Traditional Chinese Medicine Case Studies / Medical Discussions / Reference Articles for Clinical Study of TCM
Introduction: The theory of vascular channels is one of the important theories in Traditional Chinese Medicine (TCM), originating from the “Huangdi Neijing” (Inner Canon of Huangdi), developed during the time of Zhang Zhongjing, enriched during the Jin and Yuan dynasties, and flourishing during the Ming and Qing dynasties. By the time of Ye Tianshi’s “Clinical Guidelines and Medical Cases,” a relatively complete theoretical system had formed.
In the past, there was a greater emphasis on the study of meridians (such as acupuncture, the substance of meridians, etc.), while the study of vascular channels was often overlooked.
Anatomical Characteristics of Vascular Channels
From the structure and distribution characteristics of vascular channels, it can be seen that they disperse along the meridians, interweaving and crossing, forming a circulatory system that permeates the entire body, which is an important organizational structure for the overall coordination and connection of the internal and external organs.
Vascular channels in the human body have varying depths; although the “Huangdi Neijing: On the Origin of Diseases” describes that “Yang channels injury leads to blood extravasation, while Yin channels injury leads to blood internal leakage,” it was truly during the Qing dynasty with Ye Tianshi’s “Clinical Guidelines and Medical Cases” that it became a theoretical system used to guide clinical practice.
Ye Tianshi stated that superficial areas of the body, such as the head and face, are considered floating channels, belonging to the category of Yang channels;
those distributed in the deep parts of the body, connected to the internal organs and their outer structures, are called organ channels and bowel channels, belonging to the category of Yin channels;
meridians lie between the two, forming a hierarchical system of floating channels, meridians, bowel channels, organ channels, and internal organs.
Yang channels are located superficially and are easily harmed by external pathogens; mild damage to Yang channels can lead to rashes and spots, while severe damage can result in vascular injury, leading to hemoptysis, epistaxis, and other symptoms;
Yin channels are located deeper within the body; if a disease persists, the pathogen can penetrate from the surface to the interior, injuring the Yin channels, gradually affecting the internal organs, leading to blood internal leakage resulting in hematuria, melena, and in severe cases, becoming chronic and unresolvable conditions.
Meridians are primarily coarse and straight, connecting the upper and lower parts of the body; if external pathogens invade, their transmission changes rapidly, making it difficult to form stagnation of Qi and blood;
vascular channels are fine, interwoven, and tangled, resembling a network; when external pathogens attack, their transmission changes slowly, often leading to Qi stagnation and blood stasis, resulting in vascular obstruction. Hence, it is said that “Chronic diseases enter the channels and dominate the blood.”
Physiological Functions of Vascular Channels
Meridians primarily transport Qi, known as “meridian Qi;”
vascular channels primarily transport blood, known as “blood Qi.”
Vascular channels have the characteristics of permeation and bidirectional flow of Qi, blood, and body fluids, allowing the blood Qi within the channels to flow continuously, distributing body fluids and blood to the internal organ tissues, while also infusing Qi and blood into the meridians.
The body fluids outside the channels and the blood Qi inside continuously circulate within and outside the vascular channels, permeating the entire body to ensure normal metabolic functions.
Vascular channels are not only the hub for the flow of Qi, blood, and body fluids but also the bridge for communication between the internal and external environments, linking the surface of the body with the internal organs. What is within must manifest externally, hence the TCM concept of “Zang Xiang” (Organ Manifestation).
The heart opens to the tongue, the liver opens to the eyes, the spleen opens to the mouth, the lungs open to the nose, and the kidneys open to the ears and the two Yin areas, which is precisely the function of the vascular channels in transmitting and responding.
In TCM’s theory of organ manifestation, the channels have the meanings of continuity, penetration, connection, and interaction; the generation and control of the five organs, and the relationship between the internal organs, all rely on the meridians to maintain the self-stabilizing state of the entire body.
The vascular channels connect Qi, blood, and body fluids, communicating between the surface and the interior, thus able to balance blood and Qi, coordinate Yin and Yang, and to a certain extent correct the excess or deficiency of Qi, blood, Yin, and Yang, maintaining relative balance in the body’s activities.
Pathological Changes of Vascular Channels
Vascular channels are fine, with many branches and wide distribution; therefore, once pathogenic Qi invades the channels, it affects the circulation of Qi and blood within the channels and the distribution of body fluids, leading to a series of pathological changes such as Qi stagnation, poor blood flow, fluid condensation, phlegm accumulation, channel obstruction, and channel deficiency. Thus, channel obstruction is the most fundamental pathological change in channel diseases.
Ye Tianshi’s Experience with Formulas
Ye emphasized that the herbs used to open the channels must be lively and should not casually use greasy and cloying substances;
To promote blood circulation in the channels, one must moisten and nourish, avoiding the use of “spicy and drying substances;”
at the same time, “bitter and cold substances that obstruct Yang” are also not suitable for channel diseases.
In addition, Ye established methods for treating channel diseases based on common clinical channel diseases and his frequently used methods, which are summarized into five methods.
1. Spicy and Moistening Method for Opening Channels (“Clinical Guidelines and Medical Cases: Pain in the Flank, Shen Case”)
【Indications】 Liver Qi stagnation, chest and rib distension and pain, depletion of body fluids, or post-illness in the elderly, flank pain, dry throat and tongue, or left flank pain, difficulty in turning, and initial formation of masses, with a rough pulse.
Prescription as follows:
9g of Xuanfu Hua (Inula Flower) 5g of Hong Xin Jiang (Red New Jujube) 9g of Dang Gui Xu (Angelica Root)
12g of Bai Zi Ren (Biota Seed) 9g of Guang Tao Ren (Peach Kernel) 8 green scallions
【Modifications】
If the pulse is rough, with stomach pain and severe flank pain,add fried Yan Hu Suo (Corydalis);if cough leads to pain in the chest and flank,remove Dang Gui and Bai Zi Ren, add Xing Ren (Apricot Kernel), Yi Yi Ren (Job’s Tears), Dong Gua Ren (Winter Melon Seed);if the pulse is not smooth, with pain due to Qi and blood stagnation,remove Xuanfu and Hong Xin, add Xiang Fu (Cyperus), Su Geng (Perilla Stem), Yan Hu Suo;if flank pain with hemoptysis,remove Dang Gui and green scallions, add Dan Pi (Moutan Root) and Gou Teng (Uncaria);if there is chronic pain with channel deficiency, leading to masses,remove Xuanfu, add Lu Jiao Pian (Deer Antler Slice);if there is chronic pain with channel deficiency and a pale pulse,remove Xuanfu, Bai Zi, and Hong Xin, add Sheng Lu Jiao (Fresh Deer Antler) and Gui Zhi (Cinnamon Twig).
【Experience】 This is a modified method of the “Xuanfu Hua Decoction” from the “Jinkui Yaolue.”
The “Jinkui” states: “If the liver is stagnant, the person often wants to step on their chest; before it hurts, they just want to drink hot, the Xuanfu Hua Decoction is the main treatment.” The so-called liver stagnation refers to the stagnation of liver Qi. The Xuanfu Hua disperses Qi and resolves masses, green scallions promote Qi and open channels, and Hong Xin calms the channels; thus, the treatment of channels relies on spicy and moistening, as spiciness can open and moistening can enter the channels. The channels are for blood, and blood is a moistening substance, hence the addition of more moistening Dang Gui, which is warm and aromatic, directly reaches the blood channels. The use of thin flavors is to ensure rapid passage, as stated in the “Huangdi Neijing” “Thick flavors lead to leakage, thin flavors lead to passage.”
2. Spicy and Dispersing Liver Channels Method (“Clinical Guidelines and Medical Cases: Hernia, Ming Case”)
【Indications】 Liver Qi disharmony. Hernia with a firm mass in the lower abdomen, or descending pain extending to the kidney area; also treats women’s abdominal masses.
Prescription as follows:
9g of Dang Gui Xu (Angelica Root) 3g of Dan Wu Yu (Evodia Fruit) 6g of Chao Chuan Shan Jia (Fried Pangolin)
6g of Qing Mu Xiang (Aucklandia) 9g of Yan Hu Suo (Corydalis) 6g of Chuan Lian Zi (Toosendan Fruit)
【Modifications】 If pain extends to the kidney area, add orange seeds and fennel;
If there is a bitter taste in the mouth, remove Wu Yu, add Chuan Lian and Shan Zhi;
If there is abdominal distension and pain in women, remove Mu Xiang, add Tao Ren (Peach Kernel) and green scallions;
If there is constipation, add Yu Li Ren (Bush Cherry Seed);
If there is palpable abdominal pain without bowel movement, remove Shan Jia and Wu Yu, add Jiu Zhi (Leek Juice), Liang Tou Jian (Two-Headed Sharp), and Tao Ren.
【Experience】 This is a spicy and aromatic method for dispersing liver channels, used to treat hernia of the liver meridian. The liver meridian is distributed in the lower abdomen, surrounding the genital area, and requires spicy and aromatic substances to open and disperse, allowing Qi and blood to flow freely, thus resolving the disease. Yan Hu Suo and Chuan Lian Zi are key herbs for dispersing heat and relieving pain, while Wu Yu and Mu Xiang are spicy and aromatic for dispersing. Dang Gui Xu and Shan Jia enter the channels to resolve stagnation. Observing Ye’s numerous modifications, if the pain is more severe below, the use of Leek Juice and Liang Tou Jian is essential.
3. Opening Channels and Dispelling Bi Syndrome Method (“Clinical Guidelines and Medical Cases: Bi Syndrome, Bao Case”)
【Indications】 Wind and dampness invading, lingering in the meridians, causing pain in the upper and lower limbs, with the pathogenic Qi affecting various locations, chronic Bi syndrome lasting for decades.
Prescription as follows:
30g of Qiang (Scarabaeidae) 12g of Quan (Scorpion) 45g of Di Long (Earthworm)
24g of Chao Chuan Shan Jia (Fried Pangolin) 15g of Lu Feng Fang (Beehive) 9g of Chuan Wu (Aconite)
1.5g of She Xiang (Musk) 18g of Ru Xiang (Frankincense)
Grind the above herbs into a fine powder, boil with black soy sauce to form pills the size of a walnut, take 6g each time, twice a day; if ineffective, can increase to 10g.
【Experience】 The original case states: “In ancient times, it was called chronic Bi syndrome, and for decades, how could a simple decoction be effective? New pathogens should be dispersed urgently, while old pathogens should be attacked slowly.” This indicates that diseases have both new and old aspects, thus the use of medicine follows the principles of urgency and slowness.
The medicine is derived from insects and ants entering the channels, as chronic diseases enter the channels, and cannot be treated with herbal products; it must be insects and ants that are effective. Although the nature of insects and ants is harsh, they are used in pill form for gentle application, indicating the use of harsh medicine in a mild manner.
Quan, being blue, enters the liver, searches the channels to settle wind; Di Long, being salty and cold, enters the spleen and kidney, clears damp heat and alleviates pain; Shan Jia promotes the flow of the meridians, while Lu Feng Fang attacks poison with poison; all four herbs are effective in searching for wind and moving through the channels.
When the flow of the meridians is obstructed, causing pain, Musk is used to search and eliminate hidden pathogens, while Frankincense stabilizes the pain in the meridians. The use of the warming nature of alcohol combined with black soy sauce nourishes the kidney and nourishes Yin, and when used to make pills, the pain and Bi syndrome can be alleviated gradually.
Yu Dongfu observed Ye’s treatment of a local patient with gout, using 30g of Wu Tou (Aconite) and Quan, 15g of Chuan Huang Bai (Phellodendron), 45g of Han Fang Ji (Stephania), 9g of Musk, and 60g of Ma Liao Dou (Horse Bean), using Yin Chen Tang to form pills, taking 3g each time with warm water, and achieving a cure. Dongfu stated: “Each case has its own unique meaning, which cannot be grasped by superficial understanding.” This shows that Ye’s treatments were remarkably effective at that time.
I also followed this method and treated a case of damp-heat Bi syndrome, where the patient cried out day and night, with swelling in the right waist, diagnosed by Western medicine as a perirenal abscess, lasting for over a month with no effect from various medications. I then added Di Long, Shan Jia, Lu Feng Fang, and Qiang to the heat-clearing herbs, and cured the patient in three days.
Ye’s case states: “The Zhou Li collects toxic medicines for medical purposes, as they are due to stubborn and chronic conditions that attach to the body, not due to the deficiency of the internal organs, thus it is necessary to use toxic substances to attack and eliminate the pathogens that obstruct Qi and blood, in order to be effective.” This is the meaning of using insects and ants to search and attack the channels. However, those who merely listen to hearsay believe that Ye’s use of light and shallow medicines can be followed, which is a great misunderstanding.
4. Opening Channels and Reducing Distension Method (“Clinical Guidelines and Medical Cases: Pediatric Essentials, Distension Door”)
【Indications】 Specifically treats distension due to blood stasis in the channels. Children or adults with abdominal distension lasting for months, with no effect from Qi-regulating medicines, or with visible blue veins on the abdomen.
Prescription as follows:
45g of Dang Gui Xu (Angelica Root) 45g of Guang Tao Ren (Peach Kernel) 24g of Yan Hu Suo (Corydalis)
12g of Chao Shan Jia (Fried Pangolin) 15g of Qiang (Scarabaeidae) 15g of Zhi Chong (Roasted Insect)
24g of Wu Ling Zhi (Flying Squirrel) 60g of Shan Zha (Hawthorn)
Form into pills with water, adults take 5-10g each time, children reduce the dosage, 2-3 times a day.
Modifications If there is distension and pain under the right rib, add Sheng Mu Li (Fresh Oyster).
【Experience】 The disease is attached to the person, and it is not outside of Qi and blood; thus, the “Huangdi Neijing” states: “Soothe the Qi and blood, allowing them to flow freely, and achieve peace.” This statement is concise and encompasses the essence of countless medical texts.
This case notes Ye’s comment: “If Qi-regulating medicines are ineffective, one should treat the blood channels, as stasis in the channels leads to distension.” This is Ye’s elucidation of the principles, applicable to all diseases, not just distension.
Tracing the methods for treating channels, the “Huangdi Neijing” shows the beginnings, and Zhang Zhongjing’s formulas for blood stasis and pain are evident in their use, while Ye expanded upon these methods and excelled in later applications.
This spicy and moistening method for opening channels, combined with the searching and attacking method of insects, uses Dang Gui, Yan Hu Suo, and Guang Tao Ren to open the channels, while Wu Ling Zhi and Shan Zha disperse stasis and resolve stagnation, with Shan Jia specifically promoting the flow of the meridians. The insect ingredients are soft and effective in breaking stasis and resolving masses, while Qiang has the property of pushing and expelling turbid Qi, ensuring that blood does not stagnate, Qi can flow freely, and waste is expelled, thus eliminating any difficulty in resolving distension. However, for treating blood channels with tangible stasis, it is necessary to form pills for a gradual effect, achieving a slow and steady resolution.
Using decoctions for rapid expulsion may lead to faster excretion but cannot resolve tangible stasis in the blood channels, as the desire for speed may lead to failure.
At that time, Ye formulated this prescription to treat a child named Xu with simple distension, achieving recovery in ten days. I have frequently used this prescription to treat adult distension (ascites due to liver cirrhosis) with consistent effectiveness.
5. Opening Channels and Reducing Masses Method (“Clinical Guidelines and Medical Cases: Accumulation Door, Wang Case”)
【Indications】 Right chest and flank slightly elevated, initially presenting as distension and pain without form, but over time becoming firm and resembling a mass, with Qi stagnation and blood stasis, gradually leading to accumulation and masses.
Prescription as follows:
24g of Qiang (Scarabaeidae) 24g of Chong (Insect) 45g of Dang Gui Xu (Angelica Root)
45g of Guang Tao Ren (Peach Kernel) 30g of Chuan Yu Jin (Curcuma) 24g of Da Chuan Xiong (Chuanxiong)
18g of Wei Mu Xiang (Aucklandia) 60g of Sheng Mu Li (Fresh Oyster) 30g of Xia Ku Cao (Selfheal Spike)
18g of Sheng Xiang Fu (Fresh Cyperus) 60g of Da Jiu Qu (Big Wine Yeast)
Add water to form a paste, take with no ash wine, 6-10g each time, twice a day.
【Experience】 This method uses Dang Gui, Guang Tao Ren, Chuan Xiong, and Yu Jin to enter the channels and disperse stasis, while Xiang Fu and Mu Xiang are spicy and aromatic to regulate Qi and resolve stagnation. Mu Li softens hardness, Xia Ku Cao reduces masses, and the use of Qiang and Chong, which are moving substances, leads Qi and blood to push through and resolve masses, using wine to promote blood flow, and forming pills for gentle application, thus using tangible medicines to resolve tangible diseases.
In ancient times, masses were referred to as tumors. If Qi and blood are vigorous and flow freely, the body naturally possesses the ability to resist diseases, as stated in the “Huangdi Neijing”: “When the spirit is internally guarded, how can diseases arise?”
The “Nanjing” also states: “Qi governs warmth, blood governs moistening. If Qi is stagnant and does not flow, it is the precursor to Qi disease; if blood is obstructed and does not moisten, it is the precursor to blood disease.” Observing this, Ye’s statement that “Initially, Qi stagnation occurs in the meridians, and over time, blood injury enters the channels” is based on the essence of the “Nanjing.”
Indeed, Qi and blood are mutually supportive; Qi is the commander of blood, Qi regulates and harmonizes blood, Qi stagnation leads to blood stasis, Qi reversal leads to blood ascent, Qi sinking leads to blood descent, Qi abundance leads to blood expansion, Qi weakness leads to blood weakness, Qi heat leads to blood surging, Qi cold leads to blood weeping; all these indicate that Qi precedes blood, and Qi leads blood.
Discussing Qi, blood, Yin, and Yang, Yang Qi is fundamental, while Yin blood is functional. Yang Qi is the source of life, hence the “Huangdi Neijing” states: “Yang Qi is like the sky and the sun; if lost, life is shortened and not manifested.” Thus, Yang Qi is paramount; if Yang can be harmonized and spread, and blood vessels are regulated, what diseases can arise? Only cold and heat can harm the body externally, while anger and worry can harm it internally, leading to the decline of Yang Qi and the stagnation of Yin blood, resulting in the emergence of masses and accumulations, especially in women where the eight extraordinary vessels are often deficient, leading to many cases of masses, and there are also methods for warming and resolving masses.
For over forty years, Wu Yiling has been dedicated to the inheritance and innovation of vascular disease theory, first constructing a theoretical system for vascular diseases, continuously applying innovative prescriptions to clinical practice, transforming validated effective prescriptions into new drugs, and then industrializing these new drugs. He summarized: “This is drawing on the experience of the divine doctor Ye Tianshi, using modern technology to drive clinical efficacy and new drug development through original theory, thus forming a five-in-one innovative development model of TCM encompassing ‘theory – clinical – research – industry – education.'”
This article is sourced from “Exploration of Vascular Disease Diagnosis and Treatment,” organized by Shao Yao, with copyright belonging to the original author. If there is any infringement, please contact us. Reposted from Qingzhu TCM.
You may also like, click to read the original text:
Liu Bingfan: Learning “Channel Opening Method” from Ye Tianshi
Li Shoushan: Application of Sub-lingual Vascular Diagnosis in Clinical Practice
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