Think Like a Philosopher: Psychosomatics and the Luo Vessels

The philosopher was given great respect within classical Chinese culture. The Dao De Jing has many passages extolling the virtues of the "philosopher king." The same was true within medicine. It is not enough to look at things in their literal sense: the Nei Jing asks a bit more from us than that. Much of the classical texts are written in code, using philosophical metaphor to present their wisdom.

My teacher Jeffrey Yuen has called Chinese Medicine "applied Chinese philosophy," advising that we'd benefit as acupuncturists by learning Chinese philosophy. Every teaching we received from Yuen was rooted in philosophy relating to that particular tradition. To illuminate the mysteries of the Chinese Medical classics, we must try to understand and think like the philosophers who wrote them.

Acupuncture is popularly seen to address physical problems. The notion that acupuncture also affects the mind and emotions is confusing to some; enticing to others. An acupuncturist works on the external tissues of the body, exciting the "Jing Luo" (channels and collaterals), which travel along the body's external muscles. The Jing Luo have resonance with the internal organs, which control physical as well as mental-emotional function.

Physiology of the mind (and emotions) is usually discussed in classical Chinese medicine in relation to blood, and explored through study of the Primary Channels, especially those relating to blood: the Heart/Pericardium, Spleen/Stomach and Liver; pathology can be explored through the "collaterals," mainly the Luo Vessels.

Luo Vessels are conduits of ying qi. They relate to the interior of the body. As collaterals, the Luo Vessels are created as needed to take on pathology from the Primary Channels. They are pathological channels representing a disturbance to the normal physiological flow of qi and blood. The Luo are a major arena where battle between internal pathogenic factors and the body's physiology is played out. Internal pathogenic factors are mainly considered to be the seven emotions within classical medicine.

The "collaterals," or so-called "Secondary Channels of Acupuncture" can be seen as detailed explorations into the pathological process. When the Primary Channels become overwhelmed by a pathogenic factor, coming from the exterior or interior of the body, they rely on support from the collaterals so as to maintain daily physiological function. The Luo do not treat the pathogenic factors they inherit, but hold them in a state of latency as "fullness." When the Luo reach saturation, they "empty" back into the Primary Channel, or deeper into the source.

To study pathology of the mind and emotions, the Luo Vessels are paramount. It can be confusing however, when studying the Luo, to see most classical symptoms associated with them are somatic. The only "psychological" Luo Vessel symptom mentioned in Chapter 10 of the Ling Shu is "mania," associated with the Stomach Luo. Even the Heart and Pericardium's Luo symptoms sound very physical: "chest/heart pain," "loss of voice," "stiffness of the neck." Commentators, such as Yuen, have said the somatic language used to describe Luo Vessel pathology is the result of Confucian politeness, keeping discussion of the emotions within the family. It is historically considered inappropriate to speak of such things in the clinical setting. People expressed psychological pain through somatic language. "Heart pain" expresses a sense of heartache, betrayal or disappointment; "neck stiffness": the stubbornness or inability to see new options. Thinking like a philosopher, it's not difficult to see connection between the somatic and psychological within classical discussion of the Luo Vessels; descriptions in Ling Shu Chapter 10 are subtly illustrative and evocative.

Let's examine the Small Intestine Luo Vessel from this point of view. The symptom of "fullness" of the Small Intestine Luo is described as "looseness of the elbow joint." Commentators have said this is somatic language for difficulty handling situations in life. The elbow represents the ability to grasp a situation and manipulate it. The channel travels through the elbow into the shoulder, where it terminates. Progression of this Luo Vessel shows inhibition in ability to manipulate situations becoming difficulty reaching out and grasping, represented by movement of pathology from the elbow into the muscles of the shoulder.

Small Intestine follows the Pericardium in the Luo Vessel progression, as presented by Chapter 10 of the Ling Shu: Lung, Heart, Pericardium, Small Intestine, Large Intestine, ect. By the stage of the Pericardium Luo, the body has failed to release a pathogenic factor from the chest via the Lung's ability to diffuse and let go and the Heart's ability to articulate and expel the problem through use of the tongue. The problem becomes stuck in the chest, creating a sensation of "chest pain:" a sign of fullness of the Pericardium Luo. As the vessel progresses into "emptiness," the neck tightens to prevent heat stagnation from reaching the brain.

The Small Intestine Luo shows progression from a growing state of helplessness coming from the Pericardium Luo. The person has lost ability to see new options to their problem, as represented by the stiff neck. The Small Intestine tries to use its yang qi to open the chest, becoming deficient from the struggle. Incidentally, the Small Intestine is the first Luo to show symptoms of consumption and degeneration. Einstein has a famous quote: "Doing the same thing over and over, expecting a different result, is the definition of insanity."

Emptiness of the Pericardium Luo, in which a person can only see a situation in one way, can lead to doing the same thing over and over trying to get something to change. Overuse or "Lao" will eventually lead to consumption of qi and degeneration, a term known as "Wei Atrophy Syndrome." The stage of progression represented by the Small Intestine Luo suggests this scenario can eventually lead to autointoxication through weakening of the bowels.

Psychologically, fullness of the Small Intestine Luo is described as the inability to accept feedback, manifesting in a defensive demeanor. All criticism is taken as an attack. The world begins to be perceived as a toxic place where the person feels they must always defend themselves. This state progresses into a sense of insecurity as the Vessel empties.

"Pebbly stools": the symptom associated with emptiness of the Small Intestine Luo shows impact on the bowels, damaging the ability to separate the pure from the turbid. The second emptiness symptom of the Small Intestine Luo Vessel is skin breakouts, further suggesting sluggish bowel function, and difficulty with separation and elimination. Inability to remove waste properly via the bowels manifests in damp-heat or fire toxins that can express through the skin. Accumulation of fire toxins and weakening of the portals of elimination are part of the clinical picture of Wei Atrophy Syndrome. The Small Intestine Luo illustrates how an unresolved emotional issue can lead to physical degeneration. It also shows a person who cannot discern the meaning of feedback from others, which can lead to dissociative personality disorders, as taken up by the Large Intestine Luo Vessel, which follows Small Intestine in the progression.

Within Ying Level pathology, effect on the mind and emotions is often implied. Blood stasis, mostly associated with fullness of the Luo can also be seen as Shen stasis. Emptiness of the Luo is associated with phlegm stasis, as the body relies on the support of fluids to maintain latency after the blood becomes insufficient. When one humor becomes taxed and unable to deal with a pathogenic factor, or to support latency, another humor will either transform itself into the needed commodity, or support the holding process. The Gynecological model of Chen Zi-Ming (1237 C.E.) explains the mutual support amongst the body's humors. Liver blood engenders Heart qi, which allows the blood to move; the Ye fluids also support the blood (as well as Kidney Yin). Within the Luo Vessel discussion, fluids are supporting the blood to maintain latency: blood stasis gives rise to phlegm stasis, both of which affect the Shen and therefore the Heart.

Luo Vessels can also be seen as pathological expressions of a person's psycho-social development. They represent physiology gone astray, or a "break in the sequence," as eloquently stated by Lung 7. Just as physical trauma is capable of creating blood stasis within the muscles; emotional trauma can disrupt the psychological development of a channel.

The Primary Channels represent physiological process within human development. They are organized as a progression according to the priorities of life. Respiration, digestion and sleep are mandatory to sustain life. This is acknowledged by the placement of the Lung, Large Intestine, Stomach, Spleen and Heart as the first five meridians within the Primary Channel progression. This progression is also mirrored in the psychological and social development of a person.

As a child is developing mentally and socially during the first few years of life, the psycho-social attributes of the Primary Channels progressively become activated. The Lung Channel governs respiration: the most vital physiological process within human life. It allows sensation and contact with the world: the ability to be sensual. It is very primitive (being the first channel): representing nonjudgmental, indiscriminate contact and the ability to perceive stimuli. It is vital to being in the world. To create relationship with things and people, one must first be able to make contact, and have the ability to become aroused and stimulated. Without initial stimulation and arousal, one cannot make contact with oneself or others: the Lungs fail to descend to the Kidneys to support yang qi that continually renews the will to live. The psychological function of the Lungs is just as vital to sustaining life as the respiratory function; without the support of Metal, there is no will of Water.

Pathological disturbances to the Lung's psychological development manifest through its Luo. "Frequent yawning" and "frequent urination" are somatic symptoms associated with emptiness of the Lung's Luo. These symptoms can be seen to represent lack of interest in life, boredom, and the inability to hold onto stimuli. In this case, emptiness of the Lung Luo appears similar to a deficiency of Lung qi. When the Lungs are weak and unable to deal with external pathogenic factors, the Bladder channel must provide support. Within the Primary Channel theory of pathological progression, the Bladder channel is indicated for external conditions with an underlying deficiency. If the Lungs lack the Wei qi to "release" an external pathogen, they will descend the problem to the Bladder to be expelled. Metal is no longer giving birth to Water; instead the reverse is occurring, going against the generation cycle of the Five Elements.

Fullness of the Lung's Luo is described as "heat in the palms," representing hyperactive sensuality: the constant need for contact and stimulation; a seemingly excess symptom relating to the stage of psycho-social development governed by the Lungs.

The Large Intestine Primary Channel becomes involved during the teething process of a child, when the world begins to become something to "masticate." Discrimination and association begins with the Large Intestine. The Stomach Channel follows, providing the capacity for primal feelings of like and dislike. If food is not good, the child will vomit it back up. There is not yet a mental process involved at this stage, but one of pure feeling. The Spleen, which comes next in the progression, provides the mental component, through the Yi. The grouping of these four channels has been called "the survival stage" of development by Yuen. If these criteria are not met, one cannot progress into the further stages of "interaction" and "differentiation." Without adequate respiration and digestion, life cannot be sustained. The same is true for the psycho-social. One must be able to make contact and discriminate one thing from another, especially in terms of harmful or safe, to be able to interact and ultimately differentiate within the more advanced level relating to perception and major life choices.

The Luo Vessel becomes activated when there is a disturbance within one of the Primary Channels. Luo Vessel symptoms indicate trauma relating to blood. They can be formed during a person's developmental process, pathologically influencing demeanor, perception and behavior as the person grows into adulthood.

Some of us never learned how to deal with the word "no." We became rebellious whenever we were not allowed to do something, showing a disturbance within the psycho-social development of the Heart Primary Channel. Luo Vessels manifest in rebellious qi. We have already established symptoms need not be physical. Within this model, the Luo Vessel progression follows that of the Primary Channels, as they are pathological outgrowths of psycho-social development. The "heart pain" of being told "no" can cause inability to handle feedback, which leads to a sense of overreaction within our minds, a hyper-vigilant "fight or flight" demeanor, which can ultimately progress into obsessive-compulsive behavior. The psycho-behavioral progression described here is that of a disturbance to the Heart, manifesting through its Luo, and progressing to the Small Intestine, Bladder and Kidney Luo Vessels, respectively. This person could be treated through working with the affected Luo Vessels: to expel the blood stasis disturbing normal psycho-social development. Once the blood stasis is resolved, the Primary Channel is given the opportunity to build itself back, restoring natural function.

Much of the language within the classics is codified. It must be read with a philosophical, three-dimensional point of view mirroring the three levels of energetics. What may seem simple and straightforward often has deeper meaning, illustrated through the somatic language of the channel systems of acupuncture. The wonderful thing about Chinese Medicine is that it is an art as well as a science; built upon philosophy. There have been thousands of commentators to the classics throughout history; some very popular, whose way of seeing the world have inspired others. This has given rise to numerous traditions. Each of us must make the medicine our own, honoring ourselves as philosophers and commentators who create our own style based on the way we see the world. Only then does Chinese Medicine remain a living system, imbued with Shen: like the blood.