of The Journal of Chinese Medicine (1979/80) andis now out of print.

Since these articles andindeed the subject of the Extraordinary Vesselshave generated so much interest, we make noapology for publishing another article on thesubject by Giovanni Maciocia. This article isbased on the chapter Extraordinary Vessels inhis forthcoming book The Foundations ofChinese Medicine due to be published in June1989 by Churchill Livingstone. Additional partshave been added from the original article.two-part article on the ExtraordinaryVessels by Giovanni Maciocia wasoriginally published in Issues 2 and 3

THE EIGHT EXTRAORDINARY VESSELS (PARTONE)

A two-part article on the Extraordinary Vessels by Giovanni Maciocia was originally published in Issues 2 and 3of The Journal of Chinese Medicine (1979/80) andis now out of print. Since these articles andindeed the subject of the Extraordinary Vesselshave generated so much interest, we make noapology for publishing another article on thesubject by Giovanni Maciocia. This article isbased on the chapter Extraordinary Vessels inhis forthcoming book The Foundations ofChinese Medicine due to be published in June1989 by Churchill Livingstone. Additional partshave been added from the original article. By Giovanni Maciocia Drawings by Linda Upton INTRODUCTION n order to discuss the function and nature of the extraor-dinary vessel points, it is necessary to discuss the natureof the vessels themselves.The main sources of knowledge for the extraordinaryvessels derives from the following classics: the Spiritual Axis (Ling Shu), chapters 17, 21 and 62 the Classic of Difculties (Nan Jing), chapters 27, 28and 29 the Study of the Eight Extraordinary Vessels (Qi Jing Ba Mai Kao) by Li Shi Zhen, 1578 the Compendium of Acupuncture (Zhen Jiu DaCheng) by Yang Ji Zhou, 1601. The 8 extraordinary vessels and their points are:Directing Vessel (Ren Mai) LU-7Governing Vessel (Du Mai) SI-3Penetrating Vessel (Chong Mai) SP-4Girdle Vessel (Dai Mai) GB-41Yin Linking Vessel (Yin Wei Mai) P-6Yang Linking Vessel (Yang Wei Mai) SJ-5Yin Heel Vessel (Yin Qiao Mai) KID-6Yang Heel Vessel (Yang Qiao Mai) BL-62. The main functions of the extraordinary vessels can besummarised as follows: 1) They act as reservoirs of energy in relation to the mainchannels which are compared to rivers. This idea comesfrom the Classic of Difculties in chapter 27. It says:When there are heavy rains, canals and ditches are fullto the brim.... . similarly, the extraordinary vessels are left out of the channel system so that they can take theoverow from the main channels. 1

This means that the extraordinary vessels can both ab-sorb energy from the main channels and transfer energyto them when needed. This happens in cases of shock, forexample.2) The extraordinary vessels all derive their energy fromthe Kidneys and all contain the Essence (Jing) which isstored in the Kidneys. They circulate the Essence aroundthe body, thus contributing to integrating the circulationof Nutritive (Ying) Qi with that of the Essence.For this reason, the extraordinary vessels are the link between the Pre-Heaven and the Post-Heaven Qi in sofar as they are connected to the main channels andcirculate the Essence all over the body. The extraordi-nary vessels therefore represent a deeper level of treat-ment related to the PreHeaven Qi and the basic consti-tution of an individual.3) The extraordinary vessels circulate Defensive (Wei)Qi over the thorax, abdomen and back. This is a functionwhich is performed by the Penetrating, Directing andGoverning Vessels only. Since they circulate DefensiveQi, which protects the body from exterior pathogenicfactors, the extraordinary vessels also play a role in the bodys resistance to pathogenic factors. This alsoexplains the important role played by the Kidneys in theresistance to pathogenic factors since all extraordinaryvessels derive from the Kidneys.4) The Directing and Penetrating Vessels regulate the 7and 8 year cycles of womens and mens lives respec-tively. These life cycles are described in the SimpleQuestions in Chapter 1. 2 Beyond the above functions, it is impossible to general-ise as each of the extraordinary vessels has special char-acteristics of its own. INTRODUCTION ----------------------------------------------------------------------------------------------------------------------------When there are heavy rains, canals andditches are full to the brim.... . similarly, theextraordinary vessels are left out of thechannel system so that they can take theoverow from the main channels. -----------------------------------------------------------------------------------------------------------------------------3) The extraordinary vessels circulate Defensive (Wei)Qi over the thorax, abdomen and back. This is a functionwhich is performed by the Penetrating, Directing andGoverning Vessels only. Since they circulate DefensiveQi, which protects the body from exterior pathogenicfactors, the extraordinary vessels also play a role in he bodys resistance to pathogenic factors. This alsoexplains the important role played by the Kidneys in theresistance to pathogenic factors since all extraordinaryvessels derive from the Kidneys. 4) The Directing and Penetrating Vessels regulate the 7and 8 year cycles of womens and mens lives respec-tively. These life cycles are described in the SimpleQuestions in Chapter 1. Beyond the above functions, it is impossible to general-ise as each of the extraordinary vessels has special char-acteristics of its own. The extraordinary vessels can be grouped in two differ-ent ways. rst of all they can be arranged into 4 pairs of vessels of the same polarity (both Yin or both Yang)sharing similar pathways, i.e. Fig. 1: Planes defined by the extraordinary vessels

4 Directing Vessel and Yin Heel VesselGoverning Vessel and Yang Heel VesselPenetrating Vessel and Yin Linking VesselGirdle Vessel and Yang Linking Vessel Because of this arrangement in pairs, the opening pointof one vessel is usually used in conjunction with theopening point of the paired vessel. For example, whenusing the Directing Vessel, one would needle Lieque LU-7 and Zhaohai KID-6. These two points are needled onopposite sides according to sex: the opening point of thevessel being treated is needled on the left side for menand the right side for women, and the opening point of the coupled vessel on the opposite side. For example, if one were to use the Directing Vessel in a man, one wouldneedle Lieque LU-7 on the left and Zhaohai KID-6 on theright; in a woman one would needle Lieque LU-7 on theright and Zhaohai KID-6 on the left. The opening pointof the vessel being used is needled rst (in this caseLieque LU-7).When paired in this way, the extraordinary vesselswithin a pair have a common range of action in terms of body areas. These are:Directing Vessel and Yin Heel Vessel: abdomen,chest, lungs, throat, face.Governing Vessel and Yang Heel Vessel: back of legs, back, spine, neck, head, eyes, brain.Penetrating Vessel and Yin Linking Vessel: inneraspect of leg, abdomen, chest, heart, stomach.Girdle Vessel and Yang Linking Vessel: outer aspectsof leg, sides of body, shoulders, side of neck.Another way in which the extraordinary vessels can becoupled is according to their functions. From this pointof view, they can be grouped as follows:Directing, Governing and Penetrating VesselsYin and Yang Heel VesselsYin and Yang Linking VesselsGirdle Vessel Directing, Governing and Penetrating Vessels All these vessels originate directly from the Kidneys andow down to the perineum (at Huiyin REN-1) fromwhere they take different pathways: the Directing Vesselows up the abdomen along the midline, the GoverningVessel up the back, and the Penetrating Vessel up theabdomen along the Kidney channel. These three vesselscan be seen as the source of all the other extraordinaryvessels as they originate directly from the Kidneys andare therefore connected to the Essence. They, more thanthe other extraordinary vessels can be used in clinicalpractice to affect the patients energy at a deep constitu-tional leveL. Yin and Yang Heel Vessels These two vessels are directly complementary: the YinHeel Vessel starts at Zhaohai KID-6 and ows up to theeye carrying Yin energy to it, the Yang Heel Vessel startsat Shenmai BL-62 and ows up to the eye carrying Yangenergy to it. Thus when the energy is in excess in the YinHeel Vessel, the person will be constantly sleepy and theeyes will want to close, while when the energy is inexcess in the Yang Heel Vessel, the person is awake andthe eyes are open. 3 The two heel vessels also control the state of the musclesof the legs. When the Yin Heel Vessel is diseased, the Yinis tight and the Yang is relaxed, (i.e. the muscles of theinner aspect of the leg are tight, and those of the outeraspect too relaxed). When the Yang Heel Vessel is diseased, the Yang is tight and the Yin relaxed (i.e. themuscles of the inner aspect of the leg are relaxed andthose of the outer aspect tight). 4 Yin and Yang Linking Vessels

The two Heel Vessel complement eachother in so far asthey link the Yin and Yang channels. In addition, theiropening points belong to the Lesser (Shao) Yang andTerminal (Jue) Yin channels i.e. San Jiao and Pericar-dium respectively, which are internally-externally re-lated. Girdle Vessel The Girdle Vessel stands on its own as it is the onlyhorizontal channel in the body. It encircles the mainchannels and because of this, it exerts an inuence on thecirculation of energy to the legs.

JOURNAL OF CHINESE MEDICINE NUMBER 29 JANUARY 1989 Thus the extraordinary vessels form an energetic patternof the whole body which develops from the Kidneys, inmuch the same way as the embryo develops along acentral axis. The Penetrating Vessel is at the centre of thisenergetic vortex as it is also the Sea of the 5 Yin and 6Yang organs, the Sea of Blood and Sea of the 12channels (the meaning of which will be explained later)and it starts from the Kidney itself. The energy of thePenetrating Vessel is then distributed all over the bodyin small channels at the Defensive Qi energetic level.When its energy reaches Zhaohai KID-6, Zhubin KID-9,Shenmai BL-62, Jinmen BL-63 and Daimai GB-26 it givesrise to the Yin Heel Vessel, Yin Linking Vessel, YangHeel Vessel, Yang Linking Vessel and Girdle Vesselrespectively. Thus the Penetrating Vessel can be seen asthe origin of these ve extraordinary vessels.The Directing and Governing Vessels determine anddene the coronal plane of the body, the Girdle Vesseldenes the transverse plane, while the Yang Heel andLinking Vessels dene the sagittal plane (see gure 1.).The Governing and Directing Vessels cut across theGirdle Vessel linking it with the Heart above, the gen-erative gate below, the umbilicus in front and the Pene-trating Vessel in the middle. This emphasises why thesefour vessels (Governing, Directing, Penetrating and Gir-dle) are interlinked for the production, circulation, dis-charge and regeneration of the Essence. When thesemeridians are blocked, the generative force cannot beproduced and a man or woman grows old.We can now discuss the function and clinical use of eachextraordinary vessel and their opening points. GOVERNING VESSEL Opening point: Houxi SI-3Coupled point: Shenmai BL-62Starting point: Changqiang DU-1Area of body inuenced: back, spine, back of neck andhead.The Governing Vessel is called the Sea of the Yangchannels as it exerts an inuence on all the Yang chan-nels and it can be used to strengthen the Yang of the body. It can strengthen the spine and tonify Kidney-Yang.The Governing Vessel also nourishes the spine and brainas the inner pathway of the vessel enters the brain. In thissense it can be used to strengthen the Kidney function of nourishing Marrow and Brain, for such symptoms asdizziness and poor memory. To summarise, the openingand coupled point can be used for the following cases:1. To tonify Kidney-Yang and strengthen the back. TheGoverning Vessel is extremely useful in all cases of chronic lower back ache due to Kidney deciency,especially (but not exclusively) when the pain is on themidline of the back. The use of the opening and coupledpoints can strengthen the back and actually straightenthe spine. In men the Governing Vessel can be used on itsown, and in women is best combined with the DirectingVessel, crossing over the opening and coupled points.Thus in a woman, one would use Houxi SI-3 on the right,Shenmai BL-62 on the left, Lieque LU-7 on the left andZhaohai KID-6 on the right, the needles being inserted inthis order and taken out in the reverse order.When used for lower back ache, the Governing Vesselopening and coupled points are used rst and left in forabout 10-15 minutes. This has the effect of opening theGoverning Vessel, making it more receptive to treatmentwith local points. It also has the effect of actuallystraightening the spine. After withdrawal of theopening and coupled point needles, local points can beused, particularly Yaoyangguan DU-3 or the extra pointShiqizhuixia situated on the midline below the tip of L-5 lumbar vertebra.Since the Governing Vessel is the Sea of the Yangchannels it can be used to tonify the whole Yang energyof the body. Points such as Yaoyangguan DU-3, Ming-men DU-4, Dazhui DU-14, Baihui DU-20 which lie alongits

pathway have a strong tonifying effect on the Yangenergy, especially Mingmen DU-4 with moxa:Yaoyangguan DU-3: this point tonies the Kidneys,strengthens Yang Qi and Original (Yuan) Qi, controlsemissions, and warms the back and legs. It is indicatedfor coldness and numbness of the back and legs.Mingmen DU-4: this point tonies Kidney-Yang whichis the root of the Yang of the body. If Kidney-Yang isdecient, Spleen-Yang will also be decient, hence therewill be cold symptoms in the digestive and urinary tracts(diarrhoea, abdominal swelling, food not digested prop-erly, frequent and pale urination etc.). THE EIGHT EXTRAORDINARY VESSELS Fig. 2 The Governing vessel 5

JOURNAL OF CHINESE MEDICINE NUMBER 29 JANUARY 1989 Dazhui DU-14: this point has a powerful tonifying effecton the heart, which although it is a Yin organ andcontrols the Blood which is Yin, also puts Qi back into theBlood - a Yang function. Lack of Heart-Yang will involvepoor circulation and many cold symptoms (pale face,cold hands, feeling cold, pale tongue, Slow pulse etc.).Baihui DU-20: this is also a meeting point of all the Yang, but it has the added action of summoning energy to thehead. It should thus not be tonied in cases of high bloodpressure (some authors recommend it to be bled). It iseffective to raise Qi when the Central Qi is weak, withsymptoms such as prolapse of the uterus or bladder, orsimply a dragging feeling in the lower abdomen andstagnant Qi in that area.2. To expel Wind: this can be either internal or externalwind. In exterior attacks, the Governing vessel can beused to release the Exterior and expel Wind at theGreater (Tai) Yang stage of the 6 Stages. It is thereforeused for such symptoms as fever, runny nose, headache,stiff neck and a oating pulse.The Governing Vessel can also be used to treat intermit-tent fevers and cases of lingering heat where the patho-genic factors are not completely expelled. A typicalexample of this condition is myalgic encephalomyelitis(M.E. or post-viral syndrome). In these cases, the pointsTaodao DU-13 and Dazhui DU-14 are indicated.In interior conditions, the Governing Vessel can be usedto subdue interior Wind, for such symptoms as dizzi-ness, tremors, convulsions, epilepsy, or for the sequelaeof Wind-stroke.3. To nourish the spine and brain. Using the opening andcoupled points of the Governing Vessel can strengthenthe Kidney function of nourishing Marrow and Brain,for such symptoms as dizziness, tinnitus, poor mentaldevelopment and poor memory.Incidentally, the Governing and Directing Vessels arestrongly connected with the martial arts of the InnerSchool and with Taoist Yoga, precisely because of theirconnection with the Kidneys and the brain. One of theaims of the Inner School is to direct the Essence from theKidneys up the spine (Governing Vessel) to the head,down the front of the body along the Directing Vesseland back to the genitals, passing through the three dantian. It is said that when this happens, the body is greatlyrevitalised, the Qi ows harmoniously and unimpeded,and the Qi can repel any attack. It is also said that the aimof the Inner School is to transform Essence into Qi, thenQi into Shen (Spirit) and nally Shen into Emptiness.This is the reason why the Inner School stresses relaxa-tion, which alone can permit an unobstructed ow of Qi,and a straight back and neck for the same reason. In theseexercises one also keeps the tongue curled back so that itstip touches the palate: this allows the joining of ow between the Governing and Directing Vessels.4. The role of the Governing Vessel in the

circulation of energy in the back provides interesting observations.Above Dazhui DU-14 the Governing Vessel tends toabsorb excess energy from the Yang channels. Whenthere is excess Yang energy in the head there can besymptoms of Yang mental illness. Hence the use of theGoverning Vessel for hallucinations, dementia etc.1. It can be used to nourish the Yin energy of the body. Inthis context it is particularly useful to nourish Yin inwomen after menopause as the Directing channel con-trols the uterus and determines the 7-year life cycles of women. It can therefore regulate the energy of the repro-ductive system and, after the menopause, tonify Bloodand Yin to reduce the effects of Empty-Heat symptomsderiving from Yin deciency.A man suffered from chronic back ache on the midline inthe lumbar area. This was caused by a Kidney deciency,and the Governing Vessel opening and coupled points(Houxi SI-3 and Shenmai BL-62) were used, togetherwith Taixi KID-3 and Shenshu BL-23, producing animmediate and marked improvement. Directing Vessel Opening point: Lieque LU-7Coupled point: Zhaohai KID-6Starting point: Huiyin REN-1Area of body inuenced: abdomen, thorax, lungs,throat, face.The Directing Vessel is called the Sea of the Yin chan-nels as it exerts an inuence on all the Yin channels of the body. It originates from the Kidneys and owsthrough the uterus down to Huiyin REN-1 where thesupercial pathway starts. The Directing Vessel is of paramount importance for the reproductive system of both men and women, but particularly women, as itregulates menstruation, fertility, conception, preg-nancy, childbirth and menopause. Its functions andclinical use can be summarised as follows: CASE HISTORY Fig. 3 The Directing vessel 6

JOURNAL OF CHINESE MEDICINE NUMBER 29 JANUARY 1989 It can therefore be used for such symptoms as nightsweating, hot ushes, feelings of heat, mental irritability,anxiety, dry mouth at night, dizziness, tinnitus orinsomnia, all symptoms of Kidney-Yin deciency andHeart Empty-Heat. When used in this way, the openingand coupled points are best combined with GuanyuanREN-4.2. It regulates the uterus and Blood in women, so that itis responsible for menstruation, fertility, conception,pregnancy, childbirth and menopause. It can be used forinfertility to promote the supply of Blood to the uterusand in many menstrual disorders such as dysmenor-rhoea, amenorrhoea, menorrhagia and metrorrhagia.3. It moves Qi in the Lower Burner and uterus, so that itcan be used for lumps, broids and carcinoma of theuterus. In men, it is used for hernia. According to theClassic of Difculties the Directing Vessel can be usedto treat the 7 kinds of Lower Burner pain in men andthe 8 kinds of lumps in the lower abdomen in women.Of course for all these problems there will be a hot or coldkind, an Excess or Deciency kind, a damp-heat kindwhich needs to be treated accordingly. In general it can be said that the Directing Vessel is excellent in cases of gynaecological problems due to stagnation of Qi and/or blood (whether hot or cold). The stagnation of Qi can becaused by excessive consumption of cold food (foodwith cold energy eg raw foods, salads, fruit etc.) espe-cially during childhood and puberty. The stagnation canalso

be caused by emotional problems such as sadness orworry. In these cases one must use the opening andcoupled points to move the Qi stagnation. The goodresults obtained are due to the fact that the DirectingVessels opening point is Lieque LU-7 and the Lungscontrol Qi and are the mother of the Kidneys (Metalgenerates Water). This point provides a powerfulstimulation and movement of Qi, which in turn movesthe Blood. The coupled point Zhaohai KID-6 tonies theYin and has a strong upward-owing movement, hencethe use of both points sets the Qi in motion like a wheeland resolves stagnation.4. The sphere of action of the Directing Vessel extendsnot only to the Lower Burner, but also the Middle andUpper Burner. It can in fact also be used to stimulate theLung descending function and the Kidney function of reception of Qi. For this reason, it is used for chronicasthma, for which it is excellent.5. The Directing Vessel is very important for the correctdistribution of uids and Defensive Qi in the abdomen,hence it can be used in oedema, itchiness, urinary reten-tion etc. Oedema is usually caused by:i.The Lungs not descending Qi and transforminguids.ii.SpleenYang not moving uids.iii.Kidney-Yang not moving, transforming and expel-ling uids.By using the Directing Vessel we can send the Qi down by using Lieque LU-7 and stimulate the Kidneys byusing Zhaohai KID-6. The use of Lieque LU-7 in thecontext of the Directing Vessel also stimulates the Blad-der to expel uids. This reects the very close relation-ship between the Lungs and the Bladder. They are atopposite ends of the body and therefore in a sensetouching like two ends of a sheet of paper when it isrolled. There are several reasons for this:i.The Lungs and Bladder are respectively the rst andlast stages of uid transformation.ii.They are related in the Chinese clock, being at oppo-site poles i.e. 3-5am and 3-5pm.iii.The Lungs are the mother of the Kidneys and hencealso of the Bladder.iv.The Lungs are at the very top and the Bladder at the bottom hence by Chinese logic they must be related.v.The Lungs correspond to Greater (Tai) Yin whichopens the Yin, and the Bladder to Greater (Tai) Yangwhich opens the Yang.In order to affect the Directing Vessels function of bodyuid distribution, it is essential to use points on the lowerabdomen, particularly Zhongji REN-3 and GuanyuanREN-4 as well as Shuifen REN-9 in addition to its open-ing and coupled points.A man of 37 suffered from chronic asthma characterised by difculty in inhalation. There was no sputum and hefelt very tired generally. His voice was low and hiscomplexion pale. he also had a lower backache and feltcold. His pulse was Deep and Weak and his tongue waspale. These manifestations clearly point to decient Kid-ney-Yang unable to hold Qi, resulting in asthma. Besidesthis, there was also a Lung-Qi deciency as evidenced bythe low voice and pale complexion.The opening and coupled points of the Directing Vessel(Lieque LU-7 on the left and Zhaohai KID-6 on the right)were used to tonify the Lungs and to stimulate thedescending of Lung-Qi and the Kidney function of re-ception of Qi.A woman of 41 had a large broid in the uterus forseveral years. Her periods were very heavy and painfuland the menstrual blood was dark. Her lower abdomenwas extremely hard and the broid was clearly felt onpalpation.She was treated several times using the opening andcoupled points of the Directing Vessel, producing acomplete normalisation of her periods and a verymarked softening of her lower abdomen. The size of theabdominal swelling was also markedly reduced. Obvi-ously a broid of that size cannot be dissolved, but theuse of the Directing Vessel at least normalised her peri-ods, took the menstrual pain away and made her lowerabdomen much more comfortable. Notes 1. Classic of Difculties, p.68-69. 2.

Simple Questions, p.4-6. 3. Spiritual Axis, ch.17, p.50. 4. Classic of Difculties, ch.29, p.73. CASE HISTORYCASE HISTORY 7