Treating Depression With the Secondary Vessels (Part 2)
Nicholas Sieben, LAc
This article is part 2 of a discussion into the treatment of chronic depression, as seen through use of the acupuncture channel systems. The first part of this article discussed the use of the Gallbladder's Luo Vessel and its implications for treatment of depression. This article will discuss the effectiveness of the Divergent Channels for more severe states of depression.
Treating Chronic Depression
Clinically, the Stomach's Divergent Channel has proven itself highly effective in treating chronic depression that has come to alter the personality of a person.
The designation of the Divergent Channels as "the grandchild Luo" in Chapter 63 of the Su Wen establish the Divergents as the channel system that follows the Luo Vessels in the progression of pathology in the body. This establishes the Divergent Channels as appropriate treatment options for chronic states that have come to alter a person's personality: a more severe development of the depressed state.
Chapter 22 of the Ling Shu suggests that Dian Kuang (mania and withdrawal) begins at the eyes. Treatment of Dian Kuang focuses chiefly on the strategy of opening the portals: the lower and upper sense orifices.
The classical symptom of the Stomach's Divergent channel is a blockage of the upper sensory orifices. In fact all of the Divergent Channels make strong connection to points that open the upper and lower portals, implicating them as amongst the most important channel system to alter perception and treat chronic serious mental illness.
Chapter 34 of the Ling Shu also suggests treatment of depression requires opening the upper sensory orifices. However, if the condition has become chronic and stubborn, this implies that the lower sensory orifices have also become blocked, which become the priority. In order to open the upper portals, the lower portals must also be open and passable.
The way the Divergent Channels are described in Chapter 11 of the Ling Shu is as follows: they begin at points in the lower body, which have a strong impact on opening the lower orifices. They end in the head at points located around the sensory orifices.
Doorways & Windows
In his lectures on the Divergent Channels (as presented at the New England School of Acupuncture and their published transcripts), Jeffrey Yuen teaches an interesting theory relating to the Divergent Channels which he calls "Doorways to the Earth" and "Windows to the Sky." "Doorway to the Earth" points are located on the lower part of the body and effective in opening the lower orifices, "Windows to the Sky" points are located on the neck and have strong impact on the upper orifices. Most of the Divergent Channels, especially the earlier channels in the progression (Bladder, Gallbladder and Stomach) begin with "Doorway to the Earth" points. These channels either end with a "Window to the Sky" point above or with a point located around a sense orifice, usually the eyes.
The first three Divergent channels all begin with "Doorways to the Earth" points: BL-40 "Wei Zhong" on the Bladder Divergent, CV-2 "Qu Gu" and GB-30 "Huan Tiao" on the Gallbladder Divergent and ST-30 "Qi Chong" on the Stomach Divergent. These act as the starting points of the channels. The Bladder ends at BL-10 "Tian Zhu" a "Window to the Sky" point. The Gallbladder and Stomach Divergent Channels end at points around the eyes: GB-1 "Tong Zi Liao" and BL-1 "Jing Ming" respectively.
Mania & Withdrawal
Chapter 22 of the Ling Shu says Dian Kuang (mania and withdrawal) begins at the eyes. In terms of treatment, it implies first priority is to open the intestines or lower portals, indicating the condition as serious. The Divergent Channels illustrate this theory through their trajectories: they begin at points that open the lower orifices before ending at points that open the upper orifices.
In terms of treatment priority, the lower portals must be open before we can work with the upper. It is at the level of the forth Divergent channel in the sequence, the Small Intestine's Divergent Channel that the trajectory no longer begins with a lower "Doorway to the Earth" point, but instead begins at the chest with the Great Luo: GB-22 "Yuan Ye."
This suggests by this stage in the pathological progression the lower orifices have become severely "closed." The Small Intestine's Divergent Channel travels from GB-22 "Yuan Ye," to end at BL-1 "Jing Ming" at the eyes (where it meets the Stomach's Divergent Channel). One of the classical symptoms of the Small Intestine's Divergent Channel is numbness, neuropathy and pain. The classical symptom of the Great Luo in "fullness" is pain all over the body - suffering due to total saturation or overwhelm.
The theory of "Closure" from the Nei Jing and Nan Jing illuminates this process. When the upper and lower portals become blocked, the body has no way of getting rid of its toxins or changing its perception. In terms of mental health, it can create the experience of being trapped inside oneself. Since the eyes and ears are "closed," nothing can get in or out. This can lead to a state of isolation and obsession. The symptoms of the Great Luo are expressions of this process: unbearable suffering that cannot be released.
Alleviating Depression
The Divergent Channels can be looked at in several ways. One is as a progression of latency, another is as a progression of humoral support. Each channel in the progression sequence supports the prior channel and the humor it utilizes to support the ability to maintain hidden pathology in a relatively quiet state. They act like channels of tolerance or "sanity." The Stomach supports blood via its thin "Jin" fluids. The Gallbladder supports the Jing of the Bladder via its blood. They can be released to expel the toxic overload of latency, or can be consolidated to support the integrity of the latency.
When treating my patient I tend to consolidate the Stomach's Divergent Channel to support the transformative capacity of the Stomach relating to fluid metabolism as it supports the blood. This has the best effect on alleviating her depression. Jeffrey Yuen explains in his transcriptions of the Ling Shu: "When we have emotional disruption, it generally means the pure fluids of the Stomach are not nurturing the Ying qi which is supposed to nurture blood. The result is a Shen disturbance. Phlegm can aggravate blood easily."
At the level of the Small Intestine's Divergent Channel as it moves into the Triple Heater and Large Intestine, the Divergent Channels change their character, no longer containing "Doorway to the Earth" points that have effect on the lower portals. At this point in the progression, the Divergent Channels no longer possess the capacity to adequately clear latency. These channels are most effective when consolidated.
Harmonization
My theory as to why the Stomach Divergent channel has been effective in treating my patient's depression is that it rectifies the separation of pure and turbid fluids and the counterflow qi that causes them to "attack" one another, failing to nurture the blood. This can be seen as phlegm harassing the blood. The trajectory of the Stomach Divergent, as presented in Chapter 11 of the Ling Shu describes this process. After ST-30 "Qi Chong" comes CV-12 "Zhong Wan," CV-14 "Ju Que," CV-17 "Dan Zhong," CV-22 "Tian Tu" and ST-9 "Ren Ying" at the level of the throat.
These are the Mu points of the Stomach, Heart and Pericardium respectively, followed by two "Windows to the Sky" points. Mu points are "accumulation" points highly effective to either consolidate humors or to break up gatherings. The throat is described as a major site for the separation of the pure from turbid in the Ling Shu. After these points, the trajectory moves into the face to points surrounding each of the sensory orifices: chiefly the mouth, nose and eyes. There is a very heavy emphasis on transforming phlegm and opening the sensory orifices within this channel. The beginning point of the channel ST-30 "Qi Chong" is said to "harmonize qi and blood." ST-9 above does something similar. This is a channel of harmonization as well as transformation.
Understanding the Dysfunction
The order of these points paint a picture of dysfunction in fluid metabolism leading to phlegm harassing the Heart's spirit which clouds the sensory orifices. If this continues and progresses further, it would lead to a serious state of closure which would manifest in the next channel in the progression: the Small Intestine's Divergent, leading to numbness and severe pain, which can also manifest on the mental-emotional level.
It is interesting to note that Chapter 22 suggests treatment of Dian Kuang to be through the channels Small Intestine and Large Intestine. If we are to interpret the channels suggested as being the Divergent Channels, the Stomach Divergent is where depression manifests, since it rectifies the relationship between fluid physiology as it supports the blood.
When the depression progresses further and the lower portals become closed, this can lead to Dian Kuang, which is a much more severe mental-emotional state. The Small Intestine Divergent channel, and those that follow, the Triple Heater and Large Intestine Divergents both deal with more severe Shen disturbances, as well as "collapse."
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.
