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Maintaining the Smooth Flow of Daily Life - The Role of the Collaterals in Classical Chinese Medicine

by Nicholas Sieben

There are conflicting commentaries written about the "Secondary Channels" of acupuncture: are they separate from the Primary Channels, or part of them? Are they channels ("Jing") or collaterals ("Luo")? This debate is most evident in discussion of the Divergent Channels. Some call them "Distinct Channels," seeing them as "Jing" (channels) that are separate from the Primary Meridians. Others consider them to be "Channel Divergences," a type of "Luo."

A similar debate also exists with the Luo Vessels. Certain traditions speak of Luo Vessels as physiological channels involved with blood circulation. Other traditions see them only as pathological channels that maintain latency.

The term "collateral" means an offshoot of the Primary Channel. Questions arise as to where the collaterals separate from the Primary Channel, and for what purpose? Do they follow the same sequence as the Primary Channels? Do they have physiological function, or deal only with pathology? And what areas do they travel into? Each point of view presents philosophical statements about disease progression, physiological and psychological development, as well as human life itself.

The Luo Vessels popularly have three major "models" in which they are presented. Chapter 10 of the Ling Shu presents the Luo Vessels as following a sequence of progression very different from that of the Primary Channels. This Luo Vessel sequence begins with the Lung Luo Vessel, but instead of traveling into the yang pair of Large Intestine as the Primary Channels do, the sequence follows a zonal model, traveling from the "yin" arm vessels into the "yang" arm vessels, before visiting the "yang" leg and "yin" leg vessels: Lung into Heart to Pericardium to Small Intestine to Large Intestine to Triple Heater to Bladder to Stomach to Gallbladder to Kidney, Spleen and Liver. This is the model used by 19th Century Military Doctor Wang Qing Ren as the basis of his cardiovascular model.

It has been debated whether the model from Ling Shu Chapter 10 describes physiology of the cardiovascular system, or only its pathological manifestation. Consensus has favored Luo Vessels as being solely pathological channels. This model suggests Luo Vessel

"blood" circulation pathology begins in the chest and moves into the shoulders and head, before moving into the abdomen, lumbus and genitals.

Later theories expanded understanding of Luo Vessels, explaining two different routes taken by them. The Luo Vessels were differentiated into those that externalize, named the "Longitudinal Luo," and those that internalize: the "Transverse Luo."

The Luo are seen as pathological channels that maintain latency, translocating pathogens from the level of the Primary Channels into the wei level (the sinews and minor blood vessels) via the Longitudinal Luo, or into the yuan level (the internal branches of the Primary Channels) via the Transverse Luo.

Still another theory discusses Luo Vessels in relation to psycho-social development. Confucian philosophy is used to describe stages of development: represented by the Primary Channels. Luo Vessels are the disturbances to normal development.

To better understand Luo Vessels as outgrowths of the Primary Channels, it is important first to gain appreciation of the Primary Channels, as presented by Chapter 10 of the Ling Shu.

All Chinese medical theory is based on philosophical traditions of Chinese history. Clinicians and scholars created herbal formulas and acupuncture theory to present their philosophies. The order in which channels are organized, as well as their role and significance are representations of these philosophical theories.

During the Tang Dynasty, Chinese medical philosophy became fully integrated, comprised of three major traditions: Taoism, Confucianism and Buddhism. These three philosophies were themselves integrations of the "100 schools" in existence prior to the Han Dynasty. Taoism, Confucianism and Buddhism are traditions that survived the famous burning of the books during the Qin Dynasty, beginning in 213 BCE. The merging of these three traditions has created the philosophical base of Classical Chinese Medicine: the Nei Jing (Su Wen and Ling Shu).

The Primary Channels are representations of the body's physiological daily function, as well as its basic post-natal development. They are channels that connect to the Zang Fu. According to the Nan Jing, essential qi is distributed from the Kidneys into the organs via the Triple Heater mechanism. This process endows the organs with function. There is a connection between the Bladder Shu points and the Source Points of each Primary Channel. The Triple Heater deposits essential qi into the Bladder Shu, whereby it is channeled into the Source Point of each Primary Meridian.

The Primary Channels follow a sequence that prioritize the necessities of post-natal life. They follow an elemental order, beginning with Metal (Lung and Large Intestine) and Earth (Stomach and Spleen). The first two necessities to support post-natal life are respiration and digestion. Following the Spleen in the sequence comes the Heart, representing sleep as the third necessity for post-natal life. These are criteria for the body's ability to be self-surviving. Without adequate respiration, digestion and sleep, the body cannot sustain daily post-natal life.

After basic necessities of survival have been met, the Primary Channels support development of relationships, self-awareness and choices - differentiation and construction of personality and lifestyle.

The role of the "collaterals" are to support the Primary Channels. They take on pathology challenging daily physiological function by diverting it away from the "channels," into the "luo." This is the process of creating latency. The luo act as holding chambers for pathology that the Primary Channels are either unable or unwilling to deal with. They can also be seen as distractions to the primary flow of life. They divert problems away from primary consciousness into hidden areas of the body where they remain dormant as long as possible. They utilize the body's resources to maintain a level of suppression or repression, diverting blood and yin away from primary circulation to hold onto unresolved issues.

The collaterals can be viewed as detailed explorations of the pathological process. Basic disease progression is presented in Chapter 10 of the Ling Shu. This chapter discusses the Primary Channels and their associated symptomology. This is a basic progression theory. The chapter concludes with description of the 15 Luo Vessels.

When the Primary Channels become overwhelmed with a pathogenic factor, either coming from the exterior or interior of the body, they rely on the support of the collaterals to help them maintain daily physiological function. The collaterals take on the problems, freeing up the channels. Description of the Luo Vessels and their symptoms describe in greater detail how unresolved pathology affects the body as it is translocated into a state of latency. A slow degeneration process is described, occurring first in the level of blood circulation.

Similar discussions are presented in Chapter 11 of the Ling Shu and Chapter 63 of the Su Wen. These chapters describe symptoms and trajectories of the Divergent Channels. Within the classics, philosophical and physiological theory are illustrated through discussion of channel pathways and symptoms. This is the coded language of the classics.

The pathways of the collaterals describe how the body translocates pathology. They also show areas where the collaterals connect to the channels, as well as common holding areas for pathogens. For example, the Bladder-Kidney Divergent Channel begins at the he-sea points of the Bladder and Kidney Primary Channels and travels into the sacrum and Dai Mai, along the paravertebrals and into the chest, throat and head. The implications of this pathway suggest this particular Divergent Channel takes pathology out of the he sea points: representative of the bowels. Pathology is deposited into the sacrum, the Dai Mai, chest, throat and head. The mechanism of the Divergent Channels is such that wei energy travels inward into the yuan level. This can present as an autoimmune-like scenario: where the immune system seems to be attacking the body. Understanding the latency process of the Divergent Channels allows us to see that wei qi is really responding to a latent pathogen hidden in areas visited by the Divergent Channel. Pathogens trapped in physical holding areas of the body are being antagonized by the wei qi, causing the immune response.

The Divergent Channels are commonly debated concerning their role. Some commentators have called them "the true channels": a type of primary channel. Other commentators consider the Divergents to be internal branches of the Primary Channels. A similar debate concerns the Transverse Luo Vessels, which translocate blood level pathology into the yuan level via the Primary Channel source point. Commentators such as Royston Lowe say symptoms of the Transverse Luo are really those of the internal branches of the Primary Channels, also suggesting interaction between the Luo and the ("Jing") Channels.

The role of the collaterals can also be understood from a psychological point of view. Chinese Medicine is traditionally presented in somatic language. However, to the ancient Chinese, there was no split between the body and mind. What may appear as a totally physical description has levels of meaning, including the psychological. Human development is more than simply physical function. In classical Chinese medicine, physical and mental-emotional components are always given equal consideration.

Physiology of the mind (and emotions) is mostly discussed in classical Chinese literature in relation to the blood. The brain is not seen as the residence of the mind in Chinese Medicine as it is in Western medicine. In Chinese medicine, the mind is rooted in the heart and spleen, and influenced by the liver: the organs associated with blood. The brain is viewed as a depository of memory, considered a "Curious Organ" of evolution. The mind circulates through the blood, influenced by the Yi spiritual attribute of the spleen, and is "housed" in the heart. Physiology of the mind and emotions is explored through study of the Primary Channels, especially those relating to blood: the Heart/Pericardium, Spleen/Stomach and Liver; pathology is best explored through the "collaterals," mainly the Luo Vessels and Divergent Channels.

Luo Vessels are conduits of ying qi. They relate to the interior of the body. They deal with internal pathogenic factors, mainly the seven emotions. As collaterals, Luo Vessels are created as needed to hold onto pathology from the Primary Channels. They represent a disturbance to the normal flow of qi and blood.

The Divergent Channels conduct yuan qi and wei qi. They are unique in the fact that they make connection between the deepest and most superficial layers of the body. They are channels that represent effects of the external environment on the body's constitution. They manifest through changes in the DNA: the level of yuan qi, brought on by challenges from the post-natal environment. Psychologically, the Divergent Channels can manifest as personality shifts, chronic emotional states and extreme physical and emotional symptomology. They are like Luo Vessels, but involve a deeper layer of energetics and often exhibit more extreme symptoms in their pathological manifestations.

The Primary Channels, as presented in Chapter 10 of the Ling Shu have been given a Confucian philosophical reading in relation to psycho-social development. They are presented alongside the Luo Vessels, mapping the development and disturbances to physiology and psychology.

There are two ways in which the Longitudinal Luo are said to manifest: as a state of "fullness" or "emptiness." Fullness of a Luo Vessel can be seen as a sense of fixation or over-involvement in an aspect of life; "emptiness" suggests a lack of ability, interest or capability, often resembling a state of deficiency.

The Lung Primary Channel represents respiration. It is the "canopy," protecting the internal organs from the exterior world. Psychologically, the Lungs relate to sensuality, touch and physical engagement. Pathology of the Lungs manifests as excess sensual engagement or lack thereof. This is described somatically as "hot palms" and "frequent yawning" in the Ling Shu: metaphorical language for the psychological. These are classical symptoms for "fullness" and "emptiness" of the Lung Luo Vessel.

The Large Intestine Luo is described to manifest as jaw and ear symptoms: "coldness of the teeth," "tinnitus," "deafness," and also "numbness of the diaphragm." Psychologically implicated is a difficulty differentiating sensory material, metaphorically described as the process of "chewing" and hearing. When we cannot differentiate between good and bad, our diaphragms will react. The Diaphragm is the barrier between the exterior and interior of our bodies. It helps regulate what we bring in and let go via the breath. Breathing can become uneven, resulting from difficulty with unconscious sensing of good and bad. This is not a cognitive function necessarily, as this is still the Metal element. Consciousness comes with the Earth and Fire elements. Metal is unconscious knowing, similar to the unconscious functioning of the breath.

The Stomach is seen as the level of feeling. Its Luo Vessel manifestations are "mania" when in a state of "fullness," and "weakness of the lower limbs" when "empty." Psychologically we can have an overreaction in the arena of feelings. The Stomach is a Yang Ming Channel. It generates a tremendous amount of heat in response to a pathogenic factor that the Lungs and Large Intestine channels have been unable to resolve. This can be seen in the Shang Han Lun theory as Tai Yang transforming into Yang Ming. Psychologically, the Stomach channel can become over-exuberant, overreacting via a manic response. If it is "empty," the sense of direction the Stomach provides (knowing what we want) becomes weakened. Our legs are what allow us to travel where we want to go. When we lack the Stomach, we may also lack clarity and associated vitality to know where to go.

The Spleen is where cognition begins. It holds the Yi: consciousness. Its Luo Vessel manifests as "pain in the stomach and intestines" and "drum-like distention." Psychologically this is often seen as obsessive thinking and habituation: fixation of the mind on non-productive thoughts that keep us stuck in chronic stagnant mental patterns.

Understanding transmission is the mark of a "superior physician" according to the Su Wen. It is important to understand the route of pathological progression through the collaterals.

Wind and cold ("the cause of 100s of diseases") initially confront the Cutaneous Regions and Sinew Channels: the most external areas of the body. The Yang Sinews deal with the pathogen first. If they fail,  the pathogen moves deeper into the Yin Sinews. The Yang Sinews run along the outside of the body and converge at the head; the Yin Sinews runs more medial and converge in the chest, abdomen and throat. Once a pathogen has moved into the Yin Sinews, signifying the level of wei qi is failing, ying qi comes to support. This is the involvement of the Luo Vessels: conduits of ying qi.

Luo Vessels separate from the Primary Channel at the Luo point. They externalize via minor blood capillaries formed on the surface of the skin. This is known as "fullness" of the Luo. If the Luo fails to maintain fullness, the pathogen will internalize, "emptying" into the Primary Channel. Emptiness of the Luo utilizes (Ye) fluids to trap pathogens in the form of lipomas, which are also created on the skin. If the pathogen requires greater control, the source point of the Primary Channel will absorb it, activating the Transverse Luo. Symptoms of the Transverse Luo manifest as inflammation and eventually deficiency of the Primary Channels.

Deficiency leads to transmission. An insufficiency of wei and ying qi originally led to progression from the Sinews into the Luo. Deficiency in the channels suggests there's danger the pathogen could move into the Zang Fu.

The body may bring in another channel system to safe-guard against pathogenic movement into the organs. This is done via the Divergent Channels. The Divergents are said to separate from the channels at the he-sea points. They "grasp" pathogens either before or as they are attacking the bowels. The Su Wen describes basic pathological progression anatomically. Pathogenic invasion begins at the Cou Li (skin), moves into the sinews, the vessels, the flesh and finally the bone. This is also described as moving from the head to the chest to the abdomen and lumbar spine: from the wei level into the blood into the bowels and finally into the viscera. Movement of pathogens into the Fu is one step away from reaching the Zang.

To prevent organic problems, pathogens are shuttled into the joints. The joints are extensions of the bones: yuan level areas where pathogens can be surrounded by Jing and held in latency. Latency is maintained as long as the body possesses adequate resources to support it. The Luo Vessels fail when blood becomes insufficient. The same occurs in the level of Jing.

The Divergent Channels follow a humoral progression. Jing is the first yin substance used by the Divergents to maintain latency. When the Jing becomes sufficiently taxed, the blood and fluids come to support. When all of the yin of the body becomes taxed, qi and yang support. Once the yang has failed, there is collapse: organ failure.

The humor of Jing is represented by the Bladder-Kidney Divergent Channel; the blood by the Gallbladder-Liver; the Jin fluids by the Stomach-Spleen and the Ye fluids by the Small Intestine-Heart. At the level of Triple Heater-Pericardium, loss of latency occurs. This is the stage by which the qi of the body is used to support the consolidation of yin to maintain latency. Previously trapped pathogens begin to leak out at this point, spreading throughout the body. When this is not controlled, it leads to serious acute spreading, such as metastasis of a cancerous condition. Large Intestine-Lung is the final stage of the Divergent progression, representing the loss of yang qi.

Luo Vessels do not treat the problems they inherit, as stated in chapter 56 of the Su Wen. They are holding vessels that keep problems out of circulation. Luo Vessel symptoms manifest as Bi obstruction, rebellious qi, as well as heat conditions, as stated by chapters 39 of the Ling Shu and Su Wen. Chapters 24 and 62 of the Su Wen also associate the Luo Vessels with Shen disturbances through their association with blood.

Divergent Channels are a type of Luo Vessel. They also manifest with symptoms of Bi, rebellious qi and Shen disturbances. However, the type of Bi associated with the Divergents is Bone Bi, with more extreme symptoms of rebellious qi. The type of Shen disturbance associated with the Divergent Channels are personality changes or chronic phlegmatic emotional states.

When a pathogen begins to disrupt the level of yuan qi, it can interfere with the Triple Heater mechanism - responsible for distributing essential qi to the organs. It is via the Triple Heater that the organs receive the essential qi that allows them to express their nature. Distribution of essential qi determines the personality. For example, if a greater percentage of essential qi is deposited into Bladder-15, the person will become a Fire personality. The code for distribution is pre-determined at birth, held in the Jing stored in the Kidneys. It is not a random process, but one that is part of the "plan" agreed upon by the Jing-Shen at conception.

Trauma can cause an organ to become barren: a condition known as "Zang Zao," often translated as "Visceral Dryness." The essential qi being distributed from the Kidneys is seen as "water." When irrigation into an organ is blocked, it can cause it to dry out. This is partially a metaphorical concept, however Zang Zao can also involve an inflammation presentation.

In the Primary Channel progression sequence, "Zang Zao" is associated with the level of the Pericardium and Triple Heater: channels that maintain harmony between the Heart and Kidneys. Philosophically, Zang Zao suggests a person has "forgotten" who they are. They begin thinking and behaving like someone else.

They "lose" themselves. To the ancient Chinese, this is a major issue. When we are born, we are bestowed with a Ming: a mandate from heaven. The Shen and the Jing combine to create our destiny. This manifests through our personality. We need our personality to live out our Ming. A change in personality can cause major disorientation to the Ming, and therefore to our entire life. Our bodies, minds and spirits will react to this. Another common translation for Zang Zao is "visceral agitation," suggesting Shen disturbance coming from heat.

The first Divergent Channel in the continuum is the Bladder-Kidney, which is argued as functionally maintaining communication between the heart and kidneys. The channel travels through the Bladder Shu points, and treats Zang Zao via the points Bladder-23, Bladder-20, Bladder-18 and Bladder-15.

The second Divergent channel in the sequence is the Gallbladder-Liver, which connects with many of the Mu points. Mu and Shu points are depositories for Jing qi. The Mu points are also involved in the creation of the body. They gather Jing to create the physical structure. They are often associated more with the yin aspect of the body: the structure; while the Bladder Shu points are associated more with the yang: the function (including aspects of the Shen). The Divergent Channels, as collaterals, attempt to maintain the physical and functional integrity of the body when it is challenged by strong unresolved pathogens.

The Mu points are "collection points" of Jing. They can both store and distribute essential qi. The major concern of the Divergent Channels is consolidating enough yin to maintain latency. The Mu points are essential "to gather," so as to keep unresolved pathogens "tucked in." While the Divergent Channels (like the Luo) do not treat the pathogens they hold, they do allow the body to remain minimally unaffected by them. However, this is all dependent on having sufficient yin to hold.

Collaterals "hide" unresolved pathogens; their holding capacity does not treat the problem: they essentially "buy time" until the body has regained sufficient vitality and resource to begin the process of resolution. Treatment of the "Luo" is classically associated with bloodletting: releasing latency. Prior to releasing latency, the body must be strong. There must be adequate qi and blood to "expel, transform or dissipate" the problem. If latency is released before the body has capability to resolve the problem, there can be damaging consequences. Latency was induced in the first place because of insufficient resources to deal with the problem.

In the case of mental health, the shift in personality may have occurred from a "need" to be someone else. The role of the Pericardium is to maintain sanity. It does so through the process of rationalization. If a trauma is too difficult to face, repression is the body's way of protecting itself. This is a process of latency. Until there's enough blood to "expel the wind," facing repressed material may be too dangerous. The person first needs to feel strong, build courage, restore will; then they can face the demons trapped in the closets.

Treatment via the Luo can be utilized therapeutically through its holding capability. The Luo gives the body time to rebuild. Once adequate vitality has been restored, latency stored in the Luo can be released, allowing true catharsis to be achieved.

It is sometimes through stepping off the path that we gain true insight into virtue. The Luo, as distractions to the Primary Channels, indirectly help in the cultivation of virtue. Perhaps the heart can only truly understand the virtue of compassion through experiencing the pain of betrayal associated with its Luo. Maybe the Lungs need to experience the neediness for physical contact to be able to truly know how to let go and understand respect. Releasing the Luo free the Primary Channels from confusion, refocusing attention on the true path of virtue. To the Confucians, cultivation of virtue is the highest level of achievement man can reach. This is achieved through breaking up accumulations and transforming the dampness of confusion into wisdom. The Luo are central to this process.

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