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Extraordinary Vessel Pairings: Yin Qiao Mai paired with Ren Mai (Conception Vessel, REN) Yang Qiao Mai paired with Du Mai (Governing Vessel, DU) Yin Wei Mai paired with Chong Mai Yang Wei Mai paired with Dai Mai Extraordinary Vessel Master Point Coupled Point Ren Mai LU 7 KD 6 Du Mai SI 3 UB 62 Chong Mai SP 4 PC 6 Dai Mai GB 41 TW 5 Yin Qiao Mai KD 6 LU 7 Yang Qiao Mai UB 62 SI 3 Yin Wei Mai PC 6 SP 4 Yang Wei Mai TW 5 GB 41 Using the Points in Practice - Master & Couple Combinations: In general , first needle the master point of the main meridian you are treating (based on symptomology) and then needle its coupled point. For males, it is common to needle the master point on the left side and the coupled point on the right. For women, it is common to needle the master point on the right side and the coupled point on the left.

2

Yin Qiao Mai Alternate names: yin heel vessel, yin motility vessel Master Point: KD 6 Coupled Point: LU 7 Xi Cleft Point: KD 8 Intersection Points: KD 6, KD 8, UB 1 Paired Meridian: Ren Mai Effected areas: medial aspect of lower extremities, genitals, abdomen, eyes, throat, chest, lungs nervous, muscular skeletal, digestive and respiratory systems Functions: Controls the ascent of fluids and the descent of Qi Movement of the body; walking, cold and /or weakness in the lower limbs Issues of the digestive tract and abdomen Uro-genital problems, retention of urine Respiratory issues Excessive sleepiness Eye problems Hot Flashes Pathway: Originates at KD 2, travels upward to KD 6 and then to KD 8. It then continues up the medial aspect of the leg to the inguinal region where it enters the genitals. From the genitals it travels up the anterior abdomen and the chest to ST 12. From ST 12 it travels to ST 9 and along the cheek to UB 1 where it connects with the UB, DU and Yang Qiao Mai vessels. From there it rises upwards and enters the brain. Ren Mai Alternate names: conception vessel, directing vessel Master Point: LU 7 Coupled Point: KD 6 Luo Points: Ren 15 Intersection Points: ST 1, Du 28 Paired Meridian: Yin Qiao Mai Effected areas: face, thorax, abdomen, genitals, throat, chest, lungs, endocrine, urinary and digestive systems Functions: "Sea of Yin:" influences the yin, essence and fluids Regulates female cycles, menstruation (irregular, leukorrhea), reproduction Effects male genitalia, inguinal hernia, sexual desire, impotence Gastrointestinal issues, digestion Pathway: Originates at ming men and passes through the uterus and connects with Ren 1. Then it follows the ren meridian up to Ren 24. Along the path it connects internally with the SP, LV and KD meridians. At Ren 24 a second branch rises upwards and encircles the mouth and then rises to the eyes at ST 1. A separate branch originates in the pelvic cavity and rises up along the back.

3

Yang Qiao Mai Alternate names: yang heel vessel, yang motility vessel Master Point: UB 62 Coupled Point: SI 3 Xi Cleft Point: UB 59 Intersection Points: UB 1, UB 59, UB 61, UB 62, GB 20, GB 29, SI 10, LI 15, LI 16, ST 1, ST 3, ST 4 Paired Meridian: Du Mai Effected areas: back, neck, eyes nervous and musculo skeletal systems Functions: Issues of the eyes and / or face, eye pain (esp. inner canthus), redness and / or swelling, headache Effects the lateral aspect of the lower limbs, numbness, weakness, spasms Excess Yang, insomnia Pathway: Originates at UB 62 and travels behind the heel to UB 61. It continues up the calf to UB 59, up the lateral aspect of the leg to GB 29 and then up to the scapular region at SI 10. It continues to LI 15 and LI 16 and then travels to the face and connects with ST 4, ST 3, ST 1 and UB 1 where it meets with the UB, Du and Yin Qiao meridians. From here it travels over the head and terminates at GB 20. Du Mai Alternate names: governing vessel Master Point: SI 3 Coupled Point: UB 62 Luo Point: Du 1 Intersection Points: Ren 1, UB 12 Paired Meridian: Yang Qiao Mai Effected areas: Posterior midline especially spinal cord and brain nervous and muscular systems Functions: "Sea of Yang:" effects all of the yang meridians Brain, marrow and / or spinal cord issues - pain, heaviness, stroke, psychological issues, etc. Other facial issues - headache, migraine, pain/swelling in the face/head Pathway: Originates at ming men and descends to the perineum, emerging at Ren 1/Du 1. Then it continues to Du 4 where it enters the kidneys. From the kidneys it travels up the interior of the spinal column to Du 12 where it goes laterally to UB 12 and then back to Du 13. From here it continues along the midline of the head to Du 16 where it enters the brain and ends at the frenulum of the upper lib (Du 28).

4

Yin Wei Mai Alternate names: yin linking vessel Master Point: PC 6 Coupled Point: SP 4 Xi Cleft Point: KD 9 Intersection Points: KD 9, LV 14, SP 13, SP 15, SP 16, REN 22, REN 23 Paired Meridian: Chong Mai Effected areas: Medial aspect of the lower limbs nervous, cardiovascular, muscular skeletal and digestive systems Functions: Effects the balance of Yin and Yang Effects the Blood, Yin and Shen - blood circulation, heart pain, depression, blood deficiency headaches Pain in the chest, back, middle and/or lower jiaos - abdominal distention, ST ache, nausea, rectal prolapse Pathway: Originates at KD 9 and goes up along the medial aspect of the thigh into the abdomen where it enters the spleen meridian at SP 13, SP 15, SP 16. It continues up to LV 14, enters the abdomen and continues upwards through the chest and throat. It then meets the Ren Mai at REN 22 and REN 23. Chong Mai Alternate names: penetrating vessel Master Point: SP 4 Coupled Point: PC 6 Xi Cleft Point: GB 35 Intersection Points: KD 11 thru KD 21, REN 1 Paired Meridian: Yin Wei Mai Effected areas: Abdomen, thorax, genitals, Heart, inner thigh reproductive, digestive and respiratory systems Functions: "Sea of Blood:" menstrual and / or reproductive issues, irregular menstruation, infertility Physical and spiritual heart issues - Heart pain, depression Balances rebellious Qi - hiccups Abdominal stagnation Respiratory issues - SOB, asthma Pathway: Originates in the ming men and passes through the uterus and down to REN 1. From here it emerges at ST 30 and continues upwards along the kidney meridian to KD 21. It then flows up the throat, encircles the mouth and continues up to the forehead. A second branch flows from REN 1 inside the spine to the UB 23 area. A third branch flows downwards towards the foot where it splits into 2 branches and follows the KD and SP meridians.

5

Yang Wei Mai Alternate names: yang linking vessel Master Point: Triple Warmer 5 Coupled Point: GB 41 Xi Cleft Point: GB 35 Intersection Points: UB 63, SI 10, DU 15, DU 16, GB 13 thru GB 21, GB 35, TW 15 Paired Meridian: Dai Mai Effected areas: Sides of the body, hips, joints, eyes, ears muscular skeletal and immune systems Functions: Shao Yang level illnesses - alternating fever and chills Pain and / or distention in the lumbar region Pathway: Originates at UB 63 and ascends along the the GB meridian up the leg and sides of the body passing thru GB 35. It continues to UB 59 and up to the hip (GB 29). Then it continues along the lateral aspect of the body to LI 14 at the shoulder, to TW 13, TW 15 and to GB 21. It then travels down to SI 10, over to DU 15, DU 16 and then to GB 20. It continues downward along the GB meridian from GB 19 thru to GB 13 where it ends. Dai Mai Alternate names: belt vessel, girdle vessel Master Point: GB 41 Coupled Point: TW 5 Intersection Points: GB 26, GB 27, GB 28, LV 13 Paired Meridian: Yang Wei Mai Effected areas: lateral sides of the lumbar area gastrointestinal, female reproductive and muscular skeletal systems Functions: Issues in the middle aspect of the body - abdominal distention, lumbar weakness, muscular weakness in the lumbar and / or lower extremities Links the upper and lower halves of the body and helps to move Qi and Blood in the legs - weakness in the legs, walking problems Pathway: Originates at LV 13, continues to and encircles GB 26 and LV 13 and then connects with GB 27 and GB 28.

6

THE EIGHT EXTRAORDINARY VESSELS

Giovanni Maciocia

- modern textbooks say that extraordinary means odd, a little extra, surplus, suggesting that the Extraordinary Vessels are separate and different from the main channels. This interpretation implies not only that the Extraordinary Vessels are different but that they add something to the main channel system.

THE 8 EXTRAORDINARY VESSELS ARE CALLED:= extraordinary= channel= eight= vessel

BA

QI JING

MAI Opinions as to why the Extraordinary Vessels are called extraordinary (qi) vary:

- the Classic of Difficulties says that they are extraordinarybecause they are not restrained by the main channel system- Li Shi Zhen says that they are extraordinary because they do not pertain to the main channel system and do not have exterior-interior relationships

The main source of knowledge for the Extraordinary Vessels derives from the following classics: the Spiritual Axis (Ling Shu) the Classic of Difficulties (Nan Jing) the Pulse Classic (Mai Jing) by Wang Shu He, AD 280 the ABC of Acupuncture (Zhen Jiu Jia Yi Jing) by Huang Fu Mi, AD 282 the Guide to Acupuncture Channels (Zhen Jing Zhi Nan) by Dou Han Jing, 1295 the Gatherings from Eminent Acupuncturists (Zhen Jiu JuYing) by Gao Wu, 1529 the Study of the Eight Extraordinary Vessels (Qi Jing Ba Mai Kao) by Li Shi Zhen, 1578 the Great Compendium of Acupuncture (Zhen Jiu Da Cheng) by Yang Ji Zhou, 1601 the Golden Mirror of Medicine (Yin Zong Jin Jian) by Wu Qian, 1742.

Yin We

i Mai

Yang Wei Mai

Main channel

Main channel

Main ch.

Yin and Yang Q

iao Mai

Du, Ren, Ch

ong, Dai Ma

i

Nan Jing, Ch.27: "The sages built ditches and reservoirs and they kept the waterways open in order to be prepared for above-normal situations [i.e. floods]. When there are heavy rains, ditches and reservoirs are full to the brim...in the human body, when the channels are over-filled they cannot absorb the excess [and this overflow from the main channels is absorbed by the extraordinary vessels]"

Ch. 28 The sages built ditches and reservoirs; when these are full they overflow into deep lakes...in the human body, when the channels are over-filled, they overflow into the 8 extraordinary vessels where they are no longer part of the general circulation.

Yin We

i Mai

Yang Wei Mai

Main channel

Main channel

Main ch.

Yin and Yang Q

iao Mai

Du, Ren, Ch

ong, Dai Ma

i

Yin Connecting channels

TRUNK

LIMBS

The "Study of the Eight Extraordinary Vessels" by Li Shi Zhen says: "...when the Qi of the channels overflows, it flows into the extraordinary vessels where it is turned into irrigation, warming the organs internally and irrigating the space between skin and muscles externally."

ZANGFU

COULI

Warms internally

Irrigates externally

EIGHT EXTRAOR

DINARY VESSEL

S

The influence of the Extraordinary Vessels on the space between skin and muscles implies their important role in protection from pathogenic factors. As the Extraordinary Vessels circulate the Kidney-Jing, this means that Jing plays a role in many physiological functions and, in particular, in the protection against external pathogenic factors.

Because all the Extraordinary Vessels derive directly or indirectly from the Kidneys, they play an important role in the defence against exterior pathogenic factors.

The Kidneys also influence the strength of our defencedue to the fact that Defensive Qi originates in the Lower Burner and stems from Kidney-Yang.

The Qi of the Extraordinary Vessels irrigates the space between the skin and muscles where Defensive Qi circulates to prevent invasion of pathogenic factors.

COU LI

The Extraordinary Vessels all derive directly or indirectly from the Kidneys and they all contain the Essence (Jing) which is stored in the Kidneys. They circulate the Essence around the body, thus contributing to the integration of the circulation of Nutritive Qi and Defensive Qi with that of the Essence. The three main Extraordinary Vessels - the Governing, Directing and Penetrating Vessels (Du Mai, Ren Mai and Chong Mai) - all start in the Lower Burner, in the space between the kidneys where the lower Dan Tian is located.

THE EXTRAORDINARY VESSELS AND THE KIDNEY-ESSENCE

THE ROOM OF JING AND THE BAO

BAO LOWER DAN TIAN

In men ROOM OF JING

UTERUS ZI BAO

SPERM TIAN GUI

MENSTRUAL BLOOD TIAN

GUI

In women

YANG WEI MAI

HEAVEN (QIAN)

YIN WEI MAI

EARTH (KUN)

YANG QIAOEAST

YIN QIAOWEST

DU MAISOUTH

REN/CHONG MAI

NORTH

DAI MAI

DAI MAI

S

N

OE

REN, DU AND CHONG MAI

These three vessels can be considered as three branches of the same vessel. The Mirror of Medicine Abstracted by Master Luo says: The Chong , Ren and Du Mai are three branches from the same source. The Chong Mai is the Sea of Blood, the Ren Mai governs all Yin channels and the Du Mai governs all Yang channels.

All these three vessels originate directly from the space between the Kidneys and flow down to the perineum (at Ren-1 Huiyin) from where they take different pathways: the Ren Mai flows up the abdomen along the midline, the Du Mai up the back, and the Chong Mai up the abdomen along the Kidney channel. These three vessels can be seen as the source of all the other Extraordinary Vessels as they originate directly from the Kidneys and are therefore connected to the Essence. They, more than the other Extraordinary Vessels, can be used in clinical practice to nourish the Essence and affect the patient's energy at a deep constitutional level.

YIN AND YANG STEPPING VESSELS (YIN and YANG QIAO MAI)These two vessels are directly complementary: the Yin Stepping Vessel starts at KI-6 Zhaohai and flows up to the eye carrying Yin Qi to it, the Yang Stepping Vessel starts at BL-62 Shenmai and flows up to the eye carrying Yang Qi to it.

Thus when Qi is in excess in the Yin Stepping Vessel, the person will be constantly sleepy and the eyes will want to close...

...while when Qi is in excess in the Yang Stepping Vessel, the person is awake and the eyes are open.

When the Yin Stepping Vessel is diseased, the Yin is tight and the Yang is relaxed (i.e. the muscles of the inner aspect of the leg are tight, and those of the outer aspect too relaxed).

YIN AND YANG QIAO MAI CONTROL THE STATE OF THE LEG MUSCLES.

When the Yang Stepping Vessel is diseased, the Yang is tight and the Yin relaxed (i.e. the muscles of the inner aspect of the leg are relaxed and those of the outer aspect tight).

The two Qiao Mai harmonize Left and Right and Medial-Lateral structures of the Yin and Yang channels respectively and can therefore be used to correct structural imbalances in the body such as:

For example, one of the indications for KI-2 Rangu (beginning point of the Yin Qiao Mai) is one foot hot and the other cold.

one leg shorter than the other

one scapula higher than the other

unilateral sweating

muscles on one side being tighter than the other.

YIN AND YANG WEI MAI

The two Wei Mai complement each other in so far as they link the Yin and Yang channels. In addition, their opening points belong to the Lesser Yang and Terminal Yin channels, i.e. Triple Burner and Pericardium respectively, which are internally-externally related.

The two Wei Mai harmonize Interior with Exterior, and Nutritive Qi with Defensive Qi.

The Dai Mai is the only horizontal channel in the body so it stands alone. It encircles the Main channels, and because of this, it exerts an influence on the circulation of Qi to the legs.

DAI MAI

Dividing the body in two halves, it harmonizes Above and Below.

EXTRAORDINARY VESSELS POINTS

DU MAI YANG QIAO MAI

SI-3BL-62

HEAD, SHOULDERS, BACK, BRAIN

REN MAIYIN QIAO MAI

LU-7KI-6

FACE, EYES, THROAT, CHEST,

ABDOMEN, UTERUS

CHONG MAIYIN WEI MAI

SP-4P-6

CHEST, HEART, STOMACH

DAI MAIYANG WEI MAI GB-41

TB-5WAIST, HIPS, EARS,

OCCIPUT, NECK

DU MAI REN MAI

CHONG MAI

DAI MAIYIN/YANG QIAOYIN/YANG WEI

The clinical significance of these pairs of points is that it isonly by combining both points that we affect the area influenced by each Extraordinary Vessel.

As the Du and Ren Mai have their own points, they have the dual quality of a Main channel and an Extraordinary Vessel: for this reason, the Main channels are sometimes counted as 14 rather than 12.

With the exception of the Du and Ren Mai, the Extraordinary Vessels do not have their own points as the Main channels do, but they flow through points of various Main channels. Therefore each Extraordinary Vessel influences more than one Main channel; this is an important characteristic which accounts for their clinical use.

BL

GB

STLI

SI

GB

REN MAI/YIN QIAOAREAS

LU-7 and KI-6

DU MAI / YANG QIAOAREAS

SI-3 and BL-62

DAI MAI/ YANG WEI AREAS

GB-41 and TB-5 SP-4 and P-6

CHONG MAI/ YIN WEI AREAS

The Extraordinary Vessels integrate the 6 Extraordinary Yang Organs with the Internal Organs and Main channels. The word qi () in Qi Guai Zhi Fu (Extraordinary Yang Organs) is the same as in Qi Jing Ba Mai(Extraordinary Vessels). The Kidneys are the connection between the Extraordinary Vessels and the Internal Organs and also between the Extraordinary Yang Organs and the Internal Organs. Hence the Extraordinary Vessels are a vehicle through which the Extraordinary Yang Organs are connected to and integrated with the Internal Organs in the body's physiology.

THE EXTRAORDINARY VESSELS AND THE 6 EXTRAORDINARY YANG ORGANS

Therefore, although the Extraordinary Vessels are not connected to the Internal Organs in the same way that the Main channels are, they do have a connection with the Internal Organs through the Extraordinary Yang Organs, otherwise they would be like water without a source or wood without a root. We can therefore see a closed circle of relationships.

ZANGFU EXTRA-FU8 EXTRA

6 EXTRA FU AND THE EXTRAORDINARY VESSELS

BRAIN = DU MAI/ YIN-YANG QIAO MAI

UTERUS = CHONG/ REN/ DU MAI

BLOOD VESSELS = CHONG MAI

GALLBLADDER = DAI MAI

MARROW = CHONG/ DU MAI

BONES = CHONG/ REN/ DU MAI

INTERIOR

EXTERIOR

ZANG KIDNEYS

EXTRA FU

EXTRA MERIDIANS

EXTRA FU EXTRA MERIDIANS

KIDNEYS

ZANG-FU

SEA OF FOODExcess: Abdominal fullness.

Deficiency: Hunger but no desire to eat.Points: ST-30 (upper), ST-36 (lower)

The Sea of Food is synonymous with the Stomach and both of its points are on the Stomach channel. This is also of relevance in clinical practice as we always need to treat the Stomach in any disturbance of food absorption or digestion. However, the Sea of Food is also functionally related to the Chong Mai as this vessel, besides controlling Blood, influences the Stomach and Intestines and digestion. The fact that the Chong Mai corresponds to the Sea of Food confirms that this vessel is closely linked to the Stomach and it therefore links the Pre-Heaven with the Post-Heaven Qi. ST-30 Qichong.

ST-30 Qichong Old form of chong

ST-30 was called more frequently Qi-jie in ancient times, i.e. avenues of Qi

Jie

The Sea of Blood is synonymous with the Chong Mai as the text makes clear. This is of great relevance in clinical practice and especially in gynaecology as we treat the Chong Mai for disharmonies of Blood and especially Blood stasis.

SEA OF BLOODExcess: Feeling of body getting larger, feeling unwell without being able to pinpoint the trouble.Deficiency: Feeling of the body getting smaller, unable to pinpoint trouble.Points: BL-11 (upper), ST-37 and ST-39 (lower).

The Sea of Qi is clearly related to the Lungs and the Gathering Qi (Zong Qi) and its deficiency symptom (a dislike of speaking) is a Lung-deficiency symptom. The Sea of Qi is related to the Ren Mai.

SEA OF QIExcess:Feeling of fullness in the chest, breathlessness,

red face.Deficiency: Shortness of breath, no desire to speak.

Points: REN-17, DU-15,DU-14,ST-9.

The Sea of Marrow is synonymous with the Brain as it is Marrow that fills up the Brain. Symptoms of deficiency are related to obfuscation of the sense orifices due to their not being nourished by Marrow. As Kidney-Jing is the origin of Marrow, those symptoms are also symptoms of Kidney deficiency (dizziness, tinnitus, blurred vision, weak legs). The Sea of Marrow is related to the Du Mai which flows in the spine and into the Brain: for this reason, the points of the Sea of Marrow (Du-20 Baihui and Du-16 Fengfu) are on the Du Mai.

SEA OF MARROWExcess: Full of vigour, great physical strength.

Deficiency: Dizziness, tinnitus, weak legs, blurred vision, desire to lie down.

Points: DU-20 (upper), DU-16 (lower).

Chapter 8 of the Simple Questions says: The Kidneys are the official in charge of power: skill originates from them. It is interesting that the Simple Questions mentions power in connection with the Kidneys. This has two meanings. From a physical point of view, power refers to the fact that the Kidneys are the root of Pre-Natal Qi and house the Essence: this determines our innate energy, strength or power. In fact, the symptoms of fullness of the Sea of Marrow (originating from the Kidneys) are full of vigour, great physical strength). The Sea of Marrow is mentioned in chapter 33 of the Spiritual Axis.2

2. 1981 Spiritual Axis (Ling Shu Jing [#ch]), Peoples Health Publishing House, Beijing. First published c. 100 BC, p. 77

From a mental point of view, power refers to the drive and steadfastness stemming from the Kidneys. This corresponds to Zhi, i.e. Will-Power.

The symptoms of fullness and emptiness of the Sea of Marrow have mental-emotional significance. The symptoms of fullness of the Sea of Marrow (full of vigour, great physical strength) indicate a constitutional condition of strength of the individual: this is not only physical vigour but it also involves mental vigour which means that the person will be able to stand up to emotional stress keeping the integrity of his or her Shen. Contrary to what we might think, many elderly people actually have a constitutional strength of the Sea of Marrow which makes their Shenstrong and grounded.

The physical symptoms of deficiency of the Sea of Marrow are dizziness, tinnitus, weak legs, blurred vision, and a desireto lie down. On a mental-emotional level, a person with a constitutional deficiency of the Sea of Marrow will be more prone to emotional stress: his or her Shen is more vulnerable and the person lacks mental strength and resilience. Under these conditions, the person is easily prone to depression when subject to emotional stress.

The points given by chapter 33 of the Spiritual Axis for the Sea of Marrow are Du-20 Baihui (described by the Spiritual Axis as the upper point) and Du-16 (described as the lower point). I particularly use Du-20 to strengthen the Sea of Marrow, nourish the Shen and strengthen the Kidneys Will-Power (Zhi). For these reasons, Du-20 is a very important point for depression.

THE 6 EXTRA FU AND IMPOTENCE. Dr Zhang Xiao Chu

The 6 Extra Fu are related to the Ming Men and therefore impotence.

The Gall Bladder controls the ascending of Qi and it influences erection. The Blood Vessels influence the genitals because they blood vessels wrap and bind around the male genitals. The Brain, Marrow and Bones are all derived from Kidney-Essence and they all influence the sexual function.

SEA OF MARROWExcess: Full of vigour, great physical strength.

Deficiency: Dizziness, tinnitus, weak legs, blurred vision, desire to lie down.Points: DU-20 (upper), DU-16 (lower).

The vigour or fullness of the Sea of Marrow includes sexual vigour; therefore deficiency of the Sea of Marrow also includes impotence. The Qi of the 5 Zang and 6 Fu ascends to and nourishes the Brain. Therefore a deficiency of the Zangfu(from emotional stress and overwork) weakens the Marrow and Brain and this affects the sexual function.

The Du Mai starts in between the kidneys where the Dong Qi throbs, it goes to the uterus and the pubic bone.

In women, it flows around the vagina, passes to the perineum, then the buttocks to meet the Kidney and Bladder channels in the thighs.

In men, it flows around the penis and goes to the perineum.

Prescription for impotence from Yin Xu of Marrow and BrainWalnuts (because they have the shape of a brain) 10gEgg yolk (because they have the colour of a brain) 1 eggShu Di Huang 15gBei Sha Shen 15gGou Qi Zi 12gSha Ren 2gZe Xie 10gCan Yong (silkworm chrysalis) 10g (warms and nourishes Marrow and boosts sexual function)

Foods: monkey brain (!), venison, royal jelly, sea cucumber (Oloturia), eel.

The Marrow and Brain have a

Yin and Yang aspect and a deficiency of either may cause

impotence.

Prescription for impotence from Yang Xu of Marrow and Brain

When the Marrow and Brain suffer from Yang Xu, the Ming Men declines, the Du Mai is weak, the genitals are not warmed and they fail.

Zi He Che 4g

Lu Rong 1g

Sheng and Shu Di Huang 15g (each)

Shan Zhu Yu 10g

Gou Qi Zi 10g

Tu Si Zi 30g

Shan Yao 15g

Fu Ling 10g

Fu Zi 10g

Feng Fang 3g

FOODS: seal penis, deer kidney, gecko, dogs kidney.

ACUPUNCTURE: Du-20 and Du-4 each 7-15 moxa cones.

Prescription for impotence from Xu of Marrow and Blood stasis

In chronic cases, there is Qi stagnation and Blood stasis. Treatment principle is to eliminate stagnation, invigorate Blood, open obstructions, tonify Yang of Marrow.

Shi Chang Pu 6g

Chuan Xiong 10g

Yu Jin 10g

Yuan Zhi 10g

Chi Shao 10g

Dang Gui 10g

Huang Qi 20g

Tu Si Zi 20g

Yin Yang Huo 15g

Ci Shi 15g

THE EXTRAORDINARY VESSELS AND THE ORIFICES

A pathology of the Extraordinary Vessels often shows in the orifices, among which the Mind (Shen) (which is the orifice of the Heart) is included. The correspondences between orifices and Extraordinary Vessels are listed below:

Yin-Yang Qiao Mai: eyes.

Du Mai: nose and Mind.

Ren Mai: mouth and urethra.

Yin Wei Mai: Mind.

Yang Wei Mai: ears.

Du, Ren and Chong Mai: urethra, anus.

The vagina is not usually considered as one of the 7 orifices. However, if we include the vagina among the orifices, then this is influenced by the Du, Ren, Chong and Dai Mai.

The Yin and Yang Qiao Mai influence the eyes as they bring Yin and Yang Qi to the eyes respectively.

The Du Mai flows through the nose and its Yang energy keeps the nose orifice open. In addition, the Du Mai stems from the Kidneys (and therefore Zhi), flows through the Heart (Shen) and enters the Brain (Shen); for this reason, it strongly influences the Mind.

The Ren Mai flows around the mouth and influences gums, teeth and lips. Its influence on the mouth can be seen in certain pathologies of pregnancy such as gingivitis.

The Yin Wei Mai nourishes Blood and the Heart and it has a strong influence on the Mind (Shen).

The Yang Wei Mai influences the ears as it is connected to the Lesser Yang channels (Triple Burner and Gall-Bladder); for example, it is involved in acute ear pathologies from invasion of Wind-Heat.

The Ren Mai flows through the urethra and influences urination: I always treat this vessel in urinary problems in women. The Du Mai influences the anus as it flows through it; however, as we will see below, it also flows in the front ofthe body and therefore in addition influences the urethra: I would tend to use the Du Mai in urinary problems in men. The Chong Mai influences both the urethra and the anus: the urethra because it is strongly linked to the Kidneys and all theKidney points in the lower abdomen and the Kidneys control the two lower orifices; the anus because it is connected to the Stomach and Large Intestine.

THE EXTRAORDINARY VESSELS' REGULATING, BALANCING AND INTEGRATING FUNCTION

The Extraordinary Vessels have a very important balancing and regulating function in the body: terms such as regulate, balance and integrate describe their functions and nature.

The Extraordinary Vessels regulate the flow of Qi from the Main channels, either absorbing excesses of Yang or Yin or supplementing Yang or Yin. The Yin and Yang Qiao Mai are the first line of reservoirs to perform this function.

Regulating also implies regulation of Qi among the Yin and Yang channels themselves: this function is performed primarily by the Yin and Yang Wei Mai and also by the Du and Ren Mai which govern and direct all the Yang and Yin channels

As for balancing; the Extraordinary Vessels balance Yin and Yang in the trunk and also in the head. They are part of a sophisticated mechanism whereby the Luo channels balance Yin and Yang in the limbs, the Extraordinary Vessels balance Yin and Yang in the trunk and head, and the Divergent channels (Jing Bie) balance Yin and Yang in the head and the Internal Organs.

Yin We

i Mai

Yang Wei Mai

Main channel

Main channel

Main ch.

Yin and Yang Q

iao Mai

Du, Ren, Ch

ong, Dai Ma

i

Yin Connecting channels

LIMBS

The Extraordinary Vessels function of absorbing excess Qi from the main channels also involves the Connecting channels. Indeed, the Classic of Difficulties, actually says that excess Qi is absorbed by the Connecting channels (Luo): the modern Chinese commentary explains that these are the 8 Extraordinary Vessels.

This is a partial explanation as to why four of the opening points of the Extraordinary Vessels are Connecting points, i.e.:

SP-4 Gongsun - Chong Mai

LU-7 Lieque - Ren Mai

P-6 Neiguan - Yin Wei Mai

T.B.-5 Waiguan - Yang Wei Mai

Ye Tian Shi said: Through the Luo channels Qi penetrates the Extraordinary Vessels continuously.

He also said that the 8 Extraordinary Vessels pertain to the Luo channels and specifically, the Yin Luo channels.

Heart

Uterus

Motive Force

DU MAIREN MAI

Du-4 Ming Men

Ren-4 Minister FireJING Kidney Kidney

The Extraordinary Vessels create an energetic vortex, the centre of which is the Lower Dan Tian in the lower abdomen where the Original Qi (Yuan Qi) and Essence (Jing) reside.

VORTEX OF EXTRA-MERIDIANS

Du Mai

Chong Mai

Dai MaiYin/YangQiao Mai

Yin Wei Mai

Ren Mai

Yang Wei Mai

Chong Mai is the centre, vortexDu and Ren Mai define back and frontYin and Yang Qiao Mai define left-rightDai Mai defines above and belowYin and Yang Wei Mai define interior and exterior

Blastocyst

ENERGETIC DYNAMICS OF THE EXTRAORDINARY VESSELS

The Extraordinary Vessels can be grouped according to their opening points as seen before. When paired like this, the two points, when used together, influence a certain area of the body.

The Extraordinary Vessels can also be grouped in a different waythat takes their nature into account, rather than their opening points. From this point of view, they can be grouped as follows:

Above-BelowDai Mai

a) Interior-Exterior, b) link Yin and Yang

Yin-Yang Weia) left-right, b) balance Yin-YangYin-Yang Qiao

SourceDu-Ren-Chong

Defines Above and Below

SUMMARY OF THE ENERGETIC DYNAMICS OF THE EXTRAORDINARY VESSELS

Du, Ren and Chong Mai: Three branches with same origin from the space between the Kidneys

Chong Mai: Centre of vortex

Du and Ren Mai:Define Back and Front

Yin and Yang Stepping Vessel:

Define Left and Right (of Yin and Yang)

Yin and Yang Wei Mai:Define Interior and Exterior

Dai Mai:

Thus the Chong Mai can be seen as their origin and for this reason was called the father in the family of Extraordinary Vessels.

The reason that the Chong Mai is at the centre of this energetic vortex is that:

it is the Sea of the 5 Yin and 6 Yang organs

it is the Sea of Blood

it is the Sea of the 12 channels

and it starts from between the Kidneys

The Qi and Blood of the Chong Mai are then distributed all over the body through small channels at the Defensive Qi energetic level. When its Qi reaches KI-6 Zhaohai, KI-9 Zhubin, BL-62 Shenmai, BL-63 Jinmen and GB-26 Daimai, it gives rise to five Extraordinary Vessels: the Yin Qiao Mai, Yin Wei Mai, Yang Qiao Mai , Yang Wei Mai, and Dai Vessel respectively.

The Extraordinary Vessels can be grouped in two different ways. According to their opening and coupled points, they can be arranged into 4 pairs of vessels of the same polarity (both Yin or both Yang) as follows:

1. LU-7 Lieque Ren MaiKI-6 Zhaohai Yin Qiao Mai

1. LU-7 Lieque Ren MaiKI-6 Zhaohai Yin Qiao Mai

2. S.I.-3 Houxi Du MaiBL-62 Shenmai Yang Qiao Mai

2. S.I.-3 Houxi Du MaiBL-62 Shenmai Yang Qiao Mai

3. SP-4 Gongsun Chong MaiP-6 Neiguan Yin Wei Mai

3. SP-4 Gongsun Chong MaiP-6 Neiguan Yin Wei Mai

4. G.B.-41 Zulinqi Dai MaiT.B.-5 Waiguan Yang Wei Mai

4. G.B.-41 Zulinqi Dai MaiT.B.-5 Waiguan Yang Wei Mai

In this arrangement in pairs, the opening point of one vessel isthe coupled point of its paired channel and vice versa.

AREAS INFLUENCED BY THE EXTRAORDINARY VESSELS

A very important implication of these pairs of points is also that these two points together define the whole area influenced by anExtraordinary Vessel.

For example, the pair of points LU-7 Lieque and KI-6 Zhaohai (Ren Mai) will influence the whole area covered by the Ren Mai.

Indeed, some of the ancient texts mention these points in pairswithout even remarking on the Extraordinary Vessels.

Gatherings from Eminent Acupuncturists (Zhen Jiu Ju Ying):

This treatment method [i.e. the method of using the opening and coupled points of an Extraordinary Vessel] is very broad indeed. It is known as setting a very broad net in open country to catch a single rabbit.

This is a very simple but extremely important concept in clinical practice. The pair of points used together allows us to treat symptoms arising in any part of that vessels pathway. For example, if a woman suffers from acne on the chin and excessive vaginal discharge, whatever the patterns involved in each of the symptoms, both those signs occur on the Ren mais pathway: this means that they can be treated by the two points LU-7 Liequeand KI-6 Zhaohai used in combination.

Case history

A 45-year-old man had been suffering from a small patch of eczema below the nose and an itchy anus.

However, what unites these two symptoms is that they both occur along the pathway of the Du Mai: therefore, to use the two points S.I.-3 Houxiand BL-62 as a pair will affect the whole pathway of the Du Mai and treat both symptoms, whatever the patterns involved.

Obviously these two problems could be treated separately addressing the Wind-Heat in the skin and the Damp-Heat in the anus.

The patch of eczema was dry, red and flaky and could therefore be characterized as being due to Wind-Heat; the itchy anus was due to Damp-Heat as he had other signs of Dampness such as a sticky-yellow coating on the root of the tongue.

Yet another example of this principle could be that of a pregnant woman who suffers from bleeding gums and vaginal bleeding. Whatever the patterns that are their causes, these two symptoms are united by the fact of their occurrence on the pathway of the Ren Mai: they can therefore both be addressed simultaneously by using LU-7 Lieque and KI-6 Zhaohai as a pair of points.

Obviously, using the above two points to affect the whole trajectory of the Du Mai does not exclude aiding the treatment with some points that will also treat the patterns, e.g. L.I.-11 Quchi to treat the Wind-Heat and SP-9 Yinlingquan to treat the Damp-Heat.

POINTS TO OPEN THE EXTRAORDINARY VESSELS

The opening points of the Extraordinary Vessels can be used in different ways and there is no general consensus on this question. I will discuss first the use of the opening points and then a hypothesis on why the Extraordinary Vessels have those opening points.

OPENING POINTS OF THE EXTRAORDINARY VESSELSThere is no general consensus on which points should be used to open an Extraordinary Vessel and the classics are often ambiguous on this point. Modern Chinese books carefully avoid this question (probably because there is no consensus on it).

The classics sometimes mention only the opening point of a vessel (e.g. LU-7 for the Ren Mai) but more often they mention the points in pairs (e.g. LU-7 and KI-6 for the Ren Mai).

Taking the Ren Mai as an example, the points could be used in four different ways:

1) Only the opening point (e.g. LU-7 Lieque) bilaterally.

2) The opening point and the coupled point (e.g. LU-7 Lieque and KI-6 Zhaohai) bilaterally. This method is suitable for a wide range of problems.

3) The opening point and the coupled point unilaterally and crossed over (e.g. LU-7 Lieque on one side and KI-6 Zhaohai on the other). This method is suitable for problems of the head and face and of the internal organs. It is especially suitable for children, old people, those weak in body condition, or those suffering anxiety.

4) Opening point and coupled point unilaterally( e.g. LU-7 Liequeand KI-6 Zhaohai) on the same side. This method is suitable for unilateral problems: of back and limbs, backache, sprains, Painful Obstruction Syndrome, Wind-stroke sequelae. One needs only to needle the affected side.

I personally use the third and fourth techniques and primarily the third. Because of this arrangement in pairs, the opening point of one vessel is usually used in conjunction with the opening point of the paired vessel.

The technique of using two points unilaterally and crossed over,called "host-guest", was indicated for the very first time in the "Guide to Acupuncture Channels" (Zhen Jing Zhi Nan, 1295) and later expanded in the "Great Compendium of Acupuncture" (Zhen Jiu Da Cheng, 1601).

As I see it, it is like a locked door that requires two keys to open it. Most of the time, I would use these two points unilaterally and crossed over; occasionally, I use them unilaterally on the same side.

The Guide to Acupuncture Channels (1295) lists the opening point of each Extraordinary Vessel specifically indicating its combination with its coupled point.

For example, for the Chong Mai, it says: SP-4 Gongsun, two points, on the Spleen channel . . . combine with P-6 Neiguan. Interestingly, this text makes an exception for the opening points of the Yin and Yang Wei Mai (P-6 Neiguan and T.B.-5 Waiguan) which, it says, should be used on their own. However, subsequent classics do not give such instruction.

The Great Compendium of Acupuncture (1601) mentions the Extraordinary Vessels points as pairs in many passages, clearlyimplying that they are used as a couple. For example, it says:

Neiguan ought to go with Gongsun; Waiguan is put together with Zulinqi; Lieque is coupled with Zhaohai; Houxi mutually follows Shenmai.

The Gatherings from Eminent Acupuncturists (Zhen Jiu JuYing, 1529) also clearly recommends using the opening points of the Extraordinary Vessels in pairs. For example, when it gives the symptomatology of each Extraordinary Vessel (under the heading of its opening point), it always ends the passage by citing a pair of points; for example, saying for SP-4: Needle SP-4 Gongsun first and then follow with P-6 Neiguan.

The Great Treatise of Acupuncture (Zhen Jiu Da Quan, 1439) by Xu Feng says:

SP-4 Gongsun is paired with P-6 Neiguan, LU-7 Lieque can be coupled with KI-6 Zhaohai, G.B.-41 Zulinqi and T.B.-5 can act as host and guest, S.I.-3 Houxi and BL-62 respond to each other.

Thus, these classics not only recommend using the points in pairs, but they all specifically recommend using the opening point of the Extraordinary Vessel that we want to open first, followed by its coupled point (e.g. SP-4 Gongsun followed by P-6 Neiguanfor the Chong Mai).

Finally, a modern Chinese text reports a quotation from Dou Han Qing which says:

To treat a disease is like attacking an enemy. When military forces are combined and an attack is launched up and down upon a small group of traitors, they can hardly escape.

The expression up and down in this passage refers to using a point on the arm and one on the leg (all pairs of opening and coupled points are located thus): this widens the net as it were, to widen the therapeutic range of actions of the points.

The same textbook also clearly instructs its readers that the points be used in pairs and in a particular order, i.e the opening point first and the coupled point second. It says: Points should be acupunctured [sic] in pairs. Main point should be needled first, coupled point

Therefore, when using the Ren Mai, for example, one would needle LU-7 Lieque and KI-6 Zhaohai in this order. I personally needle these two points on opposite sides. The needles are withdrawn in reverse order. I use the opening and coupled points of a vessel according to sex, i.e. in a man I usethe opening point on the left and the coupled point on the rightand vice versa in a woman. For example, to open the Ren Mai in a man, I needle LU-7 Lieque on the left, followed by KI-6 on the right in this order; in a woman, I would use LU-7 Liequeon the right followed by KI-6 on the left.

I learned this particular use of paired points of the Extraordinary Vessels from Dr J. D. Van Buren in the early 1970s. Dr Van Buren, in turn, had learned it from a Korean teacher.

When used in such pairs, the Extraordinary Vessels points also harmonize Above and Below as the paired points are always one from the arm and one from the leg. By using the points unilaterally and crossed-over, we also harmonize Left and Right. For these reasons, I prefer the unilateral and crossed-over use of the points as, by harmonizing Above-Below and Left-Right, it brings into play the role of the Extraordinary Vessels as reservoirs of Qi; it also draws upon their role of regulating, integrating and balancing. Using these pairs one transcends the action of the individual points bringing into play the Qi of the Extraordinary Vessels.

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OPENING POINTS VS POINTS ON THE EXTRAORDINARY VESSELS

The next question that arises is: what is the difference between using the opening point and the coupled point of an Extraordinary Vessel (e.g. LU-7 Lieque and KI-6 Zhaohai for the Ren Mai) and using a point on the vessel itself (e.g. Ren-4 Guanyuan)?

An Extraordinary Vessel may be used in two possible ways:

a) Using the opening point (together with the coupled point)

b) Using a point on the vessel.

2. It brings into play the Extraordinary Vessels role as reservoirs of Qi, i.e. to absorb and regulate excesses and stagnation. This is particularly necessary when the pulse has the same quality in different positions. It also brings into play the function of the Extraordinary Vessels to regulate, balance and integrate.

Using the opening and coupled points achieves two results:

USING THE OPENING AND COUPLED POINTS

1. It reaches the whole area governed by that vessel (e.g. the Ren Mai, LU-7 Lieque and KI-6 Zhaohai to reach, for example, the lower abdomen and genitals as well as mouth and gums).

Using the opening and coupled points reaches the area governed by that vessel

A man complains of a pain on the lateral side of the lower left leg and earache in his left ear. These two problems are apparently unrelated and diagnosing according to patterns one would say that the leg pain might be due to invasion of Dampness and the earache to Damp-Heat. However, there is one factor that unites these two symptoms: both occur in the area influenced by the Yang Wei Mai.

Therefore, treating the Yang Wei Mai will treat both these symptoms simultaneously, whatever the patterns causing them (of course, treatment of this vessel can be combined with treatment of the patterns). However, in this case, treating the Yang Wei Mai means using its opening and coupled points, i.e. TB-5 Waiguan and G.B.-41 Zulinqi (needled in this order and on opposite sides).

It is only by using these two points in combination that we affect the whole area influenced by the Yang Wei Mai. If we used a point on the Yang Wei Mai itself (e.g. G.B.-35 Yangjiao or G.B.-19 Naokong), it would not affect the whole tract of the vessel.

Another example will clarify this concept:

Let us say a woman suffers from bleeding gums and excessive vaginal discharge. Again, we can diagnose these two symptoms separately: the bleeding gums might be due to Stomach-Heat and the excessive vaginal discharge to Damp-Heat in the Lower Burner. However, there is a connection between them: both are on the area influenced by the Ren Mai. We can influence the whole area of this vessel (i.e. the gums and the genital system) by using the opening and coupled points, i.e. LU-7 Lieque and KI-6 Zhaohai (needled in this order and on opposite sides). As in the previous example, these two points may be combined with others treating the appropriate patterns; however, what matters is that these two points will have an effect on those two symptoms irrespective of the patterns.

Using the opening and coupled points to bring into play the roles of Extraordinary Vessels as reservoirs and as agents of regulation, balance and integration

As we have discussed above, the Extraordinary Vessels function like reservoirs to absorb excesses or imbalances of Qi from the Main channels in the same way as reservoirs absorb an excess rainfall or may counteract a period of drought; they also regulate, balance and integrate various structures of the body.

In many cases, the Extraordinary Vessels are used therefore to absorb excesses of Qi or remove stagnation of Qi and/or Blood. In such situations, the pulse will reflect a pathology of the Extraordinary Vessels by having the same pulse quality and intensity in more than one position.

Why should this be?

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If the Main channels are like rivers (reflected in 12 individualpositions on the pulse) and the Extraordinary Vessels like reservoirs absorbing Qi from more than one Main channel, the reservoir pathology will be reflected on the pulse by having the same quality and intensity in more than one position (i.e. the individual pulse positions, the rivers, merge into one, the reservoirs).

This phenomenon is also due to the fact that the Extraordinary Vessels integrate various structures and their Qi often spans several different channels: for this reason, their Qi, in pathology, is often reflected on a pulse that has the same quality and intensity in different positions.

For example, in Blood stasis in the Chong Mai, the pulse will feel Firm on both Middle positions of right and left or Firm in all three positions of the left.

The same quality and intensity of a pulse in more than one position reflects the flooding and overflowing of the Main channels into the Extraordinary Vessels. It is in such situations that we want to bring into play the role of the Extraordinary Vessels as reservoirs.

Therefore, especially in Full conditions of the Extraordinary Vessels, it is necessary to use the opening and coupled points of an Extraordinary Vessel in order to bring into play its role of reservoir. Of course, these points are frequently combined with points on the vessel.

For example, in a case of Blood stasis in the Chong Mai, we use SP-4 Gongsun and P-6 Neiguanto bring into play its role as reservoir and we can add a point on the vessel itself such as KI-14 Siman which has the effect of invigorating Blood.

USING A POINT ON THE VESSEL

What is the effect of using a point on the course of an Extraordinary Vessel?

There is no general answer to this question as we must distinguish between the Du/ Ren Mai and the other vessels.

The Du Mai and Ren Mai have their own points and, from this point of view, they are like the Main channels. Using a point on the vessel itself will strengthen, tonify or move the Qi of that particular vessel and there are many very important points on these two vessels.

For example, Ren-4 Guanyuan will strengthen and consolidate the Ren Mai

Ren-6 Qihai can move Qi in the Ren Mai

Du-4 Mingmen strengthens the Fire of the Gate of Life.

Often, such points on the vessel are combined with the opening and coupled points of that vessel but this is not necessarily the case, e.g. Ren-4 Guanyuan by itself strengthens the Ren Mai.

However, it is common to use the opening and coupled points of the Ren or Du Mai in conjunction with a point on the vessel.

For example, it is very common to use LU-7 Lieque and KI-6 Zhaohai to open the Ren Mai together with Ren-4 Guanyuan to strengthen and consolidate the vessel. The same applies to the Du Mai.

For example, if we used S.I.-10 Naohu on its own (the Yang Qiao Mai goes through this point), we would have very little effect on this vessel. This point could merely be used in conjunction with the opening and coupled points (in this case BL-62 Shenmai and S.I.-3 Houxi) to direct the effect of the treatment to the local area of the scapula. Using BL-62 and S.I.-3 would open the Yang Qiao Mai to perform its function of absorbing excess of Yang energy in the top part of the body, whereas using S.I.-10 would have no such effect.

For other vessels, the effect of using a point on a vessel is different and it is much less powerful. As the other vessels donot have their own points, the effect of using a point on the vessel itself is very limited and the main purpose of doing so is to direct the treatment to a local area.

Finally, the Chong Mai is yet a different case that is placed inbetween the two above cases. Although the Chong Mai does not have its own points, as the Du and Ren Mai do, it does go through all the Kidney-channel points from KI-11 Henggu to KI-21 Youmen.

Therefore some of these points on the Kidney channel do have a powerful effect on the Chong Mai in a way that points on other vessels (such as S.I.-10 mentioned above for the Yang Qiao Mai) would not have. For example, KI-13 Qixue strengthens and consolidates the Chong Mai.

When I open an Extraordinary Vessel with its opening and coupled points, I customarily use only one such vessel at a time: for example, I would not use SP-4, P-6, LU-7 and KI-6 all together to open the Chong Mai and the Ren Mai. However, this rule does not apply when using a point on the vessel ratherthan its opening and coupled points. For example, I frequently needle Ren-4 Guanyuan (Ren Mai) and KI-13 Qixue (Chong Mai).

NEEDLING TECHNIQUES

To open an Extraordinary Vessel I generally use both its opening and coupled points, according to sex (with few exceptions), i.e. I use the opening point on the left in men and the right in women and the coupled point on the opposite side.

For example, to open the Ren Mai in a man, I would insert LU-7 Lieque on the left, followed by KI-6 Zhaohai on the right; vice versa in a woman.

Although this particular method of unilateral and crossed-over needling according to sex is not in the "Great Compendium of Acupuncture", the book does advise needling the opening point of the chosen vessel first, and then following that by its coupled vessel (e.g. LU-7 and KI-6).

The Great Compendium of Acupuncture calls this method the host-guest technique, in which the opening point of the vessel we want to open is the host and its coupled point (which is also the opening point of the coupled vessel) is the guest, e.g. if we want to open the Dai Mai, G.B.-41 Zulinqi is needled first and is the host point and T.B.-5 Waiguan is needled second and is the guest point.

It is also interesting that the idea of needling the left side in men and the right in women is mentioned by Sun Si Miao in his Thousand Golden Ducats Prescriptions (Qian Jin Yao Fang) although not in connection with the Extraordinary Vessels.

When I insert the opening and coupled points, I always start with the opening point, e.g. S.I.-3 Houxi for the Du Mai, BL-62 Shenmai for the Yang Qiao Mai, etc., and follow it up with the coupled point on the opposite side, e.g. BL-62 Shenmai in the case of the Du Mai and S.I.-3 Houxi in the case of the Yang Qiao Mai.

If I am combining the opening and coupled points of an Extraordinary Vessel with other points, I insert these after the insertion of the coupled point, usually starting from the top part of the body downwards. For example, assuming I am using the Chong Mai in a woman and wanted to add Ren-15 Jiuwei and Ren-4 Guanyuan, I would insert SP-4 Gongsun first on the right, then P-6 Neiguan on the left, then Ren-15 and last Ren-4.

I always obtain deqi (the needling sensation) but do not apply any special technique, i.e. neither reinforcing nor reducing. I simply obtain the needling sensation and leave the needle in.

If I am using other points on the limbs in combination with the opening and coupled points of an Extraordinary Vessel, I often use them unilaterally and crossed over on sides opposite to those of the opening and coupled points. For example if we use the Chong Mai in a woman for rebellious Qi and we want to combine the opening andcoupled points of this vessel (SP-4 and P-6) with L.I.-4 Hegu and LIV-3 Taichong. I would needle these points as follows:

- SP-4 Gongsun on the right

- L.I.-4 Hegu on the right (opposite side to P-6)

- P-6 Neiguan on the left

- LIV-3 Taichong on the left (opposite side to SP-4)

If I was using the same combination in a man, I would insert the needles as follows:

I would then leave all these needles in for about 20 minutes; after this time, I would withdraw the other points first (in theabove example, L.I.-4 and LIV-3), then withdraw P-6 Neiguanand last SP-4 Gongsun. In other words, when withdrawing the opening and coupled points I withdraw the coupled point first.

- SP-4 Gongsunon the left

- L.I.-4 Hegu on the left (opposite side to P-6)

- P-6 Neiguan on the right

- LIV-3 Taichong on the right (opposite SP-4)

When using points in addition to the opening and coupled points, I try to use no more than 4 or 5 additional points. Some doctors say that one must not use too many other points lest the needles on the limbs be unable to move Qi well: especially if there are scars or boils with pus.

When I use the Yang or Yin Qiao Mai for painful syndromes, I do sometimes make an exception to the rule of using the opening andcoupled points according to sex. In such circumstances I generally use the opening point on the side where the pain is felt and thecoupled point on the opposite side.

Examples of such painful syndromes are unilateral sciatica in the case of the Yang Qiao Mai and unilateral abdominal pain for the Yin Qiao Mai.

Lastly, I sometimes make an exception to the rule of using the opening and coupled point as a pair when treating the Yin or Yang Qiao Mai. The reason for this, is that these two vessels are the only ones in which the opening point coincides with the starting point. For example, when I am using the Yin and Yang Qiao Mai to treat insomnia, I would use BL-62 Shenmai to drain the Yang Qiao Mai (without S.I.-3) and KI-6 Zhaohai to tonify the Yin Qiao Mai (without LU-7 Lieque).

I personally do not use two Extraordinary Vessels simultaneously: if there seems to be an overlap of two Extraordinary Vessels in the pathology, I might use one at a time in successive treatments.

The only exception to the rule of not using two Extraordinary Vessels simultaneously is provided by the Du and Ren Mai: I sometimes use these two vessels together, especially in women.

When I use the Du Mai in treating a woman I generally do so on the basis of a deficiency of Kidney-Yang. However, in women, I often balance the Du Mai with the Ren Mai using the opening and coupled points as follows (and in that order):

In this example, the opening and coupled points of the Ren Mai are, as it were, on the wrong side from the normal technique.

The above combination of points is also very good to treat backache on the spine itself occurring against a background of Kidney-Yang deficiency in a woman.

4. KI-6 Zhaohai on the right

1. S.I.-3 Houxion the right

3. LU-7 Lieque on the left

2. BL-62 Shenmai on the left

WHEN TO USE AN EXTRAORDINARY VESSEL

What guidelines can be given for choosing to use the Extraordinary Vessels in practice? In other words, when and why do we choose to use an Extraordinary Vessel instead of a Main channel?

Let us start by defining when we use a Main channel. We use a Main channel basically either in problems of the Internal Organsor in channel problems.

For example, if a patient suffers from Liver-Qi stagnation, we can use points on the Liver Main channel and we do not need to use an Extraordinary Vessel. Similarly, if a patient suffers from a straightforward channel problem along a particular channel, we use a Main channel (or its related Connecting channel).

However, there are many situations when an Extraordinary Vessel is indicated:

1) problems of several channels simultaneously

2) complicated conditions

3) involvement of an internal organ with a different channel

4) confusing situations of Heat-Cold and Deficiency-Excess

5) some mental problems

6) some neurological problems

7) when the pulse has the same quality in several positions.

Let us consider these situations one by one.

In channel problems, if the pathology affects clearly only one channel, then we use that Main channel. However, if the channel problem affects more than one channel simultaneously, this indicates the use of an Extraordinary Vessel.

1) PROBLEMS OF SEVERAL CHANNELS SIMULTANEOUSLY

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Why should that be? The nature of the Extraordinary Vessels as reservoirs of Qi, and as agents of regulation and integration, means that as reservoirs, they receive the inflow from many different channels: therefore, when many channels are involved, using the reservoir, i.e. an Extraordinary Vessel, will affect all of them.

A good example is that of sciatica. If a patient suffers from sciatica that is clearly along the Bladder channel, we need use only the Bladder Main channel with distal and local points.

However, very often, sciatic pain starts on the Bladder channel in the buttock, it then travels via the Gall-Bladder channel on the thigh and down the Stomach channel on the leg. In order to affect all three channels, we can use the Yang Qiao Mais opening and coupled points i.e. BL-62 Shenmai and S.I.-3 Houxi.

This approach is used not only in channel problems but also in internal organs problems. For example, we adopt this same approach every time we use the Ren Mai in gynaecological problems because this vessel strongly influences the Liver, Kidney and Spleen channels in the Lower Burner which are the source of most gynaecological pathologies.

The same can be said of the Chong Mai: we use the opening and coupled points of this vessel when there is an overlap of abdominal pathology of several different organs such as the Liver, Spleen,Kidneys and Intestines.

The Extraordinary Vessels are often very useful in complicated conditions. By complicated, I mean chronic conditions characterized by multiple, confusing patterns and many differentsymptoms in different body systems.

2) COMPLICATED CONDITIONS

For example, let us consider a patient suffering from chronic asthma, some digestive problems, some gynaecological problems and allergies. The combination of these symptoms suggest the use of the Ren Mai because this vessel treats the Lungs, it nourishes Yin, it can be used for digestive complaints and, mostof all, gynaecological diseases. Therefore using the opening and coupled points of the Ren Mai, i.e. LU-7 Lieque and KI-6 Zhaohai, may have an influence on all the patient's conditions.

Another good example of the use of an Extraordinary Vessel in complicated conditions is that of rebellious Qi of the Chong Mai. Rebellious Qi of the Chong Mai causes many different symptoms starting from the lower abdomen and ending in the head.

If we analysed these symptoms one by one, we would diagnose many different patterns of various organs with Fullness and Emptiness and Heat and Cold.

However, when seen in their totality, it becomes clear that they are due to rebellious Qi of the Chong Mai and they are caused by the fact that this vessel influences many different channels. Therefore the use of its opening and coupled points, i.e. SP-4 Gongsun and P-6 Neiguan, will treat all the symptoms caused by such a complicated condition.

3) INVOLVEMENT OF AN ORGAN AND A DIFFERENT CHANNEL

In most cases, if a pathology of an internal organ affects a channel, it will affect its related channel, e.g. a Liver pattern may affect the Liver channel. Often however, a pathology of an internal organ may affect a different channel, e.g. a Liver pattern affecting the Bladder channel. Frequently, an Extraordinary Vessel will address this situation.

For example, Liver-Yang rising will normally cause headaches along the Gall-Bladder channel on the head (the Gall-Bladder channel is interiorly-exteriorly related to the Liver channel). In some cases, however, Liver-Yang rising may produce headaches along the Bladder channel on the occiput. In such a situation, we can use an Extraordinary Vessel and, in this case, the Yang Qiao Mai as this channel absorbs excesses of Qi in the top of the head. We therefore use the opening and coupled points of this vessel, i.e. BL-62 Shenmaiand S.I.-3 Houxi. Of course, these two points may be combined with other points that subdue Liver-Yang such as LIV-3 Taichong.

4) CONFUSING SITUATIONS OF HEAT-COLD AND DEFICIENCY-EXCESS

The Extraordinary Vessels are particularly useful also in situations characterized by complex conditions with simultaneous occurrence of Heat and Cold and Fullness and Emptiness.

Again, this capacity of the Extraordinary Vessels is linked to their nature as reservoirs of Qi and as agents of integration. Being reservoirs of Qi and integrating different structures, they regulate and balance the flow of Qi among the channels and this makes them suitable for the treatment of conditions of both Deficiency and Excess and Cold and Heat.

For example, women frequently suffer from conditions of mixed Heat and Cold. There are two main reasons for this:

1) A simultaneous deficiency of Kidney-Yin and Kidney-Yang: this is very common in women over 45.

2) A deficiency of Blood which gives rise to some Empty Heat symptoms: the Blood deficiency may cause cold hands and feet while the Empty Heat deriving from it may cause a feeling of heat in the face

In both these cases, treatment of either the Ren Mai or the Chong Mai can treat the condition of mixed Heat and Cold. In fact, both these vessels will influence the Uterus, Blood and several different channels such as the Kidneys, Liver and Spleen: for this reason and for their balancing and regulating nature, treatment of these vessels can deal with both the Heat and Cold.

5) SOME MENTAL-EMOTIONAL PROBLEMS

Some of the Extraordinary Vessels are particularly indicated formental-emotional problems, probably due to their regulating, integrating and balancing function which was discussed above.

For example, one of the indications of the Ren Mai is mania after labour. One of the major symptoms of the Chong Mai is mental restlessness and anxiety associated with Rebellious Qi.

The Du Mai affects three organs which have a profound influence on the mind:

For this reason, the Du Mai can be used to strengthen Will-power, lift the Mind and nourish the Heart in depression.

the Kidneys and therefore the Will-power, Zhi

the Brain and therefore the Mind, Shen. the Heart and therefore the Mind, Shen

The Yang Qiao Mai is used to absorb excesses of Yang in the headwhen they cause mental agitation and restlessness.

The Yin Wei Mai is used to nourish Blood, strengthen the Heart and calm the Mind. I personally use the Yin Wei Mai very frequently in patients suffering from depression and anxiety from mental-emotional problems such as those due to sadness, grief, worry or shock. I often use the opening points of this vessel (P-6 Neiguan and SP-4 Gongsun) combined with its starting point KI-9 Zhubin: this has the effect of strengthening both Heart (and therefore the Mind, Shen) and Kidneys (and therefore the Will-power, Zhi).

6) SOME NEUROLOGICAL PROBLEMS

Some of the Extraordinary Vessels can be used for neurological problems such as multiple sclerosis.

Also, both the Yang and Yin Qiao Mai can be used for hemiplegia after Wind-stroke.

In particular, the Du Mai and the Dai Mai can be used to stimulate the circulation of Qi in the legs and spine in neurological problems.

An interesting consequence of the Extraordinary Vessels quality as reservoirs receiving Qi from the Main channels, is that their use is indicated whenever a pulse quality spans more than one position (i.e. the reservoir rather than an individual channel is affected).

7) WHEN THE PULSE HAS THE SAME QUALITY IN SEVERAL POSITIONS

This concept applies only when two or more positions of the pulse have exactly the same quality and strength. For example, if all the three positions (Front, Middle and Rear) are Floating, it indicates a pathology of the Du Mai; if they are Firm, a pathology of the Chong Mai. If both Front positions of left and right are Wiry and Full, it indicates a pathology of the Yang Qiao Mai.

To take the pulse quality of the Du Mai as example: this is equally Floating on all three positions (Front-Cun, Middle-Guan and Rear-Chi). Why should this be? The Du Mai governs all Yang channels and rises up the spine from the bottom of the torso to the very top. As the pulse positions correspond to parts of the body as well as to channels, the Rear corresponds to the lower part of the torso and the Front to the head. Therefore, a pathology of the Du Mai involves the whole length of the torso and head and will therefore effect a change in all three positions of the pulse.

It is Floating because Wind (external or internal) is a frequent pathology of the Du Mai.

Moreover, as the Du Mai controls all Yang channels, it will influence all pulses of the Yang channels, for example, on the left, the Small Intestine, Gall-Bladder and Bladder: for this reason, the Floating pulse quality spans all three positions.

To summarize, the pulses of the Extraordinary Vessels from the Mai Jing are as follows:

Both Front positions of left and right Wiry: Yang Qiao Mai

Both Middle positions of left and right Wiry: Dai Mai

Both Rear positions of left and right Wiry: Yin Qiao Mai

All three positions Firm: Chong Mai

Hard and Full on both Middle positions: Chong Mai

...SI

GBBL

LUSPKI

Both Front positions of left and right Wiry: Yang Qiao Mai

Wiry

...SI

GBBL

LUSPKI

Both Middle positions of left and right Wiry: Dai Mai

Wiry

...SI

GBBL

LUSPKI

Both Rear positions of left and right Wiry: Yin Qiao Mai

Wiry

...SI

GBBL

LUSPKI

All three positions Firm: Chong Mai

Firm

...SI

GBBL

LUSPKI

Hard and Full on both Middle positions: Chong Mai

Hard-Full

Floating on all three positions: Du Mai

Floating in the Middle position: Du Mai

Like pellets, felt horizontally on both Front positions: Ren Mai

Tight, Fine, Full and Long in the Middle position: Ren Mai

Running obliquely from the lateral to the medial side of the pulse (from the Rear to the Front position): Yin Wei Mai

Running obliquely from the medial to the lateral side of the pulse (from the Rear to the Front position): Yang Wei Mai

DIAGNOSIS OF THE EXTRAORDINARY VESSELS

I consider the pulse a very important diagnostic factor that points to the use of an Extraordinary Vessel. For example, in gynaecology, there is often an overlap in symptomatology between the Ren and the Chong Mai: in the choice between these two vessels, I am very much guided by the pulse (using the latter if the pulse tends to be Full).I shall now discuss a few diagnostic elements for diagnosis by palpation and observation of the orifices. The Qi of the Extraordinary Vessels ascends to brighten the orifices with the following correspondence:

Yin and Yang Qiao Mai: eyes.

Yang Wei Mai: ears.

Du Mai: nose.

Ren Mai: mouth.Dai Mai: urethra.

Du, Ren and Chong Mai: urethra, anus.

REN MAI

The abdomen is the main diagnostic area for the Ren Mai. The central-lower abdomen (an area called Xiao Fu, small abdomen) is the residence of the Essence, the Original Qi (Yuan Qi) and the Fire of the Gate of Vitality. The lower-central abdomen should feel firm, but not hard, and somewhat elastic.

i. Palpation

If this area is too soft, it indicates a weakness of the Ren Mai and of the Uterus: for example, this area is often quite flaccid in multiparous women. If it is too hard, it indicates stagnation of Qi or Blood in the Ren Mai.

The epigastric area (above the umbilicus) should also feel firm but elastic: if it is too soft, it indicates a weakness of the Ren Mai and of the Stomach; if it is too hard, it indicates stagnation of Qi or Blood in the Ren Mai and the Stomach.

The small area below the xyphoid process, in the region of Ren-15 Jiuwei and Ren-14 Juque, has an important diagnostic significance in mental-emotional problems. It should feel relatively soft when compared with the rest of the abdomen. If this area feels hard, it indicates Qi stagnation in the Ren Mai from emotional problems: this stagnation is often related to the Heart and/or Lungs rather than the Liver.

ii Orifice

The orifice corresponding to the Ren Mai is the mouth. The mouth is a useful diagnostic sign in pathologies of the Ren Mai.One should observe the mouth itself, the lips and the area immediately surrounding them.

First of all, problems of the mouth such as ulcers may indicate a pathology of the Ren Mai, especially in women and particularyif such a problem is associated with a menstrual irregularity. For example, mouth ulcers occurring before the periods, clearly indicate a disharmony of the Ren Mai.

The lips and the area surrounding them indicate the state of the Ren Mai.

Red lips indicate Heat in the Ren Mai.

Dry lips indicate a state of deficiency and dryness of the Ren Mai and of Blood.

Purple lips denote Blood stasis in the Ren Mai.

If the area surrounding the lips is greenish it denotes Qi stagnation in the Ren Mai.

If the area surrounding the lips is pale it indicates a deficiency of the Ren Mai.

DU MAI

One should palpate the upper and the lower parts of the Du Mai: these two areas reflect two quite distinct aspects of the Du Mai. The lower part of the vessel reflects the state of the Fire of the Gate of Life which is situated deep in the body below the point Du-4 Mingmen. If this area feels flaccid, it indicates a deficiency of the Fire of the Gate of Life and of Kidney-Yang. If it is tense, it indicates a condition of stagnation in the lower part of the Du Mai.

i. Palpation

DU MAI

The Du Mai reflects the condition of the Yang channels in general; in particular its upper part reflects the superficial Connecting channels and the Greater Yang channels.

i. Palpation

Therefore, the upper part of the Du Mai represents a superficial energetic layer which is the first to be invaded by external Wind and other pathogenic factors. This part of the Du Mai is seldom flaccid. If it is tense, it indicates either a stagnation of Qi on the Du Mai or the invasion of external Cold and/or Wind.

The orifices related to the Du Mai are the nose and the anus.

A thick, sticky nasal discharge indicates a condition of Dampness in the Du Mai. Epistaxis may be due either to a deficiency of the Du Mai or to Heat in this vessel. Polyps in the nose also indicate Dampness in the Du Mai.

The anus is the lower orifice related to the Du Mai. A prolapse of the anus indicates a state of deficiency and sinking of Qi in the Du Mai; itchiness of the anus denotes Dampness in the Du Mai.

Haemorrhoidsusually indicate Damp-Heat and Blood stasis in the Du Mai as well as sinking of Qi.

ii. Orifice

The nose reflects the state of the Du Mai in many ways. First of all, a profuse, white and watery nasal discharge indicates a state of deficiency and Cold of the Du Mai: such a discharge associated with sneezing often indicates allergic rhinitis.

CHONG MAI

The Chong Mai influences the lower abdomen to either side, laterally (the area called Shao Fu, lesser abdomen in Chinese medicine). The lateral-lower abdomen should feel firm but elastic, not too hard and not too soft. Unlike the central-lower abdominal area pertaining to the Ren Mai (the Xiao Fu), the lateral-lower abdominal area (the Shao Fu) is seldom flaccid.

i. Palpation

A marked flaccidity in this area indicates a deficiency of the Chong Mai (with deficiency of Blood and/or Kidney deficiency); a marked tenseness, Qi stagnation or Blood stasis in the Chong Mai.

ii Orifice

The orifice of the Chong Mai is the mouth and the signs and diagnostic significance are the same as for the Ren Mai.

DAI MAI i. Palpation

The Dai Mai influences two areas: the hypogastrium (i.e. the central-lower abdominal area immediately above the pubic bone) and the lateral sides of the lower abdomen (further back from the area influenced by the Chong Mai).

If the hypogastrium feels distended and relatively hard, it indicates a condition of Dampness in the Dai Mai. If the lateral sides feel tense, it indicates Dampness and Qi stagnation in the Dai Mai.

ii. Orifice

The Dai Mai influences the urethra. Difficult and painful urination with turbid urine indicates Damp-Heat in the Dai Mai.

YIN QIAO MAI

The Yin Qiao Mai influences the lateral-lower abdomen and its pathology is indicated especially when the abdominal signs are unilateral.

i. Palpation

An unilateral hardness of the lateral-lower abdomen indicates Qi stagnation or Blood stasis in the Yin Qiao Mai .

The Yin Qiao Mai influences the eyes, bringing Yin Qi to them.

ii. Orifice

If the eyes want to close all the time, this indicates a state of Fullness of the Yin Qiao Mai.

Red and painful eyes indicate Heat in the Yin Qiao Mai.

YANG QIAO MAI

i. Palpation

If the muscles of the lateral aspect of the leg feel tight and tense, they indicate a state of Fullness of the Yang Qiao Mai; similarly if the muscles around the scapula feel tense.

...and the muscles overlying the scapula and those lateral to it.

Two areas have a diagnostic significance in relation to the Yang Qiao Mai: the muscles of the lateral aspect of the leg...

ii. Orifice

The Yang Qiao Mai influences the eyes, bringing Yang Qi to them.

Red and painful eyes indicate Heat in the Yin Qiao Mai.

If the eyes stay open and the person has difficulty in sleeping, it indicates a state of Fullness of the Yang Qiao Mai.

YIN WEI MAI

ii. Orifice

The Yin Wei Mai does not influence any specific orifice.

i. Palpation

The Yin Wei mais main area of influence is the chest as all classics state. When assessing the state of the Yin Wei Mai, I palpate the area just below the xyphoid process which is also influenced by this vessel.

If this area (in the region of Ren-15 Jiuwei) feels hard and knotted, it indicates stagnation in the Yin Wei Mai from emotional problems.

The Yang Wei Mai influences the lateral aspect of the body, particularly in its upper part and head.

YANG WEI MAI

i. Palpation

If the lateral side of the body feels tight and tense, it indicates stagnation in the Yang Wei Mai. If there is a feeling of distension of the lateral side of the head (Lesser Yang area), it indicates a Full condition of the Yang Wei Mai.

ii. Orifice

The Yang Wei Mai influences the ears. Ear pain usually indicates Heat in the vessel; ear discharge, Dampness; redness and heat in the ear, a condition of Heat in the vessel.

DAI MAI

THE GIRDLE VESSEL

The Dai Mai is the only horizontal vessel of the body. Because of this, it is sometimes called "the extraordinary of the extraordinary vessels". It divides the body into two halves and flows through LIV-13 Zhangmen, GB-26 Daimai, GB-27 Wushu and GB-28 Weidao. Not all authors accept that it connects with LIV-13.

It is closely related to the Liver and Gall Bladder and it connects with the Kidney divergent channel at BL-23 Shenshu. Because of this, the Dai Mai "guides and supports" the Qi of the uterus and the Essence.

Because the Dai Mai connects with LIV-13 (Spleen) and BL-23 (Kidneys), it connects the Post-Heaven with the Pre-Heaven Qi (in a similar way as the Chong Mai).

Thus, the Dai Mai vessel interrelates with and restrains the Liver's smooth flow of Qi (through LIV-13), and harmonizes the ascending and descending of Spleen and Kidneys.

Hence:-Kidney's nourishment of the Essence;-Spleen's raising of Qi;-Liver's smooth flow of Qiall rely on the Dai Mai being "relaxed and stretched".

1. PATHWAY

The Dai Mai flows through:

...encircling the waist

In the back, it connects with the Kidney Divergent channel at the height of BL-23 Shenshu

LIV-13 Zhangmen

G.B.-27 Wushu

G.B.-28 Weidao

G.B.-26 DaimaiClassic of Difficulties

The Dai Mai originates from the hypochondrium and it encircles the body.

a) HARMONIZE THE LIVER AND GALL-BLADDER

2. CLINICAL APPLICATIONS

CLINICAL NOTE For such conditions, I use the opening and coupled

points of the Dai Mai (G.B.-41 Zulinqi and T.B.-5

Waiguan) together with LIV-13 Zhangmen.

It can be used to harmonise the Liver and Gall Bladder, particularly in Excess patterns of the Liver, when both Guan positions are Full and Wiry, for such symptoms as temporal headaches. The Dai Mai treats pathological conditions of the lower abdomen, characterized by a feeling of distension and/or fullness. Often chosen when both Middle positions of the pulse are Full and Wiry. Moxa on LIV-13 Zhangmen is often used.

Great Compendium of Acupuncture (Zhen JiuDa Cheng)

[mentions, among other symptoms for the Dai Mai:] Headache, swelling from occiput to chin, red and swollen eyes with dizziness.

b) RESOLVE DAMPNESS IN THE LOWER BURNER

The Dai Mai is like a belt encircling the leg channels in the abdomen and back: the tension of this belt regulates the circulation of Qi to and from the legs. Dampness may arise from a dysfunction of the Dai Mai:

this may happen in Full conditions (when the belt is too tight) and there is stagnation in the leg channels leading to Dampness.

...or it may happen in Empty conditions (when the belt is too loose), the leg channels are not restrained, Spleen- and Kidney-Qi sink and Dampness infuses to the Lower Burner.

CLINICAL NOTE To treat an excessive vaginal discharge occurring with a Full condition, I use the opening and coupled points of the Dai Mai (G.B.-41 Zulinqi and T.B.-5 Waiguan) together with G.B.-26 Daimai, Ren-3 Zhongji, ST-28 Shuidao and SP-9 Yinlingquan.

The Dai Mai can also be used to disperse Damp-Heat in the genitals, causing such symptoms as burning and difficult urination, hypogastric pain and vaginal discharge.

CLINICAL NOTE To treat an excessive vaginal discharge occurring with an Empty condition, I use the opening and coupled points of the Dai Mai (G.B.-41 Zulinqi and T.B.-5 Waiguan) together with G.B.-26 Daimai, Ren-6 Qihai, ST-28 Shuidao, SP-9 Yinlingquan, BL-20 Pishu and BL-23 Shenshu.

b) RESOLVE DAMPNESS IN THE LOWER BURNER

The Dai Mai encircles the leg channels and it affects their circulation. Disorders of this channel can therefore impair the circulation of Qi in the leg channels, resulting in such symptoms as:

...or tense outer leg muscles (due to Liver-Blood not moistening the sinews).

purple feet

cold legs and feet ("like sitting in cold water"),

The Dai Mai affects the circulation of Qi in all leg channels, but the Stomach channel is the most important one for Qi circulation in the legs and it is the one that most needs to be treated in multiple sclerosis.

The Dai Mai regulates the circulation of Qi in the leg channels, and can be used in the treatment of multiple sclerosis which, is a form of Atrophy (Wei) Syndrome.

Atrophy Syndrome and the influence of the Dai Mai and Stomach channel in this disease are discussed in chapter 44 of the Simple Questions. This chapter makes some important statements with regard to the relationship between the Ancestral Muscle (Zong Jin), the Stomach channel, the Chong Mai, the Du Maiand the Dai Mai.

c) REGULATE CIRCULATION OF QI IN THE LEGS

c) REGULATE CIRCULATION OF QI IN THE LEGS

Simple Questions Chapter 44

"The Chong Mai is the Sea of the 12 channels and it moistens the valleys. This vessel meets the Yang Ming [Stomach channel] at the zong muscles. Yin and Yang meet at ST-30 Qichong which is connected with the zong muscles. The Stomach channel can control the Chong Mai and the zong muscles. All these belong to the Dai Mai: this vessel goes horizontally around the Du Mai, so when Yang Ming is empty, the zong muscles become weak, the Dai Mai fails to tighten them, the legs become weak and there may be paralysis. We have to treat the Stomach channel."Therefore, the Ancestral Muscle and the point ST-30 Qichong are strategic intersections of the Chong Mai, the Du Mai and the Dai Mai. In fact:

1. The Chong Mai emerges from the point ST-30 and controls the Ancestral Muscle, not only the rectus abdominis but also the erector spinae through its spinal branch.

2.The Du Mai flows in between the Ancestral Muscle of the back (erector spinae) and is encircled by the Dai Mai.

3.The Dai Mai encircles the Du Mai in the back and the Chong Mai and Stomach channel in the front.

Simple Questions

"The Chong Mai is the Sea of the 12 channels, it irrigates the rivers and valleys [i.e. channels and muscles] and it meets with the Bright Yang at the Ancestral Muscle, Yin and Yang channels meet here and converge at ST-30 Qichong which is on the Bright Yang. The Dai Mai and Du Mai also converge at this point. Thus when the Bright Yang is deficient the Ancestral Muscle is weakened, the Dai Mai does notfasten and Atrophy Syndrome results."

This statement is interesting because it sounds like the Ancestral Muscle is not only the rectus abdominis muscle but also the spinal muscles (erector spinae).

prescribes the use of the Bright-Yang channel to treat Atrophy Syndrome

"The Bright Yang is the Sea of the 5 Yin and 6 Yang organs, it irrigates the Ancestral Muscle which runs to the pubic bone and up the spine in the back."

To sum up, reinforcing the Dai Mai and the point ST-30 Qichong will promote the circulation of Qi in the Stomach channel downwards to the legs and upwards to the sinews and ligaments alongside the spine.

In order to strengthen the Dai Mai and the Stomach channel in Atrophy Syndrome (and multiple sclerosis), I use the opening and coupled points of the Dai Mai (G.B.-41 and T.B.-5 Waiguan) together with G.B.-26 (to tonify the Dai Mai itself), ST-30 Qichong and ST-36 Zusanli (to strengthen the Stomach), KI-11 Henggu (to strengthen the Chong Mai) and Du-4 Mingmen (to strengthen the Du Mai).

The most important channel to treat, therefore, is the Stomach because of its connection with the Chong Mai at ST-30 Qichong and also because it controls the Ancestral Muscle. When needling G.B.-26 Daimai, G.B.-27 Wushu and G.B.-28 Weidao the needling sensation should radiate down towards ST-30 Qichong.

Another symptom of the Dai Mai is abdominal pain that radiates to the lower back or vice versa, backache that radiates to the lower abdomen.

In terms of patterns, this pain may be due either to Liver-Qi stagnation or to Dampness

d) THE DAI MAI AND ABDOMINAL PAIN

The pain may be:

bilateral

or

unilateral

CLINICAL NOTE BOXIn order to treat this type of abdominal pain, I use the openingand coupled points of the Dai Mai (G.B.-41 and T.B.-5) together with G.B.-26 Daimai and BL-23 Shenshu.

d) THE DAI MAI AND ABDOMINAL PAIN

"Umbilical pain like a line with backache radiating to thighs".

To Ming Men

To thighs

"Pulse Classic"

"Lower abdominal pain [dong ku tong] radiating to the Ming Men, amenorrhoea in women or periods which stop and start, feeling of cold in the genital region, infertility, in men emissions".

Thus, to summarize:

-paralysis of legs-Backache-Abdominal pain and distension-Cold scrotum-Irregular periods-Dysmenorrhoea-Leukorrhoea-Paralysis from accident

It is interesting to note that the Dai Mai is in the middle of the body and its pathology is reflected in the top (headaches), middle (abdominal pain and leukorrhoea) and lower (cold-purple feet) part of the body.

Because of the gynaecological sphere of the Dai Mai, some authors say that the Dai Mai is energetically part of the Ren Mai, or atleast, that its pathology is included in that of the Ren Mai.

The Dai Mai is important in the treatment of some gynaecological complaints and particularly excessive vaginal discharge. The pathology of excessive vaginal discharge in the context of the Dai Mai is always due to Dampness which may be Full or Empty.

e) THE DAI MAI IN GYNAECOLOGY

In Full conditions, the excessive vaginal discharge is due to the Dai Mai being too tight so that Dampness accumulates in the Lower Burner with the characteristic feeling of heaviness.

In Empty conditions, the Dai Mai is too slack so that Spleen- and Kidney-Qi sink: this leads to the formation of Dampness and to very a chronic excessive vaginal discharge that is very resistant to treatment.

CLINICAL NOTE For a Full condition of excessive vaginal discharge use the opening and coupled points of the Dai Mai (G.B.-41 Zulinqi and T.B.-5 Waiguan) with G.B.-26 Daimai, Ren-3 Zhongji, ST-28 Shuidaoand SP-9 Yinlingquan.

CLINICAL NOTE For an Empty condition of excessive vaginal discharge use the opening and coupled points of the Dai Mai (G.B.-41 Zulinqi and T.B.-5 Waiguan) with G.B.-26 Daimai, Ren-6 Qihai, Ren-3 Zhongwan, ST-28 Shuidao, SP-9 Yinlingquan, BL-20 Pishu and BL-23 Shenshu.

In gynaecology, the Dai Mai is closely related to the Ren and Chong Mai; indeed, some authors say that the Dai Mai Deficiency pathology is secondary to a Deficiency of the Ren mai, while its Excess pathology is secondary to an Excess in the chong Mai

e) THE DAI MAI IN GYNAECOLOGY

f) FULLNESS AND EMPTINESS OF THE DAI MAI

The Dai Mai's pathology can be classified as Full or Empty: the Dai Mai is like a belt encircling the waist:

its Empty pathology occurs

when the belt is too slack.

its Full pathology

occurs when the belt is too

tight

DAI MAI

XU: Zong muscles slack, prolapse, herni