The “Essentials of the Golden Chamber” (hereinafter referred to as “Golden Chamber”) is a monograph by Zhang Zhongjing on the treatment of internal injuries and miscellaneous diseases. The book records over forty diseases, covering internal, external, gynecological, and other categories, many of which fall under the category of luo disease (络病) and its related syndromes. These include conditions such as liver invasion, deficiency labor with blood dryness, accumulations, cancer, stroke, jaundice, water qi disease, chest obstruction, blood obstruction, bleeding disorders, and menstrual irregularities.
Based on the discussions in the “Golden Chamber”, this article attempts to explore Zhang Zhongjing’s theory of luo disease from three aspects: etiology and pathogenesis, clinical symptoms, and treatment principles and methods.
1. Understanding the etiology and pathogenesis of luo disease The luo vessels (络脉) are distributed not only on the surface of the body but also internally, forming a multi-layered extensive network system. Therefore, whether it is external pathogens such as wind, cold, dampness, and heat invading the skin, or emotional disturbances or dysfunctions of the organs, all can lead to dysfunction of the luo vessels and the emergence of related syndromes.
Specifically, the understanding of the pathological mechanisms of luo disease can be summarized as follows:
External pathogens invading the luo vessels such as wind, cold, dampness, and heat can individually or collectively invade the surface luo vessels, colliding with the qi and blood within the luo vessels, leading to obstruction and disease.
For example, when dampness combined with wind and cold penetrates deeply into the joints and tendons, it obstructs the surface luo vessels, resulting in damp disease; when wind-damp or cold-damp pathogens flow into the joints and bones, the obstruction of the meridians (经络) leads to poor circulation of qi and blood over time, resulting in pain throughout the joints, known as bi syndrome (历节病).
Phlegm and fluid obstructing the luo vessels The luo vessels have the function of permeating the body’s fluids. If the metabolism of fluids is abnormal and phlegm and fluids accumulate internally, they can easily obstruct the luo vessels and cause pathological changes.
For instance, if phlegm and fluids accumulate in the chest luo vessels, leading to obstruction, symptoms of chest obstruction may arise; similarly, in chronic malaria, the malaria pathogen and phlegm-stasis can obstruct the luo vessels, ultimately forming a mass known as malaria mother (疟母) located under the ribs.
Blood stasis in the luo vessels The primary function of the luo vessels is to circulate qi and blood in the body. If there is obstruction in the luo vessels, whether due to external pathogens or pathological products from dysfunction, the circulation of qi and blood is hindered, leading to blood stasis.
Blood stasis in the luo vessels is a fundamental pathological mechanism of luo disease. Conditions such as liver invasion and deficiency labor with blood dryness in the “Golden Chamber” are caused by blood stasis in the luo vessels, representing typical syndromes of luo disease.
The onset of liver invasion occurs due to the liver being affected by pathogens, leading to stagnation in the luo vessels; deficiency labor with blood dryness results from prolonged deficiency labor, causing poor circulation of qi and blood, leading to blood stasis.
Deficiency of the luo vessels The luo vessels have the function of nourishing blood and qi. When there is insufficient blood and qi in the luo vessels, it can easily lead to the retention of pathogenic factors and the onset of disease.
For example, in the discussion of stroke in the “Treatise on Stroke and Bi Syndrome”, it states, “The pulse at the cun position is floating and tight… the floating indicates blood deficiency, and the luo vessels are empty,” indicating that the body is deficient in nutritive and defensive qi.
When the exterior is not secure, wind and cold invade, leading to obstruction of the luo vessels, causing symptoms of numbness in the limbs due to stasis of yin blood.
Thus, the occurrence of luo disease is not only related to the invasion of pathogenic factors but also significantly influenced by the emptiness of the luo vessels.
Injury to the luo vessels Excessive emotional disturbances, dysfunction of the organs, and various injuries such as falls can also lead to damage to the luo vessels, resulting in various clinical symptoms, with bleeding disorders being the most common.
The “Spiritual Pivot: The Origin of All Diseases” states: “When the yang luo vessels are injured, blood spills outside; when blood spills outside, it leads to epistaxis; when the yin luo vessels are injured, blood spills inside; when blood spills inside, it leads to internal bleeding.”
From this, it can be seen that the symptoms of vomiting blood, rectal bleeding, epistaxis, and stasis mentioned in the “Treatise on Palpitations, Vomiting, and Bleeding” are all related to the injury of the luo vessels.
2. Understanding the clinical symptoms of luo disease Since the luo vessels are distributed throughout the body, both externally and internally, the pathological changes in the luo vessels can manifest in various clinical symptoms.
Zhang Zhongjing had profound insights into this, providing detailed descriptions of the symptoms associated with luo disease in the relevant sections of the “Golden Chamber”, including typical symptoms such as:
Numbness of the skin
In the “Treatise on Stroke and Bi Syndrome”, it states: “When the evil is in the luo vessels, the skin is numb”; and in the “Treatise on Blood Obstruction and Deficiency Labor”, it states: “Blood obstruction with yin and yang being weak, the cun pulse is slightly weak, and the chi pulse is tight, with external symptoms of numbness in the body, resembling wind obstruction.”
The appearance of numbness in the body is due to obstruction in the luo vessels, leading to poor circulation of qi and blood.
Localized masses can occur when blood stasis and phlegm obstruct the luo vessels for a long time, combined with qi stagnation, leading to the formation of palpable masses, which is also a typical symptom of luo disease.
For example, in the “Treatise on Malaria”, it states: “Malaria occurs once a month, and if not resolved by the fifteenth day, it should be considered a mass, known as malaria mother.”
This indicates that due to prolonged malaria, the malaria pathogen and phlegm-stasis can obstruct the luo vessels, forming a mass under the ribs, known as malaria mother.
Similarly, the “Treatise on Women’s Pregnancy” and the “Treatise on Accumulation Disease” also discuss masses formed due to obstruction in the luo vessels and poor circulation of qi and blood.
Bleeding disorders
Bleeding disorders are common typical symptoms of luo disease. Whether it is damage to the yin or yang luo vessels, both can lead to bleeding disorders.
The “Golden Chamber” mentions symptoms such as “vomiting blood”, “rectal bleeding”, and “epistaxis”, which are all evidence of damage to the luo vessels due to damp-heat, excess-heat, or deficiency-cold.
Pain
Pain, especially chronic pain, is often a manifestation of obstruction in the luo vessels, as obstruction leads to pain.
The “Treatise on Chest Obstruction and Heart Pain” discusses symptoms such as “chest and back pain” and “heart pain radiating to the back”, which are often caused by phlegm-stasis obstructing the heart luo vessels.
Pain due to damp disease is also a result of wind and cold obstructing the surface luo vessels.
Additionally, traditional Chinese medicine states that “chronic diseases enter the luo vessels“, indicating that other chronic pain syndromes that do not resolve can often be differentiated as luo disease.
Edema
External pathogens and blood stasis can obstruct the luo vessels, preventing normal circulation of fluids, leading to symptoms of edema.
For example, in the “Treatise on Water Qi Disease”, it states: “When the menstrual flow is interrupted, it leads to water disease, known as blood division.”
This indicates that when a woman’s menstruation is delayed, it can lead to obstruction in the luo vessels, causing fluids to overflow and resulting in edema.
In addition to the typical symptoms of luo disease mentioned above, the “Golden Chamber” also records many other symptoms, such as yellow sweat caused by damp-heat entering the luo vessels; blood stasis obstructing the luo vessels for a long time, leading to the skin losing nourishment, resulting in dark complexion and rough skin.
In summary, through the analysis of the discussions in the “Golden Chamber”, it can be seen that Zhang Zhongjing’s understanding of the symptoms of luo disease is quite comprehensive.
3. Understanding the treatment methods and prescriptions for luo disease The “Golden Chamber” contains rich content regarding the treatment of luo disease and its related syndromes.
Its characteristics include:
First, the treatment methods for luo disease have further developed and improved based on the “Inner Canon”.
Second, many effective prescriptions for treating luo disease have been created, which are still commonly used in modern clinical practice.
Specifically, representative prescriptions include Xuanfu Hua Decoction (旋覆花汤), Xia Yu Xue Decoction (下瘀血汤), and Di Dang Decoction (抵当汤), with commonly used herbs including Xuanfu Hua (旋覆花), Xin Jiang (新绛, Rubia), Da Huang (大黄), and Tao Ren (桃仁).
The method of resolving phlegm and removing stasis to open the luo vessels is also a commonly used treatment for luo disease. For syndromes caused by phlegm and stasis obstructing the luo vessels, Zhang Zhongjing’s treatment method focuses on both resolving phlegm and removing stasis.
This is fully reflected in his prescriptions, such as the Gui Jia Decoction (鳖甲煎丸) for treating luo disease, which not only includes herbs for removing stasis like Tao Ren, Dan Pi (丹皮), Shao Yao (芍药), and Da Huang, but also incorporates herbs for promoting water metabolism and resolving phlegm like Ban Xia (半夏), Ting Li Zi (葶苈), Shi Wei (石苇), and Qu Mai (瞿麦).
The method of using insects and ants to open the luo vessels is a treatment method pioneered by Zhang Zhongjing, which has greatly influenced the treatment of luo disease in later generations.
Because insect and ant medicines are known for their ability to move and act, they can effectively clear blood stasis in the luo vessels, making this method generally suitable for chronic luo disease with phlegm and stasis accumulation, such as deficiency labor with blood dryness and malaria mother.
Due to the strong ability of these medicines to remove stasis, they are also applicable when the methods of promoting qi and removing stasis or resolving phlegm and removing stasis are ineffective, especially in severe cases.
Representative prescriptions include Gui Jia Decoction and Da Huang Jun Chong Wan (大黄廑虫丸), with commonly used herbs including Mei Chong (虻虫), Qiang Lang (蜣螂), Shu Fu (鼠妇), Jun Chong (廑虫), Shui Zhi (水蛭), and Qi Chong (蛴螬).
Since the overall pathological mechanism of luo disease lies in the stasis of the luo vessels, although there are various treatment methods, all methods revolve around opening the luo vessels. Zhang Zhongjing often used pungent herbs such as Gui Zhi (桂枝), Xie Bai (薤白), Sheng Jiang (生姜), Cong (葱), and Jiu (酒) to achieve the effect of dispersing and opening the luo vessels.
Additionally, Zhang Zhongjing had two characteristics in the preparation of potent prescriptions, especially those using insects and ants:
One is that the pills are slow-acting;
The second is that honey is used to make the pills.
The purpose of using potent pills and honey is to moderate the medicinal properties, aiming for a gentle effect that activates the luo vessels without harming the righteous qi, removing the evil without causing deficiency.
This method of preparation reflects the principle that chronic luo disease requires a gentle approach, emphasizing the “effort in treating luo disease“.
In summary, the theory of luo disease in the “Golden Chamber” represents Zhang Zhongjing’s refinement of the theory of luo disease in the “Inner Canon”, particularly laying the foundation for clinical differentiation and treatment of luo disease. Later physicians such as Yu Chang, Wang Qingren, and Ye Tianshi further developed this foundation, forming a relatively systematic and complete theoretical system of luo disease. It can be seen that Zhang Zhongjing played a pivotal role in the formation and development of the theory of luo disease in traditional Chinese medicine.
Currently, in-depth research on Zhang Zhongjing’s theory of luo disease is of significant guiding importance for a complete understanding of the theory of luo disease in traditional Chinese medicine and for improving clinical treatment of diseases, especially various difficult syndromes.
Excerpt from:“Journal of Traditional Chinese Medicine” by Cheng Ge