Hongliang Chen
Seeking common ground among differences
The membranes are located in certain areas and network vessels run through them. The 3 positions and 9 indicators pulse method allows one to examine the qi and blood of the whole body. A person’s life is nothing more than the time from birth until death; and as for joy, anger, sorrow, happiness, diet, and lifestyle, although these are the external manifestations of the body’s internal forms, they are actually the work of the bowels, viscera, skin, and flesh throughout the body.
Chapter 56 of the Inner Canon, entitled “Discourse on Skin Sections”, states: “The yang ［skin section］ of the yang brightness ［channel］ is called the ‘door leaf’. The same principles apply above and below. The superficial network vessels observed in this section are all yang brightness network vessels. If their color is mostly green-blue, there is pain. If it is mostly black, there is impediment. If it is yellow and red, there is heat. If it is mostly white, there is cold. If all 5 colors are visible, there is heat and cold. If the network vessels are exuberant ［i.e. full］, then ［an evil］ has entered and is visiting the channel. Yang governs the external, while yin governs the internal. The yang ［skin section］ of the lesser yang ［channel］ is called the ‘pivot holder’. The same principles apply above and below. The superficial network vessels observed in this section are all lesser yang network vessels. If the network vessels are exuberant ［i.e. full］, then ［an evil］ has entered and is visiting the channel. Therefore, that ［evil］ which is in the yang ［section］ governs ［entering］ the internal, and that which is in the yin ［section］ governs exiting, from which it seeps into the interior. All channels are like this.
The yang ［skin section］ of the greater yang ［channel］ is called the ‘gate pivot’. The same principles apply above and below. The superficial network vessels observed in this section are all greater yang network vessels. If the network vessels are exuberant ［i.e. full］, then ［an evil］ has entered and is visiting the channel.
The yin ［skin section］ of the lesser yin ［channel］ is called the ‘pivot bracket’. The same principles apply above and below. The superficial network vessels observed in this section are all lesser yin network vessels. If the network vessels are exuberant ［i.e. full］, then ［an evil］ has entered and is visiting the channel. It enters the channel from the yang section and pours into the channel, while that which exits ［does so］ from the yin ［section］ and pours into the bones internally.
The yin ［skin section］ of the heart ruler is called the ‘shoulder door’. The same principles apply above and below. The superficial network vessels observed in this section are all heart ruler network vessels. If the network vessels are exuberant ［i.e. full］, then ［an evil］ has entered and is visiting the channel. The yin ［skin section］ of the greater yin ［channel］ is called the ‘gate peg’. The same principles apply above and below. The superficial network vessels observed in this section are all greater yin network vessels. If the network vessels are exuberant ［i.e. full］, then ［an evil］ has entered and is visiting the channel.”
This introductory passage serves as one of the foundations for external treatment methods in Chinese medicine. It not only uses visual examination to refer to internal and external pattern diagnosis relationships, but also mentions the relationship between channels and network vessels. It includes the interior and exterior, the internal and external, the 5 colors, and cold and heat. Most important of all is its argument regarding external signs. Of course, that which is external is simply the skin on the body surface, as well as the sinews and flesh beneath the skin…
Although there are variations in physiological characteristics among different human bodies despite sharing the same features, there are always similar causes of disease and pathomechanisms. Based on different body parts, we can still seek differences in common ground and common ground in differences, and do more with what we have. We can observe local areas to understand the bowels and viscera. Through the perspective of yin and yang pattern diagnosis and holistic determination of treatment approaches, we can integrate local areas on the chest and abdomen with mutual relationships in the body as a whole. In addition to knowing the independent and integrated properties of the viscera and bowels, as well as the status of changes in the channels and vessels, this train of thought also requires us to truly experience and thoroughly understand where the basis for these ancient methods comes from and why we treat holistically in Chinese medicine.
When cord-like membranes with specific functions are arranged densely in layers, they gradually form the muscles, sinews, tendons, and connective tissues of the human body… Below, we will incorporate human anatomy into a deeper layer of discussion.
Membranes in anatomy
From an anatomical perspective, connective tissue is worth taking note of; most of the operations of the nervous system and blood vessels in the body are done under the protection of this tissue. It is one of the fundamental tissues in the human body. It consists of cells, fibrous bodies, and a matrix. The cells include macrophages, fibrocytes, plasma cells, and mast cells. The fibers include collagenous, elastic, and reticular fibers, which primarily serve to connect various tissues and organs. The matrix is a slightly gluey fluid substance that fills the spaces between cells and fibers, and serves as the medium for the metabolism of the tissues. The fibers and matrix are collectively referred to as the “interstitial matrix”, which comprises the majority of the mass of the connective tissue. Connective tissue has a very strong capacity to regenerate, most injuries relying on the proliferation of these tissues to heal. Connective tissues can be categorized as “loose” connective tissue (such as the subcutaneous tissues), “dense” connective tissue (such as sinews and tendons), and adipose tissue. This discussion is focused on the anatomical aspects of connective tissue because it serves like a central transfer hub in the human body; its structure consists of “extracellular matrix cells with interconnected protrusions that form a web between cells”. We can see that there is some common ground with Chinese medicine, namely that in the various life processes, like growth and development, fighting disease, and metabolism, the human body is unified, and its components help each other to exist. Thus, from this stage-based model of human life, we can understand the effects generated in the interoperation of internal tissues and systems.
Membranes in Chinese medicine
When the human body forms in the womb, all of its parts are soft (including the bits of the qi and blood that will form the bones). As soon as it is born, qi and blood will act swiftly through the operation of membrane network vessels to act out the growth of the body. This happens through the “like attracts like” combination of the qi of earlier heaven with the qi of later heaven (from the perspective of western medical theory, this is the grouping of cells of the same type). In terms of the external form, the skeleton is built as a framework according to the needs of the various parts of the human body and how they operate, and the locations of soft tissues are then derived from this framework. At the same time, the role of the membrane network vessels is to gradually complete the overall layout of the human body through the processes of the viscera and bowels.
Of course, in this process, the membrane network vessels themselves are constantly undergoing metabolism and expansion, and gradually bring about a synchronized completion together with other aspects of development. Likewise, the “life, aging, disease, and death” processes of the human body start here. In the process from the fetal stage, to infancy, childhood, adolescence, and young adulthood, and then middle age, old age, and death, how does the human body change and express itself, and what brings about all the abnormal factors that appear during this process? Although the qi of the viscera and bowels are the main factors, the membrane network vessels are the most notable hub in this process. While the various viscera and bowels interoperate by means of the channels and vessels, they each have their own independent functions. As qi and blood are dispersed towards the exterior layers, they are distributed through their specific “tunnels”.
Membranes maintain harmony in diversity
If we observe the skeleton, muscles, sinews, tendons, skin, and all related tissues from the viewpoint of membranes, network vessels, qi, and blood, and use these inherent connections and reflections of external signs to survey the internal parts of the human body, although there are different cells making up different tissues, at the end of the day they are all undergoing metabolism and interacting with each other in the same living organism. In other words, “life particles” with different functions 〖JP2〗make up a living community and, in the course of development, they must replenish each other with different forms of energy in order for the body as a whole to be healthy and strong. In fact, there is common ground shared in certain discussions of Chinese and western medicine; the difference is that western medicine tends to prioritize theoretical refinement, while Chinese medicine values clinical integration. This can be seen from the anatomical description of connective tissue alone. Therefore, as Chinese medicine practitioners, although we must respect the refinement of western medicine, we must never forget the fundamental perspectives of Chinese medicine in diagnosis and treatment.〖JP〗
Before an infant is born, the whole structure of the viscera, bowels, channels, and vessels has already been completed. As soon as the infant is born, the special functions of these parts will start to have an effect on the completion of the infant’s entire life. This must still be carried out by means of the membrane network vessels because the soft tissue in the human body has a relatively synchronized growth process, which includes the muscles, sinews, tendons, ligaments, and connective tissues. The viscera and bowels transport qi and blood through the channels and network vessels to moisten and nourish specific locations in the human body, but their effects vary, which is why Chinese medicine includes the “study of visceral manifestations”. For example, the spleen governs movement and transformation, controls the blood, and governs the flesh and four limbs. Its bloom is in the lips and it opens at the mouth. This description not only encompasses the spleen’s functions in modern medicine, but more importantly, it summarizes some of the functions of the digestive, excretory, and endocrine systems. From the various explanations given above, it is clear that the ancients performed their analysis entirely in terms of the independent and integrated properties of the interactions between viscera, bowels, channels and network vessels. Although the ancients’ analysis is not as refined as that of modern people, their perspectives on the explanation, observation, and application of these interoperating functions in the human body are extremely clear. In addition, in these structural models, the membrane network vessels move qi and blood in an orderly fashion to and from the viscera, bowels, and exterior. Through changes in speed, color, and temperature, they can show us the health status of the viscera and bowels, and when the body surface is affected or injured, they replenish the necessary qi and blood from the viscera and bowels in a timely manner. These points actually prove what western medicine discovered a thousand years later. The Merck Manual of Diagnosis and Therapy states that “in an autoimmune disorder, antibodies or cells produced by the body attack the body’s own tissues. Many autoimmune disorders affect connective tissue and a variety of organs. Connective tissue is the structural tissue that gives strength to joints, tendons, ligaments, and blood vessels.” From this, we can clearly see that both Chinese and western medicine are already aware of the intrinsic interconnections in living organisms, but it seems that their paths diverge in terms of how this awareness is applied clinically.
While the ancients’ analysis of the human body is not as refined as that of modern medicine, we can gain insight into its logical and integral properties from the mutual relationships among the 12 regular channels and the 8 extraordinary vessels, as well as various point locations and combinations. The movements of the 12 regular channels are the movements of qi and blood of the individual viscera and bowels, but how is their qi formed as a whole? Here, the 8 extraordinary vessels play a key role. “Outside of the regular channels, there are extraordinary channels; the 8 vessels have their own separate domains and names. The controlling vessel covers the front and the governing ［vessel］ is on the back. The thoroughfare ［vessel］ starts at the meeting of yin and runs along the kidney ［channel］. The yang springing ［vessel］ diverges from the outer bladder ［channel］, while the yin ［springing vessel］ starts anterior to the heel and follows the lesser yin ［channel］. The yang linking ［vessel］ links and connects all the yang vessels, while the yin linking ［vessel］ links and connects in all the yin ［vessels］. The girdling vessel surrounds the waist like a belt. ［Since these are］ not constrained by normal ［limits］, they are called extraordinary channels.” This is Li Shizhen’s description in An Examination of the 8 Extraordinary Vessels. The end of this description uses the phrase “not constrained by normal ［limits］”, which highlights the key point. Given that the viscera and bowel qi of the 12 regular channels requires the qi of other viscera and bowels to support and move it as it circulates, it must be subject to the effects of the membrane network vessels, and these effects require management, restraint, and harmonizing. By contrast, the 8 extraordinary vessels run through the membrane framework (source) in their own special ways. They mix and combine channel qi, and then transport it back to the various major channels connected to the viscera, bowels, and other areas. So it is not an overstatement to say that these vessels are the pharmacy of the human body.
The description of the 8 extraordinary vessels in the Classic of Difficult Issues states, “They follow each other up and down, flowing like a spring; like the movements of the sun and moon, they never stop to rest. Thus, the yin vessels are constructed in the 5 viscera and the yang vessels are constructed in the 6 bowels. Yin and yang link with each other, like a loop without an end. Nobody knows its cycles; it ends and then starts again. The qi that spills from this flow enters the extraordinary channels and diverts to irrigate them. Internally, it warms the viscera and bowels; externally, it moistens the interstices. The 8 vessels of the extraordinary channels are not restricted by the 12 regular channels; they do not have exterior-interior pairs, so they are called ‘extraordinary’. The regular channels are like canals and ditches, while the extraordinary channels are like lakes and marshes. When the vessels of the regular channels descend into exuberance, ［qi］ spills into the extraordinary channels.” The statement that “internally, it warms the viscera and bowels; externally, it moistens the interstices” happens to align with the role of the triple burner. Therefore, no matter whether we look at the explanations given in the Inner Canon, On Cold Damage, or Thousand Gold Pieces Formulary, we can analyze the content in these texts in a practical way. While there is no obvious exposition on how the form of the human body is constructed, we cannot ignore the fact that these texts use their own unique methods to gain insight by linking intrinsic systems together to form a whole. Moreover, this foundation is used to treat disease.
Western medical exploration is becoming increasingly refined and treating disease is someone else’s job; it is the job of medications and surgeons. By contrast, Chinese medicine approaches the human body using the 12 regular channels, 8 extraordinary vessels, and acupuncture points to unify and describe principles for health maintenance and the treatment of disease. The basic directions of the 8 extraordinary vessels are also shown in a highly systematic, rational, and methodical way through point locations on the membrane framework (source). The biggest difference from western medicine is that the latter analyzes all tissues, systems, and even physical structures in the human body in terms of each part, and then assigns an expert practitioner to diagnose and treat each part or system (such as each toe). If any specialist so much as suspects that something is not within the scope of their specialty, they will transfer the patient to be examined by a different specialist. Ultimately, medications and surgery are the primary treatments.
When using the theory of membrane network vessels to explain western anatomy, especially in terms of treatment, if we can fully comprehend the circulation and changes in the 8 extraordinary vessels, organize our approach to diagnosis and treatment based on the relationships among the relevant acupuncture points, and completely understand the underlying principles, then we will feel that Chinese medicine itself is a scientific method of thinking. As various practitioners have said, “the 8 extraordinary vessels are the great pharmacy of the human body”.
The influence of scars on membranes
If we observe the relationships between the girdling vessel and the various tissues in the pelvic cavity from an anatomical perspective, we can more directly understand some of the causes that can inhibit the girdling vessel. In the pelvic region, there are several factors that we must pay attention to: (1) abnormal phenomena caused by scars from abdominal surgery; (2) the status of the abdominal muscles; (3) the sinews and tendons that extend upward and laterally from the pubic bone area; (4) the status of the psoas major muscle extending into the pelvic cavity; (5) the status of both sides of the dorsal coccyx and L4-L5; and (6) the status of both hips. When these symptoms appear, the depletion of qi and blood is still just a manifestation. Aside from dysfunction of the viscera and bowels, another main cause of these symptoms is that tension, stickiness, depression, or stasis has formed in the membrane network vessels due to some kind of interference, which leads to stoppage of qi and blood. This makes it difficult for the 8 extraordinary vessels to harmonize the 12 regular channels, ultimately causing injury to the viscera and bowels. Moreover, these “repletion signs” due to causes of disease in the human body are often important elements that Chinese medicine can resolve.
Another example is the spine
The spine not only has a close relationship with the central nervous system, but also serves as a framework for balancing the blood vessels and lymphatic circulation. Changes in the spine have a large impact on the nerves and blood vessels distributed throughout the body; the main blood vessels include the vertebral artery, the abdominal aorta, and the iliac artery. There are 3 body cavities anterior to the spine. The heart and lungs are on top; the liver, gallbladder, and spleen are on the sides; the stomach, small intestine, pancreas, and kidneys are in the back; and the bladder and uterus are below. Nerves link the spine to the various organs and blood vessels also interconnect with them.
The muscles and ligaments serve as support structures that enable the spine to remain upright and move in different directions. The spinal ligaments also link the vertebrae together and maintain the stability of the spinal column. The ligaments consist of tough connective tissue with a criss crossed structure; they link the vertebrae into a unified whole and play a role in movement and protection. aking human anatomy into account, let us consider the main point of membrane network vessel theory: “membrane network vessels make up a framework for life, while qi and blood make up the driving force for life”. This is perfectly clear if we understand its significance as a whole based on the mutual relationship of the parallel paths of the bladder channel and governing vessel on the back, as well as the names of a few major acupuncture points. Moreover, when treating many modern disease symptoms, we can resolve the membranes and enable the movement of the network vessels, and there are many ways to reach a solution. The network vessel of the governing vessel is one of the 15 network vessels. It diverges from the governing vessel at the point Long Strong ［GV-01］, then runs up along the border of the muscles on both sides of the spine to reach the neck, and spreads out on the head. It also branches out to the right and left on the shoulders and scapulae, heading towards the foot greater yang channel and running through the muscles on both sides of the spine. From this, we can see the relationship between network vessels and membranes.
As soon as symptoms appear in this condition of alternating vacuity and repletion, in mild cases there will be lumbar aches, back pain, and cervical spondylosis; in severe cases, there will be ankylosing spondylitis or damage to the viscera and bowels. Therefore, the governing vessel truly lives up to its title as “the sea of yang vessels”; whenever there is damage and pain, the yang qi will be blocked, causing restricted mobility during the day and restlessness at night. Because this is a syndrome of alternating vacuity and repletion, the exterior should be treated by external methods, while the interior should be treated with formulas based on symptoms. Working on both aspects will yield results over time.
While there are various perspectives and theories on “membranes” in Chinese medicine, I hope we can seek common ground and put aside our minor differences. In the future, I will publish discussions on network vessels, membranes, and the interstices. Thank you!
Author information:
Chen Hongliang went to the United States in early 1980. He is a Chinese American and the founder of “Fingertip Yijin Therapy”.
In 2003, he graduated from Richmond Medical Massage College in Virginia, USA.
He founded a natural therapy clinic.
In September 2015, he served as the vice president of the World Federation of Chinese Medicine’s Tumor Treatment Research Professional Committee; and a director of the World Chinese Medicine Association’s Diabetes Committee.
