pricking the collaterals -ok -ok -ok

7/28/2019 Pricking the Collaterals -Ok -Ok -Ok

1/4

24

JOURNAL OF CHINESE MEDICINE NUMBER 58 SEPTEMBER 1998

The method of pricking the collaterals has a wide clinical

application and is especially useful in treating some recal-

citrant and otherwise difficult to understand diseases. While

sometimes used as a synonym for bleeding, pricking the

collaterals utilises the physiological functions of the

collaterals in order to treat diseases. For this reason we will

first briefly introduce the underlying principles of this form

of treatment before giving a few illustrative examples from

our own practices.

Principles behind Collateral-pricking

The principle pathology behind diseases that are treatedsuccessfully by pricking the collaterals is stated in the adage

blood collaterals are diseased and obstructed. The word

collaterals (luo) in Chinese has the sense of a network, hence

it is sometimes translated into English as network vessels

or reticular vessels. The collaterals are branches of the

primary channels and vessels that are relatively thin and

small and criss-cross over the entire body. The fourteen

primary channels each have a collateral; in addition, the

Spleen is connected to the great collateral for a total of

fifteen collaterals. Branching off from the collaterals are the

even smaller minute collaterals (sun luo) while the collateral

vessels of the skin or exterior of the body are called floatingcollaterals (fou luo). These concepts go back to the Inner

Classic (Nei jing). For example, chapter 17 of the Divine Pivot

(Ling shu) states, The channel vessels constitute the inte-

rior: the branches that go transversely are the collaterals;

those which separate from the collaterals are the minute

[collaterals]. By permeating through the various types of

collaterals, the qi from the channels spreads out throughout

the entire body, with the greatest spread over the surface.

This is stated in chapter 10 of the Divine Pivot, That which

floats and is commonly seen of the various vessels is always

the collateral vessels. This shows that the collaterals are

easily accessible from the surface.

Synopsis of Collateral Physiology & PathologyOne function of the collaterals is to serve as a conduit which

strengthens the exterior-interior relationship between the

yin-yang related channels and organs. This serves to help

keep them in balance. In addition, they also act to strengthen

the relationship between the organs and the body surface.

This is done through the intermediary of the primary chan-

nels. As the collaterals are relatively fine and are widely

distributed, they serve as one pathway by which the qi and

blood come to the body surface and pervade, moisten, and

nourish the structures there.

Collateral Pathology

The collaterals interpenetrate internally with the organsand channels while they have an external connection with

the muscles, interstices and pores, and skin. This puts them

in an intermediate position and makes them vulnerable to

insult from any disease process from any source. Internally

generated diseases secondary to emotional upset or exter-

nally-contracted diseases from pathogenic influences can

both cause pathological changes of the collaterals.

One way of conceptualising the place of the collaterals in

the transmission of disease is given in chapter 56 of the Basic

Questions (Su wen). The initial generation of the hundred

diseases must be in the skin and body hair ... When a

pathogen resides in the skin the interstices and pores open.When these open the pathogen enters and resides in the

collateral vessels. When the collaterals are full, [the patho-

gen] pours into the channel vessels and when the channel

vessels are full, it then enters into and settles in the organs.

This passage identifies the collaterals as an important path-

way for the transmission of externally-contracted patho-

gens into the interior. Pathological changes of the collaterals

are almost always seen when a disease goes from the

outside inwards. The collaterals also serve as a pathway for

diseases going in the opposite direction. Chapter 10 of the

Divine Pivot states, When there is cold in the midst of the

Stomach, the collaterals in the thenar eminence are mostly

dark (qing). When there is heat in the midst of the Stomach

the collaterals at the border of the thenar eminence are

mostly dark red. (chi). This is an important concept that is

PRICKING THE

COLLATERALSUNDERLYINGPRINCIPLESANDUSE

INRECALCITRANTDISEASESby Xie Ke-Rong & Zheng Liang-Xi


2/4

25


commonly used clinically. Another passage that discusses

the expression of pathogens from the interior towards the

exterior is found in chapter 39 of the Divine Pivot, When yin

and yang [pathogens] coalesce and form painful obstruc-

tion, this is overflowing internally into the channels and

pouring externally into the collaterals. In addition to this,diseases can be transmitted from one organ to another via

the collaterals. The collaterals are an important pathway for

such processes as Lung diseases being transmitted below to

the Large Intestine, Liver diseases being transmitted to the

Spleen, and heat moving from the Heart to the Small

Intestine. As such the collaterals serve as a link in both the

development of disease and its transmission.

When a pathogenic influence invades the body or there is

a dysfunction of an organ leading to constraint and stagna-

tion of qi and blood and pathological changes of the chan-

nels, the collaterals themselves can also manifest related

obstruction and problems. This makes them an importantlink in the process. This concept is very useful therapeuti-

cally as bleeding these diseased and obstructed collaterals

can lead to relatively rapid results of eliminating the patho-

gen while regulating and restoring the normal functions of

the organs, qi and blood.

The application of bleeding as the preferred method for

treating collateral problems goes back at least to theInner

Classic. For example, it states in chapter 62 of the Basic

Questions The five yin organs therefore together with the

yang organs make an exterior-interior [pair] and have the

channels and collaterals as their offshoots. Each of them can

generate deficiency and excess. Depending on where the

disease is, follow and regulate [that part]. When the disease

is in the vessels, regulate the blood; when the disease is in

the blood, regulate the collaterals. Furthermore in chapter

29 of the Basic Questions it states, For diseases of the minute

collaterals, treat the minute collaterals by bleeding. In both

these passages, bleeding is the preferred method for treat-

ing collateral disorders because obstruction of blood in the

collaterals is the problem.

The above gives the rationale for the wide clinical use of

pricking the collaterals. This method is fast and effective,

especially for some diseases that are otherwise difficult totreat. Below we will give four cases from our own experi-

ences as examples.

Case examples

Case 1

Male, 62 year-old businessman from Taiwan. First visit 16

April, 1990. This patient has a history of Parkinsons disease

for three years. He has sought treatment in Taiwan, Japan,

and the United States. Treatments have included biomedi-

cal pharmaceuticals, Chinese herbal medicine and acu-

puncture all without significant improvement. Recently,

the slowness of movement in the upper limbs has pro-

gressed and he has gradually developed dizziness. He had

come on business to Sichuan and took the opportunity to

come for treatment. He complained of variable dizziness

and light-headedness and tremors of the limbs, especially

the extremities of the upper limbs. This became worse when

he was upset or agitated. In addition, he had feelings of

focal distention and fullness in the chest and epigastrium.

He had profuse sputum and was drooling saliva. Histongue was dark purple with a white, greasy coating. His

pulse was choppy (se).

Diagnosis: Parkinsons disease.

Pattern: Blood stasis with phlegm obstruction.

Treatment principle: Dispel blood stasis, transform phlegm,

and stop tremors.

Areas used: the scalp lines used were the vertex-to-temporal

line (bilaterally) and Qianding DU-21 to Shenting DU-24

(see Figure 1); also the lines along the phalangeal courses of

the three arm yang channels.

Technique: A sterilised pyramid needle was used to go along

the above lines and prick the surface in order to bleed a fewdrops.

Supplementary points: Fengchi GB-20, Taichong LIV-3,

Yanglingquan GB-34 [drain]; Zusanli ST-36, Fenglong ST-40

[even].

Treatment was given daily. After six treatment sessions, the

patient reported a significant decrease in upper limb trem-

ors and dizziness. After twelve treatments the upper limb

tremors were essentially gone, the head and eyes felt clear,

and there was a marked decrease in the sputum, saliva and

epigastric distention. As the patient needed to return to

Taiwan at this time, he was counselled to continue treat-

ment along the same lines and to take a modified version of

Warm the Gallbladder Decoction (wen dan tang) with Dan

Shen (Radix Salviae Miltiorrhizae), Di Long (Lumbricus),

Chuan Xiong (Radix Ligustici Wallichii) and Ji Xue Teng

(Radix et Caulis Jixueteng). In a letter from the patient six

months later, he stated that none of the above symptoms

had recurred and that his condition had stabilised.

Comment:The basic pathology for this condition was phlegm

obstruction leading to blood stasis with the result that the

Figure 1

vertex to temporal line

Qianding DU-21

Shenting DU-24

Xuanli GB-6


3/4

26


collaterals were obstructed and the sinews and vessels lost

their nourishment. This gave rise to abnormal movement

from wind. This diagnosis came not only from the presen-

tation, which was clearly one of blood stasis and phlegm,

but from the fact that treatments based on other diagnoses

had not been helpful. Emphasis was placed on pricking thecollaterals through the scalp needling as this is a particu-

larly effective means of eliminating blood stasis, unblock-

ing the collaterals, and reviving the brain. Bleeding along

the phalangeal courses of the arm yang channels along with

needling points along the leg terminal yin (jueyin) and

lesser yang (shaoyang) channels were used primarily to

extinguish wind and stop tremors. The leg yang brightness

(yangming) channel points were used to strengthen the

Spleen and Stomach in order to dispel phlegm and turbid-

ity. Used together these points got rid of blood stasis and

phlegm while unblocking the channels. Once the channels

were unblocked, the wind and resultant tremors stopped.

Case 2

Male, 55 year-old college professor. First visit 9 October,

1991. This patient has a three-year history of left-sided

numbness. He has been diagnosed at a few major hospitals

as having autonomic nervous dysfunction. Western and

Chinese medicine (including acupuncture) have not pro-

duced significant results. Recently the numbness has be-

come worse and he has also begun to feel incessant itching.

The itching becomes worse at night and this affects his

sleep. He also experiences occasional chills, feverishness

and sweating.

On examination there was a patch of numbness accompa-

nied by itching on the left lateral third of his trunk and a

similar patch running from the lateral aspect of his left femur

to his lower leg (see Figure 2). These areas were without any

pain sensation when needles were stuck into them although

touch and pressure sensitivity was present. There were no

visible skin abnormalities such as redness or swelling.

Diagnosis: Numbness.

Pattern: Obstruction of the collaterals and lack of harmony

between the nutritive and the protective (ying and wei).

Treatment principle: Unblock the collaterals, eliminate ob-struction and adjust the nutritive and protective.

Treatment: A sterilised pyramid needle was used for scat-

tered pricking over the areas of numbness. Pricking was

done with the same amount of force everywhere until there

was slight bleeding. Care was taken not to prick outside

these areas to avoid hurting the patient. Once there was

some slight bleeding, it was stopped by the application of

sterilised cotton balls. This process was repeated twice

more for a total of three sets of pricking during each treat-

ment session.

After the treatment the areas felt much more comfortable

and both the numbness and the itching dissipated. The

above treatment was given every other day for a total of six

treatment sessions. At the end of that time all the numbness

and itching were gone and three more treatments were

given to consolidate the effects. These had to be done very

gently as now the areas had more normal pain sensitivity.

At a one year follow up there had been no recurrence.

Comment: Most cases of numbness with itching are due to an

insufficiency of qi and blood, and treatment is usually

directed at treating wind. However, in this case the problem

was an obstruction of the collaterals with a disharmony

between the nutritive and protective. This diagnosis was

arrived at in part from the peculiar nature of his complaint,

in that patches of numbness and itching at the surface

without a decrease in touch sensitivity can be a sign of

collateral obstruction and he had the classic symptoms of

nutritive and protective disharmony (occasional chills, fe-

verishness, and sweating). In addition, he had tried numer-

ous other diagnoses without success. As the disease was

located at the superficial level in the collaterals, treatment

was applied at this level with superficial pricking, just

enough to cause a slight amount of bleeding. This bleeding

signalled the removal of the obstruction which then led toregulation of the nutritive and protective with the resultant

elimination of the symptoms.

Case 3

Female, 42 year-old accountant. First visit 8 May, 1995. This

patient has a five-year history of a tenosynovial cyst on her

left wrist. Originally she tried various forms of Western and

Chinese medicine (including acupuncture) without success

and so had the cyst excised. However, soon after this the

cyst returned. This process recurred a total of three times. A

few months before her first visit to our clinic the cyst started

to grow again and this time it was painful. On examination

there was a swelling approximately 1.5 cm in diameter

located just distal to her left wrist. It was not discoloured in

any way and was soft. It had clear borders with the sur-

Figure 2


4/4

27


rounding tissues and was soft. Range of motion of the wrist

and hand were not affected.

Diagnosis: Tenosynovial cyst.

Pattern: Phlegm and blood stasis obstructing the channels

and collaterals.

Treatment principle: Dispel blood stasis, eliminate phlegmand unblock the collaterals.

Treatment: A sterilised pyramid needle was used to prick

the centre of the cyst. While this was slightly painful, no

local anaesthetic was used as that can decrease the efficacy

of the treatment. Then finger pressure was applied to

express a small amount of translucent white liquid. The

pressure was continued until no more of the liquid came

out. After this, sparrow-pecking moxa was applied for

about 30 minutes until the affected area became red. Two

days later the cyst was still leaking fluid and the above

procedure was repeated. After this the moxa alone was

done daily for half a month after which time the cyst wascompletely gone. There was no recurrence during a two

year follow up period.

Comment: This problem is usually due to a variety of factors

disrupting the flow of qi and blood locally. Over time the

local structures, including the sinews, vessels and collaterals

become obstructed by blood stasis and phlegm. Pricking is

used to express the static, obstructing matter which has the

effect of dispelling phlegm, transforming blood stasis, dis-

persing clumps and unblocking the collaterals. Moxa isadded after the pricking to increase the local flow of qi and

blood so as to encourage the channels, sinews, collaterals,

and vessels to relax. Once the source of the obstruction and

stagnation is removed, the disease dissipates and does not

return. We feel that this method is more effective in the long

term than surgery, because surgery disrupts the flow in the

channels which can easily lead to recurrence.

Case 4

Female, 18 year-old student. First visit 6 June, 1995. The

morning of her first visit she had sprained her ankle in a

physical education class. She had immediately been seen in

a clinic where a liniment had been applied and the area

taped. However, by that afternoon the pain had become

excruciating and she came to our clinic.

On examination the lateral aspect of her ankle showed

redness and swelling of the soft tissues along with bruising.

This area was exquisitely sensitive to touch and there was

significant restriction in range of motion of the ankle.

Diagnosis: Acute sprain.

Pattern: Blood stasis obstructing the collaterals.Treatment principle: Dispel blood stasis and unblock the

collaterals.

Treatment: A sterilised pyramid needle was used to strongly

prick the area of bruising. This was done very quickly to

keep the pain from the procedure to a minimum. This led to

the expression of a very dark, purplish blood which corre-

sponds to blood stasis. When the bleeding stopped, the area

was cleaned with a sterilised cotton ball. The process was

then repeated twice until no more of the dark blood was

expressed. When this was finished the pain had signifi-

cantly decreased as had the swelling and bruising. A plaster

was then applied to the area made of the herbal preparationGolden Yellow Powder (jin huang san). Two days later the

above pricking treatment was again applied after which the

pain was basically gone. The plaster was again applied to

consolidate the treatment.

Comment: Sprains come about because of injury to the soft

tissues from inappropriate forces. From a traditional Chi-

nese medicine perspective there is stasis and stagnation of

qi and blood which leads to obstruction of the channel qi.

This is the classic presentation alluded to in the adage with

no flow there is pain (bu tong ze tong).Pricking therapy here

directly expresses the bad and static blood which then

unblocks the collaterals and reduces the swelling. Once this

happens the vessels are open and the symptoms are signifi-

cantly reduced. For this type of treatment to be effective, it

has to be done within twelve hours of the injury.

ConclusionCollateral-pricking has a broad clinical application. From

the few representative clinical examples cited here, one can

see that it can be used for both chronic and acute problems

anywhere in the body. The only criteria necessary is that the

problem be due to the blood collaterals being diseased and

obstructed. Understanding of the pathological processenables one to use this method with optimal efficacy.

Bleeding cannot be done indiscriminately or it will do more

harm than good.

There is one important practical note that needs to be

made here. Whenever using a pyramid needle for collat-

eral-pricking or other forms of bloodletting, one must very

stringently adhere to clean needle technique, sterilisation

and antiseptic practices. Included in this is the application

of iodine preparations to the areas to be pricked. Practising

in this way ensures both efficacy and safety.

Xie Ke-Rong & Zheng Liang-Xi work at the Seattle Institute of Oriental

Medicine.

cyst

Figure 3

pricking the collaterals -ok -ok -ok

Documents