And… The the last of the Five Taxations repost!
The word taxation (勞) as a medical term refers to some sort of physical exertion, or fatigue resulting therefrom. It also can describe some sort of significant wear and tear on the body. Previously I had blogged about a list of Five Taxations from the Xuan Ming Wu Qi (Wide Promulgation of the Five Qi, Su Wen 23). This is the last installation on the Five Taxations and it is long overdue. For those who are new subscribers or who missed the last posts, the first was taxation that involved the Heart, the second the Lung, the third the Spleen, and the fourth the Kidney. As is typical with the Neijing the five track along the Five Phases and thus the Five Viscera.
The last of the Five Taxations goes with the Sinews and the Liver. The source chapter says, “to walk for a long time damages the sinews” (久行傷筋). Wang Bing points out here that this then relates to the Liver. Like the previous taxation, there is little other explanation with my Translation and Explanation of the Neijing Suwen adding: 过度的行走，可以伤筋 (“excessive walking can injure the sinews”).
Now, I think most of us would consider walking a great form of exercise that just about anyone can do, and this is true. It has lower impact on joints than running, and it is easy and convenient. Medically though, we do know that overdoing anything is a problem. Remember, that the word in Chinese for ‘Chinese Medicine’ is Zhong Yi 中醫. The first part of that word, Zhong (中), stands for China (Zhong Guo 中國). However, Zhong literally means center, or middle. Thus, Chinese medicine is literally medicine of staying in the center. One of the core fundamental teachings of Chinese medicine, as illustrated by all five of the taxations, is that balance, in other words staying in the center, is health. Lack of balance is disease. This is why the Ping Ren Qi Xiang Lun (Su Wen Chapter 18) says that “a balanced person has no disease” (平人者不病也). Even with walking, overdoing it can be problematic. Endurance walking in particular is known to possibly cause dehydration, blisters on the feet, and, just as this taxation suggests, muscular pulls, strains, or other injuries.
At this moment I’ll remind everyone that the word Sinew in Chinese medicine is not the same as tendon in western medicine. The Chinese word sinew (筋) can refer to tendons and ligaments, but is also refers to the contractile strength of skeletal muscle. This is why in the middle of that character we see the character for physical strength (力).
In addition to the literal reading, we can try to understand this taxation in a deeper way. Sinews and Liver go with the Wood phase, the architype of Spring. Spring is the beginning of movement, the movement of rebirth, and thus ultimately a Yang season. While the taxation of sitting too long (i.e., lack of movement) damages the Spleen, we can also see that lack of movement damages the Liver and sinews as the symbolic representation of the muscles and connective tissue. Too much movement is also problematic. In that case, too much Yang-movement damages the physical manifestation (Yin) of the Wood-Liver (Yang).
Looking at this taxation in the other direction is also possible. As the Yang declines with the aging process, people are less inclined to move. In the 54th chapter of the Ling Shu the ageing process actually starts with a decline in Liver. And in the very first chapter of the Su Wen tells us that, “as the Qi in the Liver weakens, the sinews no longer can move” (肝氣衰，筋不能動).
So, how do we work with this taxation clinically? The first thing is to counsel patients to be active, but not to be so active as to constantly injure themselves. If your clinic is like mine, this is a constant issue really. How many times do we have a patient come in with shoulder, neck or back pain (or any other type of musculo-skeletal injury) that is a direct result of some overdone exercise? After we treat them and they feel better, often the first thing they do is go right back to the offending exercise and reinjure themselves. Like Chinese medicine at its fundamental level, we need to tell patients to seek balance in movement and rest, activity and stillness. Some patients need to exercise more, but some actually need to exercise less. A lot need to vary exercise so as not to constantly stress the same body areas.
For weakness of the sinews in general manifesting as weakness in moving the limbs, pain in the joints, and intolerance to exercise, I recommend Tung’s points the Lower Three Emperors (下三皇). This is an important Dao Ma combination on the lower leg that has a strong regulatory effect on the Kidney. Why do we use the Kidney here? Because strengthening the Kidney-Water benefits the Liver-Wood, conforming with the Nanjing strategy of “in vacuity supplement the mother” (虛者補其母). We can combined the Emperors with Yang Ling Quan (GB-34), the meeting point (會穴) of the sinews. Specific locations of weakness can be addressed individually with other points in addition to this general method of strengthening the Liver (via the Kidney) and benefitting the sinews.
I hope everyone has enjoyed this short series of essays, and that they show what sort of great knowledge is embedded in our classical texts!