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, department of education & research Abstract Through an investigation and summary of the historical evolution of the network vessel diseases and the ‘free the network vessels’ method (Tong Luo, tong meaning ‘to connect; to communicate; to free the flow’, luo meaning ‘network vessels’), this article puts forward that Tong Luo method and Luo disease theory originated in the ‘Classic of Internal Medicine’ (Nei Jing) and the ‘Classic of Difficulties’ (Nan Jing), concrete treatment methods germinated in the ‘Discussion on Cold-induced and Miscellaneous Diseases’ (Shang Han Za Bing Lun) and went through endless transformations in the successive dynasties of the Jin, Tang, Song, Jin, Yuan and Ming. In the Qing-dynasty work by Ye Gui (Ye Tianshi), entitled ‘Clinical pattern guide and medical case histories’ (Linzheng zhinan yi’an), the Luo disease theory and Tong Luo method started to be basically formalized and nowadays the convergence of Chinese and Western Medicine in combined clinical explorations indicates that there are new developments in the applications of the Tong Luo method. The Tong Luo method, meaning the coursing and connecting of the network pathways, is one of the main clinical methods for treating diseases in ancient and modern times. In therapies for various enduring diseases with difficult and stubborn patterns, which are called ‘Luo diseases’, the Tong treatment method has unquestionably demonstrated its unique curative effects. Nevertheless, important scientific terms like Tong Luo and Luo disease are not listed in the ‘Great Dictionary of Chinese Medicine’ (Zhongyi dacidian) and there is no mention of it in educational books like ‘Fundamental Theory of Chinese Medicine’ (Zhongyi jichu lilun) and ‘Therapeutics of Chinese Medicine’ (Zhongyi zhiliaoxue). With regard to the revision of modern clinical disease manuals, the increasing occurrence of cardio- and cerebro-vascular diseases, diabetes mellitus, gout and other diseases is calling for renewal of theories and a systematic
Cradle and germination The Tong Luo method theory originates in the classics of the Qin-Han period: the [Huangdi] Neijing [Suwen and Lingshu] ([Huang Di’s] Inner Classic [Basic Questions and Divine Pivot]). when blood spills out in the inside this results in blood in the stools". Network vessels and blood network vessels can be located on the body surface and also reside . those which diverge from the Luo are called Sun (‘Grandchildren’)" and in chapter 10 (‘Channels and Vessels’): "Of all the vessels those which are superficial and constantly visible are the network vessels". like is said in chapter 39 (‘On Blood Network Vessels’) of the Lingshu: "Fresh fluids ooze into the network vessels" and "Strange evils which are not in the channels. if blood spills out then there is nose bleeding" and "When yin network vessels are harmed. This makes clear that luo mai (network vessels) refers to the branches of the jing mai (channels and vessels). 1. like in chapter 66 (‘On the Origin of Hundred Diseases’): "When yang network vessels are harmed. including the relatively big bie luo (divergent vessels).carding of the Tong Luo method and the historical development of the scientific problems related to it. blood spills out [of the body].1 Definitions of the network vessels and ‘Luo needling and bleeding’ method in the Neijing The Lingshu (Divine Pivot) in chapter 17 (entitled ‘Vessel Measures’) says: "Channels and vessels are interior. horizontal branches are called Luo. blood spills out in the inside [of the body]. From this we can learn that in the Neijing the network vessels already comprised ‘blood network vessels’. At the same time they include branches of the blood vessels. the fu luo (floating vessels) which manifest on the body surface and the tiniest sun luo (grandchild vessels). … … refers to the blood network vessels". Nanjing (The Classic of Difficult Issues) and Shanghan zabing lun (Treatise on Cold Damage and Miscellaneous Disorders). [The Lingshu] also says that damage of the network vessels may lead to blood disease patterns. 1. in order to extract the fundamental essences for clinical service.
illnesses may generate. When there is evil in qi. internal organs). causing disease". When there is repletion (shi) above and vacuity (xu) below. treat the (grandchild) network vessels with bleeding. when blood is obstructed . The Suwen in chapter 62 (‘On Harmonizing the Channels’) further states that needling the network vessels with bleeding can be used to prevent contraction of diseases by the channels and vessels. In the indepth analysis of the problem of the generation of illness as recorded in the Lingshu chapter ‘Channels and Vessels’. trace the knotted network vessel by examining the pulse and needle it with bleeding in order to connect the flow".deep in the depots and palaces (zang fu – bowels and viscera. the Nanjing (in the 22nd difficult issue) says: "The [Nei] Jing states that when the vessels are excited. (note: the word ‘grandchild’ is an uncertain addition following the Zhenjiu jiayi jing (AB Classic of Acumoxa). when there is evil in blood. needle with bleeding to prevent malign blood entering the channels. qi will be excited. causing emaciation. The Suwen (Basic Questions) in chapter 66 (‘On the Three Sections and Nine Indicator[-levels]’) says: "In diseases of the channels treat the channels. in blood diseases with body pains treat the network vessels. Now how can two kinds of illnesses arise from one vessel? It is like this: what the Neijing calls ‘excitement’ means qi and the generated illnesses refer to blood. in diseases of the (grandchild) network vessels. In respect to treatment methods. Qi rules genial warmth. blood illnesses generate. like in: "Water overflowing in the grandchild vessels results in retention of blood in the channels. Explorations regarding blood network vessel diseases are reflected in other relevant documents as well. When qi lingers and does not move then qi is affected by illness first. then use the method of cross needling. then needle moderately. blood rules moistening. And chapter 6 of the Lingshu (‘Lifespan and Hardness and Softness’) further records the external treatment of cold obstruction (cold bi syndrome) by means of herbal cauterisation – this also belongs to the roots of the Tong Luo method using herbal substances. if the disease endures and does not change. If the disease is due to a strange evil. the ‘needling and bleeding of the Luo’ in the Neijing is an embryonic form.
[he concluded]: it’s heart qi. Gradually a treatment system for blood network vessel disease patterns and the understanding of the disease mechanisms like blood obstruction (blood bi)."* * note of the translator: ‘excitement’ may be replaced by ‘arousal of the movement (in the vessels)’ 1. In general it resembles the cardio. the patient constantly . vacuity taxation (xu lao). then blood is diseased thereafter. inability to eat.3 Germination of the treatment of blood network vessel disease in Zhang Zhongjing’s Shanghan zabing lun Under the influence of the Neijing and Nanjing theories. the clinical experience of Chinese medicine accumulated vastly and brought forth the Shanghan zabing lun. 1. turbidity restlessly [moves in] the channels. triggered by harmful affections and emotions and failure of the qi mechanism to function normally.2 Network vessel disease in Chunyu Yi’s ‘Consultation Records’ (Zhen Ji) Canggong (‘Master of the Granary’. Zhang Zhongjing said: "In ganzhu disease. accumulation and gathering (ji & ju). Thus what first comes is excitement. the patient dies. oedema and stagnation of liver qi and blood started to be based on the viewpoint of network vessel stasis and obstruction. blood rises and exits and when blood rises and exits. it is a network vessel yang disease … … therefore there is irritation and fullness. The record on ‘Qi obstruction in the chest’ says: ‘’Upon examining the pulse. thereafter illnesses are generated. the title of Chunyu Yi) left us the earliest extant clinical case records related to Network Vessel disease transformation." What Chunyu Yi calls ‘surplus of the network vessels’ is not a common illness. resulting in a surplus of the network vessels.and cerebrovascular diseases of modern times and obviously falls in the category of blood vessel diseases. but a disorder in the flow of blood. Taking ‘liver qi & blood stagnation’ (ganzhu) as an example.and does not moisten. when there is a surplus of the network vessels. the illness is contracted by sorrow. This is generated by a grieved heart.
dihuang. harmonizing and quickening blood. the symptoms are clear: the sufferer wants to rub his chest or pound on it in order to relieve discomfort caused by feelings of stuffiness and suffocation in chest and hypochondrium or even worse feelings of distension and fullness with stabbing pains. Yuan and Ming dynasties the preliminary Tong Luo doctrine did not exhibit advanced profundity regarding theory and clinical medicine. shuizhi. xinjiang* is used to move blood and transform stasis and congjing (=congbai) to connect yang and disperse knotting. moves qi and blood and scatters the knotted stagnation. . qicao. At the onset of the illness only hot drinks may restore the flow of the mechanism and the result of the illness. Jin." Although the text is sketchy.desires to drum on the chest. tubiechong. shaoyao. can only be treated with the Inula decoction (Xuan Fu Hua Tang). huangqin and others) for dry blood fatigue. Di Dang Wan (Dead-On Bolus or: Resistance Bolus). * Note of the translator: about xinjiang . ganqi. Inula (xuanfuhua) decoction treats this. Although Zhang Zhongjing didn’t speak clearly of ‘blood network vessels’ and ‘connecting the network vessels’. medical scholars reached an unprecedented level. Evolution and in-depth studies From the Jin-Tang era onwards towards the Song. taoren and dahuang) to treat stasis-knotting and blockage of the menses etcetera. which frees the flow in the liver network vessels. mengchong. channel and network vessel coagulation and stasis. analysis and practice of qi and blood theory and treatment methods like connecting. thoughts about patterns and treatment of vessel disease are essentially already concealed in the above. comprised of shuishi. but in the application of herbal substances to connect the flow in the network vessels and in research. there is bitterness as didn’t exist before and a desire for hot drinks. Other prescriptions introduced by Zhang Zhongjing are: Da Huang Zhe Chong Wan (Rhubarb and Eupolyphaga Bolus. xingren. containing dahuang. mengchong. Besides xuanfuhua. taoren. Bie Jia Jian Wan (Turtle Shell Brew Bolus) which treats ‘mother of malaria’ (enduring malaria). a commentary states: xicaogen or honghua may be used to replace xinjiang 2.
o. caowu. zhechong. Xu Zhike (Xu Shuwei) in his ‘Generally Beneficial Original Prescriptions’ (Puji benshi fang) uses toxic substances from minerals. taoren.1 Application of herbal prescriptions on a clinical level Collections of herbal prescriptions are a great achievement of Jin-Tang medicine. connect the flow in the channels and quicken the network vessels. comparable to pulmonary cellulitis) and ‘stomach damage’. The ‘Prescriptions Worth a Thousand Pieces of Gold’ (Qianjin yao fang. houpo. a prescription to warm Yang. 2. dahuang. dahuang. ganjiang. mainly using dahuang. The ‘Harmoniously Composed Office Prescriptions’ (Heji jufang) from the Song-dynasty handed down the famous Minor Network-Quickening Elixir (Xiao Huo Luo Dan. treating wind cold damp obstruction and painful limbs. coagulation and stagnation. break hardness and masses … … and smooth the blood vessels by scattering malign blood and expelling robbing blood (zei xue)’. mix-fried ruxiang and mix-fried moyao). guixin and gancao) especially treats ‘obstinate cold in stomach and intestines. shuizhi and other herbs [treating] ‘vomiting of blood and cold pain in the chest’. The formula Warm the Spleen Decoction (Wen Pi Tang. Recognised was as well that cooked rehmannia (gandihuang) [has the ability of] ‘breaking malign blood and connecting the flow in the blood vessels’ and peony (shaoyao) is able to ‘expel blood obstruction.Objectively a scientific pillar was constructed which promoted the ongoing development of the Tong Luo method. . mangchong a. Outstanding in this respect is his single use of shuizhi and mangchong. comprised of ganqin. mangchong. stones and insects to treat various kinds of amassment. processed tiannanxing. comprising fuzi. accumulation. Essentially this is chronic intestinal network vessel disease being treated by perfusing and restoring the flow with pungent and hot herbs. Tang-dynasty) recorded clinical symptoms of blood stasis and blood patterns triggered by ‘internal bleeding’ (a kind of haematemesis). dilong. containing chuanwu. ‘lung flat abscesses’ (deep rooted ulcers in the lung. enduring abdominal pain and diarrhoea and irregularity in daily routine’.) was used to treat ‘vomiting of blood with exhaustion and feelings of restlessness and fullness accompanied by pain’. The Rehmannia Bolus (Gan Di Huang Wan.
dispersion thirst and the like.2 Scientific accumulation and condensing on the theoretical level The scientific contend between the medical scholars of the Jin-Yuan period accelerated the continual development of various theories including those of ‘Luo disease’ and ‘Tong Luo’. yizhiren. including muxiang. blindness and also wind stroke. But once the ‘Xuan Fu’ is blocked by a disease evil. dingxiang bark. Outstanding are the ‘Profound Residence Qi and Fluid Perfusing and Connecting’ and ‘Qi and Blood Free Flow’ doctrines of Liu Wansu and Zhang Congzheng respectively. Doctor Liu’s theory holds that the interstitial subcutaneous layers of the whole body. ezhu. the physiology obstructed and myriad disease patterns arise. badou.In addition. which includes sanleng. badou and ganxie) which treats blood pain. blood and fluids through the depots and palaces (zangfu-organs). in ‘severe heat blockage of the subcutaneous layer (couli) and stagnation-knotting’ we often see disease signs as feelings of stuffiness and fullness. qi. need to be unobstructed to guarantee a free flow of the construction (ying). defense (wei). kidney qi pain etcetera and also conceals the method of freeing the flow in the network vessels with pungent-hot and pungent-salty herbs. huixiang. To illustrate this. diarrhoea and diarrhoea with bloody and purulent stools (dysentery). called ‘Profound Residence’ (Xuan Fu). man is at ease and in harmony’’. The Spirit Protection Bolus (Shen Bao Wan. under the control of the ‘Spirit Mechanism’ (Shen Ji). nodes and lumps [under the skin]. we have the Sparganium Dispersing Accumulation Bolus (San Leng Xiao Ji Wan. In this way normal functions of the body are supported. the channel network and all limbs and bones. the flow of qi and fluids are hindered. vaginal discharge (leucorrhea). resembling the [condition] described by Zhang Zhongjing: "When the original and true [qi] of the five palaces (zang-organs) is flowing unhindered. which treats feelings of fullness and suffocation in heart and abdomen and belongs to the prescriptions which pungently and ragrantly connect the network vessels. hujiao. painful and difficult urination (strangury). throat obstruction. while ‘the gravity of the . recorded in the ‘Discussion on Stomach and Spleen’ from the Jin-dynasty. 2. chenpi and qingjupi). enuresis. deafness.
restoring the normal condition of unobstructed flow of qi. only the free flow of blood and qi is regarded as valuable". unblocks and leads out stagnation in the treatment of dysentery. ying (construction) and wei (defense) flourish". He was not alone in this: tracing doctor Liu’s steps was Zhang Congzheng. Zhu Zhenheng (Zhu Danxi) proposed his doctrine of ‘the Six Stagnations’. Near the end of the Yuan dynasty. quickens blood. cong[bai] and [dou]chi to open and spread stagnationknotting or the combined use of cold and warm in the ‘Reaching Treasure’ and ‘Spiritual Treasure’ Pills to ‘scatter wind clogging and open knotted stagnation’. the intestines and stomach resolve. thus shedding light on the scientific characteristic of Liu Wansu’s: stressing the importance of opening stagnation. "like old chopped straw being expelled. gancao.disease follows the severity of the stagnation-knotting’. when abdominal lumps are finished. unobstructed flow is meant … … in every case of painful obstruction and numbness and abundant stagnation. qi and blood flow smoothly and clogging and stagnation disappear". saying: "When qi and blood are vigorous and in harmony. without connecting prescriptions this cannot be cured". Liu Wansu also invented the Peony Decoction (Shao Yao Tang) which. blood and fluids. Clinical attack of evils "makes the upper and lower [part of the body] free of obstruction. The medical circle of Xian Weizi and doctor Zhang exclusively used the three methods of sweating. The famous medical scholar Wang Haizong (Wang Haogu) of the Yuan-dynasty wrote in a commentary: ‘’Doctor Liu’s use of herbs concentrates on pushing away the old to bring forth the new. Herbal treatment methods emphasize opening and spreading of the stagnation-knotting. not letting a trace of glowering (bad) stagnation". huashi. . who also stressed the value of ‘connecting’. vomiting and purging. like employing the pungent and cool [tastes] of shigao. These scientific circumstances which were stressing the importance of ‘flow and connection’ made him deeply become aware that "in the Neijing. moves qi. unaware that what those three methods intended to do was exactly dispelling evil to restore blood and qi flow in the body. ‘using flowing to treat flow’. Doctor Zhang stressed: "In the so-called connecting prescriptions. expelling nodes and make qi and fluids flow freely. the channels are hidden and do not flow.
stressing that in blood coagulation. taoren. Through an overall arrangement. huaruishi. sumu. painful swellings and nodes. The nature of these herbs include the following tastes: pungent-warm. In the survey of the vast space of more than thousand years from Jin to Ming. pungent-neutral. pungent-hot.the ten thousand illnesses do not arise. rougui. He created the Overcoming Restraint Bolus (Yue Ju Wan). puhuang. muli. Throughout the ‘Clinical pattern guide and medical case histories’. powerfully promoting guidance. yanhusuo. it spontaneously stops’ can be obtained. Miao Yiyong (Miao Zhongchun) of the Ming-dynasty also makes effort to explain the theory of: ‘One should move blood and avoid stopping the bleeding’. sanleng. tongbian (little boy’s urine). while with the method of moving blood. moyao. To enumerate the herbs he uses to ‘connect blood’: danggui. mangxiao etcetera.1 Essentials of Ye Tianshi’s Luo disease theory . Formalization and conformation With the publication of Ye Tianshi’s ‘Luo disease’ theory. running through successive generations of medical scholars. honghua. One of his three methods to treat qi and blood. ganqi. treating all of the six stagnations. pungent-salty and sweet-warm. jianghuang. quickening blood and connecting the network vessels. yujin. aspects of his systematic learning become generally distinct. jiuzhi (garlic juice). mainly treats heat effusion. which was arranged by his pupils. the result of ‘by not stopping it. yellowing. which moves qi and resolves stagnation. pungent-cold. the various diseases are sprouting forth from it". The pluralistic and symbiotic development of medical schools of thought imperceptibly established a foundation for the depth and completeness of the Tong Luo method for later generations. called ‘connecting blood’. wulingzhi. lumps and addictive masses. we see an overall interest in and close examining of the medical contents and experience of moving qi. 3. As soon as there is glowering (bad) stagnation. the Tong Luo method took fundamental shape. zhechong. 3. related information can be found. stasis and stagnation. blood not following [the flow] in the channels may lead to new bleeding. zirantong (natural copper).
‘hardness solid as thorns’. damp-heat as well as excessive taxation damage. appear. zheng) qi and therefore in treating Luo disease one should concentrate on ‘gently connecting’ and because ‘the Luo are drained with the acrid flavor’. stagnation and knotting of the seven emotions etcetera all can lead to qi and blood obstruction and stagnation which harms channels and network vessels. a wiry and rough pulse etc. as pathological masses. mainly situated in the deeper layers of the body. accompanied by aggravating and enduring pain. when evil [qi] is knotted in channels and vessels. 1) Acrid and moistening Tong Luo method . anger stirring the liver. summer-heat. in the long run this leads to blood damage entering the network vessels". Static lingering withered blood may express. This means that all externally contracted cold. from the qi aspect to the blood level and from formless to having form. when severe. this view explains clearly that any disease reaches channels and network vessels. Grounded in theory and clinical practice. [lumps occurring in] enduring malaria. internal hernia with forceful and deep noticeable pain. crimson-purple stasis spots on the skin. At the onset of disease. from channels to network vessels. lack of treatment. and. qi and blood and in the course of time shifts from superficial to deep. Ye’s four Tong Luo methods using the acrid (pungent) flavor Since in Luo disease blood damage is hidden deeply. resulting in ‘blood damage entering the network vessels’. harsh medicinal substances can easily damage right (regular. ‘Luo’ here means the blood network vessels.2 Dr. violent attack is not fruitful. Obstruction of the blood network vessels and movement of blood being hindered may cause the emergence of swellings and lumps in Luo disease. yang qi being harmed. 3.The central argument is: "At the onset of disease qi knots in the channels. depending on the location. the acrid flavor acts as the ruler [in this method]. clinical manifestations as dark complexion. that is: Luo disease taking shape. wrong treatment or a dragging on of the patient’s condition causes the disease factor to gradually enter a deeper level.
stomach pain and other patterns. Widely used to treat cold damp congealing & stagnation. moyao. a commentary states: xicaogen or honghua may be used to replace xinjiang 2) Acrid and warm Tong Luo method Acrid and warm medicinal substances which disperse cold are the rulers. taoren. added: danggui. It is used widely to treat hypochondrial pain. chuanlianzi and others. 3) Acrid and fragrant Tong Luo method Here the main medicinal substances are those with an acrid and fragrant flavor. stomach pain. (xiao)huixiang a.This is the fundamental method. xiangru. Acrid and fragrant diffusing and outthrusting (xuan-tou) and coursing and draining the qi mechanism (shu xie qi ji) substances used are: jiang(zhen)xiang. Often used in heart pain. yujin. jianghuang. It is able to diffuse.. danshen. sometimes puhuang. Substances: rougui. 4) Acrid and salty Tong Luo method . xinjiang* and qingcong. baiziren. pain in the umbilical abdomen. internal prevalence of yin cold [causing] network vessel obstruction. move fluids and frees the flow of qi and blood. * note of the translator: about xinjiang. The acrid flavor is used to moisten (the luo). acrid and fragrant [substances] are needed to free their flow". ganjiang. biba. (xiao)huixiang. taoren. yanhusuo. qi and blood are obstructed. muxiang.o. chuanshanjia and others are added. yellowing etc. Often ruxiang. Substances used are: xuanfuhua. xiebai and congbai. wulingzhi. hypochondrial pain. guizhi. fuzi. disperse and open and reach the subcutaneous layers (cou li). taoren and others are added. stagnation patterns. substances that move and penetrate. Ye said: "In enduring illness located in the Luo. xiebai. conglomerations (jia: a type of abdominal mass) and gatherings (ju: a type of abdominal lump) and other patterns. like accumulations (ji) and gatherings (ju). stomach pain. Dr. blood loss.
there is no blood congealment and qi can flow freely". it is used in headaches. dilong. qicao. 3.3 Extended use of the Tong Luo method Medical scholars of the late Qing paid close attention to bleeding patterns and blood stasis. stubborn obstruction. ‘Treatment of blood stasis discussed in parts and sections’ (fenbu lunzhi xueyu) is the outstanding scientific achievement of Wang Qingren’s. In order to fly they rise and the walkers descend. Although it is said that it treats blood stasis in the blood mansion above the diaphragm. fengfang. Amidst four prescriptions to treat stasis there is the Blood Mansion Expelling Stasis Decoction (Xue Fu Zhu Yu Tang). jiangcan. chuanshanjia. arteri . pathological conglomerations. Ye’s broad involvement in clinical practice and the formalisation of the Tong Luo method has furnished the treatment of various difficult and stubborn clinical patterns with a new way of thinking. evil knotting is being attacked and unblocked” and "Taking advantage of the velocity of insects and ants. wugong and others. it actually can be used for blood stasis in the whole body. Medicinal substances used are: qianglang. Dr Ye said: "By means of the tracking and expelling [action] of insects and ants in blood.This is the method of harshly attacking. quanxie. shuizhi. The four Tong Luo methods are the inherited result of Dr. mengchong. What is called ‘Blood Mansion’ in essence refers to blood network vessels. imperceptibly this became the [focus] of development and continuation of the Tong Luo method. accumulations and gatherings and other enduring and difficult to cure Luo diseases. zhechong. their flying and walking is both efficacious.
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