Just my point: P 5
Between P 4 xi men 郗 門 Cleft Gate and P 6 nei guan 內 關 Inner Pass lies the half-open door of P 5 jian shi 間 使.
Jian 間 shows in its original meaning the light from the sun 日 (or moon 月) streaming in through a half-open door 門. It is a gap, an interval in space or time, the space in between things, an intermediary that both separates and connects, a place of exchange. Shi 使 is an envoy, a messenger, an emissary charged with a mission. P 5 is then an Intermediary Messenger lying between the two bones of the radius and ulna, between the two tendons of palmaris longus and flexor carpi radialis and between the two meridians of the heart and lung.
Jian 間 is a space, as in a joint that allows it to move. It is found also in LI 2 er jian 二 間 Second Space and LI 3 san jian 三 間 Third Space. We can remember Zhuangzi’s famous story of the butcher who chops up oxen for 19 years with the same knife and yet it still remains sharp, because he chops in the empty voids of the joints, not hacking the solid bones. This immense skill of using the empty void we will find in this point too, though not as a physical joint. Here it is the restoring of the empty quality of the heart, uncluttered, as a peaceful and stable centre of life in times of trauma and invasion. It is a wonderful, deep-acting point.
As a jin 金 metal point it has a natural link to the lungs and interestingly some say P 5 is the group luo 絡 of the three arm yin meridians, representing the united strength of the heart, pericardium and lungs in one unique and powerful point. From that perspective it should be as well-known as SP 6 san yin jiao 三 陰 交 Three Yin Crossing – below on the leg – that gathers and unites the three leg yin in their work in the lower abdomen and uterus.
P 5, on the arm above, clears and protects the heart and the lungs, restoring harmony in the chest and by extension, purifying and stabilising the mind. This function is similar to that of REN 17 tan zhong 膻 中 Central Temple at the centre of the chest, referred to in Neijing Suwen chapter 8 as the messenger shi 使 between the emperor and minister. Used together, these two points combine well, each reinforcing the action of the other.
P 5 is the ninth of Sun Simiao’s 13 gui 鬼 ghost or demon points that cover what would now be referred to as mental illness, but in the old days as madness or possession by gui 鬼, demons. P 5’s alternative name is gui lu 鬼 路 Pathway of Demons, which is also the name for part of the Daoist temple leading to the Three Pure Ones, san qing 三 清. So here it may be seen as the pathway that the demons have invaded – through the half-open door jian 間 – or the means of expelling them in treatment.
P 5 is also called gui ku 鬼 窟 Cave of Demons or Demons in the Cave. It treats loss of normality in jingshen 精 神 and hysteria with convulsions. Jingshen 精 神 in its normal state is the cornerstone of health, where the kidney jing 精 essence is stable, strong and well-rooted and the heart’s shen 神 spirit is present, clear, conscious and active. Loss of jingshen 精 神 – of the proper relationship between fire and water, between the heart and the kidneys – can lead to the dangerous negative state where the shen 神 spirit is replaced by the gui 鬼 demon, giving rise to irrational behaviour, madness and psychotic episodes.
For some practitioners the idea of possession and demons is a step too far, even though there may be a definite change of character and behaviour in the patient. Some consider P 5 as the archetypal point for ‘insubstantial’ phlegm leading to similar symptoms of confusion of the shen 神 spirit, with irrational behaviour, manic depression, and even epilepsy with drooling. Others consider that such severe symptoms can be caused by heat disturbing the blood, so that there is no peaceful, stable home for the shen 神 spirit to reside in, leading to wild and irrational behaviour. Whatever the exact causes, these symptoms are traumatic, often dangerous to the patient and those around them and hard to treat.
The third century points text the Jiayijing gives for P 5 that the heart feels suspended as if one were hungry, there is a tendency to both sadness and convulsions of rage, the face is red and the eyes yellow. Sun Simiao adds to this that one cannot speak. Here the mood swings between depression and mania as yang and fire rise with great heat to give furious madness kuang 狂.
Sun Simiao’s seventh century text the Qianjinfang gives for P 5 furious madness that is set off with no fixed timing, violent headaches, loud shouting and a desire to kill, burn or drown themselves, madness with delirium. Many of us are unlikely to see such extreme and violently disordered patients in our own clinics, but all of these are useful indications for those who work in specialist clinics or residential institutions.
Interestingly a text known as Tianxing mijue writes that when there is an attack from gui xie 鬼 邪 demonic perverse influences, the first point to take is P 5 jian shi 間 使 Intermediary Messenger. At the risk of being simplistic in the face of an obviously complex condition, I would say this is good advice. It is certainly a leading point in the field. It was one of the major points I used with good success in a case where the patient described themselves as being depressed, angry and irrational with the potential danger of self-harm. She also described herself as being haunted by the past and by events that had occurred when she was bringing up her son as a child. These traumatic events could no longer be changed and haunted her with feelings of guilt and shame.
Treatment focused on the patient’s present life, while accepting that whatever had happened in the past, she could be there for her son now at this time of his life. Calming the heart, strengthening the lungs, while building up the kidneys and smoothing the liver qi, P 5 was an important point to restore the integrity of the heart and help reconnect it to the kidneys – so that her jingshen 精 神 could re-emerge as the strong cornerstone of health. P 5 was used with such points as LU 9 tai yuan 太 淵 Great Abyss, KID 3 tai xi 太 溪 Great Ravine and LIV 3 tai chong 太 衝 Great Rushing.
I have also used P 5 in a brain-damaged child with multiple disabilities, asthma and epilepsy. A complicated case, we had success in reducing the phlegm, so helping her breathing and strengthening the lungs, so that her immune response improved and her health became more stable. Combining P 5 with REN 17 tan zhong 膻 中 Central Temple and LU 1 zhong fu 中 府 Central Storehouse helped the lungs – and combining it with REN 15 jiu wei 鳩 尾 Dove Tail and DU 26 ren zhong 人 中 Human Centre decreased the number of epileptic attacks. This is a good illustration of the powerful use of P 5 both to help the lungs and to protect the heart.
Although the prime influence of P 5 is on the upper heater and the heart, it is useful in all three heaters. In the middle heater it helps to lower counter-currents, for example in the stomach for nausea and vomiting. This is similar to P 6 nei guan 內 關 Inner Pass. In the lower heater P 5 is an important and useful point for women in treating discharges, irregular menstruation, clotting and pain. It is similar to LIV 3 tai chong 太 衝 Great Rushing and they are often used in combination when there is blood stasis. Some say P 5 links to both the heart and the uterus via the uterine vessels bao mai 胞 脈.
A far-reaching point with strong indications – agitation, heat, fear, depression and fury, with the possibility of behavioural changes, right up to the extremes of madness and violence – P 5 jian shi 間 使 Intermediary Messenger is a uniquely powerful point that can be of immense help to prevent an increase in trauma and be one way to restore the peace of jingshen 精 神 – that natural vitality we all hold at the heart of our lives.
