This post is a compilation of my lecture in the QQ group of the World Manual Medicine Federation (Group Number: 327133248).
In Traditional Chinese Medicine (TCM), the method of diagnosing and treating diseases often employs analogy and symbolism, such as categorizing the human body according to the Five Elements: Wood, Fire, Earth, Metal, and Water. For instance, the liver corresponds to the Wood element, the heart to Fire, the spleen to Earth, the lungs to Metal, and the kidneys to Water. What does this symbolism entail? It involves classification, grouping things with common attributes together. For example, the Wood element is associated with the East, the climate of wind, the taste of sour, the color green, the organ of the liver, the bowel of the gallbladder, the emotion of anger, and the numbers three and eight, among others. In other words, TCM categorizes these into a single symbol. Other elements follow this pattern. The “I Ching” states, “Where there is a symbol, there is a number; where there is a number, there is a principle; where there is a principle, there is divination; and where there is divination, one can determine fortune or misfortune.” TCM operates similarly, grouping things with the same natural attributes together, recognizing that this grouping has both constancy and variability, allowing for the deduction of disease conditions and corresponding treatment methods.
So, can we similarly categorize the meridians? In the “Su Wen: Skin Section,” it mentions, “The skin has distribution, the vessels have management, the tendons have connections, and the bones have measurements.” This statement clearly indicates the classification of skin, vessels, tendons, and bones. Combining this with other chapters from the “Nei Jing,” the human meridian system can be divided into systems of skin, meridians, tendons, collateral channels, and collaterals, with the connections between these systems relying on the collaterals. Today, I will share my personal experiences regarding the application of collaterals.
Previously, when I entered the Nanguang Gate, my master asked me to deeply contemplate the loofah fibers. At that time, my master said, “The loofah fibers are connected to the human meridians; once you understand the loofah fibers, you will understand the meridians, and you will be able to apply them flexibly.” At that time, my understanding of meridians was quite simplistic, merely relating the organs to the limbs in a net-like structure, without delving deeper into understanding and research.
In the “Nei Jing,” there is a saying, “The straight ones are the meridians, and the branches that are horizontal are the collaterals.” Today, I will discuss the collaterals referred to as “the branches that are horizontal.” The human meridians are like the trunk of a tree, while the collaterals resemble the branches, forming a net-like structure that connects the organs and other meridians. On a large tree, the branches have forks, and these forks manifest externally as superficial collaterals. The superficial collaterals are well-known, such as the veins visible below the elbow and knee joints. Many clinicians use bloodletting therapy on these superficial collaterals. This is also mentioned in the “Ling Shu: Meridians” chapter, which states, “The meridians run deep between the flesh and are not visible; all the visible and superficial vessels are collaterals.” Here, the meridians and vessels should be viewed separately; the meridians refer to the meridian system, while the vessels refer to the collateral system. The phrase “all the visible and superficial vessels are collaterals” indicates that there are both superficial and deep collaterals, with the superficial ones being visible. What is the function of these invisible collaterals? They connect the internal and external organs with the limbs. These collaterals traverse the body in all directions, aiming to integrate the internal and external organs and limbs into an organic whole. This is the role of the collateral system in the human body.
Most friends in the group are engaged in rehabilitation therapy, and like us in orthopedics, we often deal with pain. Addressing pain is a common concern, and it is the main purpose of our discussions. In the “Nei Jing Su Wen,” there is a chapter specifically discussing pain, called “On Pain,” which states that the cause of pain is the invasion of cold qi into the body, causing it to stagnate in the meridians, leading to the qi of the meridians not flowing normally. The cold qi constricts and pulls on the small collaterals, resulting in pain. The saying “where there is pain, there is no flow; where there is no flow, there is pain” encapsulates this idea. This chapter also mentions various types of pain, such as the pulling pain between the heart and back, the pulling pain in the hypochondrium and lower abdomen, and the pulling pain in the abdomen and inner thigh. This indicates that collaterals have connections both anteriorly and posteriorly, as well as obliquely. In “On Pain,” a method for treating pain is mentioned: acupressure, which can relieve pain through the application of heat. Additionally, in the “Nei Jing Su Wen” chapter “On Miao Acupuncture,” it states, “When the evil qi invades the collaterals, it crosses left to right, right to left, up and down, and is related to the meridians, spreading to the four extremities, with its qi having no fixed location, not entering the meridian points, and is called Miao acupuncture.” This refers to the crossing of collaterals in the up and down, left and right directions. The treatment method for diseases involves selecting points on the opposite side: for pain in the left upper limb, select the corresponding point on the right lower limb for acupuncture; for pain in the right upper limb, select the corresponding point on the left lower limb; and similarly for lower limb pain, select the corresponding point on the opposite upper limb. In clinical practice, Miao acupuncture often yields significant results for limb pain.
In clinical practice, I categorize collaterals into five types: 1) superficial collaterals, 2) straight collaterals, 3) oblique collaterals, 4) crossing collaterals, and 5) scattered collaterals. Below, I will briefly introduce the clinical applications of these collaterals.
Superficial collaterals are those that are visible externally, often used in bloodletting therapy. In my clinical practice, I occasionally perform bloodletting at the Weizhong point for lumbar sprains. Since I specialize in orthopedics, I rarely use bloodletting for other diseases. Bloodletting therapy has the effect of dispersing blood stasis and reducing fever. For example, pricking and cupping at the site of a sprain or swelling falls into this category. Bloodletting at the fingertips during high fever is also applicable.
Straight collaterals refer to those that run straight anteriorly and posteriorly. I commonly use straight collaterals to treat various diseases. For instance, for eye pain, I select the tender point directly behind the eye at the occipital region for acupressure; for nasal congestion, I select the corresponding tender point at the occipital region parallel to the nostrils; for throat pain, I look for the tender point behind the pain (slightly lateral) for acupressure; for cough, palpitations, and chest tightness, I find the tender point between the scapulae; for stomach pain, I look for the corresponding point behind the twelfth thoracic and first lumbar vertebrae; and for abdominal pain, I find tenderness at the third lumbar transverse process. Pressing these tender points often provides immediate relief.
Oblique collaterals refer to those that run obliquely anteriorly and posteriorly. For example, for pain in the lumbar and sacral region, I can press the Yin Jiao point (two horizontal fingers below the navel) or use moxibustion. For acute pain in the lumbar and sacral region (especially with noticeable lumbar convexity), I can press the Yin Jiao or Guan Yuan point (three horizontal fingers below the navel). This point must be pressed deeply to achieve the best effect. For chronic lumbar pain, such as pain exacerbated by fatigue or weather changes, moxibustion at the Yin Jiao point is particularly effective. The heat sensation must be transmitted to the lumbar region for optimal results (my experience with moxibustion at the Yin Jiao point is derived from Zhou Meisheng’s “Moxibustion Rope”). Additionally, for pain while walking in the popliteal fossa, I select the He Yang and Xuan Zhong points. For calf soreness, I choose the Cheng Shan and Yang Ling Quan points, and for iliopsoas muscle pain, I apply pressure at the root of the thigh. These are all treatments using oblique collaterals.
Crossing collaterals refer to those that cross up and down, left and right. This is the most commonly used method in my clinical practice for treating collaterals. For example, for ankle sprains, I look for tender points at the opposite wrist for acupressure; for knee pain, I find tender points at the opposite elbow; for pain on the outer thigh, I search for tender points along the inner side of the opposite scapula; and for groin pain, I look for tender points at the opposite scapula seam for acupressure. (For instance, in the case of an ankle sprain with significant local swelling and severe pain upon palpation, I can find tender points or muscle knots at the ulnar styloid process of the opposite wrist for acupressure or acupuncture, which can provide immediate pain relief. For ligament injuries in the groin, I can find tender points or muscle knots at the opposite scapula seam for acupressure, which can also provide immediate relief.)
Scattered collaterals, which are not documented in literature, are a personal insight from my clinical experience. They refer to a point that extends in several directions outward. For example, in cases of peroneal nerve injury leading to foot drop, there may be hard muscle knots at the Cheng Shan point in the calf, which can be treated with acupressure or acupuncture to promote recovery. For groin pain, I can select tender points in the buttocks for treatment, generally involving three or four points.
There are many methods for using collaterals to treat diseases in clinical practice, and I cannot cover them all here. I hope to inspire everyone to deeply contemplate these concepts in clinical practice. As the saying goes, “To speak of it is paper; to understand it is gold.” Studying medicine is about understanding the principles, and this understanding must come from personal insight. I have only briefly explained some of my reasoning regarding collateral treatment, and I hope everyone does not merely follow my example blindly.