8/19/2019 ITM Triple Burner

1/8

ITM Home Page | Article Index

TRIPLE BURNER ( SANJIAO)with reference to treatment of Sjögren’s Syn romeby Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, OR

The Name SanjiaoThe meaning of the name tri!"e #$rner% san iao% is $nc"ear& '#$rner gi es the im!ression that this 'organsystem generates heat% !erha!s a "ot of heat% #$t there is "itt"e e i ence that it oes that% rather acting asa conduit for heat transferre #etween other organs* +n a"ternati e inter!retation of the name has #een the'three #$rning s!aces which is somewhat #etter% in the sense that the location or ,one of inf"$ence of thisorgan system can encom!ass three 'heat so$rces witho$t itse"f #eing the generator of the heat (e*g*% -i ney%s!"een% an heart yang)* E en then% the term is not entire"y s$ita#"e* .ne of the commentators onthe Nanjing /on"y his name 0ang is retaine /sai that iao stan s for yuan (origin& the res!onse to1$estion 22 of the Nanjing states that ' Ori!in is an honora#"e esignation for the Tri!"e B$rner )% an that

the san iao refer to the three origins3 hea en% earth% an water* This seems a reasona#"e $n erstan ing& the$!!er iao recei es etherea" inf"$ences an may #e "i-ene to hea en& the mi "e iao is associate with theearth e"ement& an the "ower iao is associate with raining of water* By contrast% one of the Nanjing commentators% 4$a Sho$% sai that 'the tri!"e #$rner re!resents the ministeria" fire& thiso!inion is not s$!!orte #y others& 5$ 6aj$n consi ere that the tri!"e #$rner !ro i e a !assageway

#etween the fire of the -i ney an of the heart (the "atter ca""e ministeria" fire)* The tri!"e #$rner is not !hysica""y oriente as s$ch a con $it% #$t a major f$nction attri#$te to it is -ee!ing o!en the f"ow of 1i% anthat may #e its f$nction in re"ation to the -i ney an heart fires*

Triple Burner: an Organ with Name but not Form or ShapeThe organ systems of 7hinese me icine o not a"ways corres!on with !hysica" organs% an e en when they

o the f$nctions attri#$te to the organ in the 7hinese $n erstan ing go #eyon what we are a#"e to isco er a#o$t a !hysica" organ* 8or e9am!"e% the s!"een% !ancreas% an igesti e system% as we"" as the !er asi eimm$ne system com!onents% might corres!on in some way to the 7hinese '!i (s!"een)% which is sai to"ie abo"e the stomach* The "ac- of a irect "in-age of s$ch 7hinese m$"ti:f$nctiona" escri!tions withmo ern o#ser ationa" organs has "e to the $se of terms s$ch as 'organ system (which I ten to ma-e $seof) or e en 'or# % so as to a oi #ecoming ca$ght $! in these re"ationa" iffic$"ties* +s a isc$ssion of thetri!"e #$rner !rogresses% the i ergence in tho$ght a#o$t the form an f$nction of organs wi"" #ecomeo# io$s*

The san iao has #een recogni,e in the 7hinese system as ha ing "ess !hysica"ity than the other efineorgans* The "i er ( !an ) oes not c"ose"y corres!on with the f$nctions of the "i er that we i entify to ay% yetthere is a s$#stanti e organ in the #o y which the 7hinese can !oint to% an we wo$" say it is the same onewe ca"" the "i er* This connection can #e ma e% in !art% #eca$se the associate organ% the ga""#"a er% whichhas some ifferent !ro!erties in the 7hinese system than are otherwise recogni,e % a"so has a !hysica"connection with the o#ser e "i er* The 7hinese s!ecify that the "i er an ga""#"a er each ha e a form%sha!e% si,e% ca!acity% etc* Since the 7hinese iew is not high"y e!en ent on the !hysica" characteristics% #$tassociate with conce!t$a" as!ects% s$ch organ escri!tions may #e a j$ste to fit the ogmatic feat$res*Th$s% it can #e sai that there is a co"or associate with the tri!"e #$rner% #$t this has to o with the genera"

!rinci!"es% not o#ser a#"e feat$res*

The "ac- of sha!e an '!hysica"ity of the tri!"e #$rner was ist$r#ing to many 7hinese me ica"scho"ars% an so they inter!rete some of the Neijing an Lingshu statements a#o$t the tri!"e #$rner as

!ointing to a mem#rane that encase the entire torso% ha ing three !arts3 one co ering the chest ca ity& one

for the $!!er;mi "e a# omen& an one for the "ower a# omen* 4owe er% s$ch !rojection of a 'formseems o$t of to$ch with the !rimary escri!tions of the tri!"e #$rner% an re!resents !art of the str$gg"e tofig$re o$t its nat$re an 1$a"ities*

http://www.itmonline.org/index.htmhttp://www.itmonline.org/index.htmhttp://www.itmonline.org/articles.htmhttp://www.itmonline.org/articles.htmhttp://www.itmonline.org/index.htm

8/19/2019 ITM Triple Burner

2/8

Before the Neijing was !ro $ce % there were eeme to #e

8/19/2019 ITM Triple Burner

3/8

Th$s% we wi"" fin a escri!tion of the u$$er #$rner in o" ing 'fog or 'mist & the middle #$rner in o" ing fermentation (rotting)% foam% an co""ections of #$##"es& an the lo%er #$rner in o" ing c"ear "i1$i an t$r#i s$#stance se!arating o$t as the regs*

This tri!artite i ision of the esse" contents is not $n"i-e the tra itiona" escri!tion of 1i that is mo e"eon the e9!erience of the rice coo-er3 the steam a#o e the coo-ing rice% which has the fragrance of the rice% is"i-e 1i& the "i of the !ot is where the a!or con enses an fa""s #ac-& the #oi"ing rice is #eing transforme

#y the heat an water to ma-e a soft% e i#"e% an igesti#"e !ro $ct from the har ry raw materia"& an the

transformation of the rice an water ta-e !"ace #y irt$e of the fire that was sto-e #e"ow the !ot an whichfirst heate the #ottom !ortion* The main ifference #etween these mo e"s is that the fermentation !rocess%$n"i-e the coo-ing !rocess% oes not re1$ire a significant amo$nt of heat to #e intro $ce % an the rice !ot

oes not "ea e #ehin a waste resi $e from the coo-ing !rocess*

The Nan!ing" #$ st Difficult ssueThe Nanjing is a series of 1$estions with answers an the co""ection of @< 6iffic$"t Iss$es is inten e to #ean e9amination an f$rther e9!"anation of the Neijing * N$m#er ?< is a#o$t the tri!"e #$rner* The 1$estionis3%The triple burner: how is it supplied and what does it generate& 'here does it start and wheredoes it end& (nd where" in general" are its disorders regulated&)

The res!onse #egins3 %The triple burner encompasses the passagewa*s of water and grain+)

This is a critica" escri!tion #eca$se the fu are genera""y rece$tacles % often recei ing materia"s that ha e #een !rocesse #y other organs* The stomach% ga""#"a er% sma"" intestine% an "arge intestine are a""rece!tac"es* The stomach is the on"y one of them which can #e sai to recei e materia" (foo an water)which has not #een !rocesse #y another organ (there is some !rocessing in the mo$th% #$t not thro$ghaction of a ,ang or f$)* +s we $n erstan it to ay% the #"a er recei es its "i1$i waste from the -i ney% #$tthat was not the way it was $n erstoo $ring the time !erio of tri!"e #$rner escri!tion* Rather% the

#"a er recei e "i1$i s that were se!arate from so"i s o$tsi e the -i ney% an organ system which wasiewe % instea % as the reser oir of yin an yang% an a so$rce of yin essence an heat* The ario$s

rece!tac"es (f$) retain materia" for a whi"e an then !ass it on& so they are not "ong:term retention sites (as%for e9am!"e% the -i ney stores the essence or the "i er stores the #"oo )* The tri!"e #$rner is in icate in thisinitia" res!onse as not #eing a rece!tac"e% #$t a $assa!e%ay & that is to say% $n"i-e the other f$ organs% it is notretaining materia" that is "ater to #e !asse on*

The ne9t !art of the answer is3 % t represents the conclusion and the start of the course of ,i+) The'start of 1i #eing isc$sse here has three meanings3 the first is that the 1i from the foo starts in thestomach% at the site of the mi "e #$rner% an the other is that the 1i coming $!war from the stomache ent$a""y transmits to the organs to ma-e the '=> !assages thro$gh the #o y $ring the ay% an again =>

!assages at night* The thir im!"ication is that the y$an 1i (origina" 1i% so$rce 1i) transmits thro$gh thetri!"e #$rner to the rest of the #o y*

%The upper section of the triple burner e tends from below the heart downward through the

diaphragm and ends at the upper opening of the stomach+) This is a ery sma"" segment* 8rom themo ern iew!oint% a !assageway for water an grain that comes to the $!!er o!ening of the stomach wo$"re!resent a $ortion of the eso!hag$s* That is consistent with one !art of the conce!t the 7hinese scho"arse9!resse 3 it is "itera""y the entry !oint for water an foo that is cons$me * The !assageway escri#e hereis also the means #y which the 1i f"ows $!war from the stomach to the ca ity of the chest% $"timate"y tointeract with "$ngs an heart* To mo e $!war % it has to !ass thro$gh the ia!hragm% which a"so has a'ho"e’ in it* e consi er the ia!hragm as ha ing a f$nction re"ate to #reathing& the 7hinese saw it as amem#rane -ee!ing the t$r#i s$#stances #e"ow% an on"y a""owing the !$rifie an etherea" s$#stances tomo e into the chest ca ity% #y coming $! thro$gh this ho"e* 7hinese me icine escri!tions genera""y startfrom to! to #ottom* This #$rner is th$s escri#e as in o" ing a sma"" section 'from #e"ow the heart

ownwar G 8$nctiona""y% tho$gh% it is not on"y for a ownwar mo ement% #$t a"so for an u$%ard f"ow*

% t is responsible for inta.e but not for discharge+) This is a !assi e f$nction% of recei ing% #$t thereis no acti e f$nction of ischarging% s$ch as the ga""#"a er s1$ee,ing o$t its contents* This $!!er #$rner ser es as a $assa!e%ay to an from the stomach*

8/19/2019 ITM Triple Burner

4/8

hat !asses into the $!!er #$rner is escri#e #y the commentators& 0 Sh$ characteri,e the $!warȕmigrating 1i this way3 'the $!!er #$rner resem#"es fog* That is to say% the $!!er #$rner a""ows the !assageof 1i that resem#"es mist gent"y f"owing o$t from the stomach an e ent$a""y entering into a"" the con $its&one co$" e en say that the $!!er #$rner is this mist*

Note that it is not 'steam #$t fog* Steam carries more heat an has a stronger $!war f"ow& foge9!an s #$t has "itt"e force* This fog mo es $!war from the stomach so that it can then #e circ$"ate & itcan #e ta-en $! #y the con $its an ma-e its !assages aro$n the #o y #eca$se it can rain own #y action of

the "$ngs or #e is!erse $!war #y action of the heart*There is a #$rning !"ace in the chest% the heart% a fire organ% an one commentator% 0eh Lin% has note

that the $!!er #$rner essences 'mo e $!war from #e"ow& they is!erse in the chest an e a!orate/"i-esteam/into the s-in an !ores* So% that !ortion which oes not rain ownwar can contin$e $!war * +ssthe 1i mo es #eyon the $!!er #o$n ary of this #$rner (#e"ow the heart)% as it reaches the heart% it is thenheate an transforme to steam% r$shing o$twar to the s-in* hen% as it is sometimes consi ere % the$!!er #$rner is e!icte not as it is here% #$t as in o" ing the entire area a#o e the stomach% one can say thatthere is a #$rner% the heart% an that it 'steams the 1i an moist$re $!war an o$twar % o#ser e as

!ers!iration*

%The central section of the triple burner is located in the central duct of the stomach/ it does note tend further upward or downward+) This is a ery sma"" segment% an is within the stomach& o notsee- o$t a centra" $ct from mo ern anatomy% for this is a conce!t$a" term not an o#ser a#"e one& acommentator in icate that the "i er was within this $ct% so the is$a"i,ation of this !ortion has #een

iffic$"t*

% t is responsible for the spoiling and processing of water and grains+) The 7hinese ai"y e9!erienceof this -in of !rocess wo$" #e a com!ost !i"e or a fermentation at* These in o" e !assi e !rocesses% onethat sim!"y re1$ires ha ing the raw materia"s an a""owing some time* 4owe er% here is where the !rocessin o" es some heat* 8ermentation re1$ires some minima" warmth% which is $"timate"y from the -i ney ans!"een yang& this is why !hysica""y co" foo is of concern* Some warmth is generate from thefermentation !rocess% which is th$s se"f:maintaining* .ne m$st #e caref$" to isting$ish this warmth fromthe !atho"ogica" con ition 'stomach fire* The norma" fermentati e action is is!"aye #y !ro $ction of

#$##"es% which can yie" gasses within the igesti e system* .ne commentator% 0 Sh$ notes that theȕcentra" #$rner 'resem#"es foam*

%The lower section of the triple burner begins e actl* at the upper opening of the bladder ande tends downward+) This section a!!ears to #e within the #"a er% #$t in fact% the #"a er is within it* % tis responsible for separating the clear from the turbid portions+) This se!aration is a !assi e !rocessthat is "i-e si"t coming o$t of water that !re io$s"y was f"owing #$t is now he" sti""* 5$ 6aj$n e9!"ains3' ater an grains are norma""y !resent in the stomach sim$"taneo$s"y* They #ecome regs an mo e

ownwar together* hen they reach the "arge intestine% they enter the rea"m of the "ower #$rner* The"i1$i !ortions are then straine off& they fo""ow the "ower #$rner an "ea- into the #"a er* The so"i

!ortion is then e"iminate ia the "arge intestine*% t 0lower section of the triple burner1 masters discharge" but not inta.e" and it se2ers as a

transmitter+) This is the o$$osite of the $!!er #$rner% which is res!onsi#"e for inta-e #$t not ischarge*There is some acti e f$nction here% #$t not strong"y so& "etting the $rine f"ow o$twar is !rimari"ya rela&ation of the s!hincter% with some contraction of the #"a er wa""* The "ower #$rner a"so masters the

ischarge of feces% which simi"ar"y in o" es re"a9ation of the s!hincter an some contraction of the intestina"wa""* The Nanjing commentator 0ang says 'the tri!"e #$rner masters the time"y !assage ownwar of thestoo"s*

hen efecation an $rination are norma"% they are 1$ic- an re"ati e"y effort"ess actions* + mo e" isthe Ca!anese #am#oo ti!!ing fo$ntains% where water ri!s into a !iece of #am#oo% an once it acc$m$"ates

!ast the ha"f way !oint% the #am#oo ti!s an $m!s its contents% this is somewhat "i-e this 'transmitterf$nction* The waters f"owing ownwar are not a"" e"iminate & there are ' itches that r$n to the "egs% ansome water is irecte to the -i ney where it steams $!war to reach the "$ngs*

8/19/2019 ITM Triple Burner

5/8

The "ower #$rner ser es as a transmitter% in that it maintains the o!enness of the #o i"y !assages3 e9cessmoist$re is raine & the regs are iso"ate an e"iminate & channe"s are re"a9e to a""ow free f"ow of 1i*

%3ence one spea.s of a triple burner+ ts ,i is collected at the street of ,i 4 qijie 5+ Jie in icates astreet* 0 Sh$% notes thatȕ #i ie refers to !oints two cun on either si e of the center in the hair of the "ower a# omen (c"arifie as #eing at the hair"ine% that is% the to! of the !$#ic hair& so on either si e of 7H:=%#u!u )* S$ch co""ection of 1i% resting of f"ow of 1i% is a"so attri#$te to the shu !oint of the tri!"e #$rner%which is BL:== ( san iaoshu )*

The Nanjing te9t in icates ac$!$nct$re !oints where one can reg$"ate each of the #$rners3 #etween the #reasts (7H:< % which is the meeting !oint of the 1i an of se era" esse"s% inc"$ ing the s!"een an tri!"e #$rner)& on either si e of the na e" ("atera" to 7H:@)% an one inch #e"ow the na e" (7H: )% for the $!!er%mi "e% an "ower #$rners res!ecti e"y* These treatments are not the s$#ject of the c$rrent !a!er* Jio anniAaciocia ('Reso" ing am!ness an !h"egm with ac$!$nct$re ) has gi en e9am!"es of !oints that might #ese"ecte to acti ate water transformation #y the san iao% which is on"y one of its f$nctions3

U!!er B$rner3 JH:=2% 7H:< % LU: & LI:K& LI:2& TB:K& TB:2Ai "e B$rner3 7H: % BL:==% 7H:

8/19/2019 ITM Triple Burner

6/8

may ca$se swe""ings*

6isinhi#its the Throat TB: ( sidu ) Re"a9es the throat to im!ro e oca"f$nctions*

.!ens the Porta"s& 8rees the Porta"s TB: ( sidu )& TB:< ( yifen! )& TB:

8/19/2019 ITM Triple Burner

7/8

Sample (pplication: S!8gren9s S*ndromeSjögren’s Syn rome (or isease) is characteri,e thro$gh mo ern in estigations as a ty!e of a$toimm$ne

isor er in which the imm$ne system attac-s% an e ent$a""y estroys% the g"an s that secrete tears ansa"i a* 4ence% the two !rimary sym!toms are ry eyes an ry mo$th (other organs e!en ent on secretionof f"$i s can #e im!acte o er time)* This isor er !rimari"y affects women ( 3< ratio o er men)% anmain"y meno!a$sa" women* Since meno!a$se is associate with ryness/affecting s-in% hair% intestines%an agina" wa""/the e9!erience of Sjögren’s Syn rome can #e e&tensi"e ry con itions* Sjögren’sSyn rome can #e of consi era#"y ifferent se erity% with some !eo!"e ha ing mi" sym!toms that can #emanage with re"ati e"y sim!"e reme ies for ryness% others ha ing a remitting;re"a!sing con ition in whichthere are !erio s of re"ati e free om from sym!toms an then f"are $!s of more se ere sym!toms% anothers ha e a !ersistent or worsening isor er with se ere sym!toms* Th$s% from the mo ern me ica"

iew!oint there are two !rimary targets for treatment3 the imm$ne system to !rotect against estr$ction of the g"an s% an the rie s$rfaces% to gi e re"ief from the sym!toms an a"so !re ent other amage $e to

ryness (es!ecia""y of the eyes)*

T7A e e"o!e witho$t a #asic -now"e ge of a$toimm$ne isor ers% so $ti"i,es a ifferent way of inter!reting the con ition* + ty!ica" T7A res!onse to Sjögren’s Syn rome is to foc$s on the ryness as asign of ins$fficient yin% an treat with her#s that are moistening in nat$re* S$ch a res!onse is f$rther s$ggeste when there are meno!a$sa" sym!toms% which are genera""y attri#$te to eficiency of -i ney an"i er yin* Some of the yin no$rishing an moistening her#s are consi ere es!ecia""y s$ita#"e for the $!!er

#o y% an these may #e of s!ecia" interest #eca$se of the ry eyes an mo$th*

The isc$ssion of the tri!"e #$rner is of interest in regar to a so!histicate a!!roach to the !ro#"em% #eca$se of the 'mist rising $! in the $!!er #$rner% an the re!$tation of the tri!"e #$rner in reg$"ating f"$i

istri#$tion (name"y% that the itches ser e as a starting !oint for trans!ortation of water)* In fact% somecases of Sjogren’s Syn rome are seen #y T7A octors as acc$m$"ation of am!ness% !erha!s accom!anie

#y heat& the !ro#"em is one of im!ro!er se!aration an f"ow of the moist$re% rather than its a#sence*

The first !art of the treatment !"an in o" es ma-ing s$re that the fermentation in the mi "e #$rner isf$""y acti e* The 'grain an water refer to foo genera""y% #$t grain is consi ere an im!ortant !art of the

1i generating !rocess% so if the !atient has e"ete or c$t #ac- significant"y on grains% that co$" #e a #eginning !ro#"em* e $s$a""y on’t a minister yeast ( #u% or ch$) to !romote igestion% #$t there is a7hinese yeast that is common"y $se 3 shen#u (shen:ch$)* Simi"ar"y% in 7hinese me icine the chic-en gi,,ar"ining ( inei in) is $ti"i,e to ai the #rea- own an meta#o"ism of foo s in the stomach* These ingre ients%an igesti e form$"ations ma e with one or #oth% may he"! !romote this fermentation !rocess* The other thing we $se in mo ern times for this !$r!ose is igesti e en,ymes*

Then% with a hea"thy 'foaming an 'fermentation there wi"" #e the mist or fog that rises $!war * This !assage is contro""e % in !art% #y ac$!$nct$re at 7H:< * +s the a!ors reach the "$ngs% some of the moist$reis raine ownwar * This is a goo thing% #$t if the "$ngs are 'co" then there is too m$ch of the fragrant 1igoing own* P"atyco on is an e9am!"e of a gent"y warming her# for the "$ngs that has an o!ening an

iff$si e 1$a"ity* If the heart is too hot% then the mist is steame ra!i "y to the s$rface% ca$sing e9cessi e !ers!iration* 4er#s s$ch as gar enia an co!tis may #e $se to re $ce the e9cess fire of the heart% anac$!$nct$re of 4T:> or other raining !oints of the heart channe" can #e $se * +straga"$s may #e of a"$ein that it !romotes the igesti e f$nction% warms the "$ng% an c"oses the !ores* The c"ear 1i that ma-es it

!ast the "$ng (when it is warm eno$gh) an !ast the heart (when it is coo" eno$gh) ma-es it to the hea *4ere% her#s an ac$!$nct$re that -ee! the channe"s o!en are of a"$e* This is es!ecia""y a ro"e of the tri!"e

#$rner meri ian* .f co$rse% other meri ians may #e nee "e to a ress !ro#"ems with stomach% s!"een% or other in o" e organs*

The a!!roach of reg$"ating the san iao for Sjögren’s has #een s$ggeste in recent "iterat$re* 8or e9am!"e% the fo""owing a#stract is from the Ae ica" +c$!$nct$re .n"ine Co$rna"3

'u " 'ang 3+ S!8gren9s s*ndrome treated b* regulating Sanjiao + nternational ;ournal of Clinical(cupuncture+ -?

8/19/2019 ITM Triple Burner

8/8

6etai" of the sym!toms% iagnosis% an T7A factors is gi en* San iao is the water !assage !oint% an !ointsa"ong this meri ian are se"ecte a"ong with "$ng meri ian an "oca" !oints* If there are signs of heat% JH: