Introduction
The clinical application of the Eight Extraordinary Meridians in TCM diagnosis is a challenging area. Nowadays, it is rare for practitioners to proficiently use the twelve regular meridians for diagnosis, and even fewer are well-versed in the diagnosis of the extraordinary meridians. However, many complex and difficult conditions in clinical practice require the application of the extraordinary meridian diagnosis. The clinical value of the Eight Extraordinary Meridians is significant, and it is meaningful to summarize and explore the patterns of medication used.
I. Physiological Functions The Eight Extraordinary Meridians interconnect and traverse among the twelve regular meridians, exhibiting the following three physiological functions:1. Further enhancing the connection between the twelve regular meridiansThe Eight Extraordinary Meridians cross-connect with certain regular meridians during their course, thereby closely linking the interrelationships among the various meridians.2. Regulating the Qi and Blood of the twelve regular meridiansThe Eight Extraordinary Meridians are intricately distributed among the twelve regular meridians. When the Qi and Blood of the twelve regular meridians are abundant, they flow into the Eight Extraordinary Meridians for storage; when the physiological activities of the body require it or when the Qi and Blood of the twelve regular meridians are insufficient, the extraordinary meridians can “overflow” to nourish and supply the entire body. Li Shizhen in “Examination of the Eight Extraordinary Meridians” likens the extraordinary meridians to “lakes and marshes,” indicating their role in regulating Qi and Blood. The “Lingshu: On Reversal and Succulence” states that the Chong Mai (Penetrating Vessel) ascends to “nourish the Yang” and “supply the meridians,” while descending to “nourish the three Yin” and “inject into the collaterals,” further illustrating the extraordinary meridians’ function in regulating the Qi and Blood of the twelve regular meridians.3. Close relationship with organs such as the liver, kidneys, and the brain marrow, as well as the uterus in womenThe uterus and brain marrow are primarily connected to the extraordinary meridians, influencing each other physiologically and pathologically. For instance, the Chong, Ren, and Du meridians originate from the uterus and interconnect, forming a system of mutual regulation. They are also connected to the liver meridian and the reproductive organs in the pelvic cavity, thus closely related to women’s menstruation, pregnancy, and childbirth. II. Pathological Conditions The “Lingshu: On Meridians” classifies the diseases of the extraordinary meridians into two types: deficiency and excess. The occurrence of diseases depends on various pathogenic factors, while the development of diseases is based on the strength of the body’s righteous Qi and the pathogenic Qi, as well as their transformation.From the analysis of the symptoms of the Eight Extraordinary Meridians, excess conditions are often caused by external pathogens, improper diet, injuries, and phlegm-stasis leading to obstruction of Qi and Blood in the extraordinary meridians; deficiency conditions are mostly due to internal injuries from emotions, congenital insufficiency, acquired imbalances, or chronic diseases leading to depletion of essence and blood, resulting in organ dysfunction.Under certain conditions, these can transform into mixed deficiency and excess conditions. The symptoms of the Eight Extraordinary Meridians are discussed in detail in related chapters, and here we will summarize them for a preliminary understanding.1. Du Mai (Governing Vessel) DisordersExcess conditions:Lower back pain, headache, neck stiffness, stroke, opisthotonos, epilepsy, mania, spasms of hands and feet, urinary retention, etc.Deficiency conditions: Heaviness of the head, dizziness, shaking of the head, tremors, stooping, weakness of limbs, frequent yawning, forgetfulness, low intelligence, etc.2. Ren Mai (Conception Vessel) DisordersExcess conditions:Pain in the genital area or penis, hematuria, dysentery, hiccups, hernia in men, pelvic masses in women, etc.Deficiency conditions: Women with cold and deficiency of the uterus leading to infertility, threatened miscarriage, irregular menstruation, uterine prolapse, etc.; men with impotence, premature ejaculation, nocturnal emissions, etc.3. Chong Mai (Penetrating Vessel) DisordersExcess conditions:Chest and abdominal pain, gastrointestinal spasms, abdominal distension with Qi counterflow, retention of the placenta, etc.Deficiency conditions: Women with irregular menstruation, threatened miscarriage, infertility, metrorrhagia, etc.; men with impotence, azoospermia, or oligospermia, etc.4. Dai Mai (Belt Vessel) DisordersExcess conditions: Pain in the lower back and groin, herpes zoster, leukorrhea, etc.Deficiency conditions: Lower limb paralysis, weakness of the abdominal muscles, hernia, and excessive leukorrhea in women, etc.5. Yang Qiao Mai (Yang Heel Vessel) DisordersExcess conditions: Stiffness and pain in the lower back, spasms of the lower limbs, foot eversion, red and painful eyes, headache, etc.Deficiency conditions: Insomnia, pain in the brow ridge, epilepsy, numbness of hands and feet, etc.6. Yin Qiao Mai (Yin Heel Vessel) DisordersExcess conditions: Epilepsy, spasms of the lower limbs, foot inversion, constipation, lower abdominal pain, etc.Deficiency conditions: Drowsiness, globus sensation, borborygmi, dribbling urination.7. Yang Wei Mai (Yang Linking Vessel) DisordersExcess conditions: Chills and fever, swelling and pain in the joints, headache, red and painful eyes, etc.Deficiency conditions: Night sweats, pain in the brow ridge, heat in the palms and soles, numbness, heel pain, coldness in the knees, etc.8. Yin Wei Mai (Yin Linking Vessel) DisordersExcess conditions: Chest and epigastric fullness and pain, lateral costal pain, herpes zoster, gastroesophageal reflux, etc.Deficiency conditions: Heart pain, borborygmi, prolapse of the rectum, etc.
III. Characteristics of Symptoms and Key Points in Medication The Eight Extraordinary Meridians are intricately distributed among the twelve regular meridians, and their functions mainly have two aspects.Firstly, they facilitate communication between the twelve regular meridians;Secondly, the Eight Extraordinary Meridians regulate the accumulation and infusion of Qi and Blood in the twelve regular meridians.Thus, it can be seen that the twelve regular meridians are interconnected by the Eight Extraordinary Meridians, allowing the Qi of the three Yin and three Yang organs and meridians to flow together, achieving a state of normal physiological function where the Qi of the organs and meridians is mutually contained. (1) Predominance of Deficiency Conditions, with Supplementation as the Core Treatment Physiologically, the extraordinary meridians communicate with the regular meridians, store and transport Qi and Blood, connect the organs, facilitate upward and downward flow, and regulate Qi dynamics. The Qi and Blood of the extraordinary meridians flow into them after being abundant in the twelve regular meridians, nourishing the twelve regular meridians and regulating the Yin-Yang Qi and Blood of the body. The “Nanjing: Twenty-Eighth Difficulties” states: “When the pulse is strong, it enters the Eight Meridians, but does not circulate around.”“Examination of the Eight Extraordinary Meridians” further clarifies that the Qi that overflows from the twelve regular meridians enters the extraordinary meridians, irrigating them, warming the organs internally, and moistening the skin externally… The regular meridians are like canals, while the extraordinary meridians are like lakes and marshes; when the regular meridians are abundant, they overflow into the extraordinary meridians.”Therefore, various reasons leading to the diseases of the Eight Extraordinary Meridians often result in Qi depletion, with deficiency being predominant, or a mix of deficiency and excess, while pure excess conditions are rare. This is determined by the physiological characteristics of the extraordinary meridians. Pathologically, if the organs are diseased and there is prolonged deficiency without recovery, leading to depletion of essence and blood, the extraordinary meridians will inevitably lack nourishment, and the organs will not be warmed, resulting in weakness and deficiency diseases.“The Eight Meridians are subordinate to the liver and kidneys”; when the liver and kidneys are deficient, leading to depletion of essence and blood, it will inevitably affect the extraordinary meridians, i.e., “damage to the lower source will inevitably affect the Eight Meridians”; “when the liver blood and kidney essence are harmed, it leads to the extraordinary meridians lacking the strength to function”; “when there is disease in the liver and kidneys, it will inevitably affect the Eight Extraordinary Meridians.”Generally, chronic and frequently occurring diseases are often due to “disorder of the Eight Meridians,” “instability of the extraordinary meridians,” and “emptiness of the Eight Meridians.” Treatment should focus on promoting the flow of the extraordinary meridians, stabilizing them, and replenishing the lower jiao. The “Suwen: On Yin and Yang Correspondences” states: “For those with insufficient form, warm them with Qi; for those with insufficient essence, supplement them with flavor.” Diseases of the extraordinary meridians often involve insufficient form and Qi, and depletion of essence and marrow. Common medications may not yield remarkable effects.As Ye Tianshi stated: “If physicians do not understand the principles of the Eight Meridians, they can only point to deficiency, just like the hard and soft properties of cinnamon and earth, which are not the methods for treating the extraordinary meridians.” “Herbs and medicines are all devoid of emotion and cannot treat the fatigue of essence and blood.” “Using emotionless herbs for supplementation will not resonate with the essence and Qi.”Ye Tianshi, inspired by the theories of predecessors that “the Eight Extraordinary Meridians are all subordinate to the lower” and “the supplementation of essence and blood must involve emotional substances,” advocated for using blood and flesh products to nourish the extraordinary meridians directly, replenishing the essence and blood of the extraordinary meridians. Blood and flesh products are all spiritually rich and can not only nourish the foundation but also often achieve remarkable effects in treating the diseases of the extraordinary meridians.In the application of blood and flesh products in the diseases of the extraordinary meridians, they should be used to supplement without stagnation, integrating flow with supplementation.Among blood and flesh products, turtle and deer products are most commonly used. The “Compendium of Materia Medica” states: “The turtle’s head often hides towards the abdomen, which can open the Ren Mai; thus, its shell is used to nourish the heart, kidneys, and blood, all for nourishing Yin.”“The deer nose often points towards the tail, which can open the Du Mai; thus, its antlers are used to nourish life, essence, and Qi, all for nourishing Yang.” Commonly used deer antler, deer horn, deer horn glue, and deer horn powder treat disorders of the Du Mai, “deer antler strengthens the Yang of the Du Mai, and deer horn powder opens the Qi of the Du Mai.” Deer horn glue paired with deer antler replenishes the blood of the Du Mai and strengthens its Yang, treating the deficiency of the Du Mai with cold back and sore lower back; when it comes to supplementation, it should be integrated with flow, and when it comes to flow, it should be supplemented, aligning with the principles of Yin and Yang opening and closing.” As Li Shizhen stated: “In ancient times, when using tonifying herbs, one must also drain evil; when the evil is removed, the tonifying herbs will be effective; this is the subtlety of one opening and one closing.” Ye Tianshi deeply understood the importance of smoothness in the extraordinary meridians, using bitter and spicy herbs to facilitate flow and combining them with aromatic substances to reach the orifices and traverse the meridians, thus smoothing the extraordinary meridians.He believed that “for the solid conditions of the extraordinary meridians, ancient practitioners must have used bitter and spicy herbs combined with aromatic substances to open the meridians; for the deficient conditions, they must use warm tonics with sweet and spicy properties, assisting in the flow of the meridians, ensuring the harmony of Qi and Blood, leading to recovery.” When applying the methods of promoting flow, he emphasized the use of gentle and Yang tonics and sweet and spicy warm tonics, allowing the treatment of the diseases of the extraordinary meridians to integrate supplementation with flow, preventing excessive flow that depletes the righteous Qi.Ye Tianshi proposed that “gentle and Yang tonics promote the extraordinary meridians without stagnation”; “for the Chong and Ren extraordinary meridians that are internally weak, it is advisable to solidify and supplement while also promoting the flow of the extraordinary meridians.” He emphasized that while supplementing, it is important to ensure the smooth flow of Qi and Blood, stating: “It must be sweet and spicy warm tonics, assisting in the flow of the meridians, ensuring the harmony of Qi and Blood,” with commonly selected flow-promoting substances including Chuan Lian Zi (Sichuan Chinaberry), Yan Hu Suo (Corydalis), Dang Gui Wei (Angelica Tail), Xiang Fu (Cyperus), Yu Jin (Turmeric), Wu Yao (Lindera), Jiang Xiang (Sandalwood), San Leng (Sparganium), and E Zhu (Curcuma). IV. Ye Tianshi’s Principles of Medication for the Extraordinary Meridians Ye Tianshi’s elaboration on the treatment of the extraordinary meridians is highly representative. His treatment often emphasizes the extraordinary meridians, using the methods of promoting flow and supplementation, thus expanding the scope of treatment for extraordinary meridian disorders. Scholars have summarized Ye’s principles of medication for the extraordinary meridians as follows. Du Mai: As the sea of Yang meridians, it plays a supervisory and governing role.The treatment of the Du Mai is focused on the Shaoyin, hence historically, the treatment of Du Mai disorders has often centered on replenishing essence and marrow, especially noted since the Ming and Qing dynasties. Li Shizhen in the “Compendium of Materia Medica” stated that deer is “a pure Yang creature that promotes longevity and can open the Du Mai,” particularly valuing deer antler and spinal marrow for their functions of “nourishing essence, replenishing marrow, nourishing blood, and strengthening Yang.”Ye Tianshi stated: “Deer is Yang in nature and enters the Du Mai.” Deer antler, deer, and deer horn powder are the main medicines, along with others such as Zi He Che (Human Placenta), lamb, pig bone marrow, sheep bone marrow, goji berries, cinnamon, Huang Qi (Astragalus), and sheep kidneys. Ren Mai: As the sea of Yin meridians, it plays a role of responsibility, with the Ren Mai primarily treating disorders in the Jueyin. Turtle shell is the main medicine.Li Shizhen stated: “Turtle is Yin in nature and enters the Ren Mai; it can open the Ren Mai.” Ye Tianshi further emphasized “blood and flesh filling Yin” and included Bie Jia (Soft-shelled Turtle), Ejiao (Donkey-hide Gelatin), Yu Jiao (Fish Gelatin), and other warming substances like Zi He Che, Ai Ye (Mugwort), and Zi Shi Ying (Purple Quartz) to warm the uterus; nourishing the kidneys and lowering fire, with medicines like Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron, Rehmannia), etc.Other medicines include Ejiao, Bie Jia, Yu Jiao, and others like raspberry, Dan Shen (Salvia), Zi He Che, Ai Ye, etc. Chong Mai: As the sea of blood, Ye Tianshi stated: “When the disease is in the Chong Mai, it is treated from both Jueyin and Yangming.” Purple quartz is the main medicine.Other medicines include Shu Di Huang (Rehmannia), goji berries, Sha Yuan Zi (Astragalus), Wu Wei Zi (Schisandra), Zhi Shi (Bitter Orange), Rou Cong Rong (Cistanche), Dang Gui, Zi He Che, Bie Jia, Du Zhong (Eucommia), Shan Yao (Chinese Yam), Dan Shen, Ba Jitian (Morinda), Bai Zhu (Atractylodes), Lian Zi (Lotus Seed), Chuan Xiong (Ligusticum), Fu Zi (Aconite), Xiang Fu, Mu Xiang (Saussurea), Wu Zhu Yu (Evodia), Huang Qin (Scutellaria), Huang Bai (Phellodendron), Ai Ye, etc.Dai Mai: It plays a restraining role. Ye stated: “If the meridian is loose and the Qi disperses without restraint, it must be drawn back to solidify it; the Zhen Ling Dan is effective in this regard, promoting flow and solidifying the lower part, ensuring it does not receive excessive cold or heat.” The Zhen Ling Dan consists of Yu Yu Liang, Chi Shi Zhi, Zi Shi Ying, Zhi Shi, Ru Xiang (Frankincense), Mo Yao (Myrrh), and Wu Ling Zhi (Flying Squirrel). Other medicines include Dang Gui, Ika (Cuttlefish Bone), Long Gu (Dragon Bone), Mu Li (Oyster Shell), Shu Di Huang, Bai Shao (White Peony), Wu Wei Zi, Lian Zi, Huang Bai, Huang Qin, Ai Ye, etc. Wei Mai: It plays a connecting role, divided into Yang Wei and Yin Wei.