Introduction The Eight Extraordinary Meridians refer to the eight meridians outside of the twelve regular meridians, including Ren Mai (Ren Meridian), Du Mai (Du Meridian), Chong Mai (Chong Meridian), Dai Mai (Dai Meridian), Yin Qiao Mai (Yin Heel Meridian), Yang Qiao Mai (Yang Heel Meridian), Yin Wei Mai (Yin Linking Meridian), and Yang Wei Mai (Yang Linking Meridian). The term “extraordinary” indicates their distinct nature. Unlike the twelve regular meridians, they do not directly connect to the organs and do not have a paired relationship. However, they play a crucial physiological role in the meridian system, and dysfunction of these eight meridians can lead to changes in multiple systems. Therefore, sufficient attention should be given to the Eight Extraordinary Meridians.Shen QingfaShanghai University of Traditional Chinese Medicine • Ye Tianshi’s understanding of the Eight Extraordinary Meridians builds upon the theories of various schools and develops through clinical practice. For example, “Chronic illness must involve Ren and Du” and “The Eight Meridians are subordinate to the liver and kidneys” are widely applied in various diseases. “In gynecological diseases, Chong and Ren are the most important,” which has significant guiding implications in gynecological disorders. • Analyzing all of Ye Tianshi’s clinical cases regarding the treatment of diseases with the Eight Extraordinary Meridians, each of Chong, Ren, Du, and Dai has a primary herb. This is what is stated in the postpartum section of the “Guidelines”: “For diseases of the Chong Meridian, use Zishi Ying (Purple Quartz) to calm the counterflow; for diseases of the Ren Meridian, use Gui Ban (Tortoise Shell) to stabilize; for diseases of the Du Meridian, use Lu Jiao (Deer Antler) to warm; for diseases of the Dai Meridian, use Dang Gui (Angelica Sinensis) to nourish.”
Why are the Eight Meridians called extraordinary? Ye Tianshi (hereinafter referred to as Ye) states in the “True Records of Ye’s Medical Cases” (hereinafter referred to as “True Records”): “The twelve meridians are like channels that rotate and circulate endlessly, while the extraordinary meridians are like ditches that overflow into deep rivers, not running parallel to the twelve meridians.” He summarizes: “The Eight Extraordinary Meridians are not bound by the twelve meridians” and “The Du Meridian runs along the back, while the Dai Meridian horizontally binds at the waist, serving as the framework for the entire body.”
Understanding
Ye’s analysis of the Eight Extraordinary Meridians is based on the pathways and symptoms recorded in the “Nan Jing” (Classic of Difficulties), combined with long-term clinical practice. For instance, regarding the Chong Meridian, since it governs menstrual fluid, which originates from blood produced by the spleen and stomach, Ye points out: “The Chong Meridian is subordinate to Yangming” (as stated in the “Clinical Guidelines”, Shen’s case in the regulation of menstruation), “Whenever menstrual fluid arrives, it must begin with the Chong Meridian; this meridian is governed by the Stomach Meridian” (as stated in the “Guidelines”, Zhao’s case in the regulation of menstruation). Ye also states: “When the Chong Meridian ascends, it invades the Stomach, causing vomiting.” He believes that infertility or irregular menstruation is related to the Chong Meridian. Because “the sea of blood is the Chong Meridian; men store essence, and women are connected to the womb; infertility and menstrual irregularities are due to the disease of the Chong Meridian.” Since the Chong Meridian is the key among the twelve meridians and is the sea of meridians, Ye states: “If the Chong Meridian moves, all meridians move,” and “During vomiting, the entire body is pulled down to the soles of the feet, and the Yin and Yang Qiao Meridians cannot stabilize, leading to a complete breakdown” (as stated in the “Guidelines”, Xi’s case).
Ye believes that the Ren Meridian governs the womb, and the nourishment of the womb is also under the control of Yangming. “Both the Chong and Ren are the sea of blood, both governed by Yangming,” he states, “The Ren Meridian governs all Yin in the body; if the Ren Meridian is not stable, it can lead to nocturnal emissions; if the Ren Meridian is diseased, it can cause seven types of hernias in men and leukorrhea in women,” and furthermore, “The Ren Meridian is the sea of Yin; if it is deficient, it can lead to masses” (as stated in the “True Records”, Qi’s case). “The Ren Meridian is responsible for its duties; if it fails to fulfill its responsibilities, the Yang cannot ascend, and the kidney essence and liver blood cannot maintain internal protection” (as stated in the “Guidelines”, Zou’s case).
Ye describes that “the Du Meridian governs the overall regulation.” The so-called Du governs all Yang in the body, meaning that the Du Meridian regulates the Yang Qi of the entire body. If the Du Meridian is deficient, it can lead to symptoms such as soreness and heaviness in the lower back. In treatment, he often employs the principle that “Chronic illness must involve Ren and Du” (as stated in the “Guidelines”, Wu’s case). For chronic illnesses, one reason is that blood and Qi must be deficient, and the other is that the essence must return to the kidneys, and the kidney essence cannot be contained.
Chronic illness produces symptoms of cold and heat; Ye believes this is a disease of the Wei Meridian. Because Wei is the framework of the body. If “the Yang Wei is ill and cannot protect,” then “sudden cold and heat arise,” and “if prolonged, the Yang Wei Meridian is damaged, leading to cold and heat” (as stated in the “True Records”, a certain case), and furthermore, “If the Yang Wei Meridian is weak, it cannot maintain the continuity and protection,” then “the lower body becomes weak, and the essence and blood cannot nourish the muscles and bones” (as stated in the “True Records”, a certain case). This also indicates the significant relationship between the Yang Wei Meridian and the lower jiao.
Ye’s understanding of the Eight Extraordinary Meridians builds upon the theories of various schools and develops through clinical practice. “Chronic illness must involve Ren and Du” and “The Eight Meridians are subordinate to the liver and kidneys” are widely applied in various diseases. “In gynecological diseases, Chong and Ren are the most important,” which has significant guiding implications in gynecological disorders.
Application
Historically, physicians prior to Ye primarily used the theory of the Eight Extraordinary Meridians to treat gynecological diseases, with little involvement in other departments. From the collection of 165 cases related to the application of the theory of the Eight Extraordinary Meridians in treating diseases, the “Guidelines” contains 89 cases for treating internal diseases, 45 cases for treating gynecological diseases, and the “True Records” contains 31 cases, mostly for treating internal diseases. The analysis is as follows:
Deficiency and Labor Ye believes that the treatment of deficiency and labor should follow the saying of Zong Zhongjing: “A large pulse indicates labor, and extreme deficiency also indicates labor.” “A large pulse indicates Qi leakage; worry and stress can damage the heart and spleen;… an extremely weak pulse also indicates labor, as essence and blood are depleted internally, and the liver and kidney Yin cannot maintain themselves…” (as stated in the “Guidelines”). He further believes that “the damaged will continue to be damaged; the organs cannot be replenished, and the Eight Extraordinary Meridians cannot fulfill their functions” (as stated in the “True Records”, a certain case), indicating that deficiency and labor, especially deficiency of the lower jiao liver and kidneys, are closely related to the Eight Extraordinary Meridians.
From the medical cases in the deficiency and labor section, on one hand, those with spleen and kidney deficiency should focus on tonifying Qi, strengthening the spleen, and warming the kidneys to achieve the effect of “nourishing the original essence and strengthening the extraordinary meridians”; on the other hand, those with liver and kidney insufficiency should focus on nourishing blood and flesh, warming and unblocking the extraordinary meridians to achieve the goal of “nourishing the muscles and bones with essence and blood.” For example:
In a case: Liver and kidney damage, the Eight Meridians lack Qi, not yet old and weak, but significantly fatigued. It is proposed to use the method of unblocking Yang and maintaining Yin: Da Zongrong, Shu Di Huang, Lu Jiao Shuang, Wu Wei Zi, Bai Zi Ren, Fu Ling.
This case illustrates: 1. The disease of the liver and kidneys must affect the Eight Meridians; the so-called Eight Meridians are subordinate to the liver and kidneys; 2. The kidneys govern essence, essence transforms into Qi; if essence is deficient, then the Eight Meridians lack Qi, and the spirit becomes weak and fatigued; 3. This formula uses Lu Jiao Shuang, Zongrong, and Fu Ling to unblock Yang, while Shu Di Huang, Wu Wei Zi, and Bai Zi Ren stabilize Yin, filling essence to replenish the Qi of the Eight Meridians, warming and unblocking the deficiency of Yin and Yang.
In another case: Zang Yin has long been deficient, the Eight Meridians are weak, indicating long-term damage that cannot recover, especially with slight pain in the middle abdomen and movement of Qi in the navel, it is certainly not suitable to use greasy and cold herbs. Following the method of Da Jian Zhong, warming and nourishing the original essence, strengthening the Eight Meridians, the method of unblocking and receiving is proposed: Ren Shen, Sheng Yi Shu, Zhi Cao, Fu Ling, Shu Di, Da Zongrong, Bai Shao, Zhen Xun Gui, Gou Qi, Wu Wei, Mi Wan, taken daily at four qian.
This case shows: 1. The spleen is the foundation of postnatal life, and the kidneys are the foundation of prenatal life; the original essence resides here; if it can be warmed and nourished, the extraordinary meridians can be strengthened; 2. The treatment of diseases of the extraordinary meridians primarily focuses on warming and nourishing, which is one of Ye’s unique methods.
Nocturnal Emission Throughout history, physicians have treated nocturnal emissions primarily by clearing and draining the fire, solidifying and astringing the essence, and nourishing the lower source. However, Ye uniquely created two methods: unblocking and receiving, and ascending and solidifying the Qi of the Eight Meridians.
The “True Records” records a case: Frequent nocturnal emissions with a rapid pulse, accompanied by soreness in the spine and heaviness in the lower back, indicating that the Du and Ren are not stable; without unblocking, the pulse cannot enter, and without astringing, essence cannot be filled. The complexion is pale and thin, and warming and tonifying are not suitable. The formula includes Shu Di, Mu Li, Yuan Zhi, Wu Hua Long Gu, Wu Wei, Fu Ling, Qian Shi, Shan Yao, and Yang Shen Pi.
This case establishes that without unblocking, the pulse cannot enter, and without astringing, essence cannot be filled; the mutual use of unblocking and receiving is a new method for treating nocturnal emissions. The essence barrier is unstable, and the soreness in the spine and heaviness in the lower back is easily misinterpreted as deficiency and cold, but the rapid pulse is not a sign of deficiency, thus avoiding warming and tonifying.
Ye believes that treating nocturnal emissions “purely with tonification and astringency is not appropriate”; “Long-term emissions damage all Eight Meridians, and it is necessary to use unblocking medicine” (as stated in the “Guidelines”, the section on nocturnal emissions). Therefore, he states: “Without unblocking, the pulse cannot enter”; “The essence barrier has become slippery, and astringent agents cannot be effective; it is necessary to use slippery medicines to guide and seek the same Qi, as the ancient methods suggest.”
Hernia Ye believes: “The methods of dispersing and draining can treat Qi stagnation; Ren Shen and Yi Shu can only treat the middle deficiency and sinking, and cannot supplement the root of the disease in the extraordinary meridians; as one ages, the disease root does not cease, and the lower jiao declines daily, thus the method of ascending Yang is quite appropriate” (as stated in the “Guidelines”). He uses Sheng Lu Rong, Lu Jiao Shuang, Dang Gui, Sheng Tu Si Zi, Sha Ji Li, Gui Zhi Jian, to warm and tonify the Ren and Du, establishing the method of ascending Yang, which is quite profound.
Atrophy Ye places great importance on the relationship between atrophy and the extraordinary meridians. For instance, if atrophy is caused by deficiency and cold of the Chong and Ren, the main treatment is to unblock Yang and receive Yin to solidify the extraordinary meridians (as stated in the “Guidelines”, Li’s case); if the kidney Yang and extraordinary meridians are both deficient, the main treatment is to unblock the extraordinary meridians to gather the scattered Yin and Yang (as stated in the “Guidelines”, Tang’s case); if both Stomach Yang and Kidney Du are deficient, the main treatment is to solidify the middle and lower (as stated in the “Guidelines”, Wu’s case); if essence and blood are internally weak, leading to atrophy due to the lack of Qi in the extraordinary meridians, the main treatment is to fill and supplement the essence (as stated in the “Guidelines”, Huang’s case). For example, in a case from the “True Records”:
In the long summer, dampness obstructs, Qi stagnates in the meridians, combined with the lower jiao meridians being deficient, leading to weakness and inability to walk, with constant soreness in the spine, and bowel movements either constipated or loose, all belong to the disease of the liver and kidney extraordinary meridians. Therefore, it is necessary to assist in unblocking the meridians as the main treatment; merely tonifying is insufficient, especially in summer, where dampness must be addressed: Rou Cong Rong, Xiao Hui Xiang, Ba Ji Tian, Bai Gui Shen, Yuan Zhi, Lu Jiao Shuang, Sang Shen Zi, Sheng Mao Shu, Fu Ling, Shu Di (prepared with ginger juice). Additionally, use Jin Gou Ji (three jin) to decoct into a paste and pills.
This case highlights that weakness and dampness belong to the disease of the liver and kidney extraordinary meridians, and in treatment, it is essential to assist in unblocking the meridians, rather than merely tonifying. In fact, this is a common characteristic of Ye’s treatment for many diseases.
Chronic Malaria Ye treats chronic malaria injuries that do not recover, often following the principle that “the Yang Wei is the cause of cold and heat”. He illustrates this with a case from the “Guidelines”:
Yuan’s case (the previous three diagnoses have been deleted). The previous discussion indicates that labor injuries to Yang Qi should be understood in terms of internal damage and evil infiltration. Whenever a woman has her menstrual cycle end, her Yin meridians become empty and weak; it is not only the cold and heat of the Ying and Wei that are affected, thus warming the spleen and stomach, and using ginger to treat the middle palace’s Ying deficiency, but fearing cold without knowing heat, this is Yin malaria, as Yin is heavy, which is also a Yin manifestation. This is the principle of warming Yang; Lu Rong warms the Du Meridian to lift it, unlike ginger which is attached to the Qi aspect, driving away evil and benefiting deficiency, but it is in the Ying aspect. The “Nan Jing” states: “The Yang Wei Meridian is the cause of cold and heat.” The formula includes Lu Rong, Lu Jiao Shuang, Ren Shen, Dang Gui, Xun Gui, Fu Ling, Zhi Cao. The righteous Qi harmonizes the Ying, and the malaria battle has stopped; the dosage should be reduced: Ren Shen, Lu Rong, Dang Gui, Chao Qi Zi, Sha Yuan, Fu Ling, Zhi Cao.
It must be pointed out that Ye’s treatment of chronic malaria injuries that do not recover is due to the Yang Wei being the cause of the disease, indicating that the malaria has persisted for a long time, and Yang Qi has become deficient. General medicines “cannot drive away the hidden evil”; it is necessary to use Yang-ascending and nourishing methods, which truly means “taking care of the righteous Qi will naturally drive away the evil”.
Chronic Dysentery Ye believes that “chronic dysentery treats the kidneys”; “Chronic dysentery must damage the kidney Yin, leading to instability in the Eight Meridians.” In the case of dysentery in the “Guidelines”, Zhou’s case states that “Chronic dysentery must damage the kidney Yin, leading to instability in the Eight Meridians; the intestines become slippery and descend, but merely focusing on strengthening the spleen is useless; the disease is not in the middle, and the lower jiao’s Yang is also declining,” thus using the San Shen Wan: Wu Wei Zi, Bu Guo Zhi, Rou Guo. Chronic dysentery injures both Yin and Yang, indicating that “the damage to the organs and meridians has reached the extraordinary meridians”; it is possible to use the method of “ascending Yang” to treat, as in the case of dysentery in the “Guidelines” using Ren Shen, Lu Rong, Fu Zi, Chao Dang Gui, Hui Xiang, Tu Si Zi. Clinically, chronic dysentery and chronic diarrhea, when treating the spleen and stomach, the effect is not significant, and the method of warming the kidneys and ascending Yang should be used.
Leukorrhea Ye believes that “the Du and Ren have lost their responsibilities; without true essence, how can they stabilize and receive?” In treatment, “due to the movement of the Chong Meridian, all meridians move,” thus taking “regulating Yang and tonifying, using Qing Nang Ban Long Wan”; due to “months of prolongation, the disease has already harmed the Ren and Du,” thus taking “ascending and solidifying the Qi of the Eight Meridians,” which is elaborated in the case of leukorrhea in the “Guidelines”:
Gu, 24 years old, with stagnant essence in the essence barrier, old corruption due to strong urination, new essence is also stagnant inside, after years, both essence and blood have become dry and withered, it is bound to lead to exhaustion and labor without treatment. The physician should regulate the Ren, Du, and Chong, just as in women’s menorrhagia and leukorrhea, physicians only know to treat damp-heat with the Eight Principles, while there are also methods like Di Huang Decoction to nourish Yin and drain Yang, but they cannot enter the extraordinary meridians: Lu Rong, Gui Jia, Dang Gui, Qi Zi, Fu Ling, Xiao Hui, Bao Yu.
This case clearly points out: 1. The Ren, Du, and Chong can be used for women’s menorrhagia and leukorrhea, and can also be used for stagnant essence and corruption in leukorrhea; 2. The Eight Principles are commonly used to treat damp-heat, which is a common method for treating leukorrhea, while Di Huang Decoction nourishes Yin and drains Yang, which is a common method for treating deficiency, but using common medicinal methods cannot enter the extraordinary meridians; 3. For stagnant essence and corruption, using “regulating the corruption and turbid essence, and then supplementing the kidney method” is inappropriate, and using “solidifying and tonifying” is also inappropriate, as it is due to “only knowing to treat the liver and kidneys, but not knowing the subtlety of treating the Eight Meridians.”
Insomnia Ye believes that the cause of insomnia, although not singular, is ultimately due to the Yang not interacting with Yin. Because “the Yang Qiao point is empty,” thus “unable to sleep.” The “Ling Shu” uses Ban Xia and Shu Mi Decoction, using Ban Xia to communicate Yin and Yang, allowing Yang Qi to descend into Yin, filling the Yang Qiao Meridian, enabling sleep at night.
Various Pains Ye’s discussion on pain is quite profound; he states, “Pain is due to the disharmony of Qi and blood in the meridians; physicians should differentiate between the channels and collaterals. If the liver and kidneys are affected, they must also involve the Eight Extraordinary Meridians; if this principle is not understood, it is no wonder there is no efficacy” (as stated in the “Guidelines”, Xu’s case). Therefore, for chronic pain, treatment can be based on the Eight Extraordinary Meridians. For instance, when treating elderly patients with low back pain, he “considers the Eight Extraordinary Meridians subordinate to the liver and kidneys, using blood and flesh nourishing products, such as Lu Jiao, Dang Gui, Cong Rong, and Xiao Gui to warm and nourish the lower jiao” (as stated in the “Guidelines”). Ye believes that “whenever Qi attacks pain, if it rises from the back, it is governed by the Du Meridian; treatment is in the Shaoyin; if it rises from the abdomen, treatment is in the Jueyin, governed by the Chong and Ren.”
Menstrual Disorders Ye believes that “the damage to the Chong and Ren meridians leads to menstrual irregularities that do not heal over the years”; regulating menstruation and stopping bleeding requires special attention to these two meridians. If the Chong and Ren meridians are deficient and cold, leading to amenorrhea, it is necessary to warm and unblock the Chong and Ren, nourishing and benefiting the kidneys and liver (as stated in the “Guidelines”, Zhu’s case). If the Chong and Ren meridians are not stable, leading to menorrhagia, it is necessary to differentiate between new and old. “For sudden menorrhagia, it is advisable to warm and tonify; for chronic menorrhagia, it is advisable to clear and unblock” (as stated in the “Guidelines”, a certain case). If the Chong and Ren meridians are mutually damaged, it is necessary to tonify Qi to cultivate Yang, warm and stabilize the lower essence (as stated in the “Guidelines”, Cheng’s case).
If “the symptoms indicate a weak stomach, this Yin is soft and sticky and should be stopped,” at this time, “the focus should be on regulating the stomach Yang.” It is also pointed out: “If the liver and kidneys are internally damaged, they gradually affect the extraordinary meridians”; “If the liver and kidney Yin are damaged, the Eight Meridians cannot be restrained.” In treatment, either “following the example of Zong Zhongjing’s sweet medicines” (as stated in the “Guidelines”, Zhu’s case), or “abandoning this tonification, fearing it may worsen” (as stated in the “Guidelines”, a certain case), or “using the method of treating the Eight Meridians” (as stated in the “Guidelines”, Sun’s case), or “using warming and softening agents to harmonize Yin and Yang” (as stated in the “Guidelines”, Yang’s case).
From this, it can be seen that Ye’s methods of using the Eight Extraordinary Meridians to treat diseases are extremely flexible, providing significant inspiration for future generations.
Postpartum Postpartum treatment primarily focuses on warming the lower body and regulating the meridians, such as:
After childbirth, the Eight Meridians are damaged, menstrual flow does not come, and there is frequent leukorrhea, indicating that the lower jiao Qi is deficient, leading to the middle palace, which is the depletion of blood and fat. Gui and Fu heat and dryness further exacerbate this; thus, warming medicines are essential for nourishment, not merely for heat: Ren Shen, He Che, Mi Rong, Lu Jiao Shuang, Gui Shen, Fu Ling, Zishi Ying.
This case shows: 1. Postpartum treatment primarily uses warming medicines; 2. It does not use Gui and Fu for dryness and heat, but rather uses soft agents for nourishment, which is a characteristic of postpartum medication.
Appendix: Analysis of Medicinal Ingredients The medicines used in the cases are preliminarily summarized as follows: Entering the Chong Meridian: Zishi Ying, Dang Gui, He Che, Bie Jia, Cong Rong, Qi Zi, Du Zhong, Shan Yao, Dan Shen, Ba Ji Ren, Bai Zhu, Lian Zi, Chuan Xiong, Fu Zi, Xiang Fu, Gan Cao, Mu Xiang, Wu Yu, Huang Qin, Huang Bai; Entering the Ren Meridian: Gui Ban, He Che, Fu Pen Zi, Dan Shen; Entering the Du Meridian: Lu Rong, Lu Jiao Pian, Lu Jiao Jiao, Yang Guo Sui, Niu Guo Sui, Zhu Guo Sui, Qi Zi, Rou Gui, Huang Qi, Sheng Xiong Yang Nei Shen; Entering the Dai Meridian: Dang Gui, Re Di, Long Gu, Mu Li, Lian Zi, Lian Xu, Bai Shao, Gan Cao, Wu Wei Zi, Wu Zai Gu, Huang Bai, Huang Qin, Ai Ye; Entering the Yang Wei Meridian: Bai Shao, Gui Zhi, Huang Qi; Entering the Yin Wei Meridian: Gui Ban, Bie Jia, Yu Rou, Wu Wei Zi. Additionally, the two herbs, Hui Xiang and Ze Lan, are used for unblocking; the former enters the Qi aspect into the extraordinary meridians, regulating Qi and alleviating pain; the latter enters the blood aspect into the Eight Meridians, primarily activating blood and regulating menstruation. At the same time, Ye provides good explanations for his medicinal use in the cases. For example: “Lu Rong strengthens the Yang of the Du Meridian, Lu Jiao Shuang unblocks the Qi of the Du Meridian, and Lu Jiao Jiao supplements the blood of the Du Meridian” (as stated in the “Guidelines”). “The nature of deer is Yang, entering the Du Meridian; the nature of turtle is Yin, entering the Ren Meridian”; “Soft agents and Yang medicines unblock the extraordinary meridians without stagnation” (as stated in the “Guidelines”). Analyzing all of Ye’s clinical cases regarding the treatment of diseases with the Eight Extraordinary Meridians, each of Chong, Ren, Du, and Dai has a primary herb, which is what is stated in the postpartum section of the “Guidelines”: “For diseases of the Chong Meridian, use Zishi Ying to calm the counterflow; for diseases of the Ren Meridian, use Gui Ban to stabilize; for diseases of the Du Meridian, use Lu Jiao to warm; for diseases of the Dai Meridian, use Dang Gui to nourish.”
All medicinal formulas mentioned in the text should be used under the guidance of a physician.
New Media Editor: Zhu Luyun