As an acupuncturist I see many people suffering from depression. I often think depression is the major imbalance of our culture. I have a patient I've been working with for several years. Her major challenge is chronic stubborn depression. I've found the most effective treatment for alleviating her depression is through using the Stomach's Divergent Channel. Nothing else seems to have as powerful an effect.
I've come to notice a particular pulse configuration in many people with depression. The middle pulse position, the Guan, becomes tight and pulls towards the medial aspect of the wrist. This is often accompanied by an emptiness in the upper Cun position of the Lung and sometimes Heart. I've found this pulse configuration is often resolved through the treatment of the Gallbladder's Luo Vessel. However my patient's pulses are frequently weak, thin and slow. They seem to disappear, and then return after a treatment, as if she is being revived and brought back to life. Working with this patient, I've come to see a close relationship between the Gallbadder's Luo Vessel, Chong Mai and the Stomach's Divergent Channel - especially in terms of depression.
Depression in the Body
Chapter 34 of the Ling Shu discusses the onset of depression in the body, saying, "When the clear and turbid qi attack each other, there will be a disturbance in the chest." The subsequent blockage in the chest and head leads to an insufficiency of chest qi and weakness of the limbs. The tightness of the Guan position in the pulse shows the blockage occurring in the chest. The Gallbladder Luo Vessel through its signs and symptoms describe the process of depression. The initial blockage leads to "deficiency" and then to "weakness of the lower limbs" as it progresses. These are the classical symptoms of "fullness and emptiness" of the Gallbladder's Luo from Chapter 10 of the Ling Shu. They are described by Chapter 34 as symptoms of depression.
Blockage in the chest occurs due to counterflow qi, which can be the result of an unresolved externally contracted pathogen or an internal imbalance due to diet or the emotions. The Luo Vessels treat rebellious qi, as well as trapped pathogenic factors disturbing relationship between Wei and Ying qi, or pure and turbid fluids. Another way to see this is as phlegm harassing the spirit as it circulates through the blood.
Chapter 34 suggests treatment using the channels of Shao Yang and Yang Ming. GB-37 "Guang Ming", the Luo point of the Gallbladder is also mentioned. Working with my patient I've come to see how pathology can move between channel systems as it progresses. The Gallbladder's Luo Vessel is an ideal example of this process. Chapter 10 of the Ling Shu describes the Gallbladder's Luo Vessel trajectory traveling from GB-37 "Guang Ming" into the dorsum of the foot, arguably the point ST-42 "Chong Yang."
ST-42 "Chong Yang" is a "source" point referencing the Extraordinary Vessel Chong Mai. No other Luo Vessel travels to a "source" point of another element; only the Gallbladder. This makes it unique and interesting, suggesting this particular Luo Vessel may be a link between the Luo Vessels and Extraordinary Vessels, where pathology is able to pass between the two channel systems. The Gallbladder, as both a Fu and a Curious Organ is a "bridge" between the post-natal and pre-natal levels.
Fullness & Emptiness
Chong Mai is the Extraordinary Vessel from which all others are born. It is also the "Sea of blood," and the "Sea of the 12 channels." The Luo Vessels are described by Chapter 10 of the Ling Shu as manifesting states of "fullness" and "emptiness." This is not synonymous with excess and deficiency of a channel, but more akin to extreme expressiveness (fullness) or lack of expression (emptiness), which can be seen as a type of rebellious qi.
This is a good description of the pulse picture of my patient: her pulses will come up when they are aroused. However they commonly fall into a state of hypo-expressiveness which leaves her feeling depressed, unmotivated and even despairing. We would consider her pulse presentation one of "emptiness" of the Gallbladder's Luo, which is a progression from a state of "fullness." When the Gallbladder's Luo Vessel become "full" the classical symptom as stated in Chapter 10 of the Ling Shu are a states of "deficiency."
When the Gallbladder's Luo Vessel becomes "empty" it is said to manifest as "weakness or paralysis of the lower limbs" or "the inability to rise from a seated position," which some say is a metaphor for a depressed state. The limbs are the body's tools for action and expression. Their weakness can be an expression of the inability to act on something in life. Inability to put thought into action or be motivated to "move" can be seen as a manifestation of depression. However, treatment of the Gallbladder's Luo Vessel doesn't have a strong enough effect on this particular patient. Her condition seems to have gone beyond the level of the Luo Vessels altogether.
When pathology is stuck in the Luo it can manifest as Shen (mind and spirit) symptoms. However, when pathology moves into the Divergent Channels this can manifest as personality changes. We don't just have symptoms of depression, we actually start to experience ourselves as a depressed person, as if it is part of our nature. The pulses used to diagnose the Divergent Channels are challenging. They are described as "hidden pulses," reflecting the role of the Divergent Channels which place unresolved issues into latency: a state of hiding. These pulses cannot be easily felt. They must be aroused via palpation.
Understanding Depression
Depression can be tricky. We don't always know why we feel depressed, sad or lacking in motivation. We feel stuck yet don't always know what the reason is. This can be due to the latency process: the reason for our distress has become hidden and sublimated. The Nan Jing describes the Extraordinary Vessels as "ditches" where pathology from the Primary Channels drain into. When pathology enters the Extraordinary Vessels, says the Nan Jing, it becomes unreachable by the Primary Channels, which can be interpreted to mean we no longer have conscious access to "the why and how" of the issue. It becomes mysterious. However, the Divergent Channels are implied to have access to these ditches.
The Stomach's Divergent channel begins at the point ST-30 "Qi Chong" which, like ST-42 "Chong Yang" makes reference to Chong Mai in its name. This Divergent Channel ends at the eyes, which Chapter 22 of the Ling Shu says is the site where another mental illness state, Dian Kuang (mania and withdrawal) begins. Bob Flaws says in his book "Chinese Medical Psychiatry" that the concept of Dian Kuang is the basic foundation for understanding mental illness in Chinese medicine.
The fact that Gallbladder's Luo ends at ST-42 "Chong Yang" and the Stomach's Divergent begins at ST-30 "Qi Chong" suggests the Luo are a way pathology drains into Chong Mai. This also suggests that the Divergent Channels have the potential to bring such pathology back out from the ditches of the Extraordinary Vessels. The Luo Vessels end with the "Great Luo" at the chest, which is classically seen to be a Gallbladder point: GB-22 "Yuan Ye."
The Great Luo is another way pathology drains into the Constitutional level of the Extraordinary Vessels. The Luo Vessels as an entire channel system collectively drain into the Constitution via GB-22 "Yuan Ye," which is to say via Gallbladder. It is interesting to note that the Divergent channel that follows the Stomach in its channel progression is the Small Intestine's Divergent channel which begins at GB-22 "Yuan Ye," and ends at the eyes.
The role of the Luo in terms of treatment seems to be the attempt to prevent pathology from "emptying" into the Primary channels, but also into the level of the Constitution, as shown by the references to the Gallbladder. By treating the Luo we can support this function.
Tightening of the Guan pulse positions illustrate blockage at the level of the chest ("fullness" of the Gallbladder's Luo) threatening to drain into the Extraordinary Vessels. However once pathology has drained into the Constitution (via "emptying" of the Luo into the "source"), we can use the Divergent channels to dig it back out. The Divergent Channels, called "the grandchild Luo" by Chapter 63 of the Su Wen are implied to be the channel system that inherits issues unresolved by the Luo Vessels once pathology has "emptied," making them applicable for the treatment of deep, chronic repressed issues that have come to seem like personality.
Editor's Note: Part 2 of this article will discuss use of the Divergent Channels in the treatment of chronic depression that can alter a person's personality.
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.
Traditional Chinese medicine and the Vedic traditions both offer rich frameworks for understanding human health, emphasizing the balance of physical, mental, and spiritual aspects. The concept of "souls" or spiritual components in TCM, namely Hun, Po, Shen, Yi, and Zhi, bears significant similarities to the yogic concept of koshas. Their similarities and differences provide insights into how these systems contribute to holistic health practices.
