Perspectives on Ho-sha and Kyo-jitsu: Historical and Modern Clinical Reflections
by Stephen Birch
Amsterdam
NOTE: In this article all Japanese words are italicized while Chinese words are left unitalicized.
I would like to congratulate NAJOM for pulling together such an interesting collection of papers on the important but difficult-to-grasp concepts of ho-sha [補-寫] and kyo-jitsu [虛-實]. These are concepts, clinical assessments/judgments, and techniques that I, like many acupuncturists before me, have struggled with. I enjoyed the different perspectives and ideas described in NAJOM volume 19, number 54 and feel inspired to add to the conversation. I doubt I have anything useful or interesting to say, which has never stopped me before, but I do apologize if the following seems too tedious. Perhaps I should follow the advice of Yoshio Manaka, one of my teachers, who said the concepts of ho-sha and kyo-jitsu (tonfication-dispersion and deficiency-excess) have different meanings according to who, when, and in what contexts they are used. He felt explanations about them in acupuncture texts don’t do justice to their depth and complexity and thus he elected not to discuss them further [Manaka, Itaya, Birch 1995]. But I am not as smart as my teacher.
A contrast of approaches
There is a fascinating and very big difference in the descriptions of needling techniques for ho and sha in the Neijing and Nanjing. These differences clearly suggest quite different concepts of kyo and jitsu and the purposes and possible actions of ho and sha.
An important innovation of the Neijing was the concept that problems causing a condition of kyo are at the root of disease. Once a kyo condition occurs (due for example to emotional imbalance), environmental influences (called xieqi or jyaki [邪氣]) can penetrate into the body and cause symptoms and disease. The basic idea in the Neijing, where needles are introduced as tools for treatment, is that with the right technique and internal condition of the practitioner, one can get the Qi to arrive and strengthen (ho) the Qi. If this strengthening is sufficient, it drives out the jyaki (literally disperses, san [散]). If this does not occur, one can also use a sha technique to drain the jyaki, causing it to leak out of the body. So the basic idea of ho and sha in the Neijing is one of strengthening the normal Qi and removing the pathogenic Qi.
The Nanjing on the other hand describes a completely different idea of ho and sha. It proposes two levels of Qi, one more superficial than the jingmai or channels and one within the channels. This is congruent with some of the concepts in the Neijing that certain Qi flows within the channels (yingqi [營氣]) and other Qi outside of the channels (e.g. weiqi [衛氣]). To accomplish ho according to the Nanjing, one first gathers Qi (deqi [得氣]) by a method of touch and then inserts the needle superficially to the level above the channel; one gets the Qi to gather there and then pushes the needle deeper (into the channel) to introduce what one has gathered into the channels. Thus one accomplishes ho – increasing the channel's Qi content. Conversely, sha involves the deeper insertion of the needle after the Qi has been gathered by a method of touch, needling to the level of the channel, where one gathers Qi again and then pulls the needle back to the superficial level, thus decreasing the Qi content of the channel. Unschuld describes this as a kind of ‘internal exchange’ [Unschuld 1986:639]. The Nanjing (see Unschuld [1986:626]) and many commentators describe the more superficial Qi as ‘weiqi’ and the deeper Qi as ‘yingqi,’ but one has to wonder about this kind of naming. The descriptions of these techniques seem to imply that the weiqi and yingqi are inter- changeable. Probably many attribute a kind of resilient quality to these Qi and will not like the idea of their inter-changeability. I suspect though that the Nanjing had other ideas in mind, to do with yin-yang balance and the effects it has on the overall Qi of the body (such as the shengqi [生氣], see below for further elaboration).
Another important difference between the Neijing and Nanjing can be seen in the following: Lingshu chapter one contains passages that are considered origin texts that other Neijing passages about needling comment on [Chace, Bensky 2009, Keegan 1998]. It makes the following statements about ho and sha: 迎而奪之, 惡得無虛, 追而濟之, 惡得無實 “By meeting it and taking it away, how could one not achieve depletion [of the qi]? By pursuing and assisting it, how could one not achieve repletion [of the qi]?” [Chace, Bensky 2009]. Most commentators interpret this practically as saying ‘If you needle with the flow of the channel how can you fail to produce ho?’ and ‘If you needle against the flow of the channel how can you fail to produce sha?’ The text and its grammar express this as a kind of certainty (if you do x you will effect ho, if you do y you will effect sha). So naturally everyone should want to do this. But the angle of needle direction is not the only way to interpret this pivotal passage.
Nanjing 79 re-expresses the passage with slight modifications as follows: 迎而奪之,安得無虛？隨而濟之,安得無實？and then proceeds to explain this in terms of the five- phase creative cycle, thereby explaining the theory of Nanjing 69: “For cases of kyo (apply) ho (to) the mother, for cases of jitsu (apply) sha (to) the child.” [Unschuld 1986:583] In this passage of the Nanjing, ho and sha are achieved by a judicious application of five phase theory in point and channel selection, which is very different from the original passage in the Neijing which is (most commonly) seen as describing essential aspects of the needling techniques. Instead of focussing on increasing or decreasing Qi amounts directly with a needle, the Nanjing appears to maintain that one can achieve ho and sha by restoring balance (among the five phases). This is similar to the ho and sha needling techniques of the Nanjing, where the balance produced is a kind of yin-yang balance (transfer between the more superficial and deeper layers of Qi as discussed above).
What do these two different visions of ho and sha from the Neijing and Nanjing have in common? What do they imply about the nature of kyo and jitsu? These are difficult questions that no one else seems to want to discuss, and maybe I should be smart and stop here, but I have some thoughts. I will share them briefly.
The Neijing model works to correct kyo and jitsu of the jingmai in order to help regulate the Qi. Lingshu 75 tells us as a definition of acupuncture, “needling regulates the qi” [Rochat de la Vallee 2006:79]. Kyo in a channel is corrected by ho, adding Qi (from some unstated place) into that channel, while jitsu is corrected by encouraging the problem (jyaki) to leak out using the sha technique. Both of these methods use needling techniques that are dependent on the internal state of the practitioner and the level of skill of the practitioner. The Nanjing describes what sound like more reproducible techniques that focus on gathering and moving Qi around within the body to create more balance among different (yin-yang) Qi levels, and allowing any practitioner to do something by employing five-phase theory according to the ideas in Nanjing 79 and through the treatment principles and patterns of Nanjing 69.
Behind the Neijing model lie unstated ideas about what the ho technique might be doing, because it’s not clear what kind of Qi is involved. The Nanjing appears to be more explicit. Since the technique revolves around manipulating Qi between different levels in the body, it is working more with the idea of balance. This description of needling techniques also implies a model of the yingqi and weiqi as basically the same thing – Qi, in its yin and yang manifestations. The techniques of ho and sha are not about changing one form of Qi into the other by moving the two Qi between their two levels. Instead it seems to be about manipulating Qi in terms of its depth and location so that it can act differently according to where it is and thus create (yin-yang) balance. Unschuld drew attention to this [Unschuld 1986:639], but I have found no other author that has focused on this. Here the Qi that is talked about is of an undifferentiated nature, a kind of all-encompassing global Qi of the body that is named differently according to location and action/function so that medical practitioners could make differentiations in order to guide treatment [Birch 2009, Chiu 1986, Rochat de la Vallee 2006, Unschuld 2003].
What kind of description of this all-encompassing global Qi or natural healing power does the Nanjing give? It is likely that the Nanjing’s model is based on the idea of the shengqi or seiki [生氣], the vital qi described in Nanjing 8. This seiki is rooted in the ‘moving Qi between the kidneys’ and is the foundation for all the major systems in the body (Qi, zang-fu, jingmai, sanjiao). Nanjing 8 states these relationships thus:
“All the twelve channels (jingmai) are linked with the origin of the vital qi. The ‘origin of the vital qi’ refers to the root and foundation of the twelve channels – that is to the ‘moving qi’ between the kidneys. This (qi) is the foundation of the [body’s] five depots and six palaces (zang and fu); it is the root of the twelve channels; it is the gate of exhalation and inhalation, and the origin of the triple burner. It is also called the ‘spirit guarding against the evil’. Hence the [moving] qi [between the kidneys] constitutes a person’s root and foundation” [Unschuld 1986:130].
Presumably when the vital Qi – seiki is in a healthier condition, the body’s systems are better able to take care of what needs to be done. It seems in the Nanjing’s model that the job of an acupuncturist is to move Qi from one place to the other so that something (probably seiki) can do this. The idea in the Nanjing is to move Qi between the level inside the jingmai and above the jingmai and use the regulatory agency of five phase interactions. The Neijing, on the other hand, has a less-developed idea of the body taking care of itself and relies more on the imagery and language of adding influences (Qi) into the body as needed, and if this is not enough, to also remove disturbing influences (Qi) from the body rather than waiting for the body to try to resolve them. Evidence for these differences lies in the practical descriptions of how the ho and sha are carried out and the general background imagery and models employed in the different texts.
Another possible rationale can be proposed for how natural healing is enhanced with needling. The Mawangdui sexual cultivation treatise the ‘Heyinyang’ [和陰陽] (circa 168 BCE) describes the arrival of Qi as follows: “The qi arrives, blood and qi flow freely, the ears and eyes are keen and bright, the skin gleams, the voice is clear, and the back, thighs and buttocks are sturdy, so that one ‘attains divine illumination’” [Lo, Li 2010:381]. The needling techniques in both the Neijing and Nanjing require that the Qi arrive in order to be effective. Perhaps there was a common understanding based on passages like this from the Heyinyang that the arrival of Qi itself promotes vitality (Qi and blood flow, the senses are keener, the skin lustre improves, the physical body stronger), while the actions of ho and sha, which are applied after the Qi arrives, help restore balance and order.
What I have described is quite different from modern explanations of ho-sha and their effects on kyo-jitsu. Modern texts tend to focus on hypothesized models of functional systems in the body that move into kyo and jitsu states, and ho and sha tend to be focused on correcting these kyo and jitsu states.
I believe the early acupuncture literature had not yet developed models like this. (It is not entirely clear to me whether this was due to lack of clarity in explanation or that such explanations were not intended). Instead, early literature focused on the rectification of a kyo condition of the seiki (shengqi) and removal of pathogens (jyaki – jitsu conditions) that interfere with the seiki’s function of maintaining a higher state of health.
Ho and sha techniques were dependent on the ability of practitioners to produce important changes within themselves so as to be able to influence the Qi (getting it to arrive). Ho and sha are directed to specific channels that are seen to be kyo or jitsu in order to also help restore better balance in the body, which itself encourages a better condition of the seiki. When the overall balance and distribution of seiki in the body is restored, healing occurs, problems are resolved, a higher, better physiological state of the patient is brought about. It seems to me that this is mediated through the seiki (or whichever term for the global Qi you prefer). I started working out this model a while ago and published a preliminary version of it in a paper three years ago where I described what is happening when we perform ho techniques – focusing on modelling the changes that can be observed in the pulses [Birch 2009]. Together with colleagues in Australia, I also studied the pulse changes associated with ‘root treatment’ (applying ho to the kyo channels and sha to the jitsu channels) in order to start figuring out the physiology of pulse changes and root treatment [O’Brien et al. in press]. In this study we can see that fundamental changes occur in the body as a result of the root treatment. These changes also help reinforce the notion that the condition of the channels must be observed through pulse diagnosis, a principle premise of the very notion of the jingmai [經脈] (keimyaku) in the earliest treatise on the jingmai. Lingshu 10 states: ‘the luomai can often be seen, while the jingmai cannot; to judge their kyo/jitsu condition, one must palpate the pulses’ [See Wu, Wu 1997 pages 570 and 574, and Matsumoto, Birch 1983 page 153.] It is through the pulses that we can observe the changes and condition of the channels. This gives us practical tools to assess the kyo and jitsu state of the channels and the effects of ho and sha on them. Modern needling techniques such as those we use in Keiraku Chiryo Meridian Therapy, the ho technique of Toyohari for example, are actually composite practical reproductions of many traditional ideas from various sources [see Shudo 1990:170-184, and for more details, Birch in preparation]. They include seemingly contradictory ideas from the Neijing and Nanjing [Birch in preparation].
All this seems to be very different than the notions of ho and sha, for example in moxibustion (okyu) and herbal medicine (Kampo). The effects of moxa as a tonic are seen sometime after the treatment when the stimulation of moxa triggers a range of biological reactions that help improve certain physiological parameters and create a higher functioning body – as can be seen in the excellent Moxafrica projects. The effects of moxa as ho build up gradually over time. The same is likely to be true with herbal products, which create changes in physiology gradually over time as the herbs are absorbed and reach their target systems. In acupuncture, the ho and sha techniques produce immediate changes at the time of needling that can be measured [Birch 2009, O’Brien et al. in press]. We thus see the same terms ‘ho’ [補] and ‘sha’ [寫] used in similar ways in three different medical practice systems, but with quite different actions both in terms of physiological effects and in time frames of action. Ho and sha thus appear to be very different concepts depending on the tradition of practice that uses them. I have focussed on needling above, since this is what I do, but I find myself coming full circle back to Manaka’s cautionary words about terms like ho and sha.
As I stated in the beginning, I probably shouldn’t have said anything. Based on the evidence I have come across, however, what I have described makes sense to me. I thought the different perspectives were not clearly represented in the various articles in NAJOM volume 19, number 54. Thank you for reading this far and I hope I have not added to anyone’s confusion.
Bibliography
Birch S. Filling the whole in acupuncture. Part 1:1 What are we doing in the supplementation needle technique? European J Oriental Medicine, 2009:6(2):25-35. Part 1:2, 2009:6(3):18-27.
Birch S. The jingmai and qi: acupuncture perspectives. In Birch S, Cabrer Mir MA, Rodriguez M. (eds). Restoring order in health and Chinese medicine: Studies of the development and use of qi and the channels. In preparation.
Birch S, Azzopardi J. A pilot study investigating practitioner-based deqi experiences, in preparation.
Chace C. On greeting a friend, an approach to needle technique. The Lantern. 2006:3(3):4-7.
Chace C, Bensky D. An axis of efficacy. The range of meaning in chapter one of the Lingshu. The Lantern 2009;6(1):5-13; 6(2):33-41.
Chiu ML. Mind, body, and illness in a Chinese medical tradition.Ph.D. thesis, Harvard University, 1986.
Field SL (translator). The Zangshu, or Book of Burial by Guo Pu (276324). July 26, 2009, http://www.fengshuigate.com/zangshu.html.
Forman RKC. Mysticism, Mind, Consciousness, Albany, SUNY Press, 1999.
Fukushima K. Meridian Therapy, Tokyo, Toyo Hari Medical Association, 1991.
Keegan, Joseph. The Huang-ti nei-ching: the Structure of the Compilation; the Significance of the Structure, doctoral diss. Berkeley; University of California, 1998.
Li Jianmin. They shall expel demons: etiology, the medical canon and the transformation of medical techniques before the Tang. In J Langerwey, M Kalinowski (eds). Early Chinese Religion, Leiden, Brill, 2009, pages 1103-1150.
Lo V. The influence of nurturing life culture on the development of Western Han acumoxa therapy.In Hsu E, (ed). Innovation in Chinese Medicine, Cambridge, Cambridge University Press, 2001:19-50.
Lo V, Li Jianmin. Manuscripts, received texts and the healing arts. In Nylan M, Loewe M (eds). China’s Early Empires - A Re-appraisal, Cambridge, Cambridge University Press, 2010, pages 367-397.
Manaka Y, Itaya K, Birch S. Chasing the Dragon’s Tail, Brookline, Paradigm Publications, 1995.
Matsumoto K, Birch S. Five Elements and Ten Stems, Brookline, Paradigm Publications 1983.
Matsumoto K, Birch S. Hara Diagnosis: Reflections on the Sea, Brookline, Paradigm Publications, 1988.
O’Brien KA, Birch S, Abbas E, Movsessian P, Hook M, Komessarof PA. Traditional East Asian Medical pulse diagnosis - a preliminary physiological investigation. In press – J Alt Complem Med.
Rochat de la Vallee E. A Study of Qi in Classical Texts, London, Monkey Press, 2006.
Shudo D. Introduction to Meridian Therapy, Seattle, Eastland Press, 1990.
Sivin N. Traditional Medicine in Contemporary China, Ann Arbor, Centre for Chinese Studies, University of Michigan, 1987.
Unschuld PU. Nan Ching: The Classic of Difficult Issues, Berkeley, University of California Press, 1986.
Unschuld PU. Huang Di Nei Jing Su Wen - nature, knowledge, imagery in an ancient Chinese medical text. Berkeley, University of California Press, 2003.
Wang JY. Applied Channel Theory in Chinese Medicine. Seattle, Eastland Press, 2008.
Wu NL, Wu AQ. Yellow Emperor’s Canon Internal Medicine, Beijing, China Science and Technology Press, 1997.
Yang ZY. On presence of mind and subtle sensations. The Lantern, 2007;IV(2):28-30.
Endnotes
by Stephen Birch
Amsterdam
NOTE: In this article all Japanese words are italicized while Chinese words are left unitalicized.
I would like to congratulate NAJOM for pulling together such an interesting collection of papers on the important but difficult-to-grasp concepts of ho-sha [補-寫] and kyo-jitsu [虛-實]. These are concepts, clinical assessments/judgments, and techniques that I, like many acupuncturists before me, have struggled with. I enjoyed the different perspectives and ideas described in NAJOM volume 19, number 54 and feel inspired to add to the conversation. I doubt I have anything useful or interesting to say, which has never stopped me before, but I do apologize if the following seems too tedious. Perhaps I should follow the advice of Yoshio Manaka, one of my teachers, who said the concepts of ho-sha and kyo-jitsu (tonfication-dispersion and deficiency-excess) have different meanings according to who, when, and in what contexts they are used. He felt explanations about them in acupuncture texts don’t do justice to their depth and complexity and thus he elected not to discuss them further [Manaka, Itaya, Birch 1995]. But I am not as smart as my teacher.
A contrast of approaches
There is a fascinating and very big difference in the descriptions of needling techniques for ho and sha in the Neijing and Nanjing. These differences clearly suggest quite different concepts of kyo and jitsu and the purposes and possible actions of ho and sha.
An important innovation of the Neijing was the concept that problems causing a condition of kyo are at the root of disease. Once a kyo condition occurs (due for example to emotional imbalance), environmental influences (called xieqi or jyaki [邪氣]) can penetrate into the body and cause symptoms and disease. The basic idea in the Neijing, where needles are introduced as tools for treatment, is that with the right technique and internal condition of the practitioner, one can get the Qi to arrive and strengthen (ho) the Qi. If this strengthening is sufficient, it drives out the jyaki (literally disperses, san [散]). If this does not occur, one can also use a sha technique to drain the jyaki, causing it to leak out of the body. So the basic idea of ho and sha in the Neijing is one of strengthening the normal Qi and removing the pathogenic Qi.
The Nanjing on the other hand describes a completely different idea of ho and sha. It proposes two levels of Qi, one more superficial than the jingmai or channels and one within the channels. This is congruent with some of the concepts in the Neijing that certain Qi flows within the channels (yingqi [營氣]) and other Qi outside of the channels (e.g. weiqi [衛氣]). To accomplish ho according to the Nanjing, one first gathers Qi (deqi [得氣]) by a method of touch and then inserts the needle superficially to the level above the channel; one gets the Qi to gather there and then pushes the needle deeper (into the channel) to introduce what one has gathered into the channels. Thus one accomplishes ho – increasing the channel's Qi content. Conversely, sha involves the deeper insertion of the needle after the Qi has been gathered by a method of touch, needling to the level of the channel, where one gathers Qi again and then pulls the needle back to the superficial level, thus decreasing the Qi content of the channel. Unschuld describes this as a kind of ‘internal exchange’ [Unschuld 1986:639]. The Nanjing (see Unschuld [1986:626]) and many commentators describe the more superficial Qi as ‘weiqi’ and the deeper Qi as ‘yingqi,’ but one has to wonder about this kind of naming. The descriptions of these techniques seem to imply that the weiqi and yingqi are inter- changeable. Probably many attribute a kind of resilient quality to these Qi and will not like the idea of their inter-changeability. I suspect though that the Nanjing had other ideas in mind, to do with yin-yang balance and the effects it has on the overall Qi of the body (such as the shengqi [生氣], see below for further elaboration).
Another important difference between the Neijing and Nanjing can be seen in the following: Lingshu chapter one contains passages that are considered origin texts that other Neijing passages about needling comment on [Chace, Bensky 2009, Keegan 1998]. It makes the following statements about ho and sha: 迎而奪之, 惡得無虛, 追而濟之, 惡得無實 “By meeting it and taking it away, how could one not achieve depletion [of the qi]? By pursuing and assisting it, how could one not achieve repletion [of the qi]?” [Chace, Bensky 2009]. Most commentators interpret this practically as saying ‘If you needle with the flow of the channel how can you fail to produce ho?’ and ‘If you needle against the flow of the channel how can you fail to produce sha?’ The text and its grammar express this as a kind of certainty (if you do x you will effect ho, if you do y you will effect sha). So naturally everyone should want to do this. But the angle of needle direction is not the only way to interpret this pivotal passage.
Nanjing 79 re-expresses the passage with slight modifications as follows: 迎而奪之,安得無虛？隨而濟之,安得無實？and then proceeds to explain this in terms of the five- phase creative cycle, thereby explaining the theory of Nanjing 69: “For cases of kyo (apply) ho (to) the mother, for cases of jitsu (apply) sha (to) the child.” [Unschuld 1986:583] In this passage of the Nanjing, ho and sha are achieved by a judicious application of five phase theory in point and channel selection, which is very different from the original passage in the Neijing which is (most commonly) seen as describing essential aspects of the needling techniques. Instead of focussing on increasing or decreasing Qi amounts directly with a needle, the Nanjing appears to maintain that one can achieve ho and sha by restoring balance (among the five phases). This is similar to the ho and sha needling techniques of the Nanjing, where the balance produced is a kind of yin-yang balance (transfer between the more superficial and deeper layers of Qi as discussed above).
What do these two different visions of ho and sha from the Neijing and Nanjing have in common? What do they imply about the nature of kyo and jitsu? These are difficult questions that no one else seems to want to discuss, and maybe I should be smart and stop here, but I have some thoughts. I will share them briefly.
The Neijing model works to correct kyo and jitsu of the jingmai in order to help regulate the Qi. Lingshu 75 tells us as a definition of acupuncture, “needling regulates the qi” [Rochat de la Vallee 2006:79]. Kyo in a channel is corrected by ho, adding Qi (from some unstated place) into that channel, while jitsu is corrected by encouraging the problem (jyaki) to leak out using the sha technique. Both of these methods use needling techniques that are dependent on the internal state of the practitioner and the level of skill of the practitioner. The Nanjing describes what sound like more reproducible techniques that focus on gathering and moving Qi around within the body to create more balance among different (yin-yang) Qi levels, and allowing any practitioner to do something by employing five-phase theory according to the ideas in Nanjing 79 and through the treatment principles and patterns of Nanjing 69.
Behind the Neijing model lie unstated ideas about what the ho technique might be doing, because it’s not clear what kind of Qi is involved. The Nanjing appears to be more explicit. Since the technique revolves around manipulating Qi between different levels in the body, it is working more with the idea of balance. This description of needling techniques also implies a model of the yingqi and weiqi as basically the same thing – Qi, in its yin and yang manifestations. The techniques of ho and sha are not about changing one form of Qi into the other by moving the two Qi between their two levels. Instead it seems to be about manipulating Qi in terms of its depth and location so that it can act differently according to where it is and thus create (yin-yang) balance. Unschuld drew attention to this [Unschuld 1986:639], but I have found no other author that has focused on this. Here the Qi that is talked about is of an undifferentiated nature, a kind of all-encompassing global Qi of the body that is named differently according to location and action/function so that medical practitioners could make differentiations in order to guide treatment [Birch 2009, Chiu 1986, Rochat de la Vallee 2006, Unschuld 2003].
What kind of description of this all-encompassing global Qi or natural healing power does the Nanjing give? It is likely that the Nanjing’s model is based on the idea of the shengqi or seiki [生氣], the vital qi described in Nanjing 8. This seiki is rooted in the ‘moving Qi between the kidneys’ and is the foundation for all the major systems in the body (Qi, zang-fu, jingmai, sanjiao). Nanjing 8 states these relationships thus:
“All the twelve channels (jingmai) are linked with the origin of the vital qi. The ‘origin of the vital qi’ refers to the root and foundation of the twelve channels – that is to the ‘moving qi’ between the kidneys. This (qi) is the foundation of the [body’s] five depots and six palaces (zang and fu); it is the root of the twelve channels; it is the gate of exhalation and inhalation, and the origin of the triple burner. It is also called the ‘spirit guarding against the evil’. Hence the [moving] qi [between the kidneys] constitutes a person’s root and foundation” [Unschuld 1986:130].
Presumably when the vital Qi – seiki is in a healthier condition, the body’s systems are better able to take care of what needs to be done. It seems in the Nanjing’s model that the job of an acupuncturist is to move Qi from one place to the other so that something (probably seiki) can do this. The idea in the Nanjing is to move Qi between the level inside the jingmai and above the jingmai and use the regulatory agency of five phase interactions. The Neijing, on the other hand, has a less-developed idea of the body taking care of itself and relies more on the imagery and language of adding influences (Qi) into the body as needed, and if this is not enough, to also remove disturbing influences (Qi) from the body rather than waiting for the body to try to resolve them. Evidence for these differences lies in the practical descriptions of how the ho and sha are carried out and the general background imagery and models employed in the different texts.
Another possible rationale can be proposed for how natural healing is enhanced with needling. The Mawangdui sexual cultivation treatise the ‘Heyinyang’ [和陰陽] (circa 168 BCE) describes the arrival of Qi as follows: “The qi arrives, blood and qi flow freely, the ears and eyes are keen and bright, the skin gleams, the voice is clear, and the back, thighs and buttocks are sturdy, so that one ‘attains divine illumination’” [Lo, Li 2010:381]. The needling techniques in both the Neijing and Nanjing require that the Qi arrive in order to be effective. Perhaps there was a common understanding based on passages like this from the Heyinyang that the arrival of Qi itself promotes vitality (Qi and blood flow, the senses are keener, the skin lustre improves, the physical body stronger), while the actions of ho and sha, which are applied after the Qi arrives, help restore balance and order.
What I have described is quite different from modern explanations of ho-sha and their effects on kyo-jitsu. Modern texts tend to focus on hypothesized models of functional systems in the body that move into kyo and jitsu states, and ho and sha tend to be focused on correcting these kyo and jitsu states.
I believe the early acupuncture literature had not yet developed models like this. (It is not entirely clear to me whether this was due to lack of clarity in explanation or that such explanations were not intended). Instead, early literature focused on the rectification of a kyo condition of the seiki (shengqi) and removal of pathogens (jyaki – jitsu conditions) that interfere with the seiki’s function of maintaining a higher state of health.
Ho and sha techniques were dependent on the ability of practitioners to produce important changes within themselves so as to be able to influence the Qi (getting it to arrive). Ho and sha are directed to specific channels that are seen to be kyo or jitsu in order to also help restore better balance in the body, which itself encourages a better condition of the seiki. When the overall balance and distribution of seiki in the body is restored, healing occurs, problems are resolved, a higher, better physiological state of the patient is brought about. It seems to me that this is mediated through the seiki (or whichever term for the global Qi you prefer). I started working out this model a while ago and published a preliminary version of it in a paper three years ago where I described what is happening when we perform ho techniques – focusing on modelling the changes that can be observed in the pulses [Birch 2009]. Together with colleagues in Australia, I also studied the pulse changes associated with ‘root treatment’ (applying ho to the kyo channels and sha to the jitsu channels) in order to start figuring out the physiology of pulse changes and root treatment [O’Brien et al. in press]. In this study we can see that fundamental changes occur in the body as a result of the root treatment. These changes also help reinforce the notion that the condition of the channels must be observed through pulse diagnosis, a principle premise of the very notion of the jingmai [經脈] (keimyaku) in the earliest treatise on the jingmai. Lingshu 10 states: ‘the luomai can often be seen, while the jingmai cannot; to judge their kyo/jitsu condition, one must palpate the pulses’ [See Wu, Wu 1997 pages 570 and 574, and Matsumoto, Birch 1983 page 153.] It is through the pulses that we can observe the changes and condition of the channels. This gives us practical tools to assess the kyo and jitsu state of the channels and the effects of ho and sha on them. Modern needling techniques such as those we use in Keiraku Chiryo Meridian Therapy, the ho technique of Toyohari for example, are actually composite practical reproductions of many traditional ideas from various sources [see Shudo 1990:170-184, and for more details, Birch in preparation]. They include seemingly contradictory ideas from the Neijing and Nanjing [Birch in preparation].
All this seems to be very different than the notions of ho and sha, for example in moxibustion (okyu) and herbal medicine (Kampo). The effects of moxa as a tonic are seen sometime after the treatment when the stimulation of moxa triggers a range of biological reactions that help improve certain physiological parameters and create a higher functioning body – as can be seen in the excellent Moxafrica projects. The effects of moxa as ho build up gradually over time. The same is likely to be true with herbal products, which create changes in physiology gradually over time as the herbs are absorbed and reach their target systems. In acupuncture, the ho and sha techniques produce immediate changes at the time of needling that can be measured [Birch 2009, O’Brien et al. in press]. We thus see the same terms ‘ho’ [補] and ‘sha’ [寫] used in similar ways in three different medical practice systems, but with quite different actions both in terms of physiological effects and in time frames of action. Ho and sha thus appear to be very different concepts depending on the tradition of practice that uses them. I have focussed on needling above, since this is what I do, but I find myself coming full circle back to Manaka’s cautionary words about terms like ho and sha.
As I stated in the beginning, I probably shouldn’t have said anything. Based on the evidence I have come across, however, what I have described makes sense to me. I thought the different perspectives were not clearly represented in the various articles in NAJOM volume 19, number 54. Thank you for reading this far and I hope I have not added to anyone’s confusion.
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Endnotes