By: Charles Chace
The first systematic discussion of the extraordinary vessels in Chinese herbal medicine appears in Li Shizhen’s 李時珍Exposition on the Eight Extraordinary Vessels (Qijing bamai Kao 奇經八脈考, circa, 1576).In our forthcoming translation and commentary on this text, Exposition on the Extraordinary Vessels, Acupuncture, Alchemy and Herbal Medicine, Eastland Press, 2009, my co-author Miki Shima and I describe Li’s approach to herbal prescribing as an overarching “meta-diagnosis” encompassing a wide range of possible zangfu presentations. For instance, Li Shizhen considers any disease characterized by masses or accumulations in the lower burner that presents in conjunction with an ascending counterflow to the upper burner to be a disorder of the chong vessel. This might present in the context of number of possible disease or zangfu patterns, but for Li the simultaneous presence of stagnation in the lower burner and counterflow extending to the upper burner define it as chong vessel problem. This is, I believe, the most pragmatic way to make use of the extraordinary vessels in herbal medicine
At its best, this meta-diagnosis interpretation of extraordinary vessels provides a means of defining the overall pathodynamics involved in complex pattern presentations. It also provides an alternative perspective to the familiar zangfu or shanghan patterns that can facilitate more creative and effective prescribing. In this, the meta-diagnosis interpretation speaks to one of the core questions surrounding extraordinary vessel herbal prescribing. If an extraordinary vessel diagnosis does not in itself constitute a comprehensive diagnosis and a more detailed pattern differentiation is still necessary, then why bother with the extraordinary vessels at all?
In some instances, an extraordinary vessel diagnosis in herbal medicine is inarguably irrelevant, a spurious addition an already comprehensive diagnosis and treatment strategy. For me, this makes the question of extraordinary vessel herbal prescribing that much more intriguing, particularly when one considers who it was that most fully developed Li Shizhen’s ideas in clinical practice. Ye Tianshi (業天士) is among the most influential physicians in the history of Chinese medicine, and the writings attributed to him are nothing if not clinically based. That Ye made such extensive use of the extraordinary vessels suggests to me that I would do well to consider the matter carefully before coming to any definitive conclusions regarding their merits in herbal prescribing.
Like Li Shizhen, Ye clearly typically employed the extraordinary vessels as a meta-diagnosis. Also like Li, he employed a wide range of therapeutic strategies for addressing extraordinary vessel pathologies. These ranged from astringing, and using shells to restrain the yang, to eliminating qi constraint and blood stasis to name just a few. The seeds of such strategies are all evident in Li Shizhen’s Exposition on the Eight Extraordinary Vessels. Nevertheless, it is safe to say that although Ye did not actually invent any extraordinary vessels treatment strategies, they all found their fullest expression in his hands.
One approach that appears in Li’s Comprehensive Materia Medica (Ben Cao Gang Mu 本草綱目) but which is conspicuously absent from the herbal discussions in his Exposition on the Eight Extraordinary Vessels is based on the premise that the extraordinary vessels are often associated with deep essence insufficiencies, and that these deficits are most amenable to treatment using animal products. Ye took this idea and ran with it to the extent that it became one of the defining characteristics of his extraordinary vessel therapeutics. Although no one treatment strategy appears in all of Ye’s extraordinary vessel cases, the use of animal products to treat extraordinary vessel insufficiencies is present in many of them, although they are invariably p administered in the context of a specific diagnostic framework.
The two cases by Ye Tianshi that follow are excerpted from a chapter on him in Exposition on the Extraordinary Vessels, Acupuncture, Alchemy and Herbal Medicine. Both cases illustrate the principle of a meta-diagnosis, and the use of animal products in treating the extraordinary vessels. The first case illustrates the use of astringing methods in the treatment of ren and du pathology. According to ye, plant-based tonification is insufficient to influence the extraordinary vessels and animal products are needed to get the job done.
Many, if not most of the questions that arise in reading pre-modern Chinese medical literature are unanswerable in any definitive sense. In addressing such questions in our book, Miki and I adopted a novel approach. Rather than suggesting our own interpretations as to what we think it might mean, we instead discuss the questions that a clinician must ask of the text in order to make their own decisions as to how they might make clinical use of the material. In this, we hope to foster an open and creative approach to engaging the pre-modern medical literature. The above two cases are presented in this spirit. In many ways, they raise more questions than they answer. Along, with Jason’s translation of Ye Tian-Shi’s Pattern Differentiation and Treatment of the Eight Extraordinary Channelss article, I’m hoping that this opens a dialogue on the relevance of the extraordinary vessels in herbal prescribing on this website.