The Five Taxations 五勞 Part III

Ok, so it’s been awhile since my last installment of the Five Taxations (the last one was back in April of this year if anyone would like to go back to read it again). To remind everyone, the Five Taxations (五勞) are a list of 5 damages caused by overuse or overexertion, and they are found in the Xuan Ming Wu Qi (Wide Promulgation of the Five Qi, Su Wen 23). The first was taxation that involved the Heart, and the second the Lung. Today we move on to the next one.

The third of the Five Taxations reads, “sitting for a long time damages the flesh” (久坐傷肉). Wang Bing then tells us in his commentary that this is taxation of the Spleen. The connection between Spleen and Flesh is clear – both are correlates of the Earth Phase. The question then is why sitting for a prolonged period of time damages the both of these structures?

In Chinese medicine it is said that the Spleen is the Zang-viscera that governs yùn huà – movement and transformation (運化). Yùn can be translated as transportation, and thus many TCM students today memorize that the Spleen governs transportation and transformation. However, what we gain in alliteration we lose in some of the other meanings of the word. The term yùn is the same as in yùn dòng (運動). This term means motion or movement, and it also means exercise, athletics or sports. Many of our patients in the modern west work white-collar jobs, and tend to sit for long periods of time during the day. Also, as time goes on, fewer and fewer people make the effort to engage in any meaningful physical activity or exercise for leisure. As our body moves less, the movement and transformation of Qi and Blood in the body is damaged. This is one way that prolonged sitting directly damages the Spleen. The link between exercise and digestion is recognized in colloquial Chinese with sayings such as “fàn hòu bǎi bù zǒu, huó dào jiǔ shí jiǔ” (飯後百步走,活到九十九) – walk a hundred steps after each meal and you will live a very long life (literally, to 99 years).

We can also arrive at Spleen and Flesh damage from the other direction. There are many patients we see who complain of feeling fatigued, and have a sensation of easily fatigable and weak limbs. Getting out of a chair is difficult, and they may also complain of aching in the joints. This sort of patient is often diagnosed with having dampness of the Spleen, perhaps due to improper diet, or other long-term habits that damage the Spleen and Stomach. As the Spleen and Stomach are damaged, impaired movement and transformation leads to the accumulation of damp and then phlegm. Thus the Zhi Zhen Yao Da Lun (SW74) says, “All damp, swelling and fullness, without exception they are associated with the Spleen” (諸濕腫滿皆屬於脾). This type of patient sits for a prolonged period of time because their body feels uncomfortable to move, so the inclination to sit is a symptom of Spleen damage. The difficulty here is that the lack of movement, which was originally from the Spleen, further contributes to damaging movement and transformation, worsening the Spleen injury more. It is a vicious cycle. This is why the Zang Qi Fa Shi Lun (SW22) says, “In the case of a Spleen disease, the body is heavy; muscles and flesh tend to be limp. The feel cannot be contracted for walking.” (脾病者,身重善肌肉痿,足不收)

The patient with damaged Flesh and Spleen can actually have two things happen – they can either become obese, or they can become emaciated. Lack of movement by itself can cause obesity. Lack of movement and obesity together can lead to all sorts of chronic diseases, such as hypertension or diabetes. That said, damage to Spleen and Flesh can also mean the person loses weight, for example in elderly patients with sarcopenia, the degenerative loss of muscle mass and quality. For both of these patients exercise as a therapeutic intervention is invaluable. Even moving a little, has tremendous benefit. The better option however is the ideal that the superior physician treats disease before it arises. Maintaining a regular exercise regimen throughout life can help prevent both obesity and emaciation. Why? Because it ensures the health of both the Spleen and the Flesh.

The first and some of the most important therapies for these patients is diet and movement (I prefer the term movement because patients find the word exercise scary or daunting). After that we can consider other treatments. In Tung’s acupuncture we can first consider points such as Si Hua Shang 77.08, a point that is the same as Zu San Li ST-36. In Tung’s own writing he said this point supplements the Qi. It is also specifically indicated in conventional acupuncture for weakness or heaviness of the limbs, and specifically the Five Taxations that we are discussing in this blog post series. If there is poor digestion, poor appetite, or abdominal comfort including diarrhea, this point is commonly combined with Men Jin 66.05. Lastly, a great Tung style point combination is a Dao Ma group called the Zu Wei San Zhen (足胃三針) – the Leg Stomach Three Needles. This is the combination of Zu San Li ST-36, Shang Ju Xu ST-37, and Xia Ju Xu ST-39. This combination is indicated for dizziness, agitation, tinnitus, enteritis, stomach pain, diarrhea, constipation, dysentery, soreness and pain of the knee and shin, lack of strength in the lower extremities. In the Taiwanese literature it is recommended for elderly patients to regulate the Zang Fu, supplement the Yuan and turn back the Jing, and to strengthen the lower extremities.

That was an interesting statement – to supplement the Yuan. Let’s also remember that weakness of the Spleen can eventually damage the Original Qi (元氣). Since the Spleen is the Latter Heaven source of Qi and Blood, if that is damaged it eventually taxes the Early Heaven Qi and Blood, in other words, the Original Qi rooted in the Kidney. This is the reason that the next Tung point combination that I recommend for the third of the Five Taxations is the use of the Lower Three Emperors (下三皇), namely Tian Huang 77.17, Di Huang 77.19 and Ren Huang 77.21. These points are located along the Spleen channel overlapping Yin Ling Quan SP-9 and San Yin Jiao SP-6. However, in Tung’s acupuncture they are one of the main Dao Ma groups for the Kidney. Notice also that it is one of the most commonly used Dao Ma groups for conditions such as diabetes, one of the complications of Spleen and Flesh taxation that we mentioned above.

The point groups listed above have a general regulatory effect on the Spleen and the Kidney, but what about the eventual other problems such as obesity from phlegm or damp accumulation, or weakening of the muscles. We can talk for hours on the subject actually, but a here is a quick set of suggestions for us to start chewing on. For accumulation of phlegm, in Tung’s acupuncture we would consider the Three Weights Three Needles (三重三針; i.e., Yi Zhong 77.05, Er Zhong 77.06, and San Zhong 77.07), or a point like Feng Long ST-40. For wasting of the Flesh we can consider points that lie along the Yang Ming channels, such as Jian Zhong 44.06 (for example, weakness of the lower extremities can be treated by combining Jian Zhong 44.06 and Si Hua Shang 77.08).

As you can see this discussion can go quite deep, and it illustrates the depth of insight that our early ancestors had in the clinic. What they saw then, we still see now, and Chinese medicine continues to be an excellent treatment for what would seem to be the ongoing human condition.