The case of Tang: Right, posterior rib pain radiating to the low back and hip producing aversion to cold and icy-cold extremities. [The patient was so cold that] it took a long time to get the patient warm. This was a lack of movement of qi and blood within the vessels and networks, culminating in congealed cold producing pain that was an obstruction pattern of the vessels and networks and is understood in the context of a yang wei and yin wei disease.

Cervi Cornu degelatinatum (lu jiao shuang)
Foeniculi Fructus (xiao hui xiang)
Angelica sinensis Radix (dang gui)
Sechuan Cinnamomi Ramulus (gui zhi)
Astragali complanati Semen (sha yuan zi)
Poria (fu ling).[i]

Translated by: Charles Chace

Original Chinese: 唐（嶇）右後脅痛連腰胯。 發必惡寒逆冷。 暖護良久乃溫。 此脈絡中氣血不行。 遂至凝塞為痛。 乃脈絡之痹症。 從陽維陰維論病鹿角霜， 小茵香， 當歸， 川桂枝， 沙苑， 茯苓

Commentary: This case involves a yang wei disorder presenting as rib side pain radiating to the low back and hip, the supple, warm, essence-nourishing Cervi Cornu degelatinatum (lu jiao shuang) is added to the primary treatment method of opening the yang to harmonize the networks. In general, the drugs in this prescription enter the liver and kidney channels while Cinnamomi Ramulus (gui zhi) opens the yang qi in the foot greater yang.

For further reading, please view the intro to this case, Herbs & the Eight Extraordinary Vessels and Ye Tian-Shi & the Eight Extraordinary Channels.

[i] This case record appears in another anthology containing case records attributed to Ye Tian-Shi (葉天士), 2004i, Combined Case Records of Three Physicians (San jia yi an’ he ke 三家醫案合刻), juan 1, Minor Construct the Middle Decoction (xiao jian zhong tang 小建中湯), juan 7, “Obstruction” (bi 痹).

The ren vessel and du vessel divide and travel to the anterior and posterior aspects of the body. The spontaneous appearance of a steaming fever and spontaneous [seminal] emissions without dreams indicate that all of these extraordinary channels are deficient. Acrid, moistening herbs are quite effective. Administration of Six-Ingredient Pill [with Rehmannia] (liu wei di huang wan) with the addition of Schizandrae Fructus (wu wei zi) was inappropriate.

The medicinals in this prescription would simply run through the patient [presumably causing diarrhea] and so would be unable to control the extraordinary vessels. Hence, the plan was to use methods of accumulating the essence, and securing it.

Mantidis Ootheca (sang piao xiao), Testudinus Plastrum (gui ban), Euralyes Semen (qian shi), Tribuli Fructus (ci ji li), Testudinus Plastri Colla (gui ban jiao), Coptidis Rhizoma (huang lian), Fossilia Ossis Mastodi (long gu), Rosae laevigatae Fructus (jin ying zi), Rubi Fructus (fu pen zi).[i]

Translated by: Charles Chace

For further reading, please view the intro to this case, Herbs & the Eight Extraordinary Vessels and Ye Tian-Shi & the Eight Extraordinary Channels.

[i] This case record appears in another anthology containing case records attributed to Ye Tian-Shi (葉天士), 2004i, Combined Case Records of Three Physicians (San jia yi an’ he ke 三家醫案合刻), juan 1, Minor Construct the Middle Decoction (xiao jian zhong tang 小建中湯)

Original Chinese: 任脈、 督脈， 分行乎身之前後， 自覺熱蒸， 不夢自遺， 皆奇經虛也。 辛濕藥頗效。 六味加五味於不應方藥僅僅達下， 未能約束奇經， 議用聚精固攝之法。 桑嫖峭， 龜板，熒實, 刺蒺藜 線魚膠, 胡連 龍骨, 金櫻子, 覆盆子

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.

Case 1 (Deficinecy of all Extraoridnary vessels)

Case 2 (The treatment of pain using yang wei and yin wei)

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. 

Original Case by: Ye Tian-Shi

A woman was postpartum for over 10 years. When her disease broke out there was a droopy head, painful spine, sagging vertebral qi, heart pain[1], and a cold sweat. This was a du and ren vessel qi disharmony and loss of use of the qiao and wei vessel, and the five yin fluids were completely dried up. In this type of situation plant-based medicinals are ineffective, being unable to treat the exhausted essence and blood. One must use flesh and blood medicinals to fill and nourish, while aiming to unblock and tonify the eight extraordinary channels.

Prescription:

Cervi Cornu pantotrichum (lù róng)
Cervi Cornu degelatinatum (lù jiâo shuäng)
Cervi Cornus Colla (lù jiâo jiäo)
Angelicae sinensis Radix (däng guï)
Poria (fú líng)
Lycii Fructus (gôu qî zî)
Platycladi Semen (bâi zî rén)
Astragali complanati Semen (shä yuàn zî)
Eucommiae Cortex (dù zhòng)
Dipsaci Radix (xù duàn)

Commentary:

Mr. Ye thought that:

1. The eight extraordinary channels belong to the Liver and Kidneys” 2. If the Liver and Kidneys are timid[2] and not secure, then the eight channels will fail to perform their duty” 3. If there is harm to the Liver and Kidney’s essence qi, this will lead to the eight extraordinary channel’s lacking their applying force” 4. If the Liver and Kidneys are damaged, then the eight channels will have no qi” 5. If the lower base is depleted this will put strain on the eight channels.”

All these phrases say that if the Liver and Kidney have chronic damage then the eight extraordinary channels must be involved. Because “the du vessel governs the body’s control and conserving,” it is said that the du vessel masters the yang of the body. That is to say that the du vessel exercises control and conserving of the whole body’s yang qi. If the du vessel is deficient then this can give rise to lower back soreness and sagging. Therefore, a disease involving damage to the du vessel also can drag in the lower base, Liver, and Kidney.

Within treatment, “if one desires to nourish[3] the yin essence and would not like it to leak out, then one should use the idea of ascending and securing the qi of the eight channels”, “Liver and Kidney lower body disease will certainly linger in the eight extraordinary channels. If one does understand this then they will get no effect with their treatment.”

Therefore, one may see various kinds of lower source essence and blood insufficiency disease patterns. Mr. Ye not only thought that these are attributed to Liver and Kidney deficiency, but also went a step further implicating the eight channels receiving damage, leading to deficiency timidity.

Therefore in this case he employed the idea that “in chronic disease it is suitable to unblock the ren and du.”

Therefore, within the prescription he selected soft yang medicinals, such as, Cervi Cornu pantotrichum (lù róng) to invigorate the yang of the du vessel, Cervi Cornu degelatinatum (lù jiâo shuäng) to unblock the qi of the du vessel. Cervi Cornus Colla (lù jiâo jiäo) to tonify the blood of the du vessel, Platycladi Semen (bâi zî rén) to cool the Heart in order to boost the Kidneys, the warm and moist Lycii Fructus (gôu qî zî) is combined with the light and quick Astragali complanati Semen (shä yuàn zî) entering the collaterals of the Liver, Poria (fú líng) is bland and leeches out. These medicinals are a modified Striped Dragon Pill (ban long wan). This formula principally uses medicinals with affinity to flesh and blood, which tonifiy the essence and blood without causing stagnating.

Translated by: Jason Blalack

For more information please see, Ye Tian-Shi & the Eight Extraordinary Channels.

Original Chinese: 案一  某，产后十年有余，病发必头垂脊痛，椎气坠，心痛，冷汗。此督任气乖，跷维皆不用，是五液全涸。草木药饵总属无情，不能治精血之惫，故无效。当以血肉充养，取其通补奇经。处方：鹿茸、鹿角霜、鹿角胶、当归、茯苓、杞子、柏子仁、沙菀、生杜仲、川断。

[1] 心痛 (xin tong)- this may refer to epigastric pain here.

[2] 怯 (qie)- this may have more of a meaning of “not full”.

[3] 涵 (han) possible meaning of “contain” here.

Zhou was a 17-year-old unmarried girl with menstrual irregularities. Her menses were sometimes early and sometimes late. Prior to her menses she had abdominal pain that was worse than normal, and her intake of food and drink was greatly reduced. This problem started at the beginning of summer, and going into autumn her lower burner was often cold. There were abdominal sounds, and alternating diarrhea and constipation. The examination revealed that she easily had depressed anger without any real reason. This was Liver qi tending towards horizontal [attack], in which the Stomach first was harmed. The chong, ren, qiao, and wei channels all belong to the Liver and Kidney. The channels were not circulating properly, and the qi and blood was gradually becoming blocked, leading to obstruction. If there is a lack of flow there must be clumping with mobile abdominal masses, accumulations of strings and aggregations (a kind of abdominal masses).

Prescription:

Crataegi Fructus (shan zha)
unprocessed Cyperi Rhizoma (sheng xiang fu)
Corydalis Rhizoma (yan hu suo)
Angelicae sinensis Radix (dang gui)
Citri reticulatae viride Pericarpium (qing pi)
Sparganii Rhizoma (san leng)
Atractylodis macrocephalae Rhizoma (bai zhu)
Achyranthis bidentatae Radix (niu xi)
Toosendan Fructus (chuan lian zi)
Lycopi Herba (ze lan)
Cinnamomi Cortex (rou gui)
Foeniculi Fructus (xiao hui xiang)
made into pills with the juice of Allii fistulosi Bulbus (cong bai)

Commentary: Ye Tian-Shi said,

the 12 channels travel through the body like ditches with circular flow and without limit, only the eight extraordinary channels are like canals, if they are overflowing they become like deep rivers, which is not the same as how the 12 normal channels flow.”

To briefly elaborate “the eight extraordinary channels are not limited like the normal 12 channels.” Concerning the physiology of the eight extraordinary channels Mr. Ye thought that they gather and contain essence qi, regulate the normal channel’s qi and blood, connect and join, protect, and the function of lifting up the body and bones. The disease is due to a disturbance in the chong and ren disrupting the Liver and Stomach, leading to chaotic qi counterflow of the Liver and Stomach and Liver and Stomach disharmony. If the menses are unable to come on time, and conversely remaining internally and following the movement of the uterine vessels, this will often lead to mobile abdominal masses.

When this is happens one must attack the accumulation, expelling and driving out stasis. This not only causes the eight extraordinary channels to flow smoothly, but also can flush away lodged stasis, preventing mobile abdominal masses. The principal method was to disperse, descend, warm, and unblock, when using an attacking method it is most suitable to use a moderate and roundabout method. Therefore Mr. Ye used the school of thought of using medicinals to promoting the movement of qi, attacking accumulation and driving out stasis. This was used to prevent further complications by reducing accumulation in the early stages.

For further reading on understanding Ye Tian-Shi’s eight extraordinary channel application, check out: Ye Tian-Shi’s Pattern Differentiation and Treatment of the Eight Extraordinary Channels.

Translated by: Jason Blalack

Ye Tian-Shi was one of the most influential doctors in Chinese medical history in developing clinical applications of the eight extraordinary channel herbal theory. Following is a translated excerpt that summarizes some of the core ideas that he used. Following this piece will be numerous case studies demonstrating these principles in action.

Ye Tian-Shi’s Pattern Differentiation and Treatment of the Eight Extraordinary Channels

Ye Tian-Shi used eight extraordinary channel theory in 165 recorded cases. Case Records as a Guide to Clinical Practice (lin zheng zhi nan yi an) contained 134 of these, with 89 internal medicine cases and 45 gynecologic cases. The remaining 31 cases appear in Master Ye’s Genuine Collected Case Records (ye shi yi an cun zhen), in which the majority are of internal medicine diseases. The disease types include deficiency consumption, seminal emissions, mounting disorders, atrophy, chronic malaria, chronic dysentery, turbid painful urinary disorder, insomnia, various pain patterns, menstrual disorders, vaginal discharge, and postpartum diseases. In differentiating the eight extraordinary channel disease patterns, Ye thought that one needed to distinguish between excess and deficiency; however the majority of cases are from deficiency.

Most of the eight extraordinary channel deficiency patterns are due to 1) damage to the Spleen and Stomach and Liver and Kidney yin, blood, essence, and qi, and 2) inability of the essence and blood to spread and distribute.”

These patterns are commonly seen in seminal emissions, irregular menses, flooding and leaking, vaginal discharge, internal damage fever, lower base debilitation, and perished complexion and spirit. For example, chronic infertility and irregular menses are often from “Liver, Kidney, chong, and ren damage”; “fever and chills occurring with taxation leading to disease” is “yang wei channel debilitation, unable to manage the connecting and extending, guarding and protective, and keeping one upright.” Putrid turbid urination is “a disease that has already entered the ren and du,” while insomnia is “emptiness in the yang qiao holes,” etc.

If there is an eight extraordinary channel pattern with simultaneous cold in the lower part of the body, then this belongs to an eight extraordinary yang deficiency pattern. If there is simultaneous irritability and restlessness with internal heat, then this belongs to an eight extraordinary yin deficiency pattern.

In regard to extraordinary channel excess patterns, his predecessors did not discuss this that much and it was Master Ye who really developed these ideas bringing them into our awareness. He thought that the majority of these excess patterns were brought about from qi and blood obstruction in the eight extraordinary channels. This is commonly seen in men’s bulging qi disorders and women’s irregular menses, painful menses, postpartum abdominal pain, and mobile abdominal masses.

In treatment, Ye pointed out that,

“When a patient was suffering from excess bind of the eight extraordinary channels, our ancestors certainly used bitter, acrid, and fragrant medicinals in order to unblock the channels and collaterals; in patients with [simultaneous] deficiency they certainly used acrid, sweet, warm, and tonifying medicinals with assistance from medicinals that spread and promote movement in the channels and collaterals. Therefore, one should regulate and harmonize the qi and blood, to cure the disease.”

Ye believed that treating eight extraordinary channel patterns is much different than treating normal channel disease patterns. Even if tonifying deficiency when treating excess, one always needs to incorporate the method of “unstopping what is blocked.” He said

“When the eight extraordinary channels are diseased the method of treatment is to unstop what is blocked. This is usual practice from ancient sages.” This so-called “unstop what is blocked” method actually refers to the method of circulating qi and blood and dispersing and promoting movement in the channels and collaterals.

Mr. Ye also believed that eight extraordinary channel deficiency patterns should be treated differently than ordinary deficiency detriment diseases. He thought that “Physicians that do not know the physiology of the eight extraordinary channels and just regard their patients with basic deficiency, giving hard medicinals such as Cinnamomi Ramulus (guì zhï) and Aconiti Radix lateralis preparata (zhì fù zî),  or soft medicinals, such as Rehmanniae Radix preparata (shú dì huáng) and Schisandrae Fructus (wû wèi zî), are not obtaining the method for the treatment of the eight extraordinary channels.” Mr. Ye emphasized that within tonifying one must combine unblocking and regulating, which will unblock the channels and collaterals. “One should regulate and harmonize the qi and blood, to cure the disease.” In eight extraordinary channel excess patterns, one must use acrid, fragrant, penetrating, and discharging medicinals to relax and unblock the channels and collaterals. In these situations, insects and worms are often used to disperse and spread out obstruction. In those that are relatively mild, Mr. Ye commonly used Xu Shu-Wei’s jiao jia san (Mutually Augmenting Powder). jiao jia san (Mutually Augmenting Powder) contains Rehmanniae Radix (shëng dì huáng) to nourish the blood and moisten dryness and Zingiberis Rhizoma recens (shëng jiäng) which is acrid, moistening, and circulating[1]. This is a “bitter acrid paired formula.”

When he encountered patterns of deficiency complicated with excess in the eight extraordinary channel diseases, he would lay particular stress on using a method of simultaneously unblocking and tonifying. If the eight extraordinary channels are depleted and there is static blood obstructing the collaterals then Mr. Ye thought

“If one follows a securing and tonifying [method] but does not use an unblocking and regulating [medicinals], there is a fear that the treatment will be too enriching and lead to distention and swelling.”

Therefore he advocated tonifying with flesh and blood as well as unblocking with aromatic medicinals in order to achieve the goal of “lifting the body and bones, harmonizing and nourishing the channels and collaterals.”

Case 1 – Eight Extraordinary Deficiency (droopy head, painful spine, sagging vertebral qi, heart pain, and a cold sweat)

Case 2 – Coming Soon

Case 3 – Menstrual irregularities (8 Extra-Excess)

[1] The juice of each medicinal was originally used.