Editor's note: In last month's issue we published part one of this article, which discussed the Su Wen and Ling Shu channel system, and the luo collaterals. Here we will continue with the primary, divergent and eight extrordinary channels.
The Primary Channels
The primary channels (main channels) are introduced in chapter 10 of the Ling Shu, these channels are referenced in many chapters throughout the Su Wen and the Ling Shu. The primary channels have become the main channel system used in TCM. The conditions listed in chapter 10 of the Ling Shu and in other chapters would be part of the diagnosis. As the understanding of the human body developed a deeper understanding of the internal organs developed as well. Treating the internal organs is the main modern application of the primary channels. The main pulse system presented in chapter nine of the Ling Shu is the Renying and Cunkou pulse; it is used to identify imbalances within a person. This pulse method is somewhat of a lost method and used by a small percentage of practitioners; this pulse method offers significant insights from the founders of Chinese medicine. The main pulse method used in modern practice is the standard wrist pulse. That pulse method is closely tied to the conditions of the internal organs. The Renying (Stomach 9) and the Cunkou (Lung 9 area at the wrist) pulses measure the channels and is defined by the Six Channels: Tai Yang, Shao Yang, Yang Ming, Tai Yin, Shao Yin and Jue Yin. There are differing views on the Renying and Cunkou pulse. Some practitioners believe it measures the channels only, some believe it measures imbalances of the Yin and Yang of the entire body. Both theory and experience confirmed for me it measures the condition of the channels. The treatment plan presented in chapter 9 is every treatment includes Yin-Yang paired channels. For example, if it were a foot tai yang imbalance, the treatment would include treating the foot tai yang channel (bladder) and the foot shao yin channel (kidneys) to balance the condition, since they are viewed as one interconnected channel pair. This is one of the few suggestions for how to combine channels in the Ling Shu.
The Divergent Channels
The divergent channels are presented in chapter 11 of the Ling Shu; they are also called the Separate Channels. The divergent channels do not have any points, and they begin and end at lower and upper areas of the body. The Yang and Yin channel pairs meet together via the divergent pathways. A translation is they form a junction. This chapter does not offer any clinical applications. There is special guidance in the first paragraph of the chapter that can guide a practitioner to exploring clinical applications.
"Study these first. Work it out to the finish. The unskilled think it is easy; the superior know it is difficult. Please explain these separations and joinings, theses exits and entrances."2
"How illuminating are these questions. The skilled pass right by them, while they are the very breath of the superior physician."2
After these quotes the pathways of the divergent pathways are presented. A practical application of this guidance can be to integrate theories and applications into chapters in the Ling Shu and Su Wen to these channels. My approach includes using the divergent channels to treat conditions along their pathway; as well as to use them to support their Yin-Yang paired channel and other channel systems. For example, the bladder divergent channel flows along the spine and the du channel also flows on the spine. The bladder divergent channel can treat the du channel because it flows in the same area as the du channel.3 Any theory and clinical application of the divergent channels should be critically evaluated, as it is someone's view and is not actually presented in the Nei Jing.
The Eight Extraordinary Channels
Information on the eight extraordinary channels is found throughout the Su Wen and the Ling Shu, including Ling Shu chapters 16, 17, 21, 23, 38, 62, 65, 80 and the Su Wen chapters 39, 59, 60, 63. They are not presented as a comprehensive system in any one chapter. In most cases some points on the channels are listed with conditions they treat in a symptomatic way. It is important to note that there are no pathway descriptions for the Yang and Yin Wei channels, so it would not be possible to do a Yin or Yang Wei treatment based on the Su Wen and the Ling Shu. There does not seem to be a clear history of who decided the pathway descriptions and the points on them.
Some of the modern theories and applications of the eight extraordinary channels are based on cosmic philosophies and psychological theories, Chinese Nei Dan ideas about becoming an immortal (alchemical Daoism), assisting in resolving past life issues (Buddhism), and the ability to resolve ancestral issues (Confucianism). The eight extraordinary channels can be applied in clinical practice based on the specific functions found in the Su Wen and Ling Shu or from theories added over the past 2,000 years. These new theories and applications should be evaluated to determine their relevancy to Chinese medicine.
Muscular-Skeletal conditions Bi-Syndrome Spasm Motion, Movement impairment
Tuina / Body Work on the Ashi point and area Needle Ashi Points Moxa, Gua Sha, Cupping, liniments
Modern day Treat stream and xi-cleft points Needle Muscle Meeting Points Well Points Electro-stimulation
Luo Collaterals Ling Shu, Chapter 10 and many chapters in the Nei Jing.
Acute local swelling Sprains, muscle strains, contusions. Varicose veins Specific conditions related to the luo mai (luo collaterals listed in Ling Shu chapter 10 and more chapters).
Bleeding Treat the Luo Collateral points for Luo collateral conditions
Treat the Luo Collateral pathways Modern day Treat the luo point (can be acupuncture) to treat main channel/organ conditions. Treats emotions Treats heat, excessive conditions. Used in the Guest-Host method to treat Yin-Yang pair channels/organs. Used as an outlet for pathogenic factors. Bleeding, Plum Blossom, Gua Sha, Acupuncture
Main Channels Ling Shu, Chapter 10 and more.
Treats the organs Treats channel conditions
Acupuncture Bleeding/Plum Blossom/Gua Sha Moxa
Divergent Channels Separate Channels Ling Shu, chapter 11
No conditions or application
Modern Interpretation and application Supports Yin-Yang paired channels / organs. Distributes Qi and Blood to the neck and face. Connects to some organs.
Needle Confluent Points Needle the pathways; either known points or the areas of the pathway.
Eight Extraordinary Channels Referenced throughout the Su Wen and Ling Shu.
Specific functions of the points. References to cycles of 7 and 8 and the menstrual cycle.
Symptomatic functions of the individual points. Opening Points (presented 1196 AD for the first time) Treat points on the pathways. Coupled pairs (rigid pairing from Xu Feng in the Ming Dynasty is commonly taught, they can be paired in any way that fits the clinical condition. Constitutional and chronic conditions.
An essential part of the Su Wen and the Ling Shu is an understanding of exogenous and endogenous factors and their influence on the human body. Pathogens can influence the internal organs and diminish their functions. The diminished function can lead to many syndromes and health conditions. For example, fire in the liver can move to the heart causing insomnia or move to the spleen and pancreas and alter the pancreas's ability to regulate insulin. In this case the pathogen is fire, there can also be other pathogens influencing the body's ability to function properly. There is no one diagnosis that fits all; this is part of the uniqueness of Chinese medicine. Clear the pathogens and blockages and in many cases the condition is resolved without more invasive methods.
The Su Wen and the Ling Shu practitioners provided a roadmap for clinical practice, which includes five main channels. Their vision included a profound understanding of the correspondences between areas of the body, pathogenic factors and treatment methods. Within their insight is the understanding that each channel system more effectively treats imbalances in its corresponding areas of the body. Treating the right channel system and the right channels is the key to clinical effectiveness, and is essential guidance found in the Su Wen and the Ling Shu.
References
2. Wu J. Ling Shu or The Spiritual Pivot. Hawaii: University of Hawaii Press. 2002.
3. Twicken D. The Divergent Channels, A Handbook for Clinical Practice and Five Shen Nei Dan Inner Meditation. London: Singing Dragon, 2014.
As modern medical standardization continues, the field of traditional Chinese medicine has the advantage of comprehensive personalization. For rare or complex cases, deeper consideration of constitution is invaluable. Proper constitutional assessment, especially with first-time clients, can guide desirable and predictable outcomes. This leads to a higher rate of return, and greater trust between you and your patient.
Though the creation of a financially sustainable, health-promoting model feels far away today, we are casting a vision for a full return on health, believing that this compels us to keep one foot firmly rooted in caring for the sick and the other foot firmly founded in maintaining health. Shifting from a fee-for-service model to value-based care using a phased approach is paramount.
Laser therapy has emerged as a powerful tool in the realm of traditional Chinese medicine (TCM). This new modality fits beautifully into the toolbox of the modern acupuncturist, as it can be used as a hybrid form of stimulation to acupuncture points, meridians, organs, nerves, and symptomatic areas in a new way that blends both moxa and energetic needle-like responses.
