THE EIGHT EXTRAORDINARY VESSELS

奇 经 八 脉

馬
萬

Copyright Giovanni Maciocia 里

The 8 Extraordinary Vessels are called:

QI 奇 = “extraordinary”
JING 经 = “channel”
BA 八 = “eight”
MAI 脉 = “vessel”

Opinions as to why the Extraordinary Vessels are called “extraordinary” (qi) vary:

- the “Nan Jing” says that they are “extraordinary” because they are not
“restrained” by the main channel system.

- Li Shi Zhen says that they are “extraordinary” because they do not pertain to the
main channel system and do not have exterior-interior relationships.

- modern textbooks say that “extraordinary” means “odd, a little extra, surplus”,
suggesting that the Extraordinary Vessels are separate and different from the main
channels. This interpretation implies not only that the Extraordinary Vessels are
different but that they add something to the main channel system.
The main source of knowledge for the Extraordinary Vessels derives from the
following classics:

• “Spiritual Axis” (Ling Shu)

• “Classic of Difficulties” (Nan Jing)
• “Pulse Classic” (Mai Jing) by Wang Shu He, AD 280
• “ABC of Acupuncture” (Zhen Jiu Jia Yi Jing) by Huang Fu Mi, AD 282
• “Guide to Acupuncture Channels” (Zhen Jing Zhi Nan) by Dou Han Jing, 1295
• “Gatherings from Eminent Acupuncturists” (Zhen Jiu Ju Ying) by Gao Wu, 1529
• “Study of the Eight Extraordinary Vessels” (Qi Jing Ba Mai Kao) by Li Shi Zhen,
1578
• “ Great Compendium of Acupuncture” (Zhen Jiu Da Cheng) by Yang Ji Zhou, 1601
• “Golden Mirror of Medicine” (Yin Zong Jin Jian) by Wu Qian, 1742
The Extraordinary Vessels act as reservoirs of energy in relation to the
Main channels which are compared to rivers. This idea comes from the
Nan Jing (chapters 27 and 28) and was later picked up by every other
author writing about the Extraordinary Vessels.

The fact that the Extraordinary Vessels function as reservoirs means that
they are able not only to absorb energy from the Main channels, but also
to transfer energy to the Main channels when needed. This happens in
cases of shock, for example.
Nan Jing, Chapter 27: “The sages built ditches and reservoirs and
they kept the waterways open in order to be prepared for above-
normal situations [i.e. floods]. When there are heavy rains, ditches
and reservoirs are full to the brim...in the human body, when the
channels are over-filled they cannot absorb the excess [and this
overflow from the main channels is absorbed by the extraordinary
vessels]”

Chapter 28 “The sages built ditches and reservoirs; when these are
full they overflow into deep lakes...in the human body, when the
channels are over-filled, they overflow into the 8 extraordinary
vessels where they are no longer part of the general circulation”.
Yin Luo channels (areas)

LIMBS

TRUNK
The "Study of the Eight Extraordinary Vessels" by Li Shi Zhen says: "...when the
Qi of the channels overflows, it flows into the extraordinary vessels where it is
turned into irrigation, warming the organs internally and irrigating the space
between skin and muscles externally."

Irrigates externally
COULI

Warms internally

ZANGFU
The Qi of the Extraordinary Vessels “irrigates” the space between the
skin and muscles where Wei Qi circulates to prevent invasion of
pathogenic factors.
Because all the Extraordinary Vessels derive directly or indirectly from
the Kidneys, they play an important role in the defence against exterior
pathogenic factors.
The Kidneys also influence the strength of our defence due to the fact
that Wei Qi originates in the Lower Burner and stems from Kidney-Yang.
The influence of the Extraordinary Vessels on the space between skin
and muscles implies their important role in protection from pathogenic
factors. As the Extraordinary Vessels circulate the Kidney-Jing, this
means that Jing plays a role in many physiological functions and, in
particular, in the protection against external pathogenic factors.
An interesting consequence of the Extraordinary Vessels’ quality as
“reservoirs” of Qi receiving Qi from the Main channels, is that their use is
indicated whenever a pulse quality spans more than one position (i.e. the
“reservoir” rather than an individual channel is affected). This concept
applies only when two or more positions of the pulse have exactly the same
quality and strength.
For example, if all the three positions (Front, Middle and Rear) are Floating,
it indicates a pathology of the Du Mai; if they are Firm, a pathology of the
Chong Mai. If both Front positions of left and right are Wiry and Full, it
indicates a pathology of the Yang Qiao Mai.
 THE EXTRAORDINARY VESSELS AND THE KIDNEY-JING

The Extraordinary Vessels all derive directly or indirectly from the Kidneys
and they all contain the Jing which is stored in the Kidneys. They circulate
Jing around the body, thus contributing to the integration of the circulation
of Ying Qi and Wei Qi with that of Jing.

The three main Extraordinary Vessels - the Du, Ren and Chong Mai - all
start in the Lower Burner, in the space between the kidneys where the lower
Dan Tian is located.

YING QI

WEI QI

JING
Chapter 65 of the “Ling Shu” says: “The Ren and Chong Mai originate
from the Lower Dan Tian [literally “Bao”].”

The actual term used by the “Ling Shu” is “Bao” which is often translated
as “uterus”. However, while the term “Zi Bao” refers to the Uterus, the
word “Bao” indicates a structure that is common to both men and women:
in women, it is the Uterus, in men, it is the “Room of Sperm” [Jing Shi 精
室]. In this context, “Jing Shi” could be translated as “Room of Jing” or
“Room of Sperm”.

Both these structures reside in the lower Dan Tian and store Jing and, as
the Extraordinary Vessels originate from here, they are closely connected
to Jing.
 THE ROOM OF JING AND THE “BAO” 胞

BAO 胞 LOWER DAN TIAN 丹 田

In men ROOM OF UTERUS – In women

JING ZI BAO
子 胞

SPERM – MENSTRUAL BLOOD

TIAN GUI – TIAN GUI 天 癸
天 癸
Li Shi Zhen:
The Yang Wei Mai is the meeting of the Yang channels, it rises from the ankle and goes to
the Wei portion (fen).
The Yin Wei Mai is the crossing of the Yin channels, it rises from the ankle and goes to the
Ying portion: therefore they link (gang wei = idea of rope) the whole body.
The Yang Qiao Mai arises from the lateral side of the heel and rises to the left and right
sides of the body.
The Yin Qiao Mai arises from medial side of the heel and rises to the left and right sides of
the body: therefore they give agility to the ankle.
The Du Mai starts from Ren-1 and rises up the back of the body, it governs all the Yang
[channels] and [for this reason] it is called the “Sea of the Yang channels”.
The Ren Mai starts from Ren-1 and rises up to the front of the body, it directs all the Yin
channels and [for this reason] it is called the “Sea of the Yin channels”.
The Chong Mai starts from Ren-1, it goes up the abdomen either side of the umbilicus, it
rises [chong “rushes”, “penetrates” upwards 冲 于 上 ], it is the meeting [chong] of all
channels and for this reason it is called the “Sea of the 12 channels”.
The Dai Mai runs horizontally to the back like a belt, therefore it gathers and encircles (zong
yue 总 约 “gather” and “restrict”, “restrain”).
Yang Wei Mai YinWei Mai Yang Qiao Mai Yin Qiao Mai
Du Mai Ren Mai Chong Mai Dai Mai
Li Shi Zhen lists the Eight Extraordinary Vessels in this order:
Yang Wei Mai, Yin Wei Mai, Yang Qiao Mai, Yin Qiao Mai, Du Mai, Ren Mai,
Chong Mai, Dai Mai.

This order is not by chance and it is partly related to the previous diagrams in
which the Yin and Yang Wei Mai connect the Main channels, and the Yin and
Yang Qiao are the first line of defence in absorbing excess Qi from the Main
channels. In fact, Li Shi Zhen compares the Yang Wei and Yin Wei to Qian and
Kun respectively, i.e. the two Trigrams representing Heaven and Earth.

YANG WEI MAI YIN WEI MAI

乾 坤
 YANG WEI MAI / HEAVEN (QIAN) 乾

DU MAI
SOUTH
S
YANG YIN
QIAO E W QIAO
EAST WEST
N
REN/CHONG MAI
NORTH

YIN WEI MAI / EARTH (KUN) 坤

 REN, DU AND CHONG MAI
These three vessels can be considered as three branches of the same vessel.
The “Mirror of Medicine Abstracted by Master Luo” says: “The Chong, Ren and
Du Mai are three branches from the same source. The Chong Mai is the Sea of
Blood, the Ren Mai governs all Yin channels and the Du Mai governs all Yang
channels.”

Du Mai

Chong Mai

Ren Mai

Ren-1
The “Classic of Categories” (Lei Jing, 1624) by Zhang Jing Yue says:
“The Ren Mai starts at Zhongji . . . underneath this point is the Uterus.
The Ren, Chong and Du Mai all start from the Uterus and emerge at
Ren-1 Huiyin. From Ren-1 Huiyin the Ren Mai flows up the abdomen,
the Du Mai up the back and the Chong Mai connects with the Kidney
channel and disperses in the chest. The Chong Mai flows up from the
pubic bone to Ren-4 Guanyuan, up inside the abdomen, to the throat
and into the eyes, following the Ren Mai pathway.”

Ren Du Chong
All these three vessels originate directly from the space between the
Kidneys and flow down to the perineum (at Ren-1 Huiyin) from where
they take different pathways: the Ren Mai flows up the abdomen along
the midline, the Du Mai up the back, and the Chong Mai up the
abdomen along the Kidney channel.
These three vessels can be seen as the source of all the other
Extraordinary Vessels as they originate directly from the Kidneys and
are therefore connected to Jing.
They, more than the other Extraordinary Vessels, can be used in clinical
practice to nourish Jing and affect the patient's energy at a deep
constitutional level.
 YIN and YANG QIAO MAI
These two vessels are directly complementary: the Yin Qiao Mai starts at KI-6
Zhaohai and flows up to the eye carrying Yin Qi to it, the Yang Qiao Mai starts at
BL-62 Shenmai and flows up to the eye carrying Yang Qi to it.

Thus when Qi is in excess in the Yin ...while when Qi is in excess in the

Qiao Mai, the person will be Yang Qiao Mai, the person is awake
constantly sleepy and the eyes will and the eyes are open.
want to close...

In the Nan Jing metaphor of the extraordinary vessels as reservoirs, the Yin and
Yang Qiao Mai are the first “line of defence” absorbing excess of Yin or Yang
respectively.
YIN AND YANG QIAO MAI CONTROL THE STATE
OF THE LEG MUSCLES

When the Yin Qiao Mai is diseased, the Yin is tight and the
Yang is slack (i.e. the muscles of the inner aspect of the leg
are tight, and those of the outer aspect too relaxed).

When the Yang Qiao Mai is diseased, the Yang is tight and
the Yin slack (i.e. the muscles of the outer aspect of the leg
are tight and those of the inner aspect slack).
 The two Qiao Mai harmonize Left and Right and Medial-Lateral structures
of the Yin and Yang channels respectively and can therefore be used to
correct structural imbalances in the body such as:

• one leg shorter • one scapula higher than • unilateral • muscles on one
than the other the other sweating side being tighter
than the other.

For example, one of the indications for KI-2 Rangu (beginning point of
the Yin Qiao Mai) is “one foot hot and the other cold”.
 YIN AND YANG WEI MAI
The two Wei Mai complement each other in so far as they link the Yin
and Yang channels. In addition, their opening points belong to the Shao
Yang and Jue Yin channels, i.e. Triple Burner and Pericardium
respectively, which are internally-externally related.
The two Wei Mai harmonize Interior with Exterior, and Ying Qi with Wei
Qi.
 DAI MAI
The Dai Mai is the only horizontal channel in the body so it stands
alone. It encircles the Main channels, and because of this, it exerts an
influence on the circulation of Qi to the legs.
Dividing the body in two halves, it harmonizes Above and Below.
Each Extraordinary Vessel has an “opening” point and is associated with a
“coupled” point: each “coupled” point is, in turn, the opening point of
another Extraordinary Vessel.

These points are called jiao hui [交 会] in Chinese, which means

“meeting” or “confluent” points.
For example the opening point of the Ren Mai is LU-7 Lieque, while this
point is also the coupled point of the Yin Qiao Mai.
Similarly, KI-6 Zhaohai is the coupled point of the Ren Mai and the
opening point of the Yin Qiao Mai.
When the points are coupled in this way, the Extraordinary Vessels are
grouped into pairs as follows:
 EXTRAORDINARY VESSELS POINTS

DU MAI SI-3 HEAD, SHOULDERS,

YANG QIAO MAI BL-62 BACK, BRAIN

FACE, EYES, THROAT,

REN MAI LU-7 CHEST,
YIN QIAO MAI KI-6 ABDOMEN, UTERUS

CHONG MAI SP-4 CHEST, HEART,

YIN WEI MAI P-6 STOMACH

DAI MAI
YANG WEI MAI GB-41 WAIST, HIPS, EARS,
TB-5 OCCIPUT, NECK
The clinical significance of these pairs of points is that it is only by
combining both points that we affect the area influenced by each
Extraordinary Vessel.

With the exception of the Du and Ren Mai, the Extraordinary Vessels
do not have their own points as the Main channels do, but they flow
through points of various Main channels. Therefore each Extraordinary
Vessel influences more than one Main channel; this is an important
characteristic which accounts for their clinical use.

As the Du and Ren Mai have their own points, they have the dual
quality of a Main channel and an Extraordinary Vessel: for this reason,
the Main channels are sometimes counted as 14 rather than 12.
The extraordinary vessels do not have their own BL
points (except Du and Ren Mai) and they GB
“meander” from point to point and from channel ST
to channel. LI
SI
The Yang Qiao Mai is the best example of this
“meandering” from one channel to the other.

GB

BL

Yang Qiao Mai

YANG QIAO MAI
The pairs of opening and coupled points of the extraordinary vessels
define the areas reached by each vessel.

These areas are areas of influence of each pair of points. This is

clinically very useful as using those pairs of points will treat any
symptom in any part of the area influenced.

Chong Mai area

 DU MAI / REN MAI /
YANG QIAO YIN QIAO
AREAS AREAS

SI-3 and BL-62 LU-7 and KI-6

DAI MAI / CHONG MAI /
YANG WEI YIN WEI
AREAS AREAS

GB-41 and TB-5 SP-4 and P-6

REN MAI/YIN QIAO AREAS

LU-7 and KI-6

 AREAS INFLUENCED BY THE EXTRAORDINARY
VESSELS

A very important implication of these pairs of points is also that these

two points together define the whole area influenced by an
Extraordinary Vessel.

For example, the pair of points LU-7 Lieque and KI-6 Zhaohai (Ren
Mai) will influence the whole area covered by the Ren Mai.

LU-7

KI-6
This is a very simple but extremely important concept in clinical
practice. The pair of points used together allows us to treat
symptoms arising in any part of that vessel’s pathway.

For example, if a woman suffers from acne on the chin and

excessive vaginal discharge, whatever the patterns involved in
each of the symptoms, both those signs occur on the Ren Mai’s
pathway: this means that they can be treated by the two points
LU-7 Lieque and KI-6 Zhaohai used in combination.

“Gatherings from Eminent Acupuncturists” (Zhen Jiu Ju Ying):

“This treatment method [i.e. the method of using the opening

and coupled points of an Extraordinary Vessel] is very broad
indeed. It is known as setting a very broad net in open country to
catch a single rabbit.”
 HOW THE OPENING POINTS ARE USED

The opening points of the Extraordinary Vessels can be used in

different ways and there is no general consensus on this question. I will
discuss the use of the opening points.

There is no general consensus on which points should be used to

“open” an Extraordinary Vessel and the classics are often ambiguous on
this point. Modern Chinese books carefully avoid this question
(probably because there is no consensus on it).

The classics sometimes mention only the opening point of a vessel (e.g.
LU-7 for the Ren Mai) but more often they mention the points in pairs
(e.g. LU-7 and KI-6 for the Ren Mai).

Taking the Ren Mai as an example, the points could be used in four
different ways:
1) Only the opening point (e.g. LU-7 Lieque) bilaterally.

2) The opening point and the coupled point (e.g. LU-7 Lieque and KI-
6 Zhaohai) bilaterally. This method is suitable for a wide range of
problems.

3) The opening point and the coupled point unilaterally and crossed
over (e.g. LU-7 Lieque on one side and KI-6 Zhaohai on the other).
This method is suitable for problems of the head and face and of the
internal organs. It is especially suitable for children, old people, those
with weak body condition, or those suffering anxiety.

4) Opening point and coupled point unilaterally (e.g. LU-7 Lieque and
KI-6 Zhaohai) on the same side. This method is suitable for unilateral
problems: of back and limbs, backache, sprains, Bi Syndrome, Wind-
stroke sequelae. One needs only to needle the affected side.
I personally use the third and fourth techniques and primarily the third.
Because of this arrangement in pairs, the opening point of one vessel is
usually used in conjunction with the opening point of the paired vessel.

As I see it, it is like a locked door that requires two keys to open it. Most
of the time, I would use these two points unilaterally and crossed over;
occasionally, I use them unilaterally on the same side.

The technique of using two points unilaterally and crossed over, called
"host-guest", was indicated for the very first time in the "Guide to
Acupuncture Channels" (Zhen Jing Zhi Nan, 1295) and later expanded in
the "Great Compendium of Acupuncture" (Zhen Jiu Da Cheng, 1601).
The “Guide to Acupuncture Channels” (1295) lists the opening
point of each Extraordinary Vessel specifically indicating its
combination with its coupled point.

For example, for the Chong Mai, it says: “SP-4 Gongsun, two
points, on the Spleen channel . . . combine with P-6 Neiguan.”
Interestingly, this text makes an exception for the opening points
of the Yin and Yang Wei Mai (P-6 Neiguan and T.B.-5 Waiguan)
which, it says, should be used on their own. However,
subsequent classics do not give such instruction.
The “Great Compendium of Acupuncture” (Zhen Jiu Da Cheng 1601)
mentions the Extraordinary Vessels’ points as pairs in many passages,
clearly implying that they are used as a couple. For example, it says:

“Neiguan ought to go with Gongsun; Waiguan is put together with

Zulinqi; Lieque is coupled with Zhaohai; Houxi mutually follows
Shenmai.”

The “Gatherings from Eminent Acupuncturists” (Zhen Jiu Ju Ying,

1529) also clearly recommends using the opening points of the
Extraordinary Vessels in pairs. For example, when it gives the
symptomatology of each Extraordinary Vessel (under the heading of
its opening point), it always ends the passage by citing a pair of points;
for example, saying for SP-4: “Needle SP-4 Gongsun first and then
follow with P-6 Neiguan.”
The “Great Treatise of Acupuncture” (Zhen Jiu Da Quan, 1439) by
Xu Feng says:

“SP-4 Gongsun is paired with P-6 Neiguan, LU-7 Lieque can be

coupled with KI-6 Zhaohai, G.B.-41 Zulinqi and T.B.-5 can act as
host and guest, S.I.-3 Houxi and BL-62 respond to each other.”

Thus, these classics not only recommend using the points in pairs,
but they all specifically recommend using the opening point of the
Extraordinary Vessel that we want to open first, followed by its
coupled point (e.g. SP-4 Gongsun followed by P-6 Neiguan for the
Chong Mai).
Finally, a modern Chinese text reports a quotation from Dou Han
Qing which says:

“To treat a disease is like attacking an enemy. When military

forces are combined and an attack is launched up and down upon
a small group of traitors, they can hardly escape.”

The expression “up and down” in this passage refers to using a

point on the arm and one on the leg (all pairs of opening and
coupled points are located thus): this widens the “net” as it were,
to widen the therapeutic range of actions of the points.

The same textbook also clearly instructs its readers that the points
be used in pairs and in a particular order, i.e the opening point
first and the coupled point second. It says: “Points should be
acupunctured [sic] in pairs. Main point should be needled first,
coupled point second.”
Therefore, when using the Ren Mai, for example, one would needle LU-
7 Lieque and KI-6 Zhaohai in this order. I personally needle these two
points on opposite sides. The needles are withdrawn in reverse order.

I use the opening and coupled points of a vessel according to sex, i.e. in
a man I use the opening point on the left and the coupled point on the
right and vice versa in a woman. For example, to open the Ren Mai in a
man, I needle LU-7 Lieque on the left, followed by KI-6 on the right in
this order; in a woman, I would use LU-7 Lieque on the right followed
by KI-6 on the left.

I learned this particular use of paired points of the Extraordinary Vessels

from Dr J. D. Van Buren in the early 1970s. Dr Van Buren, in turn, had
learned it from a Korean teacher.

. .
. . Dr. J D Van Buren
Although the classics do not mention the laterality of the opening and
coupled points according to sex, some of them do hint at the use of the
opening point on one side and the coupled point on the opposite side.

For example, the “Gatherings from Eminent Acupuncturists” (Zhen Jiu

Ju Ying, 1529) says:

“Insert the main [opening] point first meeting the disease on its left or
right and up or down location. If the disease is not cured, insert the
coupled point.”
There is one exception to the rule of using both the opening and
coupled points to open an Extraordinary Vessel, i.e. in the case of the
Yin and Yang Qiao Mai.

In some situations, it is not necessary to use both the opening and

coupled points of these vessels, but the opening point alone will do:
this is due to the fact that, only in the case of these two vessels, the
opening points coincide with their starting points.

For example, when I tonify the Yin Qiao Mai and drain the Yang Qiao
Mai for insomnia, I use only KI-6 Zhaohai for the former and BL-62
for the latter.
When used in such pairs, the Extraordinary Vessels’ points also
harmonize Above and Below as the paired points are always one from
the arm and one from the leg. By using the points unilaterally and
crossed-over, we also harmonize Left and Right.
For these reasons, I prefer the unilateral and crossed-over use of the
points as, by harmonizing Above-Below and Left-Right, it brings into
play the role of the Extraordinary Vessels as “reservoirs” of Qi; it also
draws upon their role of regulating, integrating and balancing. Using
these pairs one transcends the action of the individual points bringing
into play the Qi of the Extraordinary Vessels.
 OPENING POINT PAIRED POINT STARTING POINT
Du Mai SI-3 Houxi BL-62 Shenmai Du-1 Changqiang
Ren Mai LU-7 Lieque KI-6 Zhaohai Ren-1 Huiyin
Chong Mai SP-4 Gongsun P-6 Neiguan Ren-1 Huiyin
Yin Qiao Mai KI-6 Zhaohai LU-7 Lieque KI-2 Rangu
Yang Qiao Mai BL-62 Shenmai SI-3 Houxi BL-62 Shenmai
Yang Wei Mai TB-5 Waiguan GB-41 Zulinqi BL-63 Jinmen
Yin Wei Mai P-6 Neiguan SP-4 Gongsun KI-9 Zhubin
Dai Mai GB-41 Zulinqi TB-5 Waiguan GB-26 Daimai
OPENING POINTS VS POINTS ON THE EXTRAORDINARY
VESSELS

An Extraordinary Vessel may be used in two possible ways:

a) Using the opening point (together with the coupled point)

b) Using a point on the vessel.

The next question that arises is: what is the difference between using the
opening point and the coupled point of an Extraordinary Vessel (e.g.
LU-7 Lieque and KI-6 Zhaohai for the Ren Mai) and using a point on
the vessel itself (e.g. Ren-4 Guanyuan)?
 USING THE OPENING AND COUPLED POINTS

Using the opening and coupled points achieves two results:

1. It reaches the whole area governed by that vessel (e.g. the Ren Mai,
LU-7 Lieque and KI-6 Zhaohai to reach, for example, the lower
abdomen and genitals as well as mouth and gums).

2. It brings into play the Extraordinary Vessels’ role as reservoirs of

Qi, i.e. to absorb and regulate excesses and stagnation. This is
particularly necessary when the pulse has the same quality in different
positions. It also brings into play the function of the Extraordinary
Vessels to regulate, balance and integrate.
Using the opening and coupled points reaches the
area governed by that vessel.

A man complains of a pain on the lateral side of

the lower left leg and earache in his left ear.
These two problems are apparently unrelated and
diagnosing according to patterns one would say
that the leg pain might be due to invasion of
Dampness and the earache to Damp-Heat.

However, there is one factor that unites these two

symptoms: both occur in the area influenced by
the Yang Wei Mai.

The whole area of the Yang Wei Mai can be

treated only by using the opening and coupled
points, i.e. T.B.-5 Waiguan and G.B.-41 Zulinqi.
Therefore, treating the Yang Wei Mai will treat both these
symptoms simultaneously, whatever the patterns causing
them (of course, treatment of this vessel can be combined
with treatment of the patterns).

However, in this case, “treating” the Yang Wei Mai means

using its opening and coupled points, i.e. TB-5 Waiguan and
G.B.-41 Zulinqi (needled in this order and on opposite
sides).

It is only by using these two points in combination that we

affect the whole area influenced by the Yang Wei Mai. If we
used a point on the Yang Wei Mai itself (e.g. G.B.-35
Yangjiao or G.B.-19 Naokong), it would not affect the whole
tract of the vessel.
Another example will clarify this concept:

Let us say a woman suffers from bleeding gums and excessive

vaginal discharge. Again, we can diagnose these two
symptoms separately: the bleeding gums might be due to
Stomach-Heat and the excessive vaginal discharge to Damp-
Heat in the Lower Burner.

However, there is a connection between them: both are on the

area influenced by the Ren Mai. We can influence the whole
area of this vessel (i.e. the gums and the genital system) by
using the opening and coupled points, i.e. LU-7 Lieque and
KI-6 Zhaohai (needled in this order and on opposite sides).

As in the previous example, these two points may be combined

with others treating the appropriate patterns; however, what
matters is that these two points will have an effect on those
two symptoms irrespective of the patterns.
Using the opening and coupled points to bring into play the roles of
Extraordinary Vessels as reservoirs and as agents of regulation, balance
and integration.
As we have discussed above, the Extraordinary Vessels function like
reservoirs to absorb excesses or imbalances of Qi from the Main
channels in the same way as reservoirs absorb an excess rainfall or may
counteract a period of drought; they also regulate, balance and integrate
various structures of the body.
In many cases, the Extraordinary Vessels are used therefore to absorb
excesses of Qi or remove stagnation of Qi and/or Blood. In such
situations, the pulse will reflect a pathology of the Extraordinary Vessels
by having the same pulse quality and intensity in more than one
position.

Why should this be?

If the Main channels are like rivers (reflected in 12 individual positions
on the pulse) and the Extraordinary Vessels like reservoirs absorbing Qi
from more than one Main channel, the “reservoir pathology” will be
reflected on the pulse by having the same quality and intensity in more
than one position (i.e. the individual pulse positions, the “rivers”, merge
into one, the “reservoirs”).

This phenomenon is also due to the fact that the Extraordinary Vessels
integrate various structures and their Qi often spans several different
channels: for this reason, their Qi, in pathology, is often reflected on a
pulse that has the same quality and intensity in different positions.
 For example, in Blood stasis in the Chong Mai, the pulse will feel
Firm (Lao) in all three positions of the left.

The same quality and intensity of a pulse in more than one position
reflects the “flooding” and “overflowing” of the Main channels into the
Extraordinary Vessels. It is in such situations that we want to “bring
into play the role of the Extraordinary Vessels as reservoirs”.

Firm
.. HE

. LIV
KI
To regulate such stasis and absorb the excess, only the opening and
coupled points (SP-4 Gongsun and P-6 Neiguan) will do.

A point on the vessel itself (e.g. KI-14 Siman) would not have the effect
of bringing into play the role of Extraordinary Vessels as reservoirs.
Another example could be that of a pulse that is Wiry on both
Front positions of right and left: this reflects a pathology of Excess
of Yang in the Yang Qiao Mai in the head.

Again, in this case, to bring into play the role of the Yang Qiao
Mai to absorb Excess Yang Qi in the head, we need to use the
opening and coupled points, i.e. BL-62 Shenmai and S.I.-3 Houxi.
 USING A POINT ON THE VESSEL
What is the effect of using a point on the course of an Extraordinary
Vessel?
There is no general answer to this question as we must distinguish
between the Du/ Ren Mai and the other vessels.
3 cases:
1) Du and Ren Mai
2) Chong Mai
3) Others

The Du Mai and Ren Mai have their own points and, from this point of
view, they are like the Main channels. Using a point on the vessel
itself will strengthen, tonify or move the Qi of that particular vessel
and there are many very important points on these two vessels.
For example, Ren-4 Guanyuan will
strengthen and “consolidate” the Ren Mai

Ren-6 Qihai can move Qi in the Ren Mai

Du-4 Mingmen strengthens the Fire of the Ming

Men.

Often, such points on the vessel are combined

with the opening and coupled points of that
vessel but this is not necessarily the case, e.g.
Ren-4 Guanyuan by itself strengthens the Ren
Mai.
However, it is common to use the opening and
coupled points of the Ren or Du Mai in conjunction
with a point on the vessel.

For example, it is very common to use LU-7 Lieque

and KI-6 Zhaohai to open the Ren Mai together with
Ren-4 Guanyuan to strengthen and consolidate the
vessel. The same applies to the Du Mai.
For other vessels, the effect of using a point on a vessel
is different and it is much less powerful. As the other
vessels do not have their own points, the effect of using
a point on the vessel itself is very limited and the main
purpose of doing so is to direct the treatment to a local
area.

For example, if we used S.I.-10 Naohu on its own (the

Yang Qiao Mai goes through this point), we would
have very little effect on this vessel. This point could
merely be used in conjunction with the opening and
coupled points (in this case BL-62 Shenmai and S.I.-3
Houxi) to direct the effect of the treatment to the local
area of the scapula.

Using BL-62 and S.I.-3 would open the Yang Qiao Mai
to perform its function of absorbing excess of Yang
energy in the top part of the body, whereas using S.I.-10
would have no such effect.
Finally, the Chong Mai is yet a different case that is placed in
between the two above cases. Although the Chong Mai does not
have its own points, as the Du and Ren Mai do, it does go through
all the Kidney-channel points from KI-11 Henggu to KI-21 Youmen.
Therefore some of these points on the Kidney channel do have a
powerful effect on the Chong Mai in a way that points on other
vessels (such as S.I.-10 mentioned above for the Yang Qiao Mai)
would not have. For example, KI-13 Qixue strengthens and
consolidates the Chong Mai.
When I open an Extraordinary Vessel with its opening and coupled
points, I customarily use only one such vessel at a time: for example, I
would not use SP-4, P-6, LU-7 and KI-6 all together to open the
Chong Mai and the Ren Mai. However, this rule does not apply when
using a point on the vessel rather than its opening and coupled points.
For example, I frequently needle Ren-4 Guanyuan (Ren Mai) and KI-
13 Qixue (Chong Mai).
 NEEDLING TECHNIQUES

To open an Extraordinary Vessel I generally use both its opening and

coupled points, according to sex (with few exceptions), i.e. I use the
opening point on the left in men and the right in women and the
coupled point on the opposite side.

For example, to open the Ren Mai in a man, I would insert LU-7
Lieque on the left, followed by KI-6 Zhaohai on the right; vice versa
in a woman.

. .

. .
Although this particular method of unilateral and crossed-over
needling according to sex is not in the "Great Compendium of
Acupuncture“(Zhen Jiu Da Cheng, 1601), the book does advise
needling the opening point of the chosen vessel first, and then
following that by its coupled vessel (e.g. LU-7 and KI-6).

The “Great Compendium of Acupuncture” calls this method the

“host-guest” technique, in which the opening point of the vessel
we want to open is the “host” and its coupled point (which is also
the opening point of the coupled vessel) is the “guest”.

For example, if we want to open the Dai Mai, G.B.-41 Zulinqi is

needled first and is the “host” point and T.B.-5 Waiguan is
needled second and is the “guest” point.
It is also interesting that the idea of needling the left side in men and the
right in women is mentioned by Sun Si Miao in his “Thousand Golden
Ducats Prescriptions” (Qian Jin Yao Fang) although not in connection
with the Extraordinary Vessels.

When I insert the opening and coupled points, I always start with the
opening point, e.g. S.I.-3 Houxi for the Du Mai, BL-62 Shenmai for the
Yang Qiao Mai, etc., and follow it up with the coupled point on the
opposite side, e.g. BL-62 Shenmai in the case of the Du Mai and S.I.-3
Houxi in the case of the Yang Qiao Mai.
I always obtain deqi (the needling sensation) but do not apply any
special technique, i.e. neither reinforcing nor reducing. I simply
obtain the needling sensation and leave the needle in.

If I am combining the opening and coupled points of an

Extraordinary Vessel with other points, I insert these after the
insertion of the coupled point, usually starting from the top part of
the body downwards.

For example, assuming I am using the Chong Mai in a woman and

wanted to add Ren-15 Jiuwei and Ren-4 Guanyuan, I would insert
SP-4 Gongsun first on the right, then P-6 Neiguan on the left, then
Ren-15 and last Ren-4.
If I am using other points on the limbs in combination with the opening
and coupled points of an Extraordinary Vessel, I often use them
unilaterally and crossed over on sides opposite to those of the opening
and coupled points. For example if we use the Chong Mai in a woman
for rebellious Qi and we want to combine the opening and coupled
points of this vessel (SP-4 and P-6) with L.I.-4 Hegu and LIV-3
Taichong. I would needle these points as follows:

L.I.-4 Hegu on the right

(opposite side to P-6)
. . P-6 Neiguan on the left

SP-4 Gongsun on the right

.. LIV-3 Taichong on the left
(opposite side to SP-4)
 If I was using the same combination in a man, I would insert the
needles as follows:

P-6 Neiguan on the right . . L.I.-4 Hegu on the left (opposite

side to P-6)

LIV-3 Taichong on the right

(opposite SP-4) . . SP-4 Gongsun on the left

I would then leave all these needles in for about 20 minutes; after this time, I
would withdraw the other points first (in the above example, L.I.-4 and LIV-3),
then withdraw P-6 Neiguan and last SP-4 Gongsun. In other words, when
withdrawing the opening and coupled points I withdraw the coupled point first.
When using points in addition to the opening and
coupled points, I try to use no more than 4 or 5
additional points.

Some doctors say that one must not use too many other
points lest the needles on the limbs be unable to move
Qi well: especially if there are scars or boils with pus.
When I use the Yang or Yin Qiao Mai for painful syndromes, I do
sometimes make an exception to the rule of using the opening and
coupled points according to sex. In such circumstances I generally use
the opening point on the side where the pain is felt and the coupled
point on the opposite side.

Examples of such painful syndromes are unilateral sciatica in

the case of the Yang Qiao Mai and unilateral abdominal pain for
the Yin Qiao Mai.

Sciatica: Yang Qiao Mai Abdominal pain: Yin Qiao Mai

Lastly, I sometimes make an exception to the rule of using the opening
and coupled point as a pair when treating the Yin or Yang Qiao Mai.
The reason for this, is that these two vessels are the only ones in which
the opening point coincides with the starting point.

For example, when I am using the Yin and Yang Qiao Mai to treat
insomnia, I would use BL-62 Shenmai to drain the Yang Qiao Mai
(without S.I.-3) and KI-6 Zhaohai to tonify the Yin Qiao Mai (without
LU-7 Lieque). I would also use BL-1 Jingming where the Yin and Yang
Qiao flow to.
I personally do not use two Extraordinary Vessels simultaneously: if
there seems to be an overlap of two Extraordinary Vessels in the
pathology, I might use one at a time in successive treatments.

Ion gynaecology, there is often an overlap in the symptomatology of the

Ren Mai and Chong Mai and a good way to treat both is according to
the 4 phases of the menstrual cycle, i.e. Ren Mai in phases 2 and 3 and
Chong Mai in phases 4 and 1.

The only exception to the rule of not using two Extraordinary Vessels
simultaneously is provided by the Du and Ren Mai: I sometimes use
these two vessels together, especially in women.
 When I use the Du Mai in treating a woman I generally do so on
the basis of a deficiency of Kidney-Yang. However, in women, I
often balance the Du Mai with the Ren Mai using the opening and
coupled points as follows (and in that order):

1. S.I.-3 Houxi on the

right . . 3. LU-7 Lieque on the left

4. KI-6 Zhaohai on the right .. 2. BL-62 Shenmai on the left

In this example, the opening and coupled points of the Ren Mai are, as it were, on
the “wrong” side from the normal technique. The above combination of points is
also very good to treat backache on the spine itself occurring against a background
of Kidney-Yang deficiency in a woman.
The Du and Ren Mai may be used to treat
.
Du-20

menorrhagia as follows:

SI-3 .
Ren-6
.
Ren-4 LU-7

KI-6 .. BL-62
The Du and Ren Mai may be used to treat chronic
.
Du-20

urinary problems such as interstitial cystitis as

follows:

SI-3 .
Ren-6
.
Ren-3 LU-7

KI-6 .. BL-62
 CLINICAL NOTE

To summarize, I use the opening and coupled points of the Extraordinary Vessels
in the following three ways:

• Opening and coupled point unilaterally and crossed over according to sex (in
men, opening point on the left and coupled point on the right; vice versa in
women).

• Opening point on the side of the pain (in pain syndromes) and the coupled point
on the opposite side.

• Opening point only (only for the Yin and Yang Qiao Mai, for example in
insomia).
 WHEN TO USE AN EXTRAORDINARY VESSEL

What guidelines can be given for choosing to use the Extraordinary Vessels in
practice? In other words, when and why do we choose to use an Extraordinary
Vessel instead of a Main channel?

Let us start by defining when we use a Main channel. We use a Main channel
basically either in problems of the Internal Organs or in channel problems.

For example, if a patient suffers from Liver-Qi stagnation, we can use points on the
Liver Main channel and we do not need to use an Extraordinary Vessel.

Similarly, if a patient suffers from a straightforward channel problem along a

particular channel, we use a Main channel (or its related Luo channel).
However, there are many situations when an Extraordinary Vessel is indicated:
1) problems of several channels simultaneously.
2) complex conditions
3) involvement of an internal organ with a different channel
4) complex situations of Heat-Cold and Deficiency-Excess
5) some mental problems
6) some neurological problems
7) when the pulse has the same quality in several positions.

Let us consider these situations one by one.

1) PROBLEMS OF SEVERAL CHANNELS SIMULTANEOUSLY

In channel problems, if the pathology affects clearly only one channel,

then we use that Main channel. However, if the channel problem affects
more than one channel simultaneously, this indicates the use of an
Extraordinary Vessel. Why should that be? The nature of the
Extraordinary Vessels as “reservoirs” of Qi, and as agents of regulation
and integration, means that as reservoirs, they receive the inflow from
many different channels: therefore, when many channels are involved,
using the “reservoir”, i.e. an Extraordinary Vessel, will affect all of them.
A good example is that of sciatica. If a patient suffers from
sciatica that is clearly along the Bladder channel, we need
use only the Bladder Main channel with distal and local
points.

However, very often, sciatic pain starts on the Bladder

channel in the buttock, it then travels via the Gall-Bladder
channel on the thigh and down the Stomach channel on the
leg. In order to affect all three channels, we can use the Yang
Qiao Mai’s opening and coupled points i.e. BL-62 Shenmai
and S.I.-3 Houxi.
This approach is used not only in channel problems but also
in internal organs’ problems. For example, we adopt this
same approach every time we use the Ren Mai in
gynaecological problems because this vessel strongly
influences the Liver, Kidney and Spleen channels in the
Lower Burner which are the source of most gynaecological
pathologies.

The same can be said of the Chong Mai: we use the opening
and coupled points of this vessel when there is an overlap of
abdominal pathology of several different organs such as the
Liver, Spleen, Kidneys and Intestines.
2) COMPLEX CONDITIONS

The Extraordinary Vessels are often very useful in complicated

conditions. By “complex”, I mean chronic conditions characterized by
multiple, confusing patterns and many different symptoms in different
body systems.

For example, let us consider a patient suffering from chronic asthma,

some digestive problems, some gynaecological problems and allergies.
The combination of these symptoms suggest the use of the Ren Mai
because this vessel treats the Lungs, it nourishes Yin, it can be used for
digestive complaints and, most of all, gynaecological diseases.

Therefore using the opening and coupled points of the Ren Mai, i.e. LU-
7 Lieque and KI-6 Zhaohai, may have an influence on all the patient's
conditions.
Another good example of the use of an Extraordinary Vessel in
complicated conditions is that of rebellious Qi of the Chong Mai.
Rebellious Qi of the Chong Mai causes many different symptoms
starting from the lower abdomen and ending in the head.
If we analyzed these symptoms one by one, we would diagnose
many different patterns of various organs with Fullness and
Emptiness and Heat and Cold.
However, when seen in their totality, it becomes clear that they are
due to rebellious Qi of the Chong Mai and they are caused by the
fact that this vessel influences many different channels. Therefore
the use of its opening and coupled points, i.e. SP-4 Gongsun and P-
6 Neiguan, will treat all the symptoms caused by such a
complicated condition.
 CHONG MAI REBELLIOUS QI

HOT FACE
Kidney channel

Qi Rebellious
UTERUS
BLOOD
YIN

Qi Deficient in REN-1
leg branch

COLD LEGS
LEGS
Rebellious Qi of the Chong Mai
causes various symptoms at different
levels of the abdomen and chest. It
causes primarily fullness, distension
or pain in these areas.

By plotting the pathway of the Chong

Mai, we can list the possible
symptoms of rebellious Qi of the
Chong Mai starting from the bottom:
Hot face Anxiety, mental restlessness, “internal urgency” (Li Ji).
Headache
Feeling of heat of the face
Feeling of lump in the throat

Slight breathlessness
Sighing
Palpitations
Feeling of tightness of the chest
Feeling of distension of the breasts in women

Fullness/distension/pain of the epigastrium

Feeling of tightness below the xyphoid process
Hypogastric fullness/distension/pain
Fullness/distension/pain of the umbilical area
Fullness/distension/pain of the lower abdomen
Painful periods, irregular periods

In order to diagnose Rebellious Qi of the Chong

Mai, you need at least 3-4 symptoms at different
levels
Cold feet
What makes the Qi of the Chong Mai rebel upwards?

In my experience, this may happen for two reasons:

1) the Qi of the Chong Mai can rebel upwards by itself due to emotional stress
that makes Qi rise or stagnate. This condition is Full and I call it “primary”
rebellious Qi.

2) Qi may also rebel due to a Deficiency in this vessel (of Blood and/or
deficiency of Kidney Yin or Yang) in the lower abdomen. In such cases, Qi of the
lower Dan Tian is weak and the Qi of the Chong Mai “escapes” upwards. This is
a mixed Full/Empty condition and I call this “secondary” rebellious Qi of the
Chong Mai. This is more common in women.

Lei Jing

“The Qi of the Chong Mai rises up to the chest, Qi is not regulated and therefore
it rebels in the diaphragm, Blood is deficient and therefore there is internal
urgency in the abdomen and chest.”
 ACUPUNCTURE TREATMENT FOR REBELLIOUS QI

Right Side Left Side

“Primary” rebellious
Qi (i.e. Full type) in a
woman

5. KI-21

6. KI-14
2. P-6
3. LI-4

1. SP-4 4. LIV-3
 ACUPUNCTURE TREATMENT FOR REBELLIOUS QI

Right Side Left Side

“Secondary”
rebellious Qi
(i.e. Full/Empty
type) in a
woman

5. KI-21

6. KI-13 and
Ren-4 2. P-6
3. LI-4

1. SP-4 4. LIV-3
3) INVOLVEMENT OF AN ORGAN AND A DIFFERENT CHANNEL

In most cases, if a pathology of an internal organ affects a channel, it will affect its
related channel, e.g. a Liver pattern may affect the Liver channel. Often however,
a pathology of an internal organ may affect a different channel, e.g. a Liver pattern
affecting the Bladder channel. Frequently, an Extraordinary Vessel will address
this situation.

For example, Liver-Yang rising will normally cause headaches along the Gall-
Bladder channel on the head (the Gall-Bladder channel is interiorly-exteriorly
related to the Liver channel).

In some cases, however, Liver-Yang rising may produce headaches along the
Bladder channel on the occiput. In such a situation, we can use an Extraordinary
Vessel and, in this case, the Yang Qiao Mai as this channel absorbs excesses of Qi
in the top of the head.

We therefore use the opening and coupled points of this vessel, i.e. BL-62
Shenmai and S.I.-3 Houxi. Of course, these two points may be combined with
other points that subdue Liver-Yang such as LIV-3 Taichong.
4) COMPLEX SITUATIONS OF HEAT-COLD AND FULLNESS-
DEFICIENCY

The Extraordinary Vessels are particularly useful also in situations

characterized by complex conditions with simultaneous occurrence of
Heat and Cold and Fullness and Emptiness.

Again, this capacity of the Extraordinary Vessels is linked to their

nature as “reservoirs” of Qi and as agents of integration. Being
reservoirs of Qi and integrating different structures, they regulate and
balance the flow of Qi among the channels and this makes them
suitable for the treatment of conditions of both Deficiency and Excess
and Cold and Heat.
For example, women frequently suffer from conditions of mixed
Heat and Cold. There are two main reasons for this:

a) A simultaneous deficiency of Kidney-Yin and Kidney-Yang:

this is very common in women over 45.

b) A deficiency of Blood which gives rise to some Empty Heat

symptoms: the Blood deficiency may cause cold hands and feet
while the Empty Heat deriving from it may cause a feeling of
heat in the face.

In both these cases, treatment of either the Ren Mai or the

Chong Mai can treat the condition of mixed Heat and Cold. In
fact, both these vessels will influence the Uterus, Blood and
several different channels such as the Kidneys, Liver and
Spleen: for this reason and for their balancing and regulating
nature, treatment of these vessels can deal with both the Heat
and Cold.
5) SOME MENTAL-EMOTIONAL PROBLEMS

Some of the Extraordinary Vessels are particularly indicated for mental-emotional

problems, probably due to their regulating, integrating and balancing function
which was discussed above.

For example, one of the indications of the Ren Mai is psychosis after labour. One
of the major symptoms of the Chong Mai is mental restlessness and anxiety
associated with Rebellious Qi.

The Du Mai affects three organs which have a profound influence on the mind:

the Kidneys and therefore the Will-Power, Zhi.

the Heart and therefore the Mind, Shen.

the Brain and therefore the Mind, Shen.

For this reason, the Du Mai can be used to strengthen Will-power, lift the Mind
and nourish the Heart in depression.
The Yang Qiao Mai is used to absorb excesses of Yang in the head
when they cause mental agitation and restlessness.

The Yin Wei Mai is used to nourish Blood, strengthen the Heart and
calm the Mind. I personally use the Yin Wei Mai very frequently in
patients suffering from depression and anxiety from mental-emotional
problems such as those due to sadness, grief, worry or shock. I often
use the opening points of this vessel (P-6 Neiguan and SP-4 Gongsun)
combined with its starting point KI-9 Zhubin: this has the effect of
strengthening both Heart (and therefore the Mind, Shen) and Kidneys
(and therefore the Will-Power, Zhi).
6) SOME NEUROLOGICAL PROBLEMS

Some of the Extraordinary Vessels can be used for neurological

problems such as multiple sclerosis.

In particular, the Du Mai and the Dai Mai can be used to stimulate the
circulation of Qi in the legs and spine in neurological problems.

Also, both the Yang and Yin Qiao Mai can be used for hemiplegia after
Wind-stroke.
7) WHEN THE PULSE HAS THE SAME QUALITY IN SEVERAL POSITIONS
An interesting consequence of the Extraordinary Vessels’ quality as “reservoirs”
receiving Qi from the Main channels, is that their use is indicated whenever a
pulse quality spans more than one position (i.e. the “reservoir” rather than an
individual channel is affected).
This concept applies only when two or more positions of the pulse have exactly
the same quality and strength. For example, if all the three positions (Front,
Middle and Rear) are Floating, it indicates a pathology of the Du Mai; if they are
Firm, a pathology of the Chong Mai.
If both Front positions of left and right are Wiry and Full, it indicates a pathology
of the Yang Qiao Mai.
To take the pulse quality of the Du Mai as example: this is equally Floating on all
three positions (Front-Cun, Middle-Guan and Rear-Chi).
Why should this be? The Du Mai governs all Yang channels and rises up the spine
from the bottom of the torso to the very top. As the pulse positions correspond to
parts of the body as well as to channels, the Rear corresponds to the lower part of
the torso and the Front to the head. Therefore, a pathology of the Du Mai involves
the whole length of the torso and head and will therefore effect a change in all
three positions of the pulse.
Moreover, as the Du Mai controls all Yang channels, it will influence all pulses of
the Yang channels, for example, on the left, the Small Intestine, Gall-Bladder and
Bladder: for this reason, the Floating pulse quality spans all three positions.
It is Floating because Wind (external or internal) is a frequent pathology of the
Du Mai.
 PULSES OF THE EXTRAORDINARY VESSELS

The “Pulse Classic” (Mai Jing, AD 280) gives some pulse qualities for
the Extraordinary Vessels which were later discussed by Li Shi Zhen.
These are the only references to pulse qualities reflecting a pathology of
the Extraordinary Vessels rather than of the Main channels.

Mai Jing:

“If the cun positions of left and right are like a pellet [Wiry] it indicates [a
pathology of] the Yang Qiao Mai. . . If the guan positions of left and right
are Wiry, it indicates [a pathology of] the Dai Mai . . . If the chi positions
of both left and right are Wiry, it indicates [a pathology of] the Yin Qiao
Mai.”
The text says the pulse is “dan” [单] which literally means “pellet”
or “bullet”, something used as a weapon. I interpret this quality as
“Wiry” for two reasons.

First, the character for dan is based on the radical for “bow” which is
also present in the character for “Wiry” (Xian).

Second, the character can also be read as “tan” which means “to
spring” or “to leap”, in my opinion an image describing the way the
Wiry pulse “leaps” or “springs” upwards towards the surface.
Mai Jing:

“When the pulse is Firm from the chi to the cun position, beating straight up and
down, it indicates [a pathology of] the Chong Mai.”

“If the pulse is hard and Full in the middle level on [both] guan positions, it
indicates [a pathology of] the Chong Mai.”

“If the pulse is Floating from the chi to the cun position, beating straight up and
down, it indicates [a pathology of] the Du Mai.”

“When the pulse is Floating in the guan position, beating straight up and down,
it indicates [a pathology of] the Du Mai.”

“When the pulse feels like pellets felt horizontally on [both] cun positions, it
indicates [a pathology of] the Ren Mai.”

“When the pulse is Tight, Fine, Full and Long on [both] guan positions, it
indicates [a pathology of] the Ren Mai.”
 “A pulse beating obliquely from the Shao Yin towards Tai Yang
corresponds to the Yang Wei Mai . . . a pulse beating obliquely
from the Shao Yang towards the Jue Yin corresponds to the Yin
Wei Mai.”

Yang Wei Mai Yin Wei Mai

Both these diagrams illustrate the left pulse.

These pulse qualities and this paragraph can only be understood in the
context of the pulse reading from the Mai Jing (following slide).
The Mai Jing describes an entirely different topography of the pulse positions in
Book 10. In this book, for each side of the pulse (i.e. left and right), it
distinguishes three different areas for each position (Front, Middle and Rear).
The pulse can be felt in three areas (rolling the finger): a lateral one, a central one
and a medial one. This makes a total of nine areas, each of which reflects the Qi
of a particular organ.
If we look at the drawing below, we can understand the quote from the Mai Jing,
i.e. A pulse beating obliquely from the Shao Yin [KI] towards Tai Yang [BL]
corresponds to the Yang Wei Mai . . . a pulse beating obliquely from the Shao
Yang [GB] towards the Jue Yin [LIV] corresponds to the Yin Wei Mai

Lateral Central Medial

Cun BL HE LIV

Guan ST P SP

Chi GB LU KI
Yang Wei Mai
Yin Wei Mai
To summarize, the pulses of the Extraordinary Vessels from the Mai Jing are:

Both Front Both Middle Both Rear

positions of positions of positions of
left and right left and right left and right
Wiry: Yang Wiry: Dai Mai Wiry: Yin
Qiao Mai Qiao Mai

All three Hard and

positions Firm: Full on both
Chong Mai Middle
positions:
Chong Mai
Both Front positions of left and right Wiry: Yang Qiao Mai

SI LU Wiry
GB SP
BL KI
Both Middle positions of left and right Wiry: Dai Mai

SI LU
GB SP Wiry
BL KI
Both Rear positions of left and right Wiry: Yin Qiao Mai

SI LU
GB SP
BL KI Wiry
 All three positions Firm: Chong Mai

SI LU
Firm SP
GB
BL KI
Hard and Full on both Middle positions: Chong Mai

SI LU
GB SP Hard-Full

BL KI
Floating on all three Floating in the Middle
positions: Du Mai position: Du Mai

Like pellets, felt Tight, Fine, Full and Long in

horizontally on both Front the Middle position: Ren Mai
positions: Ren Mai

Running obliquely from Running obliquely from the

the medial to the lateral lateral to the medial side of the
side of the pulse (from pulse (from the Rear to the
the Rear to the Front Front position): Yin Wei Mai
position): Yang Wei Mai
In his book “A Study of the Extraordinary Vessels” Li Shi Zhen gives
the following pulses for the Extraordinary Vessels:
- The Ren Mai is Long, Tight and Fine on both Front positions,
extending down to Middle position. Although the Mai Jing says that
the pulse quality is felt in the Middle position, I say that it is felt from
the Front to the Middle Position.
- The Du Mai is Floating in all three positions.
- The Chong Mai is Firm in all three positions and hard on both
Middle positions.
- In the Yang Qiao Mai both Front positions are shaped like a pellet
(Wiry).
- In the Dai Mai both Middle positions are shaped like a pellet (Wiry).
- In the Yin Qiao Mai both Rear positions are shaped like a pellet (Wiry).
- In the Yang Wei Mai it pulsates like a chord from the Rear-medial to
the Front-lateral side of the pulse.
- In the Yin Wei Mai it pulsates like a chord from the Rear-lateral to the
Front-medial side of the pulse.
 DIAGNOSIS OF THE EXTRAORDINARY VESSELS
I consider the pulse a very important diagnostic factor that points to the use
of an Extraordinary Vessel. For example, in gynaecology, there is often an
overlap in symptomatology between the Ren and the Chong Mai: in the
choice between these two vessels, I am very much guided by the pulse (using
the latter if the pulse tends to be Full).
I shall now discuss a few diagnostic elements for diagnosis by palpation and
observation of the orifices. The Qi of the Extraordinary Vessels ascends to
brighten the orifices with the following correspondence:

Yin and Yang Qiao Mai: eyes. Yang Wei Mai: ears.

Ren Mai: mouth. Du Mai: nose.

Dai Mai: urethra. Du, Ren and Chong Mai:

urethra, anus.
 REN MAI
i. Palpation
The abdomen is the main diagnostic area for the Ren Mai. The central-lower
abdomen (an area called Xiao Fu, “small abdomen”) is the residence of the Jing,
the Yuan Qi and the Fire of Ming Men. The lower-central abdomen should feel
firm, but not hard, and somewhat “elastic”.
If this area is too soft, it indicates a weakness of the Ren Mai and of the Uterus:
for example, this area is often quite flaccid in multiparous women.
If it is too hard, it indicates stagnation of Qi or Blood in the Ren Mai.
The epigastric area (above the umbilicus) should also feel
firm but elastic: if it is too soft, it indicates a weakness of the
Ren Mai and of the Stomach; if it is too hard, it indicates
stagnation of Qi or Blood in the Ren Mai and the Stomach.

The small area below the xyphoid process, in the region of

Ren-15 Jiuwei and Ren-14 Juque, has an important diagnostic
significance in mental-emotional problems. It should feel
relatively soft when compared with the rest of the abdomen.

If this area feels hard, it indicates Qi stagnation in the Ren

Mai from emotional problems: this stagnation is often related
to the Heart and/or Lungs rather than the Liver.
ii Orifice
The orifice corresponding to the Ren Mai is the mouth. The
mouth is a useful diagnostic sign in pathologies of the Ren
Mai. One should observe the mouth itself, the lips and the area
immediately surrounding them.

First of all, problems of the mouth such as ulcers may indicate

a pathology of the Ren Mai, especially in women and
particularly if such a problem is associated with a menstrual
irregularity. For example, mouth ulcers occurring before the
periods, clearly indicate a disharmony of the Ren Mai.
The lips and the area surrounding them indicate the state of
the Ren Mai.

Dry lips indicate a state of deficiency and dryness of the Ren

Mai and of Blood.

Purple lips denote Blood stasis in the Ren Mai.

Red lips indicate Heat in the Ren Mai.

If the area surrounding the lips is pale it indicates a

deficiency of the Ren Mai.

If the area surrounding the lips is greenish it denotes Qi

stagnation in the Ren Mai.
 DU MAI
i. Palpation
One should palpate the upper and the lower parts of the Du Mai: these two areas
reflect two quite distinct aspects of the Du Mai.
The lower part of the vessel reflects the state of the Fire of Ming Men which is
situated deep in the body below the point Du-4 Mingmen.
If this area feels flaccid, it indicates a deficiency of the Fire of Ming Men and of
Kidney-Yang.
If it is tense, it indicates a condition of stagnation in the lower part of the Du Mai.
The Du Mai reflects the condition of the Yang channels in general; in particular its
upper part reflects the superficial Luo channels and the Tai Yang channels.

Therefore, the upper part of the Du Mai represents a superficial energetic layer
which is the first to be invaded by external Wind and other pathogenic factors.
This part of the Du Mai is seldom flaccid. If it is tense, it indicates either a
stagnation of Qi on the Du Mai or the invasion of external Cold and/or Wind.
ii. Orifice
The orifices related to the Du Mai are the nose and the anus.

The nose reflects the state of the Du Mai in many ways. First of all, a
profuse, white and watery nasal discharge indicates a state of deficiency
and Cold of the Du Mai: such a discharge associated with sneezing often
indicates allergic rhinitis.

A thick, sticky nasal discharge indicates a condition of Dampness in the

Du Mai. Epistaxis may be due either to a deficiency of the Du Mai or to
Heat in this vessel. Polyps in the nose also indicate Dampness in the Du
Mai.

The anus is the lower orifice related to the Haemorrhoids usually

Du Mai. A prolapse of the anus indicates indicate Damp-Heat and
a state of deficiency and sinking of Qi in Blood stasis in the Du Mai
the Du Mai; itchiness of the anus denotes as well as sinking of Qi.
Dampness in the Du Mai.
 CHONG MAI

i. Palpation
The Chong Mai influences the lower abdomen to either side,
laterally (the area called Shao Fu, “lesser abdomen” in
Chinese medicine). The lateral-lower abdomen should feel
firm but elastic, not too hard and not too soft. Unlike the
central-lower abdominal area pertaining to the Ren Mai (the
Xiao Fu), the lateral-lower abdominal area (the Shao Fu) is
seldom flaccid.

A marked flaccidity in this area indicates a deficiency of the

Chong Mai (with deficiency of Blood and/or Kidney
deficiency); a marked tenseness, Qi stagnation or Blood stasis
in the Chong Mai.

ii Orifice
The orifice of the Chong Mai is the mouth and the signs and
diagnostic significance are the same as for the Ren Mai.
 DAI MAI
i. Palpation
The Dai Mai influences two areas: the hypogastrium (i.e. the
central-lower abdominal area immediately above the pubic
bone) and the lateral sides of the lower abdomen (further back
from the area influenced by the Chong Mai).

If the hypogastrium feels distended and relatively hard, it

indicates a condition of Dampness in the Dai Mai. If the lateral
sides feel tense, it indicates Dampness and Qi stagnation in the
Dai Mai.

ii. Orifice
The Dai Mai influences the urethra. Difficult and painful
urination with turbid urine indicates Damp-Heat in the Dai
Mai.
 YIN QIAO MAI

i. Palpation
The Yin Qiao Mai influences the lateral-lower abdomen and
its pathology is indicated especially when the abdominal
signs are unilateral.

An unilateral hardness of the lateral-lower abdomen indicates

Qi stagnation or Blood stasis in the Yin Qiao Mai.

ii. Orifice
The Yin Qiao Mai influences the eyes, bringing Yin Qi to
them.

If the eyes want to close all the time, this indicates a state of
Fullness of the Yin Qiao Mai.

Red and painful eyes indicate Heat in the Yin Qiao Mai.
 YANG QIAO MAI

i. Palpation
Two areas have a diagnostic significance in relation to the
Yang Qiao Mai: the muscles of the lateral aspect of the leg...

...and the muscles overlying the scapula and those lateral to

it.

If the muscles of the lateral aspect of the leg feel tight and
tense, they indicate a state of Fullness of the Yang Qiao Mai;
similarly if the muscles around the scapula feel tense.
ii. Orifice
The Yang Qiao Mai influences the eyes, bringing Yang Qi to
them.

If the eyes stay open and the person has difficulty in sleeping,
it indicates a state of Fullness of the Yang Qiao Mai.

Red and painful eyes indicate Heat in the Yang

Qiao Mai.
 YIN WEI MAI

i. Palpation
The Yin Wei mai’s main area of influence is the chest as all
classics state. When assessing the state of the Yin Wei Mai, I
palpate the area just below the xyphoid process which is also
influenced by this vessel.

If this area (in the region of Ren-15 Jiuwei) feels hard and
knotted, it indicates stagnation in the Yin Wei Mai from
emotional problems.

ii. Orifice
The Yin Wei Mai does not influence any specific orifice
 YANG WEI MAI

i. Palpation
The Yang Wei Mai influences the lateral aspect of the body,
particularly in its upper part and head.

If the lateral side of the body feels tight and tense, it indicates
stagnation in the Yang Wei Mai. If there is a feeling of distension of
the lateral side of the head (Lesser Yang area), it indicates a Full
condition of the Yang Wei Mai.

ii. Orifice
The Yang Wei Mai influences the ears. Ear pain usually indicates
Heat in the vessel; ear discharge, Dampness; redness and heat in the
ear, a condition of Heat in the vessel.