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The luo (络) is where blood gathers; luo disease refers to pathological changes that occur when pathogenic factors penetrate deeply into the blood vessels of the organs. The scope of luo vessel pathology is extensive, involving various clinical specialties, and can generally be divided into two main categories: luo vessel diseases and chronic diseases affecting the luo. The former refers to diseases that originate directly in the luo vessels, while the latter refers to diseases that affect the luo vessels due to conditions in the meridians or organs, indicating a transmission of disease. Ye Tianshi believed that if a patient is improperly treated or if the disease persists for a long time without resolution, as long as the pathogenic qi remains trapped for an extended period, it will inevitably harm the blood vessels and lead to luo disease. In his book Clinical Guidelines for Medical Cases, he repeatedly pointed out: “After several months, the qi has entered the blood;” “After a hundred days of illness, the blood vessels must be harmed;” “After several years of chronic illness, the disease must be in the luo;” “Chronic and frequently recurring ailments must harm the luo, as the luo is where blood gathers, and prolonged illness must lead to stagnation and blockage,” as well as “prolonged pain must enter the luo; if qi and blood do not circulate, pain will occur.” This indicates that the theories of “chronic disease entering the luo” and “prolonged pain entering the luo” suggest that luo disease often belongs to chronic diseases or chronic pain syndromes that are difficult to resolve. However, Ye also believed that luo disease is not solely caused by chronic illness; some new diseases can also lead to luo disease. For example, “being overheated in summer can cause confusion as if startled… this is due to heat obstructing the orifices, with the pathogenic factor entering the luo…” This is an example of summer heat entering the luo. Additionally, there are cases where “injuries from knives or needles can directly damage the luo vessels, leading to luo disease.” It is evident that both new and chronic diseases can injure the luo vessels and lead to luo disease. Once luo disease forms, its condition is often heavy and persistent, involving not only common and frequently occurring diseases but also many difficult and complicated conditions. Luo vessel disease can arise from the invasion of pathogenic qi into the luo vessels or from the transmission of diseases from the meridians or organs, making the causes of luo disease complex. The main clinical characteristics can be summarized as: “chronic, stagnation (pain), stubborn, and mixed.” Luo disease is often associated with chronic diseases that persist for years, with deep-seated conditions that are far from superficial; it often belongs to stubborn and chronic ailments. The luo vessels are narrow and prone to stagnation, thus luo disease often presents with varying degrees of qi stagnation, blood obstruction, or phlegm accumulation, as Ye stated, “Chronic disease in the luo leads to stagnation of qi and blood.” Furthermore, due to the obstruction caused by pathogenic factors, if the luo is not open, pain will occur, or “if the luo is deficient, pain will occur.” Therefore, at certain stages of luo disease, local pain symptoms are often present. Luo disease often has deep-seated roots, with stubborn and recurrent conditions, where the righteous and the evil are entangled, making it difficult to resolve quickly. As stated in Medical Cases by Zhang Yuqing, “The straight path is the meridian, the horizontal path is the luo; once the evil enters the luo, it is easy to enter but difficult to exit, and it cannot be freed from its burden.” The luo vessels have varying depths, with qi and blood within the luo, and the duration of the pathogenic factors can be long or short. Therefore, luo vessel disease often presents with a mixture of deficiency and excess, with cold and heat coexisting, leading to diverse clinical manifestations and complex pathological changes.The Causes and Mechanisms of Luo DiseaseChronic illness, in contrast to external pathogens and new diseases, refers to some chronic diseases that are difficult to cure and includes those that have not been treated in a timely manner. Why does chronic illness enter the luo? In summary, there are three reasons: First, the luo vessels physiologically connect the exterior and interior, serving as pathways for the circulation of qi and blood. In pathological states, they also become pathways for pathogenic factors to enter from the exterior to the interior and to follow the meridians into the luo. Second, due to the small size and widespread distribution of the luo vessels, they have physiological characteristics of permeation and slow circulation of qi and blood, which predisposes them to stagnation and abnormal infiltration, leading to a multitude of diseases. Third, the luo governs blood and is one of the sites where pathogenic factors can cause disease. When the meridians are chronically ill, pathogenic factors enter the luo, and the interaction between qi stagnation, blood stasis, and phlegm turbidity often occurs through the luo vessels. Therefore, the pathological changes primarily occur in the luo vessels. Ye Tianshi’s statements in Clinical Guidelines for Medical Cases that “the meridian governs qi, the luo governs blood” and “initially, qi stagnates in the meridian, but over time, blood is harmed and enters the luo” serve as the main theoretical basis for the concept of “chronic illness entering the luo.” The meridian governs qi; initially, the disease is in the qi, which is also in the meridian. The luo governs blood; when the disease enters the blood, it also enters the luo. Qi is formless and belongs to yang, governing function; blood is tangible and belongs to yin, governing form and substance. This indicates that the occurrence of disease is primarily due to a disturbance in defensive functions, known as the initial disease in the qi, which subsequently transitions from function to form, entering the blood. Since the luo governs blood, when the disease enters the blood, it naturally affects the luo vessels and the physical form, indicating a universal rule of pathogenesis, and also shows that luo disease is characterized by the sequence of qi and blood, with the meridians determining the depth of the condition.The occurrence of luo vessel pathology can be caused by external pathogens, injuries from falls, or internal injuries from emotions, improper diet, fatigue, etc. The basic pathological changes mainly include the following four aspects.Stagnation of the luo vessels:The luo vessels are the hub and pathway for the distribution and circulation of qi, blood, and body fluids. Therefore, smooth qi flow and unobstructed luo pathways are prerequisites for maintaining their normal function. If pathogenic factors invade the luo, causing stagnation of qi within the luo, blood flow becomes obstructed, or body fluids condense and phlegm accumulates, blocking the luo pathways, this can affect the circulation of qi and blood and the distribution of body fluids, leading to a series of pathological changes of luo vessel obstruction. Additionally, the stagnation of qi, blood stasis, and phlegm accumulation within the luo often influence each other, leading to the solidification of pathogenic factors, making them difficult to resolve.Deficiency of the luo vessels:This refers to insufficient qi and blood within the luo, leading to a lack of nourishment in the luo vessels. The luo vessels have functions of permeating and nourishing qi and blood, transforming body fluids and circulating qi. The fullness of qi and blood within the luo is one of the important conditions for fulfilling these functions. If qi is insufficient, blood flow becomes sluggish; if blood is insufficient, the luo vessels lose nourishment, leading to stagnation of qi flow, phlegm and blood stasis accumulating within the luo, resulting in luo disease due to deficiency leading to excess. The saying goes, “The most deficient area is where the evil resides.” The more deficient the luo, the more stagnant the evil, leading to a mixture of deficiency and excess, with the righteous being deficient and the evil lingering.Accumulation of toxic substances in the luo:Chronic diseases of the meridians and organs can lead to pathogenic factors affecting the luo vessels, causing blood stasis and phlegm accumulation, obstructing the luo pathways, and leading to the accumulation of toxins. The retention of toxic substances harms body fluids and depletes qi, causing blood to stagnate and injure the organs, leading to various symptoms and worsening the condition. The pathogenic toxins not only have a violent aspect but also a chronic aspect; when the evil toxins remain deeply embedded in the luo vessels, they form a pathological characteristic of stubborn and recurrent disease.Injury to the luo vessels:This refers to direct injury to the luo vessels, such as from falls, blows, or needle and knife injuries, which can lead to blood spilling and chaotic qi flow, resulting in luo disease; or due to emotional distress, heat damaging the blood vessels, or dietary irregularities causing injury to the luo vessels, leading to blood spilling outside the luo. As pointed out in Spiritual Pivot: The Origin of Diseases, “Sudden overeating can cause fullness in the intestines; irregular living and excessive exertion can injure the luo vessels. Injury to the yang luo leads to blood spilling outside, resulting in nosebleeds; injury to the yin luo leads to blood spilling inside, resulting in internal bleeding.” It is evident that the basic pathological change of luo vessel injury is what Ye Tianshi referred to as “leaving the luo and becoming stasis” (in Clinical Guidelines for Medical Cases: Hemoptysis). In summary, the mechanisms of luo disease can be encapsulated in four words: “stagnation, deficiency, toxicity, and injury.” Although luo disease can manifest in different types such as stagnation of the luo vessels, deficiency of the luo vessels, accumulation of toxins in the luo, and injury to the luo vessels, “stasis” is a common pathogenesis among them, further exacerbating the condition and increasing the difficulty of resolving the pathogenic factors. For instance, in the case of stagnation of the luo vessels, it is due to the evil invading the luo vessels, leading to stagnation of qi, blood stasis, and phlegm accumulation within the luo; in the case of deficiency of the luo vessels, it is due to insufficient qi and blood within the luo, leading to blood and qi stagnation; in the case of injury to the luo vessels, it is due to blood spilling from the injury, leading to stagnation of blood and qi; and in the case of accumulation of toxins in the luo, it is due to the prolonged presence of evil toxins leading to stagnation. Therefore, luo vessel disease is characterized by obstruction of the luo vessels, indicating a pathological state of deficiency of the righteous and excess of the evil. Since “the luo governs blood,” luo disease is closely related to blood diseases. In a certain sense, “chronic illness entering the luo” can also be understood as “chronic illness entering the blood,” or as a pathological explanation for certain organ blood diseases.In short, the theory of luo disease posits that internal injuries to the organs, due to qi affecting blood, lead to deficiency causing stasis, with phlegm and blood stasis accumulating, resulting in prolonged toxicity, which remains in the luo is the foundation of luo disease. The argument of “chronic illness entering the luo” reveals a general trend in the development of various diseases, indicating that at a certain stage, all diseases exhibit changes in the luo vessels, with the basic pathological changes being the intertwining and binding of deficiency, stasis, and toxicity, obstructing the floating luo, the sun luo, and the entangled luo. This is the fundamental pathological change and common pathway for many chronic and common diseases, as well as the pathological basis for the treatment of various diseases at the stage of “entering the luo.” This is the essence of luo disease. Due to the obstruction of the luo pathways, prolonged stagnation of toxins, and deep entrapment in the floating luo, sun luo, and entangled luo, this is the fundamental reason for the persistent and difficult-to-resolve nature of luo disease. Therefore, we believe that the principle of “treating the luo” is to unblock the luo vessels and expel the luo (toxic) evil.The method of expelling evil should be determined according to the condition, which may include regulating qi, expelling stasis, transforming phlegm, eliminating dampness, clearing heat, detoxifying, dispersing cold, supporting the righteous, unblocking the luo, and nourishing the luo, or a combination of methods, aiming to eliminate the luo evil, drive the evil outward, regulate qi and blood, and balance yin and yang. Expelling evil means expelling toxins, and the key to detoxification is to provide an outlet for the evil. The treatment focuses on expelling the evil, but it should not be excessive, as it may harm the righteous qi. It is important to emphasize the “skill in treating luo disease,” ensuring that the evil is expelled and the luo is unblocked, leading to the improvement of luo disease.Related link: Luo Vessels
Disclaimer:This article is an excerpt from the Journal of Beijing University of Chinese Medicine, March 1998, Issue 2, by Lei Yan.The articles shared by this public account are for reference and learning purposes only. If there are any inappropriate uses of the published content, please feel free to contact us for deletion. Please retain copyright information when reprinting. All treatment methods, formulas, and medicines mentioned in the text are for learning reference only and should be used with caution by non-professionals.