Thursday, May 24, 2012

Acupuncture and Diaphragm

The diaphragm character
The ancient character for 鬲


The diaphragm and its constriction caught my attention some years ago as I noticed that most of the patients coming to the “infertility” treatments had their diaphragm constricted, coldness of abdomen, cold womb and many of them had acid reflux.
Physically the diaphragm is a sheet of muscle separating thoracic cavity and abdominal cavity. The diaphragm plays important role in respiration, and is also involved in vomiting, expelling feces and urine. The pressure from diaphragm helps esophageal hiatus to preventing acid reflux. The muscular structure is also connected to ligaments of vertebral column.  The diaphragm is innervated by phrenic nerve formed from nerves coming from C3-C5.

In Chinese medicine

In classic medical texts the problems of diaphragm are usually seen more as symptoms of disease than the source of the problem. Most of the classics speaks of heated, cold, full or distended diaphragm. The symptoms mentioned in connection are mostly of vomiting, constipation/diarrhea, food retention, qì rebellion and breathing difficulties.
However the problem is much deeper. For example physician named Yùchāng (喻昌) wrote in 1645 in Yùyìcǎo (寓意草) how the dàlùo of Stomach and the qì of Lung go through the diaphragm. Because of moving and transformations of jīng, blood and qì the constricted diaphragm is seen to cause serious problems as it is “Not only the womens disease but also the child [in womb and while breatfeeding] loses it nourishment”.
When we look at the channel pathways we can see something very interesting:
  1. The Stomach channel coming downwards from the throat goes downwards and goes through the diaphragm area. The dàlùo of stomach goes from stomach to lungs passing the through the diaphragm as it goes.
  2. The Spleen channel likewise go through the diaphragm as it ascends. One branch that enters the spleen and stomach rise from stomach through the diaphragm and enters the Heart.
  3. The Lung channel beginning from the middle burner descends to the lower burner and ascends again passing the diaphragm before entering the lungs.
  4. The Large intestine channel after ascending the arm goes from Li15 to Du14 and goes to qūepén area where it branches. The descending branch enters the lungs and penetrates the diaphragm before entering the colon.
  5. The Heart Channel starts from the Heart and descends through the diaphragm to small intestine. The Heart also has network of connection to every Zàng-organs and most of these connections has to go through the diaphragm.
  6. The Small intestine channel after rising the arm branches at the qūepén area. The descending branch goes to Heart and descends further through the diaphragm to small intestine.
  7. The Kidney channel goes through diaphragm area while ascending before it dives to the Lungs and Heart.
  8. The liver channel after ascending from toes to abdomen enters the liver and gallbladder and continues to ascend through the diaphragm to costal region and finally to throat.
  9. The Gallbladder channel descends from qūepén area down the chest passing the diaphragm and enters the gallbladder and liver.
  10. The Sānjiāo channel branches after reaching qūepén area and the one part of it goes down to chest connecting Xīnbāo and descending trough the diaphragm to connect all the three burners.
  11. The Xīnbāolùo Channel starts from the chest and descends through the diaphragm to join the three burners.
  12. The Rènmài  pass through the diaphragm and the rènmài 15 is seen as a lùo-point of Rèn as from there the channel branches and the branch disperses to diaphragm.
  13. Chòngmài as it rises from womb it passes through the diaphragm. Chòngmài is responsible of red blood transforming to white milk during the breastfeeding.
There are also numerous other connections from different branches of the main channels. And as the diaphragm is a muscle it is very important to note that the Stomach, Spleen, Heart and Xīnbāo muscle channels all connect to the diaphragm.
From this it becomes clearly understandable why the diaphragm plays such important role upon all the ascending and descending within the energy system.

In alchemy

The diaphragm in Chinese language is 膈 (gě). Today the character for diaphragm is written with flesh radical (月 + 鬲) and the whole character is translated as diaphragm. The older form of character omits the flesh radical and the simple 鬲 translates as iron cauldron or earthen pot. This older name reveals much clearly the function of the whole diaphragm.
All the six fǔ-organs and three of the five zàng-organs reside below the diaphragm. Only the Heart and Lungs reside above it. The diaphragm stands between the upper and lower, separating them. The qì and jīng are below and the source of blood (Heart) is above. Water (Kǎn) below and Fire (Lí) above. In cultivation practices the diaphragm is very important as it controls the rising and descending of fire and water. It mixes the yuan qì and post heaven qì. The earthen pot is the whole abdominal area where the cooking of alchemical herbs is done.
In inner alchemy the diaphragm is connected to following “parts of the body”:
  1. Squeeze the spine pass (夾脊關 - Jiājǐguān) in the back
  2. Doves tail (鳩尾 - Jiūwěi) and Crimson palace (Jiànggōng) in the front
  3. The Great gate tower (巨闕 – Jùquè) within.
In emotional level the diaphragm works as an emotional shield and bridge between the unconscious and conscious emotions. It can block the emotions stored in the lower abdomen from over-flooding the Heart and consciousness. Its functioning can be easily observed in children. When the emotions are too hard to deal with the diaphragm becomes tense and whole upper stomach get tense. The sobbing, crying or vomiting are biological ways of relieving the formed tensions. Quite common result of diaphragmatic tension is digestion problems or diminished appetite. One very common manifestation of this blockage is that there is cold and possibly qì masses or even blood stagnation masses below while there are heat and fullness above manifesting as symptoms like feeling of stuffiness at the chest and throat, nausea and acid reflux.
It also seems that many common anti depression medicines block the diaphragm. This also might explain some of the most common side effects like nausea and heart-burn. Sometimes you can see how medicated bodies express strange division where rest of the body still show the emotional strain while the facial expressions seem tranquil and rationally distant. In these cases the certain caution is in place while treating the area.

Acupuncture and diaphragm

One commonly used acupuncture point is called 膈俞 (Bl 17 – gěshū).  In Nánjīng reads “血會鬲俞”, meaning that the Blood meets or collects in Gěshū. The point is seen as “master of blood” as the Heart above produces the blood and the liver below stores it. This point is commonly used in many Blood related diseases and it is great for moving blood and qì. Shū point are places from where channel branches to fill places/organs with qì. The great meaning of point is revealed while applying moxa here as it results in warming the whole abdomen or the cauldron for alchemical cookings.
The point lateral to Gěshū is much less used point called 膈關 (Bl 46 – Gěguān). It is a great point to open the diaphragm and open the lid upon the cauldron. This point is better for opening the diaphragm than the Gěshū.
In front we have Ren 14 Jùquè (巨闕). The name means the great gate tower. It is the mù (募) point of the Heart. It is the watchtower to protect the imperial city. At the back there is also hidden points called 巨闕俞, the shū point for this watchtower.
In emotional problems with constricted cauldron one of my favorite ways of opening the diaphragm is to first needle Gěshū and Gěguān in intention of first stirring the cauldron and opening the lid. Then using qìgōng at Jùquè to very genty open the gates to the Crimson palace of Heart.
One good point for very prolonged blockage is Ren 15 – Jiūwěi (鳩尾). Jiūwěi means Doves tail. It is also called  Shéns treasury (Shénfǔ 神府). The point is yuán point for gāo (膏) and the point has a great effect to all the Zàng-organs. This point is also the lùo-point of Rènmài. The lùo merges to the diaphragm. It is said that when one descends from here he/she becomes tangled in emotions and thoughts of later heaven and when one ascends from here one returns to the Palace of Shén.
These are just a few points affecting the diaphragm. Other common points include other local points (mostly stomach and kidney channel points). Also because the fact that diaphragm is a muscle and the courses of muscle channel pathways the distal points of Spleen, Stomach, Heart and Xīnbāo channels are also effective.
It is very important to be very gentle while trying to open the diaphragm. Any tension or forcing will easily prevent the opening from happening. The opening is sometimes accompanied with involuntary laughter, crying, sobbing and/or shaking. Care must be taken that the emotions have time to settle down before leaving the patient.

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