1. Background

“To understand the future, you do not need techno-autistic jargon,obsession with “killer apps”, these sorts of things. You just need the following: some respect for the past, some curiosity about the historical records, a hunger for the wisdom of the elder, and a grasp of the notion of “heuristics”, these rules of thumb (which are often unwritten) that are so determining of survival.

In other words, if you want to understand the future, you will be forced to give weight to things that have been around for some time:things that have survived. Nassim Nicholas Taleb[1].

Undoubtedly, the I-Ching is one of the most significant texts in the literature of the world. Its mythical origins go back more than three thousand years, when the interpretations and discoveries of the old Chinese thought were written in it, reflecting its spirit as no other text has ever done.

This book embodies the structure and symbology of Chinese thought and philosophy, and it has prevailed for more than three thousand years. It is difficult to establish an exact first date of edition, which may have been in 3 300 BC, although the Eight

Trigrams appeared in bones, bronzes and turtle shells from older times[2].

Regarding its influence on Chinese medicine, it resulted in the constitution of a body of knowledge that still prevails after almost 5 000 years, thanks to its structure and regulation upon the basis of two basic natural laws:

(1)The Yin/Yang Theory

(2)The Theory of the Five Elements/Movements

In the Five Elements Theory, TCM explains causes and effects of its principles through the interplay among them, in a multi-parametrical based conception framed like Euclid in a fundamental theorem of classification.

According to biographical data provided by Proclus, Euclid (330-275 BC) was an inspired and virtuous mathematician who made significant contributions not only to exact sciences, but also to human knowledge in general. His posthumous work “Elements” has been of compulsory reading for general knowledge purposes, and has had the same literary impact as the Bible or Don Quixote[3].

He was a student at the Platonic Academy in Athens, which he attended to improve the knowledge he had received from his Geometry teacher. He was obsessed with the origin and constitution of the Five Dimensional Solids enigma, and established their beautiful configuration in space. And in a wonderful but simple demonstration, he turned them into the Five Regular Polyhedra,through the propositions included in his formidable work, which he concluded, after a brilliant deduction, with these words:

“Now I can say that, apart from the figures presented, no other equilateral or equiangular figure can be formed”[3].

This is why, since then and for almost 2 300 years, Euclidean Geometry has also been called “God’s Geometry.”

Regarding the Chinese hypothesis of the action of these cosmogonic theories, we may extrapolate what Riedl expressed when he stated that: “…it contains the expectation that similar events or states will enable the prediction of similar sequences of events or states,and that this hypothesis of possibility of abstraction expectation includes a determined field of similarity; one same group of events or states allows us to foresee also a determined sequence of events or states.”[4] As if he was analyzing traditional Chinese medicine,Riedl presents a valid argument for its perpetuation along millennia in his book “Biology of knowledge. “Since every concept hierarchy is generated by a guiding principle, we understand then that “…a system of principles composes a hierarchy of hypotheses that control one another. This system contains inside the possibilities which are closer to certainty, to potential predictions.”[5]. Maybe, the accuracy of the predictions as the Oracle of the I-Ching may also find its valid support in the deductions expressed in the previous paragraphs.

This fundamental classification theorem reflects the intention of the Chinese ancient sages to organize, in some way, the knowledge acquired until then. Maturana would say:

“What is the organization of something? It is something which is both simple and potentially complicated. It is those relationships that have to exist or to be given in order for something to be…”;“This situation in which we implicitly or explicitly recognize the organization of an object when we indicate it or distinguish it is universal, in the sense that it is something we constantly do as a basic cognitive act, which consists no more and no less than in generating classes of any type.”[6].

Indeed, for Chinese medicine, this system of natural laws has composed a “body of assumptions”, which has provided it along millennia with amazing accuracy and which is very efficient to process expectations or arguments or to affirm or reject its judgments.

Nevertheless, as we have already seen with Euclid and then with Heraclitus of Ephesus, Empedocles of Agrigentum, Meister Jan Eckhart or Walter Russell, among others, synchronicity was never an impediment to the development of Western thought. I found the clearest example of this when I learnt that Empedocles [504 BC-433 BC] who disseminated in Agrigento (then a Greek colony in Sicily, Italy) his Fundamental Classification Theorem was born less than 100 years before Zou Yen [350 BC-270 BC], who followed suit after coming into existence thousands of kilometers from there, in China. The only difference between them as we will explain in detail afterwards is that in China the human being was introduced into this taxonomic scheme of the Elements[3,7].

However, we could practically affirm that almost simultaneously in the context of the history of mankind both Eastern and Western medicines began their path as sciences when they introduced general classification parameters to determine the characteristics of ill patients and their potential pathological conditions, and their relationship with the time and environment they live in.

As stated by Wilhelm and Hoffmann, the laws of synchronicity“are characterized by their evident significance and by the impossibility of being experimentally reproduced.”[8]. In fact, they do not need to be thoroughly verified upon the basis of the laws of probability. It seems that since yesteryear, the West has overcome the “Dilemma of determinism”, which according to Nobel laureate Ilya Prigogine has disrupted the West so much, that has even been integrated into present knowledge, providing it with its peculiar way of contemplating and discerning in the surrounding world and the reciprocal relationships of their causal conditions and nexus[9].

It has been decided that this research would be done from such holistic and integrating perspective.

2. Introduction

“In a word, the only and true God would be immutable and the theater to all mutations; indivisible and object of all divisions;joyous and center of all miseries, of all pain; perfect and array of all imperfections.”

Gioacchino Ventura di Raulica, medieval theatinepriest.

(1) Relation between hexagrams 23 and 24

We will start this section with Maturana’s thought: “Now we need to make a distinction between determinism and predictability. We talk about prediction every time we affirm, after considering the present state of any system we may observe, that there may be a consequent state in it that will result in its structural dynamics that can also be observed. A prediction, therefore, reveals what we, as observers, believe will happen.”[10]. Chinese medicine seems to have been structured upon the basis of such conceptual configurations. In this way, such knowledge may have been organized hierarchically in what Riedl calls “a super-structure”, a natural system that enables the understanding of the harmonic transformation that takes place within each element (and at the same time, for example, inside each meridian). The same happens with the taxonomic classifications that organized botanic and zoology, which help the metamorphosis of these fields of similarities to continue, enabling thus their appropriate integration[11].

These “recoupling cycles” provide this knowledge with a never ending and multidimensional renovation that allows keeping a “selfregulated” process of optimization, which is very similar to what happens in quality management cycles. Then the Chinese sages may have based themselves upon this “virtuous circle” to reaffirm or reject the outcomes that derived from their experiences.

Both Schneider and Sagan illustrate this when they state that:

“Complex cyclic structures arise around flows of energy.” [12]. “The evolution of complex and intelligent forms of life may be explained by the efficacy of life as a cyclic system devoted to the reduction of gradients.” And they finish clearing it by saying also that: “Mutations(I have highlighted the word) in chemical structures constitute the proper raw material upon which natural selection may act […]getting rid of what is not capable and enabling the survival of the most capable types.”[13].

From the universal appearance of the Yin/Yang which, according to Pialoux, are energetic qualities through which the Universe ensures its own genesis[14], these two basic energies have given place to the symbols that are part of the Eight Pathways or Trigrams that symbolize the eondrous vessels, determining in this way the constant and sequential alternation of all these processes. Hence the famous quote by Fu Hsi:

“The secrets and mysteries of existence are found in the movement of Trigrams.”[15].

From the quoted Octogram of Fu Hsi(Figure 1), the Trigrams are distributed by Eight “Marvelous vessels”, four of which are Yin and four, Yang, and which are reservoirs where energy structures ensure their balance[14]. In Nguyen Van Nghi’s graphic mention of the aforementioned Octogram, the mountain can be seen – a representative of the Jue Yin plane through PC-6 Nei Guan–located equidistant to the earth and connecting directly to KI-6 Shao Hai.

Figure 1. Fu Hsi´s Octogram (according to Prof Nguyen Van Nghi)[16].

The situation described in the consequent hexagram is very fragile:there is only one last solid line, which is “strong and light”, to be disintegrated by the inner forces, until the most feared situation takes place “almost imperceptibly but inexorably”: Colapse[17].

(2) “Reconciliation vessel”: The alternative tool to treat cardiac arrest contingencies:

The Shao Yin energy level, composed by the heart and kidney meridians, also involves the Xin Bao or master of the heart channel.“… the Tsou Chao Yin (kidney) meridian. Through such meridian(energy) reaches the kidneys, then the heart (organ), from there it spreads through the chest to join later the Ch´eouTsiu´e Yin Pericardium meridian.” (Hoang Ti:“Ling Shu”; Chapter 14: “Speed of energy circulation”)[18].

The participation of XinBao or Pericardium channel – was evident thanks to a collateral branch relating it to the Shao Yin circuit is that of integrating its main function of “protecting the heart”, thus ensuring the normal performance of its cardiovascular function(Figure 2). It is part of the so-called “Survival axis”, neuro-hormonal axis described by both neurophysiologists W. D. Cannon in his “Fear,fight or flight” reaction and H. Seyle in his “Stress model” response.The close relationship existing between both meridians concerned the performance of their key function during CV resuscitation maneuvers[19].

Figure 2. Collateral branch connecting Kidney &Xin Baomeridians[20].

said circuit, hereinafter called “Reconciliation vessel” (due to its capacity to balance both celestial and terrestrial energies), promotes a new parameter for its critical function as an effective and efficient complement for life-support maneuvers (Figure 3), providing acupuncture with a new pathway based upon traditional Chinese medical principles[20].

Figure 3. K-1 Yongquan topography & stimulation[21]

The utmost importance this interrelation brings about was captured in several references in the Ling Shu, such as the one that follows:

“…When the energy of Ch´eou Chao Yin (Heart) is depleted,arteries cease to work and blood does not circulate so that its hue loses its sparkle and becomes dark; it marks the end of energy and of blood. In Taoist terms, Water triumphs over fire.”[20, 22].

In the case of hexagrams 23 and 24, Richard Wilhelm himself recommends never treating them separately, but together[23].Thus, the complementary hexagram complements the scenario or status that shows the probabilities arising from the mutation of the main hexagram (the consulted done). These are warnings,to rectify or to avoid being, for example, in situations which are difficult to stand with no mistake or damage.

The complementary hexagram is that which completes a scenario in which no change is made[24].

(3)Methodolical analysis of Hexagrams 23 & 24:

I-Ching: Hexagram N 23

PO or BO: Splitting apart (“To break into pieces”)[25]

Other possible titles may be: Decay – Deterioration – Stripping away – Collapse – Tearing – Separation – Division – Denudation– Oppression – Fracturing

Above: GUEN: “Keep still” – “Mountain”

Below: KUN: “The receptive” – “Earth”

Hu Gua (hidden influence) N 2: The receptive: Yield

ZongGua (underlying cause) N 43: GUAI–Determination–Breakthrough

4. Meaning

Mountain has earth for its foundations: if the Earth is thick, the Mountain is high; if it is not, it is a symbol of fall because of the stripping or deterioration of its foundations. For Thomas Cleary,stripping means suppression: the mountain that yields earth illustrates the preponderance of weakness over strength[26]. This is why the hexagram reminds us to observe special precaution and resistance when facing near danger[7].

Chronologically, its description coincides with the annual cycle of the ninth month (October-November) in China, when the Yin force is more powerful and is about to completely displace and remove its opposite Yang in a gradual and unperceivable manner[27].

The open or “obscure” lines are about to reach the highest point of the hexagram, trying to “disintegrate” or “collapse” the light upper solid line, in an attempt to tear the ceiling of the hexagram (Yang line) down, which staggers and is ready to fall[28].

A comparative analysis with current medical knowledge proposes that the most significant symptom that characterizes it is the collapse or syncope – that is, the sudden loss of consciousness, which takes place when the blood pressure falls as the heart stops beating,reducing thus the cerebral blood flow. That is why the cardiac arrest is one of the main causes of Syncope, as well as another one of its serious consequences: the ischemic stroke[29,30]. According to the Zagua, the hexagram represents something that “is already impossible”; something that can be compared with erosion: that is,a natural process that is constant and irreversible, which inexorable deteriorates the mountain and which will enable then through a generation cycle – the creation of a fertile and productive valley that will be full of life[31]. Ultimately, “Po” or “Bo” teaches us to face and accept with courage and determination what it is inevitable.Only such qualities will provide the opportunities of rebirth and renewal[27].

In the medical Emergency jargon, both sudden death and cardiac arrest are usually used as synonyms. Sudden cardiac death is defined as the death that takes place in an unexpected manner(within the first 24 h after the beginning of the symptoms) in patients whose previous situation made it impossible to foresee such fatal outcome[29]. It is also something definitely “impossible to be viable any longer.”

Therefore, the terms “Deterioration”, “Collapse” and “Oppression“are pathognomonic signs of cardiovascular collapse. It is not strange for at least one of them to be present in such a serious situation. It would not be strange either, then, to relate ancient Chinese knowledge illustrated in this hexagram and in those which have a direct relationship with it. The energetic configuration of the“Reconciliation vessel” interrelates the trigrams that justify its circuit with outstanding accuracy, which should be considered more than just a coincidence[20].

That is why “Po” definitely suggests a “rebirth”, a concept which is scientifically similar to “reanimation”. It advises us to be cautious and resistant “until the pendulum of the cosmic forces starts again to swing towards the opposite side.”[3,7]. According to Tao, the process of interaction between full and empty presupposes the knowledge of the laws that rule nature. “Po” induces us to reflect in a mature manner about the mortality of human beings and the finitude of every living creature[32].

5. Action

The action that this hexagram represents is definitely regeneration.Upon the basis of a simple rule of opposites, disintegration determines the only possible path to reestablish Recovery and “ad integrum” restitution[27].

There are several metaphors that may be used to illustrate the figures of this hexagram. According to Wilhelm, it could be seen as “…a house that is about to fall but still has its roof.” [33].Nevertheless, in the reading of the judgment, the most accurate comparison is that which is deduced from the nuclear trigrams that compose it. The upper trigram is the mountain, whose attribute is firmness and stillness. Conversely, the lower trigram represents the earth and the docile surrender to it. “Hexagram 23 tells us about a condition we should in one way or another deal with.” [32].

Indeed, and regarding the cardiac collapse, it can be deduced how the aforementioned clearly illustrates the implicit mandate of the global implementation of life support protocols, a situation every human being should with no exception “in one way or another deal with. “Such protocols are specifically framed within standards aimed at reversing “life risk” conditions.

As we have already stated in the analysis of the action of hexagram “Bo”, an alternation is shown – determined by “Divine laws” between generating forces and their opposite destructive ones; between progress and decay, as its tendency to decline is fairly marked[23], which expresses a “suspense situation” between Plenitude and void. Such temporal conditions do not allow at this point for the temporization of any analytical disquisition, as it would thus be impossible to counterbalance their consequences. We should the wait with a “contingency plan” which may lead us to direct action, with no restrictions or distracting objections, and which will be the only way to overcome such collapse.

For such purpose, we will paraphrase the I-Ching, when it urges us to act: “It is not cowardice but wisdom to adjust and not avoid action.”

“The mountain rests on the earth: The image of splitting apart. Thus those above can ensure their position by giving generously to those who are below.”

This image derives from the judgment described above. As it rests on the earth, if the mountain is high and steep, as it lacks a sustainable foundation, it will inexorably fall down, causing thus the collapse.

Curiously, hexagram N 43 Guai = Determination (ZongWa or underlying cause of hexagram 23) shows a “negative image” of the image of Po, and the message it conveys is quite similar to it:“Superior men do not accumulate wealth but they share it with those who are beneath.” The idea is subtle–it does not mean to satisfy one’s own weaknesses, but to impose an encouraging control, the essential spirit that supports every rescue maneuver, so that events “…are balanced in such a way that they can become positive forces.”[34].

Nevertheless, the warning about collapse is clear and the increasing danger of splitting apart will make its recommendation deepen increasingly towards the last lines of the hexagram. That is why we will see which of its Lines specifically emulate the methodological steps taken in risk management, which is a sequence that is almost identical to that presented as Global Quality Performance Process (“Risk Statements” ISO 31.000: 2009)[35].

a)Risk identification;

b)Risk status;

c)Risk impact analysis;

d)Risk exposure;

e) Management planning [operational strategy] before such risk (Risk planning);

f) Continuous surveillance through the presented sequence (Risk Monitoring and control);

g) Safeguard measures against new, collateral or residual risks(Safeguard against risks)[35].

6. Lines

In the first, second and fourth place, the lines warn about a clearly destructive erosion, “with clear signs that danger is approaching the person.”[36].

In every successive line, the hexagram pictures the increasing risk that threatens an unfavorable situation, emphasizing how its closeness increases upon imminent danger.

If we compare the content of “Po’s” Lines to a risk management ISO, we will find that there are astonishing similarities in the sequence set in such Rule, regarding the project risk goals to reduce potential danger (“Risk statements”).

The statement presented by the first Line is:

“The leg of the bed is split. Those who persevere are destroyed.Misfortune！”

Such statement introduces us to misfortune: there are forces that are trying to destroy the foundations[37]. Unfortunate times are approaching. In such unstable and unfavorable situation, the baseline tends to give in.

The Oracle’s intention is evident in the expression of this first Line,which coincides with the first stage in risk management: there is a clear identification of the risk (a)“Risk identification”(Figure 4).“While considering together these potential converging threats, an exhaustive evaluation will help to elucidate their mechanisms of action, which will allow us to identify them.”[35].

Figure 4. First stage: “ISO Risk Identification” in a sudden death protocol [38-42].

Therefore, the I-Ching suggests that we should not look for a way out based upon our own fragility otherwise we may speed up the arrival of collapse. We are before a risky situation where we have no help whatsoever. Disaster is inexorably approaching; our integrity is at risk, and its proper assessment is of major significance.

During cardiovascular collapse, breathing usually stops at the same time a systemic failure occurs, due to lack of blood flow.Again, the most significant symptom is the syncope or sudden loss of consciousness: as there is a sudden fall of blood pressure when the failure occurs, the patient may feel dizzy immediately before collapsing of fainting[43].

Due to the clear configuration weakness shown in hexagram “Po”,this falling tendency shown in its structure can be understood. In fact, Jacoby de Hoffmann explains it by analyzing such constitution:both trigrams that compose it belong to the earth element and both gravitationally and energetically lead to descent or fall, which is a graphic concept to define Collapse.

As to the specific statement of the second line:

“The bed is split at the edge. Those who persevere are destroyed.Misfortune！”

According to Wilhelm: “One must adjust to the time, trying to avoid danger in due time.”[36](Figure 5). This means not only to act in a precise way in due time and manner, but to appreciate each moment,treasuring it in order to avoid a fatal outcome. Only by turning away from ignorance will we be able to properly perceive danger and to avoid it in due time.An intriguing reference is implicit in the second stage in risk management: (b) “Risk status”: this indicator relates to the probability of occurrence to risk impact.”[35]. This stage specifies the real possibility for a certain risk to turn into a dangerous issue,concerning the information about its lethal side effects[35]. This stage tends to identify high-risk groups and to avoid parasitic or ineffective attitudes that may delay the development of the essential performance even more. Precisely, this line presages “miserable times” and therefore suggests intercepting the magnitude of the risk before it becomes a truly serious problem, “trying to avoid danger in due time.”[44]. This last phrase comprises the mission and the vision that result from the application of processes to manage risk.

According to Wilhelm, in the third line, the following statement can be read:

“He splits with them. There is no blame.”[36].

Another version with a different translation in “The Gnostic Book of Changes” provides a different vision of the meaning of the same line:

“Persistent intransigence will invariably lead to disaster.”[45].

For some authors (Blofeld), this implies losing contact with those above and below. For some others (Ritsema/ Karcher), it means letting-go above and below or (Cleary), losing above and below indeed[46].

In this situation, extreme caution is needed before the risk. Danger is now ominously close and we must therefore adjust to the precise moment to be able to avoid the consequences of such risk and not to become victims of an inexorable destruction[47].

This idea of avoiding disregarding a close danger is also similar to the third stage in a risk management ISO: Risk impact analysis(Figure 6):“This is an indicator for measuring the extent of loss caused by a risk.”[35].

This variable can be considered as “life-quality” by avoiding secondary or residual risk sequels (central nervous system lesions;neurological impairments, etc.) due to sudden death or cardiac arrest[47].

Adjusting to the situation and to the moment implies the proper management of the risk scenario, by instructing and organizing ourselves beforehand, reducing our weaknesses and consolidating our strengths as much as possible. More than three thousand years ago, the authors of the I-Ching incredibly took into account the assessment of risks that could be potentially lethal, avoiding thus the lack of preventive or contingency measures that may lessen the inexorable increase of imminent danger.

This is the basic criterion upon which all the sequences of primary attention are programmed in case of emergency codes. The quoted evaluation of risk exposure enables us to consolidate a risk diagnosis in the process of establishing an appropriate risk planning strategy[35].

This condition acquires its utmost severity in the analysis of the fourth line:

“The bed is split up to the skin. Misfortune！”

The Oracle is here warning about the fatality that is threatening over the victim(s). Misfortune has reached its peak and its consequences are almost inescapable[17]. Integrity has been cracked and disgrace and calamity have reached their peak. Now their consequences are unavoidable[28].

According to “Bo”, splitting apart and its downfall are imminent. We have to be extremely cautious[48]. We have not been able to avoid danger… In this scenario we can only establish “contingency measures”[49] to resolve this gloomy situation. The limbo in which the continuity of life has been interrupted due to an unavoidable conflict caused by the disintegration of the interaction of fundamental energies (Yin/Yang) that rule the human being, becomes clear.

Figure 5. Second Stage: “ISO Risk Status” (Probability of occurrence) in a Sudden death protocol[38-42].

The international consensus over the definition of cardiac arrest is that it is a condition that implies the “sudden interruption of the mechanical function of the heart with the consequent loss of consciousness, non-detectable pulse or breathing or agonal breathing that may be reversed if the appropriate measures are taken immediately, otherwise it will lead to the death of the victim[50]. As it is an extremely serious condition, spontaneous reversions seldom occur.

Nevertheless, the fourth line of hexagram Po refers to the fourth stage of the ISO risk management: Assessment of increasing risk (“Risk exposure” Figure 7): “This indicator relates to the probability of occurrence against an imminent and severe risk impact.”[35].

In these moments, the “operational strategy” that comprises the following stage (Fifth stage: “Risk management planning”Figure 8)will be absolutely decisive over the impact of the fatality threatened by such risk[35]. However, the possibility of having successful overcomes after taking the aforementioned measures will depend not only on the mechanism that caused the collapse but also on the immediate life support protocol carried out, on the commitment of the rescue team to succeed in recovering the patient’s blood flow and consciousness[29,50].The fifth line has a different direction in the process of risk management:

“A shoal of fish. Favours come through. The ladies of the palace. Everything acts to further.”

Due to its proximity to the upper light line, the dark line over which it rests is influenced by it, as well as the lower lines. The fifth line rules over the rest of the Yin lines of the hexagram although it is strongly influenced by the upper Yang line. The fate posed by the development of the Po lines may be changed:there is a clear light of hope to achieve recovery(Figure 9)[17].

Figure 6. Third stage: “ISO Risk Impact Analysis” in a sudden death protocol[38-42].

Figure 9. K-1 Yongquan protocolization into the different stages of the CPR sequence[21,47].

Darkness is not opposed to light any longer and it submits to its guidance. Its proximity to the strength of the upper line hinders its downfall and makes the rest of the hexagram submit through it.

“The first weak line leads all of the other weak lines to the strong principle, just as a princess would lead the palace maids as a shoal of fish to her husband to gain his favor.”[28].

There is a correspondence among the energies that govern the upper and the lower that imprints a favorable turn to the dangerous situation mentioned in the hexagram.

This hexagram – and those directly related to it–approaches us to a possible response when facing situations of imminent risk. If we know how to assess a warning that is implicit in the preceding lines,we will be able to understand that knowing how to manage danger is the beginning of every solution[51-53].

From this moment onwards, and until the meaning of the following hexagram Fu is understood (Po’s inverted image), along with that with the negative image of Po (hexagram N 43 Guai: Resoluteness)[48], the book reaches its balance and thus the situation can be resolved. Then “Po” will lead us to a contingency plan that may enable us to overcome the potential risks of collapse.

The sixth stage: “Risk monitoring and control”: “Implies a continuous surveillance over the presented sequence, involving a continuous analysis and monitoring performance for identifying new, collateral, potential or residual risks thanks to a permanent contingency plan revision.” (Figure 10)[35] It helps to achieve the risk mitigation by modifications of previous plans and an effective assessment of the risk through responsible quality performance.

The last line (“Nine at the top”– the governor of the hexagram) tells us show, despite the gloomy arising of terrible and serious dangers,the light (the Good) will prevail:

“There is a large fruit still uneaten. The superior man receives a carriage. The house of the inferior man splits apart.”[54]

Once collapse has finished, Splitting apart ends: when misfortune has finished, dispersion comes to an end. The risks are over and good times return[17]. Disaster is left behind and therefore “the conditions for rebirth are given.”[7].

Figure 7. Fourth stage: “ISO Risk Exposure” in a sudden death protocol[38-42]

Figure 8. Fifth stage= “ISO Risk Management Planning” in a sudden death protocol[38-42].

Figure 10. Sixth stage: “ISO Risk Monitoring and Control” in a sudden death protocol[38-42].

The concept that is implicit in the above stated phrase is surprising.I believe that it summarizes the profound meaning of the whole hexagram. Its scope is so wide that it can be compared to any risky situation and the consequences of being able to manage it in an efficient and coherent way[51-53].

In hexagram 23 there is only one Yang line, the sixth one. The last upper line, solid and light, contains in itself the meaning of the concept of resuscitation through the “seed of the good remains.”[55].“Virtue has prevailed over darkness. Evil finally destroys itself:it cannot subsist as its own negation has been neutralized.”[28].According to the spiritual essence of the I-Ching, “light is invincible;even during its downfall it is capable of generating new life.”[23].

The same is felt after a successful resuscitation; to recover someone’s life; to save a fellow human being and to be able to grant him a second chance to their existence. This influence is tacitly implicit in the rescue outcome, in an absolute correspondence with the natural laws expressed in the wisdom of this book.

According to Cleary, the sixth line is the line of the wise man: “it is the one that keeps the reward”[37]. Yang keeps stoically still upon the fall of the five inferior lines that put it in grave danger; “…it is like a lighthouse that destroys darkness: the night lookout in the sixth position.”[32]. It stands out how the aforementioned quote agrees with the seventh and last stage of the ISO risk management project(Figure 11): it is it and it means every safeguard measures considered against new, collateral or residual risks[35]. There is no doubt: the profound wisdom of the I-Ching updates the impermanent nature of things thanks to the permanent inter-transformation of opposites, which enables them to change towards their complementary opposite end.Translator Helena Jacoby de Hoffman explains in her final comments on “Po” her revealing idea about this hexagram, which has a continuum with the following one. According to her, “It shows the relationship between decay (of what has existed) and new life.”[23]. In a way, her conclusion illustrates the metaphor of the seed revealed in the last line, which refers to the germ that is reborn after the fruit has disintegrated[46]. There is nothing that may illustrate in a more faithful way the joyful outcome of a successful rescue.

Hexagram N 24: Returen (“Of the hidden dragon”)

Other titles are: Turning point–Returen to the way–Change in time-Critical moment–Recovered dragon–New beginning

Above: Kun (The receptive–Earth)

Below: Dshen (The arousing[or the “awaking]–Thunder)

7. Meaning

Figure 11. Seventh stage= “ISO Safeguard against Risks” in a sudden death protocol[38-42].

The first line of this ideogram is Ch´ien and the other five are K´un. It represents a “writing paper roll.” A rolled sheet of rice paper “that the dragon shall open to begin a new story. It contains the information that describes the dragon which rests underground,which it will read having recovered his strength [that is, when its Yin and Yang energies are balanced – sic]. It may be said that the name of the hexagram represents the “Dynasty of the dragon.”[52].

Jacoby de Hoffmann says that: “The movements are made in six stages. The seventh one brings the return…as seven is the number of young light.” The “young Yang” is a changing Yang. The solid bottom line of the hexagram is called Yang. “Young light” also refers to the sun during the winter solstice[53]. H. Jacoby de Hoffmann then translates: “That is why seven is the number of the new light; it arises when six, which is the number of the great Darkness, increases by one.”

Author’s note: Coincidently, the risk management ISO rule has been set in a sequence of seven stages. In fact, this last stage of the “Risk management” appears in “Fu”, the reversed hexagram following“Po”, repeating that the safety recommendations made before should be taken into account so as not to dilute the efforts made or to miss in vain this valuable “second chance.”

The Fu hexagram is linked to the eleventh month, the month of the solstice (December – January). During the winter, life energy is underground. The arousing (or the revival) is there. The trigram symbolizes it as the thunder. The shortest day of the year is the day when the winter solstice begins: from that moment onwards,darkness will begin to decrease and light hour will increase. Energy will be progressively renewing itself until spring comes[53].

According to Richard Wilhelm, the idea of a “Turning point” is suggested by the fact that in the preceding hexagram Po, the “dark”lines were broken upwards, trying to break the upper light line. Now,return is the Turning Point itself: the one that takes place when a light line enters the hexagram from below[54]. Geophysically, the winter solstice “makes the light return” (eleventh month: December– January). According to Cleary, this also means that “strength stabilizes; it returns to action and goes on in harmony.”[55]. That is to say, after the dark lines have pushed all the light lines (from the previous hexagram) upwards, one of these returns to (re-enters) the hexagram from below, announcing thus the end of darkness[28] or the “Re-entry of light.”[52].

The “Reconciliation vessel”, formed by the kidneys and the master of the heart(Figure 12), establishes a complete circuit that enables the circulation and recycling of its ancestral energy, allowing it to play a vital support based upon the fundamentals of traditional Chinese medicine[56].

It is not just a coincidence that the meridians of the kidney and of the Master of the Heart had a very close relationship in view of those Western studies that suggested the existence of a moment during the day where the “Imperial fire “was under unfavorable circumstances.It is also important to notice that the Chinese also considered such vulnerability at the daily moment of dominance of the “Supreme Yin” to be diametrically opposed to the heart´s polarity. It can be clearly understood why the Chinese sages needed to organize the acupunctural meridians in such a way that the kidneys while transmitting their energetic legacy towards the Pericardium would safely convoke again the fire element (a peculiar situation within the daily chrono-biological cycle) in order to counteract the power of the“Primordial water” and thus “protecting and saving the heart.”[56].

In our life risk management, the hexagram Fu represents that turning point when after the appropriate management of the vital support – the victims “return to life”, recovering their consciousness and becoming hemodynamically stable. Return finds its foundation in the course of nature. Its movement is circular: the patient restarts a new cycle of life. The road is closed upon itself. The opportunity comes when the risk and its contingency have been managed in due time. Such is the cycle of heaven and earth, in which all the movements are completed in six stages and the seventh one brings the return. Thus, during the seventh month after the summer solstice,where the year begins to decline, the winter solstice comes, and so too sunrise comes in the seventh hour after the sunset (vide infra).There is where the translation of Hoffmann is based upon[28].

8. Relevant connections

At the beginning of the hexagram Fu, the following statement can be read:

“Return. Success. Going out and coming in without error. Friends come without blame. To and fro goes the way…”

After “Splitting apart” and “Collapse” (Po), there is a change in the paradigm: movement returns, and with it, the lost light. Such transformation announced by the upper trigram KUN transforms the old into the new. There is “a return to the Way.” [57].

We are no longer bogged down: after the stop (cardiac arrest),movement comes back (and the heartbeats). The period of rest has come to an end. In conceptual coherence with the sixth line of hexagram N 23, “the seed sprouts again and there is new life.”According to Helena Jacoby de Hoffmann’s interpretation, such transformation comprises reanimation thanks to the “return of the powerful life.”[23].

In fact, both hexagrams have an intimate link that suggests a successive concatenation of events from the collapse to a clear reference to recovery – expressed by the idea of “Return” to life,following the course of the laws of nature.

In a way as also affirms Wilhelm both hexagrams Po and Fu establish the everlasting outcome of a circular cycle (Figure 13)which, according to his own words: “…derives from the established sense between heaven and earth.”[58]. Thus we can understand the intrinsic link between both hexagrams, which ensure the continuity of this cyclic process that their Lines determine, completing both of them the subsequent stages which are implicit in every risk management process.

Nonetheless, it should be taken into account that even though an active cycle may be started with prosperity different obstacles may appear that might compromise the safety of the path traced by the referred processes[59]. As we have already understood, this is the main warning of this hexagram and we cannot miss this valuable opportunity because as has been announced in the judgment of“Return” there is a proposal of the other threatening enigma:

“So too sunrise comes in the seventh hour after sunset [7 p.m.].Therefore seven is the number of the “young light”; and it arises when six, the number of the “great darkness”, increases by one. In this way, the period of rest gives place to movement.”[59].

Figure 12. The “Reconciliation vessel” [30,56].

Figure 13. Reanimation after out-of-hospital cardiac arrest [58].

Curiously, during a research on the Ling Shu – a Classic book of the Yellow Emperor – it was found out that, more than 3 000 years ago, the wise Chinese doctors knew and announced that, during these hours, the Heart was more vulnerable:

“The Heart, which corresponds with fire, will have a worsening period from 17 h to 19 h, moment of the passage of energy to the kidneys, which correspond with water; fire fears water, since water(Kidneys) triumphs over fire (Heart).”[60].

Such assertions led to the research with academic thoroughness on the veracity of such statements. The result was the work “Acute myocardial infarction and Yin Yang imbalance”[61]. It could be proved that such statements had a true scientific basis after a thorough cosine trigonometric analysis of the variables present in the 57 000 cases studied in different health institutions around the world.Therefore, in the Judgment of hexagram N 24[62] the same statement expressed in the Ling Shu is repeated, as it describes the generative (and regenerative) ability that allows for this energy link. The ancestral energy that tours along meridians might enable us to use their chromosomal potential in emergency situations for example during sudden death or cardiac arrest allowing our species´ perpetuation. Precisely in those conditions where our lives are seriously threatened, this energy link manages to restore the absent vital signs to “safeguard life” during these extremely urgent situations[63].

9. Image

Thunder within earth symbolizes return[64].That is why the phrases that compose the image of return state thus:

“Thunder within earth: The image of the turning point.Thus the kings of antiquity closed the passes at the time of solstice…”

As we have seen at the beginning, the hexagram “Fu” is composed of three trigrams for thunder and earth: “…Thunder in the other course of heaven...”. According to Wilhelm, life energy represented here by Thunder – is still underground during the winter. During the winter solstice, “… the kings closed the doors of the citadel; the provinces were not inspected and caravans did not travel.”[57].

That is what nowadays is celebrated in New Year: the return of benevolence and life. That is why this magnificent Chinese oracle predicts good fortune[64].

The description of the Image can be compared to the development triggered by the activation at the beginning of the meridian of the kidney and the reconciliation vessel. When the complementary maneuver is made over point K-1 Yongquan(root of the Shao Yin level), Qi will ascend in a similar manner as lightning “climbs” from earth to heaven (Figure 14), seeking to restore movements in the organs of the Upper Jiao whose vital function can never be interrupted[65].

This harmony between Heaven and Earth is the baseline for this principle and allows for the restoration of life energy that was absent, which will bring the subject back to life and will enable the recovery of health.

Figure 14. Upward discharge after K-1 Yongquan stimulus[20,30].

10. Lines

In this case, the lines are all favorable up to the last one of the hexagram.

The rule in hexagram Fu is Nine at the beginning – whose line we have already described in the Judgment – and it states that:

“Return from a short distance. No need for remorse. Great good fortune！”[66].

This phrase has also been interpreted as the “line of the awaking dragon.”[52].

This “governing trace” indicates that “the solid comes back”[23].Undoubtedly, the idea of Revival is expressed, that is, even though everything seems to have been destroyed, it may be rebuilt from its foundations. This is the reason why the solid light line is placed and consolidated in the lower end of the hexagram.

For Jacoby de Hoffmann, such configuration means: “This one is life ascending energy.”[67]. In another analysis of the work we can also find: “…there has been a survival from a period of collapse.Persevere, return to the main road, and “Good fortune” will lie ahead.”[54] That is the same situation the first line of this hexagram refers to: the “Great fortune” of having a second chance to stay in the road of life.

Such statement is curiously identical in its conception and path to the energy vector described for the reconciliation vessel: ascending energy from the origin of the kidney meridian and root of the Shao Yin level[20,65]. Such energy vector can be seen as this hexagram Fu has an inverted configuration with respect to the previous hexagram“Po”. The lower position of the trigram Dshen (“the Arousing –Thunder”) implies that the provision of the necessary restoration energy requires an “intense ascending movement”[23] identical to that in the electro-physical genesis of lightning[65]. Thus hexagram Fu strongly arises from below, making it clear that its upper trigram Kun(“the Receptive”) is willing to receive this powerful regenerating energy.

“Quiet return. Good fortune！”

This second line in particular emphasizes the importance of taking a timely decision to bring “Good fortune”. It is the “line of the approach to the truth[66]. Return always requires resoluteness[27]. Here we can see how hexagrams 23 and 24 are related again with hexagram N 43 Guai (“Resoluteness”). Good fortune for the Superior Man calls for firm decisions. But this analysis will be part of another work.

The third line also warns against being constantly doubtful when walking along the correct path. The path will become extremely dangerous[7]. It is also known as “the hidden line: the one the Dragon is keeping for itself”[55]. It is also said about it: “Be sure to chart a steady course and move steadily toward your goal”[53]. Moving forward directly and inexorably towards our goal will be of utmost importance, not surrendering while a life support protocol is taking place.

The fourth line states thus: “Walking in the midst of others one returns alone.”

For some authors, it is the line that “tells the truth and astonishes everyone.”[59]. Making the decision of doing the good (or what is appropriate or rightful) brings its own reward[66]. That is: one returns“harmoniously and independently thanks to the fact that in our own nature there is a Returning possibility by means of the activation of the circuit of the “Reconciliation vessel.”[20, 30].

Moreover, the fifth line states: “Noble-hearted return. No remorse.”It also refers to making a key decision, a magnanimous and balanced one so as not to make any trivial excuse or to regret afterwards. One gains respect for having consciously accepted the mistakes made[7].

Another version of this line tells us that: “the noble search their Heart, and so discover their proper course”[53]. In this case, the“course towards the heart” is the path to reestablish its circulatory function, recovering tissue perfusion and avoiding the organic failure of the other organs.

Such advice appears in the last line (“Six at the top”) when stating:“Missing the return. Misfortune. Misfortune from within and without…”

For such reason, Richard Wilhelm finishes the analysis of this hexagram with this warning:

“If a man misses the right time for Return, he meets with misfortune. The misfortune has its inner cause in a wrong attitude toward the universe. The misfortune coming from without is also the consequence of a wrong attitude. This last line pictures what obstinacy brings upon it.”[64].

If the right time for Return (or to “make return”) is missed, one will have to face misfortune, the hexagram warns that this misfortune can be caused by a wrongful attitude.[27].

The aforementioned sentence is closely related to the sixth stage:“Risk Monitoring and control”[35], which implies the continuation of the post cardical arrest protocal to draw the victim away from such dangerous situation and to reduce the risk of collateral damage.People who have had cardiac arrest are at risk of having another one. Careful medical control is essential in these cases, as it will determine the immediate need for treatment with antiarrhythmic medication or the use of an automated implantable cardioverter defibrillator (ICD)[58].

Here the hexagram reminds us that the situation may become unfortunate in case of missing the valuable chance of making positive changes[7]. Others also interpret it as “the line that escaped from the Dragon. It is also impossible for it to know it all.”[57].

Another version of this last Fu line states that: “Blind obstinacy brings misfortune, because opportunities available to the openminded are lost when rigid pride prevails[54]. Once a “golden opportunity” has been missed, trying to re-create it again will not work. The best attitude in such a circumstance is to be humble, let go and learn from your mistakes.”[54].

The complementary maneuver over point K-1 Yongquan, root of Shao Yin and opening point for the “Reconciliation vessel” (Figure 15): is then deemed as a “golden opportunity” (“golden standard”),that is to say, the last available resource when basic and/or advanced CPR has failed[68].

This reminds us of what Jung called the “the Eternal return”[65].As this is a cyclic principle, misfortune and disgrace can also come back. The line warns us that the chance of making good decisions can be neglected and collapse can be present again. In the same way in the end of the hexagram Po announced the sprouting of the “seed of good”, now Fu or Pu warns as that confusion may arise.

“Like in the course of Nature and its circular movement, the path ends in itself…after movement, resting time comes…”;“… If recovery time is missed, unfortunate times will come.”

R.L. Wing: “I-Ching Workbook”

Figure 15. “Reconciliation vessel”: its complete circuit[30].

11. Discussion

Nowadays the number of cardiovascular and cerebrovascular collapse victims is 20 000 000, and it is expected to increase to 30 000 000 by the end of this decade. This number equals the genocide that may result from throwing 50 Hiroshima-like bombs o 120 tsunamis like the one that took place in Indonesia, per year.Such catastrophe is already threatening us. The announcement of a disaster is not only a presage. Today it is a clear reality.

The Chinese have agreed for millennia on how to establish a similar electrical state during cardiac arrest. This concept clearly shows the interaction between the Yin terrestrial Qi and its compensation through melting with the heavenly energy in the upper Jiao, something essential to understand how the Celestial Yang Qi provides continuous motility to those thoracic organs whose function cannot be interrupted in order to maintain our life, as it is the case of the heart and the lungs[20].

As to the physiological consideration that leads us to choose the Xin Bao or pericardium meridian, instead of the heart channel(undeniable member of the energetic circuit Shao Yin level) in the somatotopic projection of the “Reconciliation vessel” is such as follows: the quoted interconnections among Shen & Xin Bao meridians justify its “extraordinary” property during extremely severe life-threatening situations such as sudden death and cardiac arrest[30,68].

This is a similar vector to that established in the Shao Yin or Lesser Yin circuit: the Earth’s Yin energy stimulates KI-1Yongquan, and starts with an upward discharge, ascending in search of the celestial Yang energy, calling to action to those organs located in the upper part of the body, whose vital functions cannot be interrupted (Heart-Lungs)[20,30,65].

It could be said that the Chinese supported the possibility of a biological pacemaker at the beginning of the channel of the kidney(driven by the ancestral energy) as well as another physiological mechanism of contingency in the presence of having a predisposition of certain phenomena that pathophysiologically “threaten” the heart(Xin) as it is the reference to the pulse of the only couple of organs that are capable of coupling as spouses and also of transmitting the energetic circadian cycle at the same time[30].

The Xin Bao or pericardium channel, conceived by the Chinese as the meridian specifically meant to protect the heart, also adequately complements the kidney meridian, conductive reservoir of the ancestral energy. The fact that the Chinese wise men determined precisely the coincidence that among the twelve main meridians,only these two ones – the kidney and master of the heart meridians were the only “husband and wife” in pulses (Figure 16) and were connected in their bioenergetical transfer, allows us to assume that such an event – not casual for TCM indicates both the physiological generative (and regenerative) capacity represented in this link[30, 68].

Figure 16. Kidney & Pericardium = “Spouses” in pulses[30].

The above mentioned circuit clearly shows, for its hopeful results in rescues during “impending death situations”, a close relationship with the profound Shao Yin level and with Chong Mai and Yin Wei extra meridians. As all the other extraordinary vessels, it is never damaged by the perverse energies as they lack the shu point through which they usually penetrate, and must be used when other classic therapies fail. Extra meridians represent the deepest level of action in the acupunctural treatment[20,30].

The paragraphs above take our attention back to the close relationship that links the meridians that compose the “Reconciliation vessel” between Xin Bao and the kidneys, established through a coupling of pulses and their transmission of the chrono-biological legacy in the circadian cycle. kidney (17.00 h to 19.00 h)transmits its chrono-biological energetic legacy to Xin Bao channel (19.00 h to 21.00 h). Both combined situations present here an “exclusive point” which is only present between these two meridians and not in the other main 12[30]. The obtained data justifies completely such integration to exercise utmost protection over the heart, especially in the time of the day when it is more vulnerable. Surprisingly, according to the work of Dr. Rafael Acunzo and his vast bibliography, the bimodal circadian curves in serious cardiovascular emergencies: massive AMI, shock, malign arrhythmias, sudden death, ictus, aortic dissection, rupture of abdominal aneurisms are given invariably at these hours (7:00 a.m.;19:00 p.m.)(Figure 17)[56,68].

Figure 17. Cardiac vulnerability - Comparison between oriental &occidental concepts[54,56,58,63].

Precisely in those conditions where our lives are seriously threatened –for example during sudden death or cardiac arrest– this energy link manages to restore the absent vital signs to“safeguard life” during these extremely urgent situations. The ancestral energy that tours along the quoted meridians might enable us to use their chromosomal potential under emergency situations,allowing for our species’ perpetuation[45,68].

As every rescue maneuver, its usefulness will depend on the application of appropriate protocols with international scientific and academic consensus. That was the reason why the prestigious World Journal of Critical Care Medicine presented its protocol in the cover story, showing there is unanimous consent among the reviewers from 80 different countries[63].

12. Conclusion

What is, definitely, the I-Ching?

Is it a divination treaty? Is it a book with mysterious mystical codes? Is it a compendium of natural and political sciences? Is it a codex with secrets that have been encrypted in binary calculations?Until today, it was considered impossible to understand Acupuncture principles following a logical cartesian thought, typical of our Western cultural way of thinking. There is always a Western tendency to minimize as simple, empirical or allegorical the essential concepts of TCM. We have forgotten that this civilization has been responsible for these advances in the world history.

This “bipolar” statement that the I-Ching proposes from the beginning is worth considering as it states that thousands of years ago, the Chinese were already showing us this “significant coincidence” between the organization of the Trigrams born from the Yin/Yang and binary calculation.

In 1671, Leibnitz– coincidentally the inventor of one of the first calculators – suggested the possibility of making a mathematical analysis based only on two numbers (“De Progressione Dyadica”).At that time, J. Bouvet – a Jesuit missionary in China devoted to the deep study of the I-Ching found that there were sequences of Hexagrams in different positions as in Fu Hsi’s “Square and circular arrangement” that could be interpreted in a similar way to Leibnitz’s binary system, that is to say, taking each solid line as number 1 and each open line as number 0[69].

These opposing polarities are “…the structural forces of the universe and the forming energies of the human being…”[70], which have microcosmic correspondence and are available to be recognized in their own depths.

This was clear in the minds of the ancient sages. That is the reason for the Yellow Emperor’s statements that holistically comprise the universal laws:

“Yin and Yang are the way of heaven and earth, the great schemes of all things, parents of change, the origin and the beginning of birth and destruction, the palace of the gods. Treatment of the disease should be based on the origins (Yin and Yang).”[71].

“If these objects (Yin/Yang) are dispersed, birth and transformation will cease to exist.”[71].

The Chinese took into account the cosmic-telluric phenomena,relating them to these constituent five elements, product of Yin/Yang Inter-Transformation through keen observation of natural phenomena, which was a peculiar way to optimize their critical experience. Again, with respect to the conformation of the surrounding universe, based upon these five interrelated principles,conceiving them: “…in a theoretical abstraction that relates all existence through a dynamic balance between its continuous mutation of mutual generation and reciprocal control.”[3].

This Five Elements Theory – homonymous with Euclid’s book title was also drawn more than two thousand years ago. It seems that since then – and subject to the taxonomic methodology – one of the most ancient medicines of our planet may have been twinned with the oldest formal science in history.

Hippocratic medicine in Ancient Greece had identical origins, when Empedocles of Agrigento (504 BC-433 BC) almost contemporary to Zou Yen(350 BC-270 BC) formulated a made up of four essential elements, fully equivalent to East-looking, interpreting changes of matter in nature and man[3].

This dynamic conception has been performed on human chrono-biology for millennia, enabling the Chinese to manage complementary antagonisms of the human body as a self-regulated system by the delicate balance or Homeostasis of their constant mutation.

“Observing the transformations and their movements, you can discover the secrets of nature.”[72].

As Riedl says, in biology, systematization aligns the concepts that describe real things, grouping characteristics that determine singular stratums, organizing genealogical curves along evolution.This process is carried out “…tracing paths under the analysis of ontogenesis that derive to future predictions.”[73]. Such teleonomy allows to foresee coming changes supporting all logical or scientific elaboration – as the Chinese made with the suggestions of this oracle thousands of years ago, “…in the accumulation of countless fortuitous events and, consequently, in their being established as a necessity.”[74].

Riedl reminds us that the characteristics that are called“homologous” are those which are not identical in nature, that is,those which confirm an “identity”, enabling then a “reciprocal order”that may allow for the “hierarchical organization” of knowledge[74].Therefore, for Riedl, the I-Ching represents a wonderfully simple way of processing, balancing and selecting data that may support or guide our learning in this complex world of non-lineal systems and their cause-effect chains[75].

This situation is identical to that of the taxonomic classification included in the five elements which we can affirm were not poor formulations , which have laid from yesteryear the foundations for a safe acquisition of knowledge and which enable the introduction of different therapeutic or strategic planning based upon said vital laws.Thus, it may be inferred that Chinese medical principles recognize an exact basis demonstrated by the oldest formal science there:Geometry to support the dynamics of their precise relationships,linkages and Inter-Transformation, and their successful diagnosis and accurate therapeutics through times.

Finally, we will refer to the results obtained then presenting the“Reconciliation vessel” during the Asian Pacific International Emergentology Forum – APIEF – 2016 Congress in Lingao, Hainan,China. In such event, the following conclusions were presented[76]:(1) The increase of the frequency of serious cardiovascular events between 17.00 h to 19.00 h is absolutely coincident with the time referred to in chapter 40 of Ling Shu[77].

(2) Said data was also coherent with the findings suggested by the curves of myocardial necrosis markers[78-80].

(3) Western researchers, by means of strict and methodological scientific studies, concluded that there exists an important influence of the time of the day at which myocardial infarction occurs and its size[81].

(4)These findings would confirm natural spontaneous mechanisms of cardio-protection related to the circadian cycle mediated by certain hormones (catecholamines, cortisol, etc.)[78], similar to what was proved by the millenary Chinese medical systematization[56].

Once the World Resuscitation Committee accepts this therapeutic maneuver, this whole theory will open the possibility of converting cardiac arrests victims into responders, allowing the K-1 Yongquan maneuver inclusion in the life-support protocols, upgrading the survival rates even much more, upgrading as a key strategy treatment to raise up the survival rates of all species.

12. Conflict of interest statement

The author reports no conflict of interest.

13. References

[1] Nassim Nicholas Taleb. Chapter 20.Anti-fragile: the things that benefit from disorder. Buenos Aires, Paidós; 2013. p. 384.

[2] Wilhelm, R. Foreword by the translator.I-Ching: The Book of Changes.Trans Helena Jacoby de Hoffmann. Lo Barnechea, Cuatro Vientos;1976, p. 8.

[3] Inchauspe AA. Is traditional Chinese medicine definitely an exact science?EC Dental Sci2017; 11(6): 255-277.

[4] Rupert Riedl. Biology of knowledge:The phylogenetic foundations of reason. Barcelona: Labor Universitaria Monografias; 1983, p.152.

[5] Rupert Riedl.Biology of knowledge:The phylogenetic foundations of reason. Barcelona. Labor Universitaria Monografias; 1983. p.162.

[6] Humberto Maturana R, Francisco Varela G.The tree of knowledge. 5th ed. Santiago de Chile: Universitaria; 1989, p.25.

[7] Castle F.23 the disintegration. [Online]. Available from: http://ichingfastale.blogspot.com.ar/2015/05/23-la-desintegracion.html.[Accessed on April 2018].

[8] Wilhelm R.I-Ching: The book of changes. Trans Helena Jacoby de Hoffmann. Lo Barnechea: Cuatro Vientos; 1976. p.16.

[9] Prigogine Ilya.Prologue: Une nouvelle rationalité?La fin des certitudes:Temps, Chaos et les Lois de la Nature. France: Odile Jacob; 2001, p.1.

[10] Humberto Maturana R, Francisco Varela G.The tree of knowledge. 5th ed. Santiago de Chile: Universitaria; 1989, p. 81.

[11] Riedl R.Biology of knowledge: The phylogenetic foundations of reason.Barcelona: Labor Universitaria Monografias; 1983, p.114.

[12] Schneider Eric D, Sagan Dorion. The thermodynamics of life.Physics,cosmology, ecology and evolution. 1st ed. Barcelona: Tusquets Editores,S.A; 2008, p.31.

[13] Schneider Eric D, Sagan Dorion. The thermodynamics of life.Physics,cosmology, ecology and evolution. 1st ed. Barcelona: Tusquets Editores,S.A; 2008, p.40.

[14] Pialoux Jacques.Guide of Acupuncture and Moxibustion. Valais,Switzerland: © Cornelius Celsus Foundation; 2001-2009, p.33.

[15] Inchauspe AA. New advances in research on reconciliation vessel for emergency treatments.J Acute Dis2016; 5(4): 274.

[16] Van Nghi N.The eight curious meridians system. [Online]. Available from: http://www.centrobrasileiro.com.br/biblioteca/13/data/Van_Nghi,_Nguyen_-_Sistema_de_los_ocho_meridianos_curiosos.pdf[Accessed on April 2018]

[17] ichingfortune.com.I Ching Hexagram 23 - Po / Splitting Apart.[Online]. Available from: http://ichingfortune.com/hexagrams/23.php.[Accessed on April 2018].

[18] Hoang Ti. Speed of energy circulation. In:Linshu. Buenos Aires:Continente; 2009.

[19] Inchauspe AA. Traditional Chinese medical criteria about the use of yongquan as a life support maneuver. In:Kuang H. Recent advances in theories and practice in Chinese medicine. Croatia: InTech Pub;2012, p. 361. [Online]. Available from: https://www.intechopen.com/books/recent-advances-in-theories-and-practice-of-chinese-medicine/traditional-chinese-medical-criteria-about-the-use-of-yongquan-as-alife-support-maneuver.

[20] Inchauspe AA. Reconciliation vessel, a pathway to increase survival rates and its energetic integration with Shao Yin level.J Acute Dis2016; 5(3): 194-201 .

[21] Inchauspe AA. Manual for the application of the resuscitation maneuver on point R-1 Yongquan. Buenos Aires: Consejo Argentino de Resucitación; 2013.

[22] Hoang Ti. Pathway of the meridians. In:Lin shu. 1st ed . Buenos Aires, Argentina: Continente; 2009, p. 81.

[23] Wilhelm R. Third part. In: I-Ching: The Book of Changes. Trans Helena Jacoby de Hoffmann. Lo Barnechea: Cuatro Vientos; 1976. p.380.

[24] Ortiz M.I CHING, the meaning of the trend hexagram. [Online].Available from: https://abatesoderini.blogspot.com.ar/2013/04/i-chingel-significado-del-hexagrama.html. [Accessed on April 2018].

[25] Wilhelm R. Bo: The Disintegration (“Splitting Apart”). In:I-Ching:The Book of Changes. Trans Helena Jacoby de Hoffmann. Lo Barnechea, Santiago de Chile: Cuatro Vientos; 1976, p.170.

[26] Cleary T.I-Ching: the Book of Change. Madrid: EDAF S.A; 2005. p.27.

[27] Hohne K.Po (Split Apart). [Online]. Available from: http://cafeausoul.com/iching/po-split-apart. [Accessed on April 2018].

[28] www.adivinario.com.23. PO / Splitting Apart. [Online]. Available from: http://www.adivinario.com/i_ching_desc_23.php. [Accessed on April 2018].

[29] Garuz V.Heart attack. [Online]. Available from: https://www.slideshare.net/josegarv/paro-cardiaco-63588091. [Accessedon April 2018].

[30] Inchauspe AA. New advances in research on reconciliation vessel for emergency treatments.J Acute Dis2016; 5(4): 271-280.

[31] Barrett H.Hexagram 23? Now what?[Online]. Available from: http://www.onlineclarity.co.uk/answers/2007/08/21/hexagram-23-now-what.[Accessed on April 2018].

[32] Ortiz M.The hexagram 23, PO, and the lookout in the sixth place.[Online]. Available from: https://abatesoderini.blogspot.com.ar/2011/11/el-hexagrama-23-po-y-el-vigia-en-el.html. [Accessed on April 2018].

[33] Wilhelm R. Bo: The Disintegration (“Splitting Apart”). In:I-Ching:The Book of Changes. (Helena Jacoby de Hoffmann, Trans). Lo Barnechea: Cuatro Vientos; 1976, p. 171.

[34] Wilhelm R. Guai: Breakthrough (the Determination). In:I-Ching: The Book of Changes. Trans Helena Jacoby de Hoffmann. Lo Barnechea:Cuatro Vientos;1976, p. 263.

[35] ISO/FDIS 31000:2009(E). Risk management-principles and guidelines.Geneva, Switzerland: © ISO 2009; 2009.

[36] Richard Wilhelm. Bo: The disintegration (“Splitting Apart”). In:I-Ching: The Book of Changes. Trans Helena Jacoby de Hoffmann. Lo Barnechea: Cuatro Vientos; 1976. p. 172.

[37] Cleary, T.I-Ching: the Book of Change. Madrid, España: EDAF S.A;2005, p. 77.

[38] Longo D, Kasper D, Jameson J, Fauci A, Hauser S, Loscalzo J.Harrison: Principles of internal medicine. 18th ed. USA: McGraw Hill;2012.

[39] Bayés de Luna A, Elosua R. Suddendeath.Rev Esp Cardiol2012;65(11): 1039-1052.

[40] Arrythmia Alliance: The heart rhythm charity: “Heart Rhythm Week:Over half public underestimated own ability to save lives of cardiac arrest victims. United Kingdom´s Continuous Educational Course(2013).

[41] Rodríguez Morales MM, Alsina Restoy X.Sudden death. Manual of Nursing in Arrhythmias and Electrophysiology. Asociación Española de Enfermería en Cardiología; 2013, p. 106-122. [Online]. Available from:https://www.enfermeriaencardiologia.com/wp-content/uploads/electro_06.pdf.

[42] Asmundis C, Brugada P. Epidemiology of sudden cardiac death.Rev Esp Cardiol2013; 13 (A): 2-6.

[43] Chang T. Hexagram Bo. In:Unveiling the mistery of the I Ching.[Online]. Available from: http://www.iching123.com/23_text.htm.[Accessed on April 2018].

[44] www.jamesdekorne.com.23 -Disintegration. [Online]. Available from: http://www.jamesdekorne.com/GBCh/hex23.htm. [Accessed on April 2018].

[45] Inchauspe AA. Torsadogenic index for prevention of acute death.J Acute Dis2015; 4(4): 266-273.

[46] Araujo Leonetti E.Hexagram 23: Wearing Dangerously. [Online].Available from: http://www.yijingorienta.com.br/jdownloads/e_323.pdf. [Accessed on April 2018].

[47] Inchauspe AA. Traditional Chinese medical criteria about the use of Yongquan as a life support maneuver. In:Haixue Kuang recent advances in theories and practice of Chinese medicine. Croatia: InTech;2011, p. 32. [Online] Available from: http://www.intechopen.com/books/recent-advances-intheories-and-practice-of-chinese-medicine/traditional-chinese-medical-criteria-about-the-use-of-yongquan-asalife-support-maneuver.

[48] Wilhelm R. Guai: Breakthrough (the Determination). In:I-Ching: The book of changes. Trans Helena Jacoby de Hoffmann. Lo Barnechea,Santiago de Chile: Cuatro Vientos; 1976, p. 262.

[49] Wilhelm R. Bo: The disintegration (“Splitting Apart”). In:I-Ching:The Book of Changes. Trans Helena Jacoby de Hoffmann. Lo Barnechea, Santiago de Chile: Cuatro Vientos; 1976, p. 173.

[50]Master of risk management. Continuing education program.Universidad Antonio de Nebrija, Spain [Online]. Available from:http://mastersonline.ealde.es/Master-Gestion-de-Riesgos?utm_source=Spanish. [Accessed on April 2018].

[51] Ortiz M.Hexagram 24, Creative leisure. [Online]. Available from:https://abatesoderini.blogspot.com.ar/2017/06/hexagrama-24-el-ociocreativo.html. [Accessed on April 2018].

[52] Wikipedia.Chapter 24. [Online]. Available from: https://es.wikipedia.org/wiki/Chapter_24. [Accessed on April 2018].

[53] Divination foundation.24: Returning. [Online]. Available from: http://divination.com/iching/lookup/24-2/. [Accessed on April 2018].

[54] Wilhelm R. Bo: The disintegration (“Splitting Apart”). In:I-Ching:The book of changes. Trans Helena Jacoby de Hoffmann. Lo Barnechea,Santiago de Chile: Cuatro Vientos; 1976, p. 174.

[55] Cleary T.I-Ching: The book of change. Madrid: EDAF S. A; 2005, p.78.

[56] Inchauspe AA. Acute myocardial infarction and Yin Yang imbalance.J Acute Dis2018; 7(1): 5.

[57] Wilhelm R. Fu: Return (The turning point). In:I-Ching: The book of changes. Trans Helena Jacoby de Hoffmann. Lo Barnechea: Cuatro Vientos; 1976, p. 175.

[58] Jouffroy R, Orsini JP, Lamhaut L. Resuscitation of out-of-hospital cardiac arrest. EMC-Anestesia-Reanimación 2015; 41(2): 1-13.https://doi.org/10.1016/S1280-4703(15)70757-7.

[59] es.scribd.com.Hexagram 24 Fu: Return. [Online]. Available from:https://es.scribd.com/document/80964637/hexagrama-24-Fu-El-Retorno#. [Accessed on April 2018].

[60] Hoang Ti. Four periods in a day. In:Lin shu. 1st ed. Buenos Aires:Continente; 2009, p. 186.

[61] Inchauspe AA. Acute myocardial infarction and Yin Yang imbalance.J Acute Dis2018; 7(1): 12.

[62] Wilhelm R. Fu: Return (The turning point). In:I-Ching: The book of changes. Trans Helena Jacoby de Hoffmann. Lo Barnechea: Cuatro Vientos; 1976, p. 176.

[63] Inchauspe AA. Drawing the Yongquan protocol into the different stages of the cardiopulmonary resuscitation sequence.World J Crit Care Med2013; 2(3): 17-20.

[64] Wilhelm R. Fu: Return (The turning point). In: I-Ching: The book of changes. Trans Helena Jacoby de Hoffmann. Lo Barnechea: Cuatro Vientos; 1976, p. 177 .

[65] nchauspe AA. “Between heaven and earth” Scientific basis of the action of Shao Yin: Lightning’s physical-mathematical analysis.Pharmacology & Pharmacy2014; 5(2):175-180.

[66] Wilhelm R. Foreword by the translator. In:I-Ching: The Book of Changes. Trans Helena Jacoby de Hoffmann. Lo Barnechea: Cuatro Vientos; 1976, p. 27-29.

[67] Wilhelm R. Foreword by the translator. In:I-Ching: The book of changes. Trans Helena Jacoby de Hoffmann. Lo Barnechea: Cuatro Vientos; 1976, p. 17.

[68] D´Negri CE, Nicola-Siri L, Vigo DE, Girotti L, Cardinali DP.Circadian analysis of myocardial infarction incidence in an Argentine and Uruguayan population.BMC Cardiovasc Disord2006; 9(6): 1.

[69] Leibniz GW. De Progressione Dyadica, Pars I. In:Erich Hochstetter and Hermann-Josef Greve Herrn von Leibniz'Rechnung mit Null und Einz.Berlin: Siemens Aktiengesellschaft; 1966. [Online]. Available from:http://www.bibnum.education.fr/sites/default/files/69-analysis-leibniz.pdf [German]

[70] Hoang Ti. Great treatise on Yin-Yang classifications of natural phenomena. In:Su Wen Part I Book II. 1st ed. Buenos Aires:Continente; 2009, p. 186.

[71] Hoang Ti. Chapter 68. In:Su Wen Part II; Book XIV. 1st ed .Buenos Aires, Argentina: Continente; 2009, p. 186.

[72] Hoang Ti. Displacement of essence and transformation of breaths. In:Su Wen Book IV. 1st ed. Buenos Aires: Continente; 2009.

[73] Riedl R.Biology of knowledge: The phylogenetic Ffoundations of reason.Barcelona: Labor Universitaria Monografias; 1983, p. 197.

[74] Riedl R. Biology of knowledge: The phylogenetic foundations of reason. Barcelona: Labor Universitaria Monografias; 1983, p. 112.

[75] Riedl R. Biology of knowledge:The phylogenetic foundations of reason.Barcelona: Labor Universitaria Monografias; 1983, p. 169.

[76] Inchauspe AA. Can Yin/Yang imbalance be the cause the cause of Myocardial Infarction? Observational analysis of the circadian cycle under the chrono-biological systematization of Chinese medicine. Author´s conference during the Asian Pacific International Emergentology Forum –APIEF 2016- in Lingao, Hainan, China.December 2-4, 2016.

[77] Hoang Ti. Four periods in a day. In:Ling Shu. 1st ed. Buenos Aires:Continente; 2009, p. 186.

[78] Núñez-Gil I. The circadian clock of myocardial infarction: more intense in the morning. [Online]. Available from: http://secardiologia.es/multimedia/blog/3342-el-reloj-circadiano-de-los-infartos-masgrandes. [Accessed on April 2018].

[79] Aroche R, Naranjo A, Rodríguez A, Llera R. Cardiovascular risk factors in the circadian rhythm of myocardial infarction.Rev Fed Arg Cardiol2013; 43(1): 32-37.

[80] Dominguez-Rodriguez A, Abreu-Gonzalez P, Burillo-Putze G.Myocardial infarction and biological clock: Role of melatonin”.Medicina Clínica2013; 141(2): 92-93.

[81] Tartabul lPoutriel K, Rodriguez Lopez AJ, Nicolau Pestana E.:”Circadian rhythm in acute myocardial infarction”. [Online].Available from: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1025-02552009000100010. [AccessedonApril 2018].