How do we communicate the depth and sophistication of Chinese medicine, especially in the treatment of mental health? Language, terminology and different theories about body function make this challenging. It’s important as practitioners to be as clear as possible and to communicate from a place of deep belief.
The luo vessels are important in the treatment of mental health issues. They are conduits of “ying qi”: blood and fluids. We believe that the shen is “housed” in the heart and circulated through the blood, making a channel system that “conducts” ying qi ideal for treatment of the mind and emotions.
Nineteenth-century herbalist Wang Qing Ren focused on the luo vessels in his book Yi Lin Gai Cuo. Viewing formulas from Ren alongside passages from the Ling Shu, we can understand blood stasis and its relationship with the luo vessels, especially relating to mental health.
A striking discussion about mental illness is that of dian kuang, a type of manic-depression. Ren created a formula to treat dian kuang called Dian Kuang Meng Xing Tang, a variation on his popular blood stasis-resolving Xue Fu Zhu Yu Tang.
Ren’s dian kuang formula is classified as resolving “qi and blood stasis complicated by phlegm obstruction.” The Ling Shu suggests how to treat dian kuang, yet it remains unclear which channel systems are most appropriate.
This raises a common debate about acupuncture treatment strategy. Is it best to treat the physiology of a patient or the pathology? The primary channels, even if they technically treat all aspects of the body, are generally seen as meridians of physiological function; whereas the collaterals (luo) are vessels of pathology.
Luo vessels act as storage containers for the primary channels, diverting pathogens away from physiological pathways. They manifest states of blood stagnation when they are in a state of “fullness” and phlegm stagnation when they “empty.”
The concept of “full” and “empty” is something master teacher Jeffrey Yuen has emphasized when discussing the luo vessels. “Fullness” indicates the primary channels have put unresolved pathology into their collateral system: the luo. The pathology becomes trapped as blood stagnation, manifesting varicosity on the surface of the skin. The trapped pathology is visible in “fullness.”
Vessels keep filling to capacity, then overflow. With “emptiness,” they go back into the physiological primary pathways or deeper into the internal branches. “Emptiness” manifests as phlegm stagnation: lipomas appear.
Three stages seem to manifest: first, that of compartmentalization in “fullness,” then direct confrontation as they empty, followed by invisibility and unconsciousness tolerance.
Internal branches of the primary channels connect with the organs; first with the bowels (fu), where the divergent channels become activated, diverting pathology into the joints (the level of yuan qi).
“Ying qi” is the realm of the mind and emotions, composed of blood and body fluids. It is the “nourishing” energy of the body. In contrast to the wei and yuan levels, the ying possesses a degree of conscious awareness. It manages our emotions, thoughts, cognitive ability and relationship capacity. The luo vessels circulate here.
Stagnation of blood impacts thought, emotion and relationship. “Ying” is the post-natal, interactive level of the body. Progression from blood stagnation into phlegm causes a more serious state.
Yuen says: “Emptiness [goes] into the Primary Meridians. So you just allow it to be part of your life. It becomes something that is problematic, but you just have a certain degree of acceptance, that this is something that [you] can’t change ... So even if you feel somewhat upset by it, you come to accept it. There’s a certain level of tolerance, and that tolerance is where it no longer becomes visible over time.”
Blood stagnation has a level of conscious awareness of it: the blood contains the shen. It is still visible in our life. There’s a sense of “fullness” or agitation about it. The mind is able to rationalize and contain it, putting it into a luo vessel. However when the issue “empties” back into the primary channel, there’s no way to compartmentalize it. It’s in your face. In order to cope or “tolerate” the problem, it becomes phlegmatic.
The philosophy of “emptiness of the luo” suggests a conscious issue becoming invisible; unconscious. It brings to mind another classical mental-emotional syndrome called zang zao: “visceral dryness,” whereby a trauma or disappointment can lead to personality change.
It is easy to visualize a pathogen trapped in the internal pathway of the primary channels creating inflammation, burning up the (endocrine) ying fluids, leading to a dryness state. Yet in terms of the luo, blood stasis is always seen as the origination of the problem.
Ren’s strategy for treating dian kuan suggests the luo vessels are primary for treating mental health, as they address the initial blood stagnation leading to phlegm complication.
In terms of acupuncture, understanding progression of the problem is key. Severity of symptoms often relates to the degree of phlegm complication, and underling stagnations and deficiencies. Acupuncture differs from herbal medicine, looking at progression through channels to target depth of disease. This is key to treatment success.
The luo vessels eventually culminate in the “great luo of the spleen” and eventually the “luo of yin and yang,” which the Nan Jing designates as the qiao vessels. The classic symptoms of the great luo are: pain all over the body (fullness) and looseness of the joints (emptiness). Yin Qiao Mai is indicated for severe states of yin stasis (phlegm), and yang qiao for yang excess (wind).
The joints suggest movement into the divergent channels. The qiao vessels are extraordinary vessels. This indicates pathological movement from the ying into yuan level of the body. Ying is interpersonal, while yuan is constitutional. Ying has consciousness to it, being the interactive aspect between ourselves and the world. Yuan is our nature and personality. The qiao are called “stance,” but qiao is also a word for the sensory portals. The qiao are involved in our posture, but also our unconscious “stance” and perception.
The description of dian kuang in the Ling Shu says the condition begins in the eyes, an area where the qiao vessels meet before entering the brain. When viewed through the lens of the luo vessels, mental illness can be due to long-term unresolved pathology that finds its way through the luo into the source by emptying into the extraordinary vessels and curious organs.
Divergent and qiao vessels impact the brain, bones and uterus. This is when an unresolved issue can impact a person’s form (posture), perception (brain) and offspring (uterus). Something that originally had a storyline, able to be contained and compartmentalized, transforms into our very being – an unconscious altered state which can be categorized as mental illness.
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