Today’s post is about a subject, most appropriate for Halloween, and considering my recent inclusion in a psychology trial, that has both fascinated and troubled me since I first studied it: the Luo (Blood) vessels and their treatment. The Ling Shu, chapter 39, describes them as the “superficial veinules” and recommends treating them with various techniques of bloodletting. The history of medicine nerd in me is intrigued, but the pragmatic clinician knows that suggesting we attempt bloodletting is probably going to have most of my clients running for the hills, as well as hold back my desire to see acupuncture evolve into a specialist discipline taking current developments in physiology, psychology, anthropology and systems theory into account without losing its essential Taoist principles. Despite a few serious attempts to question whether bloodletting was perhaps the lesser of worse evils in ancient times (Brain, 2009, p.158-172; McCann, 2014, p.47-48) I suspect the sheer vitriol with which bloodletting was attacked in Europe and is held as a paragon of the triumph of benevolent science over dangerous superstition has left a scar so deep in our culture that it is probably a symbol too counterproductive to even bring up in clinical practice, and not without reason.
Europe seems to have always had an all or nothing approach to letting blood, with the great physician Galen at one time chastising his contemporaries for ignoring its use, and then later chastising them again for letting too much too often (Brain, 2009, p.15-66). He did appear to have built his reputation on chastising everyone who was not himself but what we see from his criticisms and his critics is that its use was far from universal even in antiquity, its methods were highly variable and did not always demand the draining of pints (ibid. p. 145-154). It has been my belief that the reason it persisted so long after the mechanism was found to be flawed was in fact due to the effects of acupuncture with many of the points being on or near acupoints, probably providing subjective improvements in cases where there was little else to do. In an amusing aside, the most common vein to bleed was the basilic, in the location of Zhizheng SI-7, concerned with judgement (or “separating the clear from the turbid” in Chinese medical terms) so perhaps they were unconsciously treating the patients poor choice in physician. Although early acupuncture was almost certainly a bloody affair with some authors claiming that originally all needling was probably a bleeding to reduce excess while moxa was used to supplement a deficiency (McCann, 2014, p.16-17), acupuncture has most likely survived due to its focus on Qi, a philosophical concept of conscious perception rooted in the body. This enabled the Chinese to find methods that involved no bleeding but just the elicitation of a nervous response. The practices which remain that were traditionally grouped with bloodletting are often referred to by their specific techniques in order to sanitize them. Cupping is one common example of this, where the bruise marks are thought to indicate the stagnant blood rising to the surface, helping it to be replaced by fresh blood, in a manner almost identical to Galen’s rationale for bloodletting (Brain, 2009, p.154-157). This may have been accompanied by an incision with the cup assisting the blood to come out as is common in other forms of traditional medicine, especially Islamic Hijama (McCann, 2014, p.47, 57). Needle cupping is perhaps a symbolic reference to this but the needle acts like a plug preventing any actual bleeding into the cup.
This has not stopped some attempting to revive the term, most likely to the detriment of the entire practice of classical acupuncture, as their theories often leave them open to ridicule. Some insist that blood must be let to constitute a treatment of the Luo vessels and suggesting using lancets on superficial veins (Cecil-Sterman, 2013, p.58-59), or in patterns over zones as in Master Tung’s system (McCann, 2014, p.87-119). In 2010 the California Department of Consumer Affairs had to approach the state’s Acupuncture Board and insist it withdraw courses teaching bloodletting techniques (California Acupuncture Board, 2010, p.4). It saddens me that people within the field of acupuncture want to bring it down by believing uncritically in such patent nonsense, but then most professionals do not want to question their profession. They prefer to be told what is good and get on with their job, and that job is to profess, not criticize. Fortunately I am no such professional. It is my contention that like European bloodletting, these practices may have remained popular because they were operating on a different mechanism than the physical leakage of fluid. There may be times when the use of lancets, seven star needles and other bleeding techniques may actually be safer and make greater sense, such as non-sensitive areas over organs where deep needling is dangerous like the ribcage (coincidentally where a lot of back shu and front mu points that are bled to “release heat from the zangfu” are located). Here the act of massaging the point to get blood to the area and then pinching the skin up and pricking with a lancet will produce a stronger sensation with less risk of piercing a lung than vigorous needle manipulations. However, the main points that are bled are the Luo on the arms and legs so in order to delve into this more deeply I am going to examine the context of the Luo in order to find its essential principles and see if we can preserve their essence without using that much maligned term and falling into the fallacies that accompany it.
Blood and Feeling
Jeffrey Yuen, as always, is a mine of information on the interpretation of classical principles. In the transcript of his lectures on the Luo he explains the relationship between Blood and emotion (Yuen, 2004). The Heart houses the Shen (mind) and diffuses our consciousness (Ying qi) into the body through the Blood. This can be seen in some common events such as losing feeling in a limb that has its blood flow restricted, or our attention becoming disproportionately focused on an area of pain after injury which will be accompanied by a literal pooling of blood such as a scab or bruise. Emotions in particular have a close affinity to the blood, being accompanied by changes in blood flow to particular areas and an altered heart rate. Within ourselves emotions are as much a detection of these physiological changes as they are alterations in levels of neurotransmitters in the brain.
This can be seen in pulse diagnosis, which I would suggest is not so much a direct gauge of the physical state of the organs, but actually an attempt to listen to the Shen and emotional aspects of our body through the pace, rhythm and quality of the heart beat and the tightness of the vessels under our fingers. This presents something of a problem for modern pulse diagnosis since we may often be picking up the events of the day and not the baseline readings for their emotional propensities. The Ling Shu, Ch. 9, supports this criticism with an indication that people should be calm, rested, not fatigued, angry, frightened, thirsty, hungry or just eaten, and even suggests patients who walk should rest for an hour before seeing the physician. Ling Shu pulse diagnosis also has a different method, measuring the difference in strength between the radial and carotid pulses for imbalance of Yin and Yang, which does seem less subjective and a better measure of overall distribution of flow than trying to extrapolate a picture of the whole body by a single region. The only way it would be possible to do this is if we are measuring a single source that affects all systems, such as the Heart / Shen which has branches in all systems, but also meaning it would be even more susceptible to fluctuation from recent events than the Ling Shu method. Yuen (2004, p.113-114) explains how the modern method evolved to accommodate the separation of the sexes and taboos on touch in the Song, Ming and Qing Dynasties, where perhaps the only part of a noble female patient the physician may see is a hand extended from behind the curtain of a sedan car. This makes me wonder if we should be expanding our repertoire of pulse taking skills again as well as perhaps limiting them to appropriate situations. Yuen (2003) does acknowledge this with pain and movement being the main diagnostic methods of Sinew treatments, but pulse diagnosis in every patient was standard in my TCM training. It often left me feeling a bit awkward when treating a twisted ankle where I could not see a way to explain why I should be reading the pulse, or be sure what I will get from it as the diagnosis seemed obvious, and yet felt I was not doing acupuncture ‘properly’ if I did not.
The difficulty is not so much the physiology but the treatment: at some point the leap in logic is made that to ease emotional suffering we must release Blood. An answer slowly unfolds itself as we trace the use of medical metaphor to avoid emotional discussion in China. In a Confucian society that prizes control and suppression of emotion, psychological disturbances have often been edited out of medical literature and ended up in Taoist meditation practices. These also abound with medical and anatomical metaphor to avoid direct discussion of emotional issues and have ended up drawing this parallel between blood and emotion to discuss the effect of traumatic events on our lives. Therefore a sentence such as “trauma causes the Blood to stagnate” can refer to physical bruising, and also mean “traumatic experiences cause the emotions to become blocked” which can ultimately lead to physical Blood Stasis disorders like increased risk of heart disease. In Chinese medicine there is little difference between physical and emotional trauma, only a tendency for the Blood to become stuck in a different place. The notion of “bloodletting” can therefore also refer to “releasing emotion” or even “freeing the mind”. The origins of the Luo lie in certain meditation practices, which Yuen (2004, p.50) describes, concentrating on a Luo point and tracing its trajectory to the end, which were designed as visualisations to lower emotional rises such as anger and panic, similar to modern cognitive exercises that teach us to visualise our feelings as a fluid and picture them descending and draining away. As meditations these would not employ actual bleeding but when converted into ritual the natural choice of action was to drain the blood, even if just a few symbolic drops.
A similar confusion in interpretation comes from the reference of Luo as “visible”. Yuen explains that “visible” can also mean “conscious” or “aware” in terms of noticeable symptoms that demand our attention (p.13). Fixed pain that the patient is aware of and can point to is the main diagnostic symptom of Blood Stasis in Chinese medicine and opens the use of the Luo to a much wider range of possibilities than cases of cosmetic changes. This is quite an important distinction as if these treatments are used as methods for treating spider veins they will fail in both counts, being neither backed by evidence for resolving varicosities (the only evidence I found was from companies selling derma rollers, and there was just as many forums saying it had made them worse), nor adhering to their original purpose, which was to look for symptoms of emotional origin.
Another criticism of the “visible Luo” interpretation would be the suggestion that they will come and go with emotional fluctuations. In Cecil-Sterman’s (2013) book she says that if the emotion is not released or dealt with, the Luo will attempt to hold it as long as possible, and when it no longer can, it empties into the primary channel, or its Yin/Yang pair causing more serious issues and palpable nodules along channel, but no visible veins (p.86). I have seen a few people with spider nevi and varicose veins but once they are there, especially when age is a factor, they do not tend to disappear. They just seem to get more as they get older. To the best of my knowledge they are generally caused by faulty valves, failure of the sphincteric muscle around the blood vessel, or liver problems, which create a bulge and do not get better with changes in emotion or mental state. They are often contraindicated to direct treatment as clots may form in them. Even in Chinese terms these should be explained by a weakness of the vessels causing stagnation, or “Spleen not holding the Blood” and “Liver Qi stagnation” in TCM and treated through correcting the underlying organ system. Letting the blood in this case would be symptomatic at best and cause complications at worst.
I suggest that “blood vessels becoming visible” means the colour that accompanies emotion: think of the red face of fuming anger, the flushing of embarrassment, the pallor of shock, or even the green of sickness and envy, and not permanent nevi or varicosities which are an internal pathology and so do not disappear when calm. This seems to be supported by the Su Wen, Ch. 56, which describes diagnosis in terms of the skin taking the hue of the five colours.
“If their color is
mostly green-blue, then pain [is present],
mostly black, then a block [exists],
yellow and red, then heat [is present],
mostly white, then cold [is present]. ” (trans. Unschuld & Tessenow, 2011)
These attributions can still apply where redness is Heat of emotional arousal which makes the vessels relax and fill with Blood; white is Cold, constriction, signifying an emptiness and a lack of circulation in that Luo; black/blue is Stasis, bruising; while green is pain due to Stagnation indicating the venous system is not keeping up with the arterial circulation. Yellow, the Su Wen includes with red as Heat, but since we know this to be from bilirubin, the last part of the stagnant blood to be taken broken down as it is taken back into the body, we could also see it as a sign of reabsorption, the function of the Stomach/Spleen, whose colour is yellow. These are different from the appearance or disappearance of spider nevi or varicose veins from overwork, age and internal dysfunction, although in principle this internal dysfunction may have an emotional aetiology at its core, but one that has gone beyond treatment and resolution with a physical emotional release.
This sort of filling is perfectly normal and even facilitates normal emotional expression, such as enabling sexual arousal, but when full to saturation it may appear permanently flushed as if constantly in that emotional state, especially if they have a strong propensity to engage that emotion. Examples may include the red faced person who quick to anger (although good luck suggesting plum blossom needling on their face!), the constricted diaphragm of the constantly stressed (Kidney Luo goes to the diaphragm), which must be accompanied by increased blood flow to support the constant activity, or the person obsessed with sexual satisfaction, who may not have a “permanent erection” as mentioned in the Ling Shu as a symptom of Liver fullness but will have a strong propensity to one. This excessive dilation may eventually fail to hold the Blood and lead to psychosomatic bruising (“bursting a blood vessel”) and awareness in the form of tenderness, especially areas that feel bruised when they do not appear to be, or guarding, where excessive attention is being played to a particular area (try pressing the diaphragm of a stressed out client). “Emptiness” is therefore when the emotion is exhausted and no longer experienced or causing the blood to move in the way characteristic of that feeling. The trauma that caused the arousal has worked deeper, often appearing as a numbness or fatalistic acceptance to that issue instead.
The last confusion then is the techniques employed and for this we should go back to the origin of the procedure in the Taoist meditations. The idea is to visualize the channel in order to move the Blood/emotion and clear out the Luo vessel that was holding it, releasing it back into the world and not letting it work deeper into our personality, or to affect our health. The medical procedure is attempting to do the same thing, but for someone for whom the vessel is not yet a reality or who needs it reinforced for an extra push. My argument is that the techniques are not so much dependent on the physiological response to the release of blood but in etching the vessels into the body using a tattoo style technique so that they become a embodied experience, made real to the senses through the infliction of strong tactile perceptions, even pain which in a ritual context may be a therapeutic as it allows the hidden experience of suffering to be acknowledged (Hsu, 2005). The visual marks and soreness of the healing phase which last beyond the session further reinforce this, bringing awareness back to the treatment to all who can see them for the following days. If not complete the process was repeated again.
The seven star or plum blossom needle seems a lot like a traditional tattooing tool, being a small hammer with several short needles on the end. The ancient method of creating this tool, to bind a bundle of sewing needles around a bamboo handle (McCann, 2014, p.53), sounds even more like a traditional tattooing needle. The use of tattooing to mark a principle for continuous contemplation is not unheard of either. Yu (2012: 196) documents the use of tattooing the face with words, not only as a punishment for criminals, but also self-inflicted with the word “chastity” by a woman who vowed not to remarry. It may follow that a topic that needed equally constant attention but which would hopefully improve and not be needed for life, such as an emotionally based illness, might be marked in a way that has all the process of a tattoo, bringing the mind constantly to the attention of the mark by sight and feeling, minus the ink that makes it permanent. If the problem was a chronic one inks could have be been used as permanent reminders of points that need frequent treatment for pain control wherever the person may be, as has been reported in several ancient mummies whose skin has been preserved (Dorfer et al, 1999) although since the Luo are supposed to be temporary holding reserves it would be inappropriate to mark it permanently so it can be forgotten about once healed.
An alternative tool for this type of treatment is the three edged needle, which is a solid metal shaft with a triangular shaped head said to be derived from the lance needle mentioned in the Ling Shu, but the ones I have found available today have been so blunt that piercing the skin requires some considerable force and discomfort. A regular large guage needle seems better.
The key point is that the procedure works as a means of making the Luo meditation an embodied practice and not physiologically through the release of blood. Whether the ancients knew this is pure speculation, especially in a culture that drew no mind-body split, but knowing this today helps us develop more refined methods suitable for the modern world to achieve the result.
If we consider the aim of bloodletting practices in Chinese medicine was to temporarily etch a Taoist meditation into our body then perhaps we can come up with some alternative methodologies. In order to stay true to the principles of the Luo we should stick with mainly superficial methods that are considered to have an action on the Blood. A few obvious ones include cupping and Gua sha, which I have briefly mentioned above that were thought to move Blood by bringing it to the surface, leaving visible marks. I could imagine a simple but strong Luo treatment being performed by using Gua sha along the length of the Luo observing where the “Sha” came up strongest as being diagnostic of the areas where the Blood was most stagnant and a visual display of how the hidden has been made real. The areas of greatest Blood stagnation could then be released with plum blossoming and cupped to draw the blood out, further reinforcing the treatment with strong tactile sensations and visual symbolic release. At least two problems exist with this style of treatment in a modern clinic: first, Gua sha uses oil which would make the skin no longer sterile when doing the plum blossom needling and second, wet cupping requires sterilization facilities which most acupuncture clinics do not have. For these reasons it is probably necessary to deconstruct what the treatment is doing and attempt to preserve its integrity without compromising hygiene. Therefore I want to consider on some methods for those (the majority) in our image conscious culture who may find scabs, bruises and rashes undesirable. This may be especially important in our most emotionally unbalanced clients because marks, especially around the wrists, would be quite visible and could be interpreted as attempts at self harm with possible interventions from other healthcare professionals.
The first of these would be Tui na techniques that move the Blood and break up Stasis. Of these perhaps the most powerful is Ji fa or striking techniques that immediately reminds me of a therapeutic technique known as Emotional Freedom Technique which a few clients have asked me about before. EFT appears to be a hodge-podge of New Age, Chinese and NLP techniques where people tap on the end points of the meridians while focusing on an affirmation. I would venture to suggest that this is not the same as a Tui na treatment on the Luo although both may use striking and can be used as a take home technique. The method of treatment I would suggest is to tweak (Che fa, essentially a kind of pinching grasp and twist) on the Luo point itself and then strike down the entire channel to bring redness and sensation to the channel. Therefore a person who is tightening their jaw, grinding their teeth and developing tension along their shoulder due to emotional pressure could be shown how to massage Pianli LI-6 and strike the entire Large Intestine Luo, from the face and jaw, down to their arm when feeling symptomatic. They should feel it for a time afterwards and see the blood flow if possible, in effect doing the same as a bleeding or bruising technique by bringing the channel into awareness but only for a brief time and diffusing the attentive focus from a few stagnant areas to a whole Luo channel. The area will most likely experience increased blood flow and develop reddened skin as it sensitises, also satisfying the the criteria of “moving Blood” and enabling the client to continue their treatment every other day as classical protocol advises. This can be great as an alternative to techniques that visibly bruise and may help to function as both a massage of symptoms and a visualisation of the emotional stressor draining away. This is quite different from EFT as the points chosen are based on observable symptoms and the treatment is aimed at relieving those symptoms along with a visualisation to help the cause behind them (and cognitive or lifestyle changes to help the causes behind that), not an attempt to condition an affirmation into a point.
The second technique to create an invisible Luo treatment is needling. Cecil-Sterman (2013) is quite insistent that needling does not constitute a Luo treatment as she takes it all very literally and insists on drawing blood, usually with a lancet (p.58-59). I am not keen on this as it presents all kind of hygiene hazards, especially where she declares that sometimes you get more than you bargained for and describes incidents of “spraying” (p.125) that sound frankly hazardous. She also claims that such sprays may actually have averted a heart attack which suggests that she either has a very poor knowledge of physiology or is letting amounts of blood significant enough to lower the systemic pressure, both of which are quite worrying. In general I use her book as a reference guide, because it is one of the few with nice diagrams of the complement channels, and tables of the classical associations, but I take her actual writing with a large pinch of salt and use Jeffrey Yuen’s lectures for my actual treatment ideas. The natural choice of needling would be lancet-like, superficial with no retention time required and using a large gauge needle in the region of visible vessels or colour changes. Some additional techniques that influence the blood flow can include strong reduction techniques with circling to open the hole, cupping over the needle to bring blood to the surface, or preceding the needling with massage. Most of these will bleed incidentally at the point when the needle is removed but this in because they have stimulated blood flow at the area and therefore fulfilled the requirements of a Luo treatment, to move Blood.
Finally, a simple method of treating the Luo that avoids all bleeding would to use herbs. Either internal decoctions that move the Blood or external compresses, liniments and plasters may perhaps be the most acceptable method of moving the Blood in a particular area. Even a simple suggestion like arnica gel would have the effect of resolving a bruise and so should be considered to be moving Blood but many Chinese liniments contain high amounts of Wintergreen which produces the characteristic feeling when applied to skin both alleviating pain and also bringing awareness to the channel and fulfilling the psychological aspect of the Luo. The great advantage of this would be palatability for the queasier of clients, hygiene of not handling blood in the clinic and the fact that the client can apply the treatment daily when the traditional recommendation of a treatment every other day (Yuen, 2004, Cecil-Sterman, 2012) is untenable. It does mean abandoning the insistence of Luo treatment purists that Blood must be released and instead assisting the internal metabolism to reabsorb it but it probably fits with our modern understanding of circulation and sensibilities the best out of all.
Which method to choose depends on the client. Many Luo methods are quite strong and not for the feint of heart. This may reflect the tendency of some people with emotional difficulties to want strong manipulation, instinctively knowing that they need are “full” and need to empty the excess from their system, even the to the point of attempting it themselves in acts of self-harm while those who fear a strong treatment may be “empty” and instinctively know that they should not have anything released. For the latter herbal treatments may be the most appropriate, especially since they can have the possibility of being customised to move and nourish Blood without releasing anything although in physical treatments we could use moxa or Tui Na until the pale Luo has some colour restored. If we wish to avoid bloodletting for other reasons and still wish to give a strong Luo treatment then we can still use a method like Gua Sha to bring up the areas of stagnation and then use external herbs to assist with the bruising and directing the attention to the treatment area visually and with tactile stimulus.
The next thing to consider is how to determine which Luo is affected and needs treatment. Luo can be either Full or Empty, which is different to the usual terms in Chinese medicine of Excess and Deficient, and to understand this it is necessary to consider their function a little. The Luo points are positioned above the ankles and wrists, one point proximal to the Yuan Source point, with the intention of diverting pathogenic factors from progressing along the channel. This is important because it allows them to catch factors may come from the external environment, entering from the distal Jing Well points and Sinews, or from internal factors such as negative emotion that can enter the primary meridian through the Yuan Source point. They act like a buffer, holding the problem and filling up to protect organ function until they can no longer hold any more, when they are then forced to empty back into the primary channel at the Yuan Source point of either the same meridian or the Yin/Yang elemental pair via a transverse connection. As these Yuan Source points are distal to the Luo of their own channel, the pathogen can theoretically be kept in a continuous loop, filling one Luo and then another, before being sent back to the Yuan Source point of the original channel and filling the original Luo again until we are able to release it back to the exterior. If we are not able to expel to problem, and the Luo – Yuan loop can no longer hold it, it will will start to move deeper along the primary channel. The first response will be to try and impede its progress by forming nodules along the primary meridian before either entering the interior through the transverse trajectory into the Yuan Source point, creating rebellious movement and Heat along the internal pathway, or being passed into the Divergent Meridian to become a chronic condition or Extraordinary Vessels, especially the Qiao mai, “motility vessels”, that determine our approach to life.
In terms of diagnostics the important part is to recognise that when a Luo is full, it will be conscious and the person will be aware of the problem, be able to express it and quite possibly come to us because of that issue (“I’m really nervous about an interview tomorrow and I can’t eat”, Full Spleen Luo). When it empties back into the primary channel the problem will no longer be conscious (“visible”) as some degree of acceptance has happened and we are likely to discover it through consultation of something else (insomnia because the brain cannot switch off, Empty Spleen Luo). This is because fullness often appears as a conscious exaggeration of the channel’s emotional function as it attempts to buffer the impact of emotional arousal, while emptiness is the result of this buffering system being overwhelmed and shutting down altogether. We stop feeling the rise of emotion as it is now becoming a personality trait, so that many of the empty Luo symptoms are disinterest in the channel’s main principle or an assumption that the feelings the Luo protects against are natural. When it enters the interior the psychological trait will become fully integrated into the temperament and somatic complaints, especially cardiovascular or gastrointestinal, the systems most affected by emotional arousal, will most likely be the presenting difficulty.
To understand this better it is good to look at the function of each Luo in terms of emotions. They may not seem quite the same as the usual emotions ascribed to Zang organs in TCM or five phase theory, but this is because they are extracted from metaphorical interpretations of physical symptoms given in the Ling Shu, Ch. 10. I have tried to show the relationship to their normal attributions where I can. They are often divided into three groups of four, consisting of primitive survival responses, social interaction and aspects of differentiation and individuation. I have also noticed that within each of these three the channels follow a pattern of perception, judgement, emotional arousal and conscious thought.
The first four are concerned with basic processes of survival:
The Lung houses the Po, the corporeal spirit, which connects us to our bodies. The Lungs and skin are seen as one continuous surface in Chinese medicine and so the Lung Luo is concerned with our ability to sense, especially touch and the desire to perceive and live in the world. Its five phase emotion, grief, can be seen as the feeling we have when we lose a part of our world and it feels as if we have lost a part of ourselves. The trajectory of the Luo spreads across the palm of the hands and fullness is described as an urge to be constantly stimulated, to touch and grab, and never be satisfied. Its emptiness manifests in the opposite, of a loss of interest in the world and finding nothing stimulating any more.
The Large Intestine Luo travels up to the mouth and face and indicates our ability to assimilate, to “chew” and “swallow” new experiences or spit them out. It often seems odd that the Large Intestine meridians tend to ascend to the face instead of the gut but the power to absorb the wanted (in digestion, fluid from the substances passed on from the Small Intestine) and reject the unwanted can happen at both ends and as a concept is perhaps more important at the top. This is the beginning of judgement, the ability to determine good and bad in the primitive sense of “feels good” or “feels bad”, before moral concepts have been defined. I would consider the flushing of embarrassment to come under the normal functioning of the Large Intestine as we are confronted with an experience we do not wish to digest. Revulsion would also come under this heading, at least the kind the makes us reject an unpleasant experience. Disgust at an experience we have been forced to “swallow”, which makes us nauseous or even sick, would probably be the Stomach, the Large Intestine’s Yangming pair. Fullness is indicated in someone who makes repetitive actions over and over again, as if automatically rejecting the experience and needing continuous re-exposure. Autistic spectrum disorders would fall into this category as they often engage in repetitive behaviours as if they are not absorbing and processing the experience the first time. Autistic spectrum people often have strong perceptions of tactile, auditory and olfactory stimulation, reflecting the arm Yangming pathway from hand to the side of the face. Addicts also seem to keep repeating an action, often involving the mouth, which other people would do, enjoy, absorb the experience and rest from a while. These are different from obsession or fetish as reasons for the behaviour are an afterthought. The need to repeat them comes from a more instinctive place of “that feels good” and needing it continuously. Its position, paired with the Lung in Yin/Yang relationship and the Stomach in Yangming zonal pairs demonstrates the connection between the hands (Lung Luo) and mouth, to ingest into the Lungs or Stomach, or in the case of more abstract addictions, the need to see (Stomach meridian goes to the eyes) or feel (Lung’s relation to skin, sensation and housing the Po, Corporeal Soul). Emptiness is indicated in someone who does not “chew” at all and just “swallows” or accepts everything without making any differentiation. It may indicate someone who has simply been told to accept things over and over until eventually they do.
The Stomach Luo is concerned with our automatic emotional responses and “gut feelings”. It aims to give us control over our urges so that we can find meaning in our actions. Its trajectory runs up the front of the body, across the face, to the top of the head and back down to the other side of the throat, indicating the rising tide we feel when emotion gets the better of us. This is the classic “rising of anger” that can make us lose control when it fills and so its fullness is indicated by inability to control impulses and acts of passion, including crimes. Going past the eyes, crying can also be seen as a function of the Stomach Luo, as an attempt to reject an experience, similar to trying to wash dust from our eye. The nausea of disgust mentioned earlier can be seen as attempting to reject an experience we have ingested, just as we vomit a poison. This idea of rejecting an experience through the way it came in seems to make some sense to me, since I can think of more effective means to communicate distress and the last thing someone upset needs is a spontaneous face wash. Since emotions are bodily experiences it makes sense they will manifest as metaphorical bodily functions. Our bodies probably process them in the same way, which is essentially the main principle of Chinese medical psychology: the mind and body are not just mirrors of each other, but are one indivisible unit. Emptiness is when we have become desensitized to emotional experience and no longer find personal satisfaction or meaning in anything.
The Spleen houses the Yi, intention or thought. This is the ability to hold a thought in our head. Yuen (2004, p.48) gives the example of the difference between Stomach and Spleen when we conjure up an image of someone we know in our head: the Spleen enables us to hold the image in our head, while our emotional reaction to the image, whether we like them or not, is the function of the Stomach. This is still a primitive form of thought, the ability to think, and not related to any moral aspects yet. Fullness of the Spleen Luo is indicated by obsession and thinking about the same thought over and over again. Physically this is likely to manifest in the kind of abdominal and digestive dysfunctions that can accompany extreme worry, the emotion usually defined as damaging the Spleen. Butterflies in the tummy would be an example of this as it happens when our thought is so fixated on an upcoming event that we cannot shift our focus away. In emptiness we can no longer concentrate on a single thought any more but find them all in our head at once. The ability to switch off the mind has gone and we are constantly thinking about different things all the time. It ends up thinking about how to stop thinking all the time.
From here thought allows us to develop social values, ethics and conscious ideals, so the next four are concerned with interaction:
The Heart is primarily concerned with making connections to people. It facilitates our ability to feel connected to society and others, represented by its trajectory running to the chest and up to the tongue, indicating verbalisation skills. It’s Luo is filled when we are betrayed, the heaviness and pain in the chest from heart break or when society shatters our dreams. When it empties this sense of betrayal becomes ingrained and we give up on trying to express ourselves because we feel our voice does not count. A general heavy heartedness and a loss of engagement follow.
The Small Intestine‘s function is to separate the pure from the impure. In emotional terms this means our ability to differentiate when praise is genuine and take criticism appropriately. Fullness is shown by insecurity about how we are perceived by others leading us to continually ask for reassurance, seek attention and take criticism badly. Emptiness is when this becomes internalised and a person continually worries and self-examines their performance or abilities.
The Bladder can perhaps best be seen as the external aspects of the Kidneys, so in emotional terms this becomes our adrenal response. In the Sinews, its position as the most external meridian demonstrates this function as our first line of defence against the outside world, our immune system, or Wei qi. The equivalent at the level of the Blood is the fight-flight stress reaction. Its trajectory up to the diaphragm indicates the change in breathing and even the gasp of surprise when we are shocked. Fullness of its Luo is indicated in a sudden mounting of the alarm response that cannot be switched off, such as panic attacks and anxiety disorders. Its trajectory that runs up the midline of the body to solar plexus, shows the sense of rising panic that stifles our diaphragm. In extreme cases it may even affect bladder or bowel function if allowed to affect the primary meridian. The connection to its Sinew channel also demonstrates how this stress response can cause tightness in our shoulders, headaches and nosebleeds. Emptiness is when our alarm response has been so overwhelmed it has switched off. Our ability to protect our boundaries no longer activates and we appear fearless, unable to tell when enough is enough, allow society to invade our privacy or refuse to say “no”.
The Kidney Luo follows much the same trajectory as the Bladder and is also related to fear. The Kidney is the house of the Zhi, Will Power, our main defence against being overwhelmed by fear and so fullness is indicated by control freaks and obsessive-compulsive behaviour. Where the Spleen may obsess in thoughts, or the Large Intestine engage in repetitive behaviour, fullness of Kidney Luo draws them both together into acting compulsively on obsession. OCD has been described as a form of magical thinking which attempts to control anxiety with repetitive ritual, to overcome fear with pure Will. Emptiness is when fear overwhelms the Will leading us into a constant state of fear, especially in a social aspect, so paranoia. They will feel a general sense of dread which they cannot pinpoint.
The final four are concerned with differentiation and our ability to evolve and mature:
The Pericardium protects the Heart, helping us handle adverse experiences by developing rationalizations as a means of self-preservation. Yuen (2004, p.55) cites the example of us being angry at our boss but instead of venting it at the appropriate target, we redirect the emotion to our family and argue with them instead. It may seem negative from a moral standpoint, but from a personal one it preserves our job and finds a way out of the uncertainty of questioning our career path by providing an outlet for the emotions. When it is full the outbursts will be coming more often and in poorer judgement and the chest may hurt as it struggles to contain it all. When overwhelmed and it empties back into the primary channel the person is no longer able to deal with conflict and starts to view the world as a bad place so they become an ascetic, a hermit or a recluse. The physical sign, rigidity of the neck, indicates an attempt to block harmful emotional experiences from reaching the brain. The most extreme form of this is loss of consciousness which may be literal, like when we face an experience so shocking we faint to prevent us seeing any more, but can also occur in a subtle way, becoming numb so we do not experience things and live in a less conscious way.
The Triple Heater deals with self-examination and individuation. It helps us find options and make new possibilities. Fullness is indicated by stubbornness and rigidity. We no longer try to find creative solutions to the problems in our life but stick to doing everything the same way all the time and refuse to accept alternatives. When it becomes overwhelmed this turns into indifference to others and a complete focus on self-satisfaction, even ignoring the destructive influence our actions may have on those close us. The classical description is of rigidity and dislocation of the elbows, presumably because the arms are the means by which we perform tasks, so stiffness represents our way of doing things becoming rigid and eventually breaking rather than changing. It may also be of note that the primary channel goes around the ears, so deafness, or a refusal to listen to others, could be implied too.
The Gall Bladder is about making choices to redefine our lives. Some texts have named courage as the virtue of the Gall Bladder (Maciocia, 1997, p.285) and we can see how this relates to our ability to make decisions that bring about great changes. There is a certain amount of “magic” (Yuen, 2004, p.57) in the Gall Bladder in that its actions are not rational but creative and courageous. Rather than solving problems intelligently it gives us the inspired realization that there are options we did not see before, and then gives us the strength to take the plunge. When it is full we feel frustration or despair because we only see one way to go. As it empties even this single path becomes untenable and we feel we have no place to go. Hopelessness and an indifference, even to our own well being, may follow, ultimately leading to suicidal tendencies, and more subtle ways of killing ourselves such as ignoring signs of severe illness. Yuen (ibid, p. 63) describes how this Luo travels across the dorsum of the foot, connecting to Chongyang St-42, where it enters the Chong mai, the inherited constitution and in Buddhist influenced schools, reincarnation and the karma from past lives. This is describing where suicidal thoughts come from as we start to see the only way forward is in moving onto the next life, even though our problems will follow us there.
The Liver houses the Hun, the Ethereal Soul, that is said to record our memories to create continuity in our lives and define our sense of self. This is the part of us that is closest to the western notion of the soul and said to leave the body at death to pass into the afterlife or be reincarnated. As it tells this story it also generates goals and ambitions of who we ought to be, which is why it is said to be affected by frustration, the stress we feel when our lives are not going the way we believe they should have gone. Its trajectory going up to the genitals indicates the involvement of sexual intimacy in our identity and normal filling and emptying of the Liver Luo enables us to maintain arousal. The relation between self and sexuality is strong in Taoist philosophy with the essence of our being, Jing, contained in the sexual fluids. This is demonstrated in the way we attempt to find partners who complement us, reflecting how we want to see ourselves, and fantasize as a means to escape reality and live the life we would like. Therefore disorder of the Liver Luo is described in terms of sexual dysfunction, with an implied dissociation from ourselves as well. Fullness of the Liver Luo is described as “hernia (a displacement) and persistent erection” and reflected in attempts to connect with ourselves as we become fragmented. There may be fetishistic practices as we attempt to find our identity in increasingly bizarre forms of arousal, or hallucinations as exaggerated forms of daydreaming. Yuen (2004, p. 58-59) describes the schizophrenic’s act of talking to themselves as trying to maintain an intimate contact with a part of yourself that is becoming lost. In emptiness the classical description is one of “sudden itching of the genitals”, perhaps indicating the progression from constant arousal to STDs which would have been common in times before condoms, and may still be relevant today if people are forsaking them because they feel pressure on their identity to risk irresponsible behaviour. In psychological terms it indicates destructive impulses we can no longer control. We find ourselves intolerable and disassociate even further, creating multiple personalities, or becoming totally immersed in delusional beliefs.
The Great Luo of the Spleen helps to deal with overflow from all the other Luo and its main symptom is pain in fullness, and flaccidity in emptiness, all over the body. It’s location in the intercostal spaces may reflect pain in these muscles from protracted crying or the dispersing effect of sorrow weakening the Lungs and Qi flow around the body. Psychologically that equates to a feeling of being victimized, oppressed and beaten in every way. When it empties we become totally passive and lose our will to live. These could both indicate severe depression as our emotional defences are all but exhausted.
It should be remembered that the order presented here is in the order of development, not necessarily pathology. In the Ling Shu Ch. 10, a different order is presented, going from the three arm Yin, to three arm Yang, three leg Yang and three leg Yin, while the Su Wen, Ch.56, gives a different order yet again in terms of the six divisions. They are Yangming, Shaoyang, Taiyang, Shaoyin, Jueyin and Taiyin. Yuen (2004, p.23, p.94-95) says this is a cyclical movement with the Yangming Luo being the most external, ascending to the face in an attempt to expel the pathogen (presumably though digesting the experience, or rejecting it). It then moves internally until it enters Yin where it finds its way to Taiyin. From here it can attempt move the problem externally again through its Yin/Yang connection back to the exterior Yangming. This transfer can happen at any stage creating a constant flow in a zonal or internal/external direction as the pathogen is shunted around until the Luo can move it to the exterior to release it, or it descends deeper into the interior, affecting the internal trajectories, Primary Channels, Divergent Meridians or Extraordinary Vessels. The technicalities are not so important as realising that these are filling and emptying all the time as we respond to stimuli as part of normal emotional coping. A problem arises when trauma causes stasis in one or more so that it can no longer absorb any more stress and begins to overflow or collapse.
The main method for using the Luo is quite simple. First decide which ones are affected and whether they are Full, Empty, entered the interior via the transverse trajectory, or being used to support a Sinew treatment in a case of physical trauma, and perform the procedure as follows:
Full: Plum blossom the Luo point, then follow the trajectory of the channel performing plum blossom on any areas that are displaying signs of “visibility”, including awareness by the patient such as feeling painful and bruised or producing guarding. Gua sha can also be used to bring areas of blockage into literal visibility, or in the case of dark skin where visual signs may be less obvious, the areas of greatest heat. Harmonise the Blood by needling the point on the channel one above the He Sea point, stimulating with even technique until Deqi is obtained and removing immediately after.
Empty: Plum blossom the Luo point and immediately apply heat with a moxa stick. Then palpate the entire primary channel breaking up any obstructions, nodules and swellings. With acupuncture this is traditionally done with “Tortoise Shell” needling technique: surround the nodule with three to four needles, plus one in the middle and strongly reduce all, but as long as they are resolved then any technique, including Tui na or Gua sha will do.
Harmonise the Blood by needling the point on the channel one above the He Sea point, stimulating with even technique until Deqi is obtained and removing immediately after.
A variation on this might be to lightly plum blossom and moxa the whole or selected areas of the channel, especially pale areas, until the paleness is replaced by redness. Tui na or Gua sha and moxa could also replace the plum blossom as long as the skin becomes red along the Luo. This would be attempting to remind the body what it is like to be flushed in those areas, evoking the emotion with biofeedback. Needling the Luo in the direction of the channel to direct Blood in that direction and harmonising after might be good additions too.
This would be a method to “refill” an empty Luo and so the Primary could still be checked for obstructions as according to theory the actual pathogen would have moved on here.
Transverse: Moxa the Yuan Source point of the deficient channel and then plum blossom the Luo point of its Yin/Yang pair.
Harmonise the Blood by needling the point on the channel of the Luo, one above the He Sea point, stimulating with even technique until Deqi is obtained and removing immediately after.
Physical Trauma:: There are two opposite variations depending on acute or chronic presentations:
Acute: Plum blossom or needle the Luo point away from the site of injury with strong reduction technique to draw Blood away, together with the harmonising point, one above the He Sea point on meridian where the pain is located. Then plum blossom in a line from the site of the injury towards the Luo.
Chronic: Plum blossom or needle the Luo point towards the site of injury with tonification technique to send fresh Blood to the area, together with the harmonising point, one above the He Sea point on meridian where the pain is located. Then plum blossom in a line from the Luo to the site of the injury.
In both cases follow with a Sinew treatment, using needles, moxa, both, or Tui na if appropriate, on the ah shi points, depending on the presentation.
This final protocol is an example of how the physical and mental are treated identically in Chinese medicine. Just like the emotional aspects of the Luo, the body responds to experiencing a physical trauma by making the area become red for a minute as blood rushes in before returning to normal. If it is too strong to be absorbed the blood vessels will break resulting in a bruise and the fixation of mind on the area, experienced as pain. By stimulating the Luo strongly we will get a rush of endorphin as well as drawing our attention to a place other than where the injury is. The Harmonising point will do this as well, and being located on the same meridian as the wound, are most probably along the same nerve or segment as the one that is transmitting the pain, helping to reduce it. The use of the plum blossom in a line to the Luo will be irritating the skin along the path to the Luo point, diffusing the fixation on the single location of the injury and increasing blood flow which the Chinese believe aids recovery, seen in the arrival of redness.
The erythema caused by the plum blossom is said to help the blood in the bruise to drain and fresh blood to reach the wound as the nearby vessels dilate. This demonstrates the fundamental difference between eastern and western methods of dealing with injury: western practice indicates putting cold onto the wound to limit blood flow, thus reducing swelling and bruising, while eastern thinking sees these as part of a natural healing reaction and use only pressure to stop bleeding, and then alcohol based liniments, such as Zheng Gu Shui (“Correct Bone Water”), or seven star needling to encourage blood flow around the wound to improve drainage and healing. Cold, they say, closes off blood vessels, slowing healing and possibly driving the problem deeper to become a chronic condition. The main advantage of using a plum blossom instead of say Tui na, which is my usual go-to technique for working on a whole region, is that the plum blossom uses almost no physical pressure so it is unlikely to cause any further damage to an undetected injury. Considering how much research is published on acupuncture it is surprising that a comparison of these two methods seems to be quite hard to find. I might have to do my own experiments with cupping bruises.
The main practical consideration in performing a Luo treatment is preparation. It is important that the client is prepared for the treatment and has agreed to it. These have a very different feel to regular acupuncture with the fact that they leave marks and are not within everybody’s perceptions of what acupuncture is. As such they are not treatments that I would normally include in a first session, with the possible exception of Tui na versions, possibly as a take-home exercise. It is also vitally important that they understand the principle which I have been trying to convey, that of etching a meridian in thought, sight and feeling for a few days, and are prepared to engage with the concept, and not be under the impression that you are attempting to resolve their issue with a medieval draining of bad blood. This is a general consideration for acupuncture as it should be a means to provide a person with some support and focus to achieve change in their life, but with the Luo treatments and their potential for marking this must be made extra clear. Just as acupuncture removed from this concept is only the insertion of needles, so is a Luo treatment removed from the meditative practice it is emulating simply a bloodletting.
The comparison to traditional tattooing has helped make people understand what I am doing and generated interest in the plum blossom technique, where reference to bleeding inevitably tends to switch people off. I think the extreme bloodletting treatments of Europe have left an indelible mark on our consciousness so that even people who have no knowledge of physiology know that it is bad. On the other hand the interest in body modification and tribal cultures makes people quite open and interested in the idea of a therapeutic tattoo-like practice. This may seem like a point of marketing but its importance goes a beyond that. Bringing the correct intention to the clinic is vital, not in the sense of intending to heal, which hopefully every practitioner brings, but whether we intend to provide a tool to assist a somatic visualisation or whether we intend to bleed the pathology out. I also feel that advertising Luo treatments as bloodletting will give easy ammunition to critics who can cash in on the aversion to the European variety to score an easy win, while finding proof to support their arguments in practitioners who have also taken the term literally. I am not suggesting we deny its origins but that we call it by what it is, rather than what it was. I am not sure what that should be. “Chinese medical tattooing” sounds catchy but implies the use of ink. “Meridian marking” or “channel etching” perhaps?
One client of mine described the less aggressive form of plum blossom needling, that just produces redness over a wide area, as being like the acupuncture equivalent of massage with bundles of sticks seen in Russian saunas (banny venik) or nettles used in traditional forms of medicine as far apart as ancient Rome and modern Ecuador (Randall, 2000, p.305). This may be a good way of describing it to people when doing it in this style. It certainly sounds less intimidating than being hit with a spiked hammer that sounds like we are tenderising meat. Once again this comes back to the importance of the approach you take in making people feel comfortable with what might seem a surprising treatment if they are just expecting standard acupuncture needles.
Since realising the similarity between the plum blossom needle and traditional tattooing tools, all sorts of new possibilities have occurred to me. Why do people have tattoos where they do? In a recent BBC news article on the history of the swastika it featured a tattooed man who wanted to rehabilitate it from its recent dark past (Campion, 2014). He has it inked on his armpit, a very sensitive area that is about as hidden and internal as a piece of skin can be. It is also the location of Jiquan Heart-1 and so can be seen in Chinese medicine as something he holds very dear to his heart, but wants to keep internal, or to himself, for the most part for the sake of social interaction, the main function of the Heart. Perhaps plum blossom acupuncture originated from tattoo artists noticing the symbolism of certain anatomical locations and naming them for the positioning of tattoos or other body markings. That would certainly explain the exaggerated importance given to Quanliao SI-18, under the cheekbone, as the meeting of all the Yang Sinew channels of the legs (Yuen, 2004, p.139). As an anatomical feature it seems an unusual point to give such importance to regarding pain in the legs and torso (edit 7-7-16: this may reflect of how strain or pain in these sinews will result in a grimace, tension and eventually an ahshi at this point or, edit 28-9-17: from a more medical perspective it may describe the progression of tetanus which was certainly known the Nei Jing, e.g. Ling Shu Ch. 13, and begins with lockjaw and ends in opisthotonos, spasm of the muscles in the back and neck, Taiyang channels, causing the head to arch backwards). If some ideas similar to the Maori practice of tā moko crept into the orient with the ink removed (tattooing was associated with punishment of criminals or to mark slaves while bloodletting was a sacred rite) then it is the main area for adornment and hugely important for its position affirming our standing in society, the binding place for all our outer projections, and may have been the marking around which many other pieces were designed. Perhaps our treatments of the Luo can adopt a little more creativity from the world of body art, not just tapping a few points until they are fixed into the mind for a time, but even etching some characters or a mantra. This would still satisfy my broad definition of acupuncture as a ritual that focuses a person on making life changes but also cross over into a kind of therapeutic body art. These are all interesting possibilities that may evolve out of considering the Luo in a deeper sense and considering their metaphors, instead of taking them literally and developing a Chinese medicine that simply reproduces the past, complete with its mistakes.
There are many other ways to use the Luo, described in the classics, modern textbooks, or passed on through word of mouth. I have been focusing on their main principles and origins, especially in relation to traumatic events and the use of body work techniques as a ritual of marking a philosophical practice onto the body. This has taken me from an aversion to Luo treatments, for the backward physiology presented in Cecil-Sterman’s (2013) account, to a realization that they are the bridge between traditional medicine and body art. Since traditional practices of modifying and manipulating the body has been my passion since I was at university this is of considerable interest to me. My first real job was in the piercing and tattooing industry and I took up the study of Chinese medicine because it preserved the idea of manipulating the body for meaningful ends rather than simply for show. I am quite pleased to find out that a tradition that blends an ancient style of tattooing with Taoist philosophy is still alive. Perhaps more importantly, the connection with body art procedures can help to free them from the negative associations of bloodletting and enable them to become a part of a modern practice again. I am not suggesting we whitewash the history of these practices, but rather that we see it for what it is so we can create better forms, instead of distorted ones based on dramatic nomenclature. Anyone engaging in a practice like acupuncture, especially traditional forms, has some primitivist yearning to believe in the practices of the past, but its important we acknowledge that and look at them from a modern perspective of safety and effectiveness and keep them evolving.
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