DONGUIBOGAM; Internal Bodily Elements 27. Triple Energizers 三焦腑 삼초

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△ Donguibogam(東醫寶鑑)

01 Shape of the Triple Energizers 三焦形象 삼초의 형상

① The upper energizer is like mist, the middle energizer is like foam, and lower energizer is like a ditch.
② The upper energizer mainly lets out the yang qi and warms the gap between the skin and the flesh. This resembles the moistening action of mist and dew, so it is said that ‘the upper energizer is like mist.’
③ The middle energizer mainly transforms the five flavors of water and food and sends the essence to the lungs and the transformed blood to the meridians. As it provides nutrition to the five viscera and rest of the body, it is said that ‘the middle energizer is like foam.’
④ The lower energizer usually allows the flow of the urine and sends it downwards. It does not embrace but only sends downwards and opens up the blocked so it is said that ‘the lower energizer is like a ditch.’
⑤ The three energizers represent the torso. They contain the stomach and the intestines and are responsible for the overall management of the body. The area above the pleura inside the chest is the upper energizer, the area between the pleura and the navel is the middle energizer, and the area below the navel is the lower energizer. On the whole, they are known as the triple energizers.

02 Areas of the Triple Energizers 三焦部位 삼초의 부위

① The upper energizer is located right below the heart which is at the upper entrance of the stomach below the diaphragm. It mainly embraces and does not let out. In order to treat the upper energizer, CV17 is used. This acupuncture point is located 1.6 chon below the acupuncture point CV18 which is the dented spot between the nipples.
② The middle energizer is at CV12 so it does not lean either upwards or downwards. Its main function is to ferment the water and food and the areas next to the navel are controlled in order to treat the middle energizer.
③ The lower energizer is the area that corresponds to the upper entrance of the bladder below the navel. The lower energizer is mainly responsible for distinguishing the clear and the turbid and only delivers by mainly letting out and not embracing. The lower energizer is treated by controlling the area 1 chon below the navel.
④ The area from the head to the chest corresponds with the upper energizer, the area from the chest to the navel with the middle energizer, and from the navel to the feet with the lower energizer.
⑤ The home of the triple energizers is at ST30. ST30 is the pathway of eum and yang and the place where the qi of stomach meridian is spread out and its main function is fermenting the qi of water and food. Once the qi of the triple energizers spreads out, it moves up and down penetrating the twelve meridians and collaterals, and circulates the qi and blood which lets us know that ST30 circulates the qi of the triple energizers.
⑥ The upper, middle, and lower energizers work together to protect the body as a single body of qi. The triple energizers are not a viscera or bowel in the true sense of the words and they do not have form, but only functions.

03 Functions of the Triple Energizers 三焦傳受 삼초가 하는 일

① The qi of the upper energizer starts at the upper entrance of the stomach, ascends through the esophagus, and penetrates the diaphragm. It then spreads out inside the chest and goes to the axilla to run alongside the lung meridian and eventually reaches the large intestine meridian. It runs upward until it reaches the tongue and then runs downward towards the stomach meridian. Once it completes a round by making 25 runs within the yang part and another 25 times within the eum part with the nutrient qi, it accumulates once again at the lung meridian. This is called the defense qi.
② The qi of the middle energizer also starts from within the stomach but comes out behind the upper energizer qi. The middle energizer embraces qi and after filtering out the residues transforms it into essential qi by steaming with fluid and humor. It then sends this transformed qi into the lung meridian and changes it into blood. It is this newly transformed blood that supports the body which makes the middle energizer most precious. Only this can travel though the meridians and channels and this is known as nutrient qi.
③ The qi of the lower energizer is divided separately from the large intestine and permeates through the bladder. Once the water and food inside the stomach has been transformed into residue, it moves to the large intestine and descends further by permeating into the lower energizer. Subsequently, the water and fluid is filtered and the clear and turbid separated, and then it circulates the lower energizer and permeates into the bladder.
④ The upper energizer becomes qi for it is like mist and the lower energizer becomes blood for it resembles a ditch. The middle energizer is the place where the qi and blood are eparated. ⑤ How could the heart and lungs supervise nutrient and defense qi if it were not for the upper energizer? How could the spleen and stomach ferment food and water if there was no middle energizer? How could the liver and kidneys send down the fluid and humor if it were not for the lower energizer? Though the triple energizers have no form, they have functions and upervise all qi. Thus, the triple energizers are the pathways of water and food and the place where qi begins and ends.

04 External Signs of the Triple Energizers 三焦外候 삼초의 외후

① If the center of the bridge of the nose is protruded, it is a sign that the triple energizers do not flow freely.
② The outer expressions of the triple energizers are mentioned in detail in the chapter on Bladder.

05 Disease Patterns of the Triple Energizers 三焦病證 삼초병증

① When the triple energizers become diseased, the abdomen bloats, and the lower abdomen hardens. It also becomes difficult to urinate, which causes discomfort. If it overflows, it causes edema and if it remains in that state, it causes water distention.
② Symptoms of swelling and pain in the lower abdomen and loss of urination are due to the flow obstruction of the triple energizers by pathogenic qi.
③ The upper energizer is like mist. If the mist isn’t dispersed, it leads to shortness of breath. This is because it only lets out without taking in. The middle energizer is like foam. If the foam does not flow freely, it causes persistent fluid retention; if that fluid isn’t dispersed for a long time, it leads to fullness in the middle. This is because it can neither receive from the upper area nor let out downwards. The lower energizer is like a ditch. If the ditch is blocked, it leads to edema because it can only receive from the upper area but cannot let out downwards.[P20] ➃ If the lower energizer overflows, it leads to edema.
➄ The triple energizers are the bowel for bing Fire, or yang Fire. Once it is activated, it becomes ministerial Fire without root.

06 Treatment Methods of the Triple Energizers 三焦病治法 삼초병 치료법

① There is a sentence in the Inner Classic (內經) that says, “The triple energizers are the organ responsible for opening a ditch [決瀆之官] so the waterways come from here.” The triple energizers are the pathway for water and food at the upper, middle, and lower parts of the body so when diseased, one should aim to restore the free flow of urine and stools.
② For diseases of the triple energizers, a Bitter Orange Pill, Aucklandia and Betel Nut Pill, and Triple Harmony Powder should be used. [See the chapter on Qi for the prescription].

Bitter Orange Pill 枳殼丸 지각환: It treats the condition in which there is no urination or bowel movement due to the abnormal flow of the triple energizers. 2 nyang of Aruantii Fructus Immaturus (枳殼), 1 nyang of Citrus Unshius Pericarpium (陳皮), 5 don of Arecae Semen (檳榔), 2.5 don of Aucklandiae Radix (木香), and 4 nyang of Pharbitidis Semen (黑丑). (Use half in a raw state. Stir-fry the other half, grind into powder and use the first pile of powder after sifting. Use only 1.5 nyang and throw away the rest). Grind up these herbs and knead with honey to form pills as big as the seed of a royal foxglove tree. Take 30~50 pills with a Zingiberis Rhizoma Crudus (生薑) decoction.

Aucklandia and Betel Nut Pill 木香檳榔丸 목향빈랑환: It allows the free flow of qi through the triple energizers and moistens the bowels. 2 nyang each of Pinelliae Tube Fermentata (半夏麴), and Gleditsiae Spina (皂角) (roasted with a coating of condensed milk, rim peeled off and the seed removed), Pruni Nakaii Semen (郁李仁) (peeled off and ground into powder). 1 nyang each of Aucklandiae Radix (木香), Arecae Semen (檳榔), Aruantii Fructus Immaturus (枳殼), Armeniacae Semen (杏仁), and Citri Unshius Pericarpium Immaturus (靑皮). Grind up these herbs. Soak an additional 4 nyang of Gleditsiae Spina (皂角) in the clear upper layer of millet porridge, rub it together, and simmer to make paste and throw away the residue. Add a bit of honey into the paste and knead to form pills as big as the seed of a royal foxglove tree. Take 50~70 pills with a Zingiberis Rhizoma Crudus (生薑) decoction on an empty stomach.

07 Simple Prescriptions 單方 단방

There are 13 kinds in total.
∙ Astragali Radix 黃芪: It tonifies the triple energizers and strengthens defense qi. This is a herb that is used for the upper, middle, and lower parts and the interior and exterior of the triple energizers. Decoct in water to take.
∙ Tetrapanacis Fructus 燕覆子: It gets rid of invading heat in the triple energizers. Take after cooking.
∙ Bovis Medulla 牛髓: It smoothes out the triple energizers evenly. Take mixed with wine.
∙ Alpiniae Oxyphyllae Fructus 益智仁: It soothes the triple energizers. It can be taken either in powder or tablet forms.
∙ Sesami Oleum 脂麻油: It lowers heat and toxic qi within the triple energizers. Do not add other medicines.
∙ Melo Fructus 甛瓜: It allows blocked qi among the triple energizers to flow freely. Take cooked.
∙ Ginseng Radix 人蔘: It tonifies the original qi of the upper energizer. It can be taken either in powder or tablet forms.
∙ Canitis Caro 黃狗肉: It strengthens the lower energizer. Take after boiling sufficiently and seasoning with spices.
∙ Coturnicis Caro 鶉肉: Decocted with condensed milk, it builds up only the lower energizer.
∙ Citrus unshiu Markovich 靑橘: It treats cold qi within the lower energizer. It can be taken in either decocted form or powder.
∙ Nelumbinis Rhizoma 藕: This is the lotus root. Take steamed to tonify the lower energizer.
∙ Suis Intestinum 猪腸: It tonifies the lower energizer that has been deprived of qi. Boil sufficiently and take the meat or take in the form of a soup.
∙ Braseniae Schreberi Herba 絲蓴: It stabilizes the lower energizer. Take in the form of a soup.