artery and streaming blood and Qi give rise to different words AND different styles of speaking about pulse and qiemo • Styles of speaking inseparable from styles of listening. Qiemo like listening to close friend and read in more than what passively observed. • People express themselves not just in words (which can hear) but in language assessable to touch. • palpate body, guide not only by beliefs about arteries and mo and body organization, but assumptions about nature of human expressiveness.

6. Styles of Seeing: Muscles GREEKS • Compare Vesalius with Acupuncture Man. • Why did the Chinese miss muscles? • Better yet, why did the Greeks see muscles?

7. Historically, visions of muscles exception not rule. • Muscles: much to do with Western Art. Don't usually see muscles (nude body). • Muscles inside, portrayal inseparable from what imagine within, but even anatomical seeing mystery • Anatomy paramount in West, but again anomaly. • Anatomy: particular way of seeing • Dissection: • Plato (forms important, not what eye see) didn’t dissect. • Aristotle first to dissect animals to discern purpose. (Alexandrian pd use humans.) • Divination by entrails expand into anatomy only in West. • . Galen: Dissect to seek purpose. Learn to see order. As in pulse, w/o training, no see • Origin of Muscular Body: • Hippocrates: muscles no role, just flesh. Describe how body looked.. • Aristotle: ignorant of muscles. Movement depend on primal mover. • Evolution to how body worked: muscles become organ with Galen • . • Galen, common to speak of muscles; change with rise of anatomy. Study of muscular body alter anatomical vision • Organs of voluntary motion. Associate with free will. (Heart not muscle.). • Pulse involuntary contraction of heart/arteries. Beyond choice • Feeling in heart, willing in brain.

8. PHYSIOLOGY OF GALEN brain Animal spirit forms from vitalspirits when blood enters; animal spirit sent out through nerves (Descarte: part of blood contained animal spirit; came into contact with thinking substance in brain, flowed over nerve channels to activate muscles) Air (pneuma) - life breath of cosmos; modified by 3 organs (liver, brain, heart), distribute by 3 vessels: veins, arteries, nerves; lungs Arterial vein (mod. Pulmonary artery) Releases smoky vapors produced when air reached invisible fire of heart (hearth) Bring air to L ventricle of heart by venal vein (mod pul vein); Gives up waste (smoky vapors) Through arteries to body Some enter right ventricle; hole in L ventricle mix blood with air;charged with”vital spirit", (To Aristotle, seat of intelligence) • with arteries maintain and distribute heat, pneuma and vital spirits heart liver • blood originates from food delivered in form of chyle; • charges bile along with pneuma form with natural spirit or nutritive soul; • blood leaves by veins to lungs • liver origin of veins Pneuma delivered to liver

9. Styles of Seeing: Colors CHINESE Nanjing: To gaze and know the illness is divine. Bian Que: Hippocrates of China. See inside bodies. Look at living not dead. Little on dissection. Just measure and weighed viscera, traced blood vessels. Coincide with standardization in unification. (Greeks/Galen no measure) . In LIngshu, Heaven can’t be measured but body can and get glimpse of heaven. Opposite to Arisototle who urged dissection of plants, animals, but not heavenly bodies. • Somatic Structures • GREEK • Brain/heart/liver rule muscles/vessels. • Brain supreme – seat of reason Cut nerve, arm limp. Block artery, pulse stop. • STRUCTURE MEDIATES FUNCTION • CHINESE • mo form circle, no controlling source. Began and return to place, cunkou • No governance in body for Chinese so less interest brain, heart. • Neijing: correspondence btw body and state - 5 phases/YY: • TIES INVISIBLE TO DISSECTION.

10. The Ties: • Bian Que: w/o treatment, disease sinks deeper. Spatial layering and disease progression to greater depths. Or rise from depths. • Noxious breaths or wind from outside into inside. Treat outside. • Palpate Qi and Cun, check if mo float or sinking, slippery or rough. • Floating vs sinking: light fingers feel abundance, harder and mo disappears, mo is floating. But if little at surface, mo sunken. • FLOATING AND SUNKEN: superficial vs deep afflictions. MOST FUNDAMENTAL DISTINCTION IN QIEMO. LOGIC OF DEPTH TO SIGNAL CHANGES. • Shape of organ defined by struct/function important to Greeks • In China, shape not important, but place is. Order by depth. • How contemplate a body organized by depth? • Gaze on surface: Skin give 5 colors.

11. GAZE Sight (Se) Color privledged. Microscopic body ruled by 5 phases, wax/wane seen in change in color. (G,R,Y,W,Bl) Even used today in TCM. But why ideal? Close relationship btw seeing and divining. Illness more severe, color more intense. Superficial or sunken. Attention to Se (observe expressions on others) moral Confucian duty. (like rectitude, righteousness, modesty). But why does face have color? Spirit: Se expressiveness – face mirror feelings and inclinations. Wax/Wan phases in person. Se best expressed unguarded moments. Chinese use botanical metaphors. Governing organs and governed parts, inner core and expressive surface: related like roots and stems to leaves/blossoms. Words like nourish, wilt. No other metaphor as central in imaging body. Subtlest: hue of blossom. Greeks parallel btw animal and plant. Both nourished and grew. Vegetative soul. But farther in China. Mencius: turn to plants to show goodness human nature. (4 virtues like roots) Greek vision of body: intention and muscular will Chinese: neither, but metaphor of growth and flourishing of plants (even in moral development)

12. Styles of Seeing – blood and life ch5 Blood letting large part West history. Not in China. Not from Hippocrates but prevalent in Galen’s work. http://www.bruce.ruiz.net/PanamaHistory/Pirates/Wafer_Blood_Letting_500.jpg http://webpub.allegheny.edu/employee/l/lcoates/CoatesPage/FS101/FS101_Images/BloodLetting.jpg

13. Blood and life: Except lose of blood/breath in injury lead away from letting • Evolution of Greek phlebotomy: From doubts to cornerstone. View phlebotomy as release of excess. • GREEK • Hippocrates: menstruation, nose bleed beneficial. • Food to blood. Too much problem. Influx eliminate with, bleeding. • Blood can putrefy and cause inflammation (cancer one form). • Lead to Galen view of plethora: ruddy complexion, large pulse, excessive eat/drink, lack activity. . • Use to treat plethora and AND suspicion of disease development. • CHINESE • No real equivalent of plethora. Disease similar to plethora: shi or fullness. Full and hard mo, tension, pain, fever. But differ from plethora: not problem of blood; • Real issue in China the opposite: xu – emptiness;depleted vitality.xu main concern • Shi when Qi come in • xu when Qi leave • later – relative imbalances: Shi: external influences. Vs Plethora (Greeks) which arises from within.

14. Harm from without if predisposed. • GREEKS • : if internal excess; • fear blood putrefaction/corruption; accumulate in lethargic bodies; prevent by bleeding • pores paths for excretion. Worry about retention/excess. Favor strenuous exercise • . • CHINESE • : if internal emptiness • worry about dissipation and dispersal (Dispersed Qi is death.) • exercise: stimulating flow, shaping body, not require muscles. Worry about loss or lack • .

15. Blood and Breath: • Phlebotomy vs acupuncture: treat blood, qi (breath). • CHINESE • Blood and Qi essentially same with some distinction • Blood had form, Qi formless • Blood constructive, qi protective • Slippery mo, more blood than Qi, rough mo, reverse. Just differences in aspects, not essence • vitality flow in single network of channels: the mo • BLOOD AND QI COMPLEMENTARY FACETS OF UNIQUE VITALITY: YIN AND YANG MANIFESTATIONS. • GREEK • more dichotomies btw blood and pneuma; eventually, blood passive, corruptible; pneuma active, essence of soul • separate conduits: veins blood sustain vegetative function of growth, nutrition; nerves, filled with pneuma, carry sensation and will. • Blood become flesh; pneuma from brain through nerves transform flesh into muscle, instrument of soul. • Arteries (3rd conduit): motions drive past, present, future. • Breath: cool heat of inborn fire; exhale hot smoky residues. • Cycle of cooling and elimination defined use of pulse. • Galen: Pulse regulate internal heat. Imagine pores in arteries like nose/mouth.

16. Styles of Seeing – wind and self ch6 • Greeks: Wind associate with disease. Pneuma used for wind/breath • Chinese: cause chill, headaches. Wound by wind. • Nejing: Wind is chief of the 100 diseases and 100 diseases arise from wind. • Fengshui –art of wind and water; flow of breath in each locality; Site: xue – holes or caverns – same as acupuncture sites. • Both: Wind around body related to breaths sustaining life. Wind: foreshadow change – link to health. Feng Shui "The Bagua, originating from the I Ching or Book of Changes, is an eight-sided map that overlays the floorplan of a lot, building or room. Each of the eight sections and the center corresponds to a section of life experience: career, wisdom/knowledge, family, finances, reputation, relationships, children/creativity, benefactors/supportive people, and health. By overlaying the Bagua onto a floorplan (it stretches to fit!), it is easy to identify the locations of these life areas and how chi flows through the structure. If any areas are “missing” or weak in some way, simple solutions can adjust the chi flow to strengthen the area and bring it into harmony." www.fengshui-bydesign.com/ how_work.htm

17. GREEK • Breath and being inseparable. • Hippocrates: pneuma - inside breath, outside air, but really one: wind and breath. • Close to idea: nerves filled with pneuma. Air to brain induce intelligence; to hollow veins induced movement. Epilepsy – block. • Eventually all disease – matters going in/out of body and wind. • N/S wind most important (strongest). North cool, healthy since make body drier, cooler, south warm/moist, make flabby, weak, putrefaction.. • China • Less cause of disease than disease itself, like invader. Attack skin, chills; further in worse. • No group by temp or humidity. Direction not important. Winds not spirits. • Neijing: Wind beginning of hundred diseases. • Proper/full wind (repletion) vs evil/empty (depletion). Problem from latter. • Proper: blow from right direction at right time. Evil winds deviate. • Warring States: 8 winds (bafeng) based on 8 fold division of space. • Han: divining boards: circulation of wind to Taiyi and 9 palaces (one in center). Full from occupied place, evil from empty place. In Neijing: 9 palaces, 8 winds. • Body had seasons, Spring liver ascendant, summer heart, etc. • GREEKS: Anatomists describe wind as force, • CHINESE: body articulated by time. Change of season, mo rise or recede. THEORY OF WIND WAS THEORY OF TIME • If life changed in unison with seasons, no sickness. • Erratic, empty winds, seasons mixed up, time awry. • Wind arise unexpectedly, associate with sudden illness; stroke, epilepsy, madness. • To live long, blood and qi flow unobstructed, pores in skin closely knit. Avoid wind after sweat when pores open.

18. Greeks • Hippocrates:  illness due to force (change humors), and due to forms (organs).  From shape comes properties (attract, repel water, etc); Wind little importance after Hippocrates.  • Aristotle:  innate breath gave shape to body, blood from within.  Also preserve shape, form, which the 4 elements couldn't. Pneuma inner content.  Pneuma breaths within body • Internalization of pneuma place anatomical knowledge at core of.medicine Redefined the body. • Galen:  organ a part of the animal that is the cause of complete action (eye - vision, legs - walk). • Body as sum or organs required presence of active soul.  Galen: usefulness of all organs related to soul - body is instrument of soul.  To see body anatomically in Greeks was to see purpose.  Combo of action and anatomy.  • By 17th century, this view increased challenges.  Use purely mechanical metaphors. Retract body from soul. Believe in pneuma fade slowly.

19. Chinese • Body's interior center around 5 zang and 6 fu organs. • not anatomical, not what viscera are but what they do in health/disease. •   Neijing:  organs not tools of controlling source, implements of soul.  They were repositories of Qi (vital breath) • . • Fu organs:  • hollow deposits (like stomach, intestines, bladder, gall bladder, triple burner) temporarily housed coarser, turbid essences.  • Zang Organs •   solid viscera, (liver, heart, spleen, lungs, kidneys)  that store the refined Qi and don’t let it escape.  More vital than Fu:  • kidney most important - held most refined Qi.  • Not logic of ruler and ruled, but by imperatives of storage and retention. • Modern (Western) explanation of TCM stress YY, 5 phases, with microcosmic body in macroscopic world: Cosmic Correspondences • Opposing ideal of being:  body self contained, ruled by inner logic ( heat/cold, dry/wet, fullness/emptiness, especially wind). Overlooked by West. • Inner fullness lead to security.  Zang keep vital breath secure within, person deflect chaotic change.  • Empty winds no harm since if full, no way to enter.  • Only when untimely wind encountered depletion develop problem.  • Fullness also protect against aging • NO PRINCIPLE MORE BASIC TO CHINESE THINKING ABOUT SICKNESS. • .  • Outer breezes/inner breaths, and external/internal changes in autonomous body - in both Chinese and West.   But differ approach: • China:  full figures resist depletion of outflow of life, loss of vital breath and time; • Greek: autonomous muscleman: capacity for genuine action, for change due neither to nature nor chance, but on the will. • Galen: Start not with wind but with body with expressed purpose.  Parts became organs, implements of soul;  Muscles: organs of voluntary motion, actions determined by self.  Different way to imagine human being in world of ceaseless change.