Year : 2021 | Volume
: 4 | Issue : 1 | Page : 19--24
“Focusing on treating the spirit (神)” in acupuncture and moxibustion: The dialectical unity of regulating the body and the spirit
Bing- Li Chen, Qian Fan, Li- Xin Guan, Wen- Guang Hou, Yue- Lai Chen
Acupuncture Department, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
Prof. Yue- Lai Chen
Acupuncture Department, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437
”Focusing on treating the spirit (神)” is an important principle in acupuncture and moxibustion. It is a unique psychosomatic therapy involving the doctor and the patient, which includes regulating the spirit and the body. Traditional Chinese medicine attaches great importance to it. Focusing on treating the spirit is also a component of the standards of medical ethics. Only when doctors have noble medical ethics can they achieve clinical treatment of the mind and give full play to their skills to cure diseases. Focusing on treating the spirit runs through the entire clinical process of acupuncture and moxibustion. Before the treatment, it is necessary to focus on the spirit to distinguish the spirit and qi. During the treatment, attention should be paid to the mind to regulate the spirit and qi. It is the premise of clinical diagnosis and treatment of acupuncture and moxibustion and the key to the curative effect. Focusing on treating the spirit is also in the realm of doctor-patient double treatment, which requires doctor-patient communication before treatment and the preservation of the body and spirit after treatment. Therefore, concentration of the mind is the key to acupuncture and moxibustion treatment.
|How to cite this article:|
Chen BL, Fan Q, Guan LX, Hou WG, Chen YL. “Focusing on treating the spirit (神)” in acupuncture and moxibustion: The dialectical unity of regulating the body and the spirit.Chin Med Cult 2021;4:19-24
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Chen BL, Fan Q, Guan LX, Hou WG, Chen YL. “Focusing on treating the spirit (神)” in acupuncture and moxibustion: The dialectical unity of regulating the body and the spirit. Chin Med Cult [serial online] 2021 [cited 2021 Jun 13 ];4:19-24
Available from: https://www.cmaconweb.org/text.asp?2021/4/1/19/312777
”Spirit (神)” is a unique concept in traditional Chinese medicine and a concentrated embodiment of human life activities. It summarizes people's spiritual consciousness and thinking as well as the manifestations of the external Zang-Fu organs, qi, blood and fluids. “Focusing on treating the spirit (治神)” is from Su Wen “Bao Ming Quan Xing Lun”（《素问·宝命全形论》 Basic Questions “Discourse on Treasuring Life and Preserving Physical Appearance”. It is stated that “The key point for acupuncture is to pay full attention (凡刺之真,必先治神).” It is an important principle in the clinical diagnosis and treatment of acupuncture and moxibustion. Focusing on treating the spirit mainly refers to managing the conscious and unconscious mind, and regulating mental abnormality. It requires the cooperations of both doctor and patient, as well as the involvement of the mind and body. Traditional Chinese medicine attaches great importance to it. The concentration of the mind in acupuncture and moxibustion is a unique form of psychosomatic therapy, which runs through the whole clinical process. Through teaching of the theory and practice of focusing on treating the spirit, the author deeply understands that focusing on treating the spirit will help better understand the principles of acupuncture and its manipulation. It will improve the clinical efficacy of diagnosis and treatment.
Focusing on Treating the Spirit is One of the Clinical Principles of Acupuncture and Moxibustion
Focusing on treating the spirit is the rule. Ling Shu “Ben Shen” (《灵枢·本神》 Miraculous Pivot “To Consider the spirit as the Foundation”) states that “the use of needling methods must be based on the spirit.” Basic Questions “Discourse on Treasuring Life and Preserving Physical Appearance” puts forward that “All the things [in nature] follow these rules and the examples are numerous. [As to] acupuncture, there are five points to be publicized [because] ordinary people only care their living and do not know [the secrets of acupuncture]. [These five points are:] Zhishen (paying full attention); knowing how to cultivate health; being familiar with the action of drugs; understanding how to select the size of stone needles; being sophisticated in examining blood and qi in the Zangfu-Organs.” In the above principles of treatment, focusing on treating the spirit is in the first place, because the “spirit” is not only a reflection of the mind, emotion and brain activities, but also a concentrated expression of the qi and blood function of the ZangFu organs, the meridian and collaterals. Dan Xi Xin Fa（《丹溪心法》 Danxi's Experiential Therapy states that “The change of the inner part of the body can be reflected in the outer part of the body.” In other words, the change of mind is the fundamental change of life activities. Therefore, “mind” is fundamental, and focusing on treating the spirit is also essential. As the Yuan Dynasty's Du Su Wen Chao (《读素问钞》 Annotation of Basic Questions states that “It's called the way of the needle. If the spirit is adjusted, the disease can be cured; if the spirit and the will are scattered, even if the needle is used, the disease will not be cured.”
The evaluation of the spirit is the first element in the formulation of the treatment principles of acupuncture. First of all, the rise and fall of the spirit reflects the gain and loss of the essence qi of the Zang-Fu organs. Through examining the changes of spirit, one can judge the constant change of the five Zang organs. Secondly, by identifying the improvement or decline of the spirit, one can judge the prognosis of the disease after acupuncture treatment. Therefore, knowing the status of mind is a prerequisite for the formulation of acupuncture principles. Zhang Jiebin (张介宾) said, “Spirit is righteousness. Those who have spirit will be prosperous. Otherwise, will die.” Therefore, the diagnosis of disease not only relies on observing the various symptoms, but also on judging the gain and loss of spirit on the whole. According to Ling Shu “Guan Neng” (灵枢·官能 Miraculous Pivot “Function and Competence”) said, “[In applying acupuncture, one] must not forget the cultivation and regulation of the spirit.” Ling Shu “Xiao Zhen Jie” (灵枢·小针解 Miraculous Pivot “Explanatory Remarks on the Small Needles”) states that “ 'Ordinary [doctors] just stick to the Xing (form)' [means that ordinary doctors] only stick to the needling techniques. 'Excellent [doctors] closely observe the Shen (spirit)' [means that excellent doctors] use reinforcing and reducing [needling techniques] according to the Shi (Excess) or Xu (Deficiency) condition of blood and qi.” This is also the basis for the formulation of the principles of acupuncture treatment, which are “If the [evil] qi is abundant, they are to be drained. If the [proper qi] are depleted, they are to be supplemented. In the case of heat, [the needle is to be inserted and withdrawn] quickly. In the case of cold it may remain [inserted] for a while. If an indentation forms, [when the vessel is squeezed, that fails to level again when the finger is withdrawn,] then it is to be cauterized. When [the qi] is neither abundant nor depleted, then [the disease] is to be removed from the [respective] conduit.” Here the spirit means the condition of blood and qi.
Focusing on treating the spirit is the first step. It indicates the importance of adjusting the emotion or mentality of patient during treatment. Basic Questions “Discourse on Treasuring Life and Preserving Physical Appearance” states that “The key point for acupuncture is to pay full attention.” It emphasizes on improving the overall therapeutic effect of the acupuncture treatment by first concentrating the mind. This is mainly reflected in two aspects: first of all, focusing on treating the spirit by differentiating syndromes is the first way of treatment. Acupuncture points with soothing effect can be used first to tranquilize the mind and smooth the qi. Then, treatment can be done by selecting points dialectically, so as to treating the spirit and improving the curative effect. According to the Lei Jing (《类经》 Classified Classic), “treatment must be based on the spirit, but invisible. Treatment must be based on the spirit, and the blood and qi can be improved. Therefore, in acupuncture, focusing on treating the spirit takes top priority.” Secondly, the abnormal emotion is both the cause and the result of the disease. Many diseases are manifested or accompanied by abnormal mental symptoms, such as insomnia, anxiety or irritability. So, in acupuncture treatment, we should give priority to treating the spirit, through concentrating the mind to improve or treat abnormal mental states. To achieve the effect of tranquilizing the mentality at the same time, it is more beneficial to regulate the functions of the Zang-Fu organs, the qi and the blood.
It is the Requirement of Standard Medical Ethics to Focus on Treating the Spirit and Concentrating the Mind
To some extent, the state of spirit reflects a doctor's ethics. The connotation of focusing on treating the spirit includes the norms of medical ethics., The article Da Yi Jing Cheng (《大医精诚》 Mastership of Medicine Lies in Proficient Medical Skills and Lofty Medical Ethics) in the book Bei Ji Qian Jin Yao Fang (《备急千金要方》 Essential Prescriptions Worth a Thousand Gold Pieces for Emergencies) is essentially a requirement of medical ethics. The first important point is that doctors should have excellent medical skills, and they should think that medical treatment is “the most delicate thing.” Doctors should learn about abundant medical resources with diligence and work tirelessly to improve their skills. The second important point is to be sincere. Doctors should cultivate noble morals. In the process of diagnosis, they should have empathy for the pain of the patient. In addition, “when treating diseases, doctor must be calm and determined, have no desire and demand, and be kind and sympathetic. Doctors cannot show off their ability to be outstanding, seek fame in a matter of vital importance and rely on their own expertise to seek wealth”. For clinical practice of acupuncture and moxibustion, “Mastership of Medicine Lies in Proficient Medical Skills and Lofty Medical Ethics” means that doctors should remain honest and upright, wholeheartedly provide effective and appropriate medical services for the patients. At the same time, doctors should care about the patients' mental state and focus on treating the spirit. No matter how rich or poor the patients are, whether they are close family and friends or not, doctors should always “concentrate on the minutest detail and focus their senses on the disease” ( Ling Shu “Jiu Zhen Shi Er Yuan” 《灵枢·九针十二原》 Miraculous Pivot “The Nine Needles and the Twelve Origin Openings”). Biao Yu Fu (《标幽赋》 Song to Elucidate Mysteries) puts forward that”Doctors should not focus on irrelevant things and should hold the needle carefully, just like facing a man of dignity.” It indicates that the curative effect of acupuncture and moxibustion depends not only on a doctor's skilled acupuncture techniques, but also directly related to attitude, attentive diagnosis and treatment, and trust between doctors and patients. Only by adhering to noble medical ethics can doctors focus on treating the spirit in clinical practice. Similarly, only with a focus on treating the spirit can doctors achieve the purpose of curing diseases, saving people with excellent skills, as well as reflecting sincerity and benevolence. This is completely consistent with the requirement of medical ethics in modern medicine.
Focusing on Treating the Spirit is the Premise of the Clinical Diagnosis and Treatment of Acupuncture and Moxibustion and is the Key to Achieving the Curative Effect
Before the treatment, it is necessary to concentrate on circulating qi to distinguish the spirit and qi.
(1) Concentration: Focusing on the spirit is based on the premise of concentrating the mind. In Ling Shu “Zhong Shi” (《灵枢·终始》 Miraculous Pivot “End and Beginning”), it is stated that “tranquilizing the mind, concentrating the attention, balancing physical build and spirit, avoiding any disturbance from the outside in order to concentrate the attention and focusing the whole mind on needling.” Doctors should concentrate themselves before treatment. By concentrating doctors can evaluate the condition of the patient's essence and spirit, and understand the reaction of the qi of the acupoints under the fingers. This will provide the basis for the formulation of the principle of acupuncture and the implementation of appropriate manipulation.,
Concentration is also a necessary preparation for patients. Song to Elucidate Mysteries states that it is necessary for the patients to focus their mind on the treatment before needling. When patients are focused, their spirit will be pacified and the qi will proceed without hindrance. Doctors guidance for patients to concentrate, act modestly, also meet the requirements for treating the spirit psychologically. In Ling Shu “Shi Chuan” (《灵枢·师传》 Miraculous Pivot “The Transmissions from the Teachers”), it is stated that “[The doctor should] tell the patients [what are] harmful [to their health], let them know [what are] good [for their health], guide them [to do what they] like [for restoring their health] and try to straighten them out of their anxiety.” Obtain informed consent from patients before treating them with acupuncture methods. If the patient comes in a hurry, let the patient rest for a while. Wait for the qi and the blood to become calm, then give the acupuncture treatment.
(2) Observation: Observing the condition of blood and qi of patients is the key to treatment. It is stated in Miraculous Pivot “To Consider the spirit as the Foundation” that “thus acupuncturists must carefully observe the physique of the patient [when treating the patient] in order to know the state of Essence, Spirit, Ethereal Soul and Corporeal Soul.” Doctors can identify the state of qi and blood by observing the spirit. In Miraculous Pivot “Function and Competence”, it is stated that “To use acupuncture [to treat disease, one] must be clear about the physical [characteristics] and the location of qi; the upper, the lower, the left and the right; yin, yang, the external and the internal; the quantity of blood and qi; the normal and abnormal [flow of Channel-qi]; as well as [the acupoints where blood and qi] converge [when they] go out of and come [into the body].” This shows that before acupuncture treatment, doctors should observe and distinguish the mind, collect the physiological and pathological information of patients in detail, evaluate the decline and prosperity of qi, observe the changes of qi, and determine the treatment principle before applying acupuncture.
Focusing on concentrating the mind and regulating the spirit and qi.
(1) Concentrate: During acupuncture treatment, doctors should focus on the patients, treat them carefully and concentrate on the mind and the acupuncture needles. They cannot be careless.
Pay attention and hold the needle prudently before puncturing. Miraculous Pivot “The Nine Needles and the Twelve Origin Openings” states that “The rule for holding the needle is like this: [The needle] must be held firmly and straightly, inserted directly [into the acupoint] without any deviation. [When inserting the needle, the doctor should] concentrate his mind on the patient.” The needle should be held firmly when puncturing, so as not to slide between the fingers. Be conducive in rapid needling to reduce pain. At the same time, in order to acupuncture safely and correctly, the doctor should carefully observe the patient's appearance so as to, to achieve the synchronicity of the doctor's and patient's spirit. Zhen Jiu Da Cheng (《针灸大成》 Complete Compendium of Acupuncture and Moxibustion) states that”Calmness means that doctors and patients should both have a steady mind. Acupuncture treatment should not be given until both the patients and doctors are settled.””The patient must be emotionally stable and breathe smoothly when they are treated with acupuncture.”
After inserting the needles, the doctor should be spirit-specific, to control the needle. Feel the needle carefully, identify whether the qi is being obtained. If the feeling under his fingers is like “fish swallowed bait ups and downs”, that means the qi has arrived. Only in this way can we obtain the qi, keep the spirit and qi together, and then apply the techniques of supplementing and reducing effectively. As stated in the Basic Questions “Discourse on Treasuring Life and Preserving Physical Appearance” “When the Channel-Qi has arrived, [the acupuncturist] should carefully keep it, either deep or shallow [according to] the therapeutic requirement and [the acupoints selected may be] either distal or proximal, [the rule is] the same, [In doing acupuncture, the acupuncturist must be very careful,] just like approaching a deep abyss or holding the tail of a tiger, with rapt attention.” Otherwise, according to Su Wen “Zheng Si Shi Lun” (《素问·徵四失论》 Basic Questions “Discourse on Evidence of the Four Failures”, “cannot concentrate [their] mind, make logical analysis and take both the external [manifestations] and the internal [disorders] into consideration. That is why [they are] frequently confused and failed [in treating dieseases].” At the same time, doctors should pay attention to the changes in patient's appearance. After acupuncture, the patient should have a soothing complexion and a calm spirit. If there is any pain or discomfort, the patient should be consult in time and adjustments should be made to make him or her comfortable. Otherwise, it will be difficult to obtain the qi and difficult for doctors to sense the qi, thus leading to qi and blood disorders. Even if they obtain it successfully, it is more likely to lead to accumulation and dispersion of qi.
Professor Zheng Kuishan, a famous acupuncturist, emphasized that when needling, the left hand should feel the qi under the acupoint, the right hand should hold the needle firmly and concentrate on the entry of the needle and guard the qi. Both hands need to”experience the impulse under the needle, and observe the patient's mental condition and tolerance of the needle.” Therefore, it is summarized as acupuncture treating disease via the arrival of qi under the needle. The qi will then pass to the diseased area.
(2) Guarding the mind: Guarding the mind in acupuncture is also guarding the qi. This refers to the obtaining of qi after needling and concentrating the force to make the qi of the needle tip not loose and smooth. According to Miraculous Pivot “Explanatory Remarks on the Small Needles”, “To obtain qi in needling requires careful observation [of the changes] of qi lest [the best time for needling] be lost.” It indicates that the patient should keep the qi and concentrate his or her mind after obtaining qi from the needle. Based on the condition of the blood and qi of the patient, doctor adopts the technique of reinforcing deficiency or reducing excess. The meridians, qi and blood proceed in full flow, and the mind goes with. As the ancients said: “when needling, the important matter is to get fullness of vitality and obtain qi.” The qi and mind accompany and promote each other. Only by fully grasping the status of the meridian and qi, by timely supplementing and relieving the mind, and by regulating the sense of effective acupuncture, can qi reach the diseased area and achieve a good curative effect. If the needle cannot obtain the qi successfully, then hold the needle and wait for it. At the same time, concentrate on the qi and keep the mind at the tip of the needle. Once the qi arrives, keep and circulate it. If the doctor cannot concentrate and is absent-minded when needling, he can neither keep the qi nor circulate the qi, let alone use the method of reinforcing deficiency and reducing excess as he is unable to distinguish the status of qi.
During acupuncture, doctors also need to guide the patient to concentrate. Experienced physicians often subtly induce or inspire patients to focus their attentions on the acupuncture site, which can guide and facilitate the conduction of acupuncture sensation, thus achieving the goal of concentrating the mind and promoting the effect of conducting acupuncture sensation and qi to the location of disease. Keeping the mind and qi between doctors and patients makes acupuncture treatment effect twice the result with half the effort. Therefore, the patient is also required to concentrate while needling, in order to experience the dynamics of qi and blood under the needle, attentively. Zhang Jingyue (张景岳) said, “After inserting the needles, be sure to focus on the patient's eyes to control their mental activity, so that the flow of qi circulates freely and the vessels are unobstructed.” Only in the state of gathering and concentrating the mind can the doctor perform the needling accurately, and only when the patient receives treatment in a stable and calm state can the effect of the needle be induced. “The key point in needling is that the arrival of qi ensures curative effect.” Miraculous Pivot “The Nine Needles and the Twelve Origin Openings”.
(3) Regulating the spirit: “Regulating the spirit” means that doctor selects acupoints according to syndrome differentiation and coordinates these points with corresponding acupuncture techniques to unblock the patient's channels and collaterals, regulate the qi and blood, and direct the qi to the location of disease, so that the yin and yang of the patient can be balanced. When the functions of the Zang-fu organs are harmonious, the settled mind and spirit can improve the curative effect.
The effect of “regulating the spirit” is reflected in two aspects: yin and yang are harmonized, and the spirit is governed. Ling Shu “Gen Jie” (《灵枢·根结》 Miraculous Pivot “Root and Connection”) states that “thus it is said that the rule in applying acupuncture lies in knowing how to regulate yin and yang. [Only when] yin and yang are regulated [can] Jingqi (Essence-Qi) be replenished, the body and qi be integrated and the spirit maintain inside.” The occurrence and development of disease is the result of imbalance between the yin and yang. Clinically, acupuncture method of supplementing the yin and expelling the yang, or reinforcing the yang and expelling the yin should be adopted in accordance to whether the body's yin and yang are over excessive. This to ensure the yin and yang are balanced to contain the spirit inside. Mind and spirit are settled so that the functions of the Zang-fu organs are harmonious. Being in a good mental state represents harmony in the functions of the Zang-fu organs and vice versa. Traditional Chinese medicine believes that each of the Zang-fu organs has its own spirit, Su Wen “Tian Yuan Ji Da Lun” (《素问·天元纪大论》 Basic Questions “Comprehensive Discourse on Arrangements of the Pricinpal [qi] of Heaven”) states that “in the human body there are Five Zang-Organs that produce five kinds of qi respectively which are responsible for [the five emotional activities of] Xi (joy or happiness), Nu (anger or rage), Bei (grief or sadness), You (anxiety) and Kong (fear or fright).” Ling Shu “Ping Ren Jue Gu” (《灵枢·平人绝谷》 Miraculous Pivot “A Healthy Person Ends the Ingestion of Grain”) states that “the blood vessels are smooth and the spirit is vigorous.” People's emotional activities and responses are based on whether the physiological functions of the Zang-fu organs are normal. Pathological changes in the functions of the Zang-fu organs, obstruction of qi and disharmony of blood vessels will lead to abnormal changes in emotions. If the mind is lax, patients may lose their minds and even become frantic, the liver does not store blood so that patients will be agitated. In clinical treatment, regulate the Zang-fu organs, tranquilize the mind and reinforce the function are needed. In the same way, a change in one's mood can react on one's internal organs. Gui Gu Zi (《鬼谷子》 Kuei Ku-tzu states that if it could not be treated reasonably then one would lose spirit and rule. Ling Shu “Kou Wen”（《灵枢·口问》 Miraculous Pivot “Oral Inquiry” states that “sorrow, grief, worry and anxiety will disturb the heart. [When] the heart is disturbed, the Five Zang-Organs and the Six Fu-Organs will be shaken.” Different emotional abnormalities can lead to different syndromes, ranging from light viscera qi injury, long-term viscera injury, injury to the mind, psychosomatic diseases, and losing the mind even death. Clinically, different acupoints and acupuncture techniques can be used to regulate the emotions and harmonize the functions of the Zang-fu organs.
Focusing on Treating the Spirit is also in the Realm of Doctor-Patient Double Treatment, Which Requires both Doctor and Patient to Communicate Before and After the Treatment to Preserve the Spirit, Mind and Body of both Parties
Focusing on treating the spirit includes enhancing the doctor-patient communication and building mutual trust and confidence. In the process of diagnosis and treatment, especially before carrying out treatment, patients can take the initiative to concentrate their mind under the guidance of doctors to achieve the desired effect. For example, through communication, patients can understand the ability of doctor, believe in acupuncture and moxibustion and have confidence in the treatment. Su Wen “Wu Zang Bie Lun” （《素问·五藏别论》 Basic Questions “Further Discourse on the Five Depots” puts forward that “Do not discuss medical theory with those who are superstitious; do not talk about the therapeutic skills with those who dislike acupuncture. [Those who] do not want to receive medical treatment when ill are incurable. In this case, forced treatment is ineffective.” It is the same meaning of “If they firmly believe in acupuncture and the doctor, patients will get twice the curative effect with half the effort” (Jin Zhen Mei Hua Shi Chao《金针梅花诗钞》 On the Techniques of Plum-blossom Needle).
The importance of focusing on treating the spirit comes after treatment. After receiving acupuncture treatment, patients should have a restful, calm demeanor, not be too angry, happy, sad, or worried, so as not to dissipate their qi, which is conducive to recovery. At the same time, doctors should also concentrate their minds to nourish their spirits and strengthen their bodies by regulating the functions of channels and collaterals. This will help facilitate concentration and recuperate the spirit. Especially after confirming the diagnosis and treatment, doctors should carry out purpose-oriented adjustment to promote “mind keeping” and the recovery of qi and the blood. Therefore, Basic Questions “Discourse on Treasuring Life and Preserving Physical Appearance” mentioned that people should “Zhishen (pay full attention) and know how to cultivate health.” Only when doctors are mentally and physically healthy, can they be supported to effectively carry out the treatment based on syndrome differentiation during acupuncture and moxibustion. It fully illustrates the importance of doctors maintaining their own health and ensuring recovery of their own energy after diagnosing and treating patients.
The spirit is the manifestation of the state of human life activities, and treating spirit is to regulate the integral life activity, which is an important content in traditional Chinese medicine practice, and has a special meaning in acupuncture and moxibustion. Acupuncture and moxibustion is the best method to treat the spirit, which is closely related to the moral cultivation and medical skills of doctors. The process of acupuncture and moxibustion treatment is an important interaction between doctor and patient. During the process, psychological guidance is carried out, thinking, trust, and confidence are also established. This ensures the improvement and expansion of therapeutic effect of acupuncture and moxibustion treatment. It also promotes patient's compliance and confidence. By superimposing psychological adjustment on the intervention of acupuncture, treating the spirit embodies a kind of comprehensive psychosomatic therapeutic principle and effect, which is worth thinking and studying in modern medicine.
This study was financed by a grant from the National Science Foundation of China (No. 81674090).
Conflicts of interest
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