Acupuncture Points Notebook

Tantalisingly little is writen about these meridians in the classics except their pathways described in Ling Shu, ch. 11 and some mysterious statements that they enable "people to be in harmony with the Dao of Heaven" (人之合於天道也) and that they "the unrefined pass by, while the outstanding take pause" (此麤之所過 上之所息也). Later authors elaborated little on this chapter resulting in them mainly being thought of as deep channels that helped to make the meridian circuit continuous, as opposed to the earlier models where Qi all flowed from the extremities to the trunk. This makes them only of theoretical interest, providing connections between the Yin and Yang pairs of organs and channels, and linking the Zangfu to their associated sense organs. Some have reflected upon this paucity of literature and speculated that it hints at a lost tradition. Following is a summary of one of the main schools of thought on these from the tradition I follow most with some supporting evidence, a criticism of this model and the way I employ Divergents in my practice.

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Yuen's Divergent Theory

Jeffrey Yuen notes that their sequence in the Ling Shu ch. 11, goes in a cycle representing the cycle of life (primordial Water giving birth to growing Wood, Earth as the central pivot, destructive Fire diminishing from Sovereign to Ministerial Fire, ending in the decaying autumnal element of Metal), imply they are about acceptance of life. They connect our deepest selves, the Yuan Qi, with our relationship to the world, the Wei Qi. In this system they store Pathogens that cannot be expelled through the more superficial channels, initating compensation mechanisms that enable us to continue functioning but at the cost of consuming our resources as we hold the Pathogen in latency. No symptoms are given for Divergent pathologies in the classics but they are considered to manifest as signs of chronic internal conflict such as:

• Opposite side symptoms, when the source of the problem is on the opposite side to the manifestation, including up/down and left/right.
• Wind disorders, such as Bi syndromes and neurological issues.
• Allergies due to Lung (Wei) and Kidney (Yuan) disharmony, where the person is rejecting the world around them.
• Autoimmunity, where the our Wei Qi attacks our self.
• Nodules, growths and tumours.
• Disorders related to cycles of time (i.e. seasonal or daily flare ups during the same season or time period).
• Chronic emotional issues that operate below the level of consciousness.

Specific disorders can be differentiated by the trajectory on which symptoms appear, the Zangfu organs affected, the resource associated with each Divergent (Water = Essence, Jing 精; Wood = Blood, Xue 血; Earth = Thin Fluids, Jin 津; Sovereign Fire = Thick Fluids, Ye 液; Ministerial Fire = Qi 氣; Metal = Yang 陽) or the emotion connected to each element.

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Retain Pathogens in the Nei Jing

The Ling Shu, ch. 71, says:

"When there is Evil in the Heart and Lungs, it's Qi resides in the joints of the arm (肘);
when the Liver has Evil, its Qi flows into the armpits;
when the Spleen has Evil, its Qi resides in the thigh;
and when the Kidneys have Evil, its Qi resides in the back of the knees...
Evil Qi and malign Blood must not remain here permanently.
If they are to remain here permanently, they will damage the Sinews, the Blood Vessels, the bones and the joints.
The joints will be unable to bend and stretch resulting in contractions."

This supports the idea that the joints are holding points for Pathogens attacking the Zang, preventing them from affecting internal function but at the cost of damage to the musculoskeletal system. It makes no reference to the Divergent Channels but it is notable that the Kidney and Spleen Divergents begin at the backs of the knees and thighs and the Heart and Lung go to the shoulder or underarm. Only the Liver does not go to the armpit. However, it is possible that these two chapters combined indicate that Pathogens in Zang can be shuttled along the Divergent Meridians to connect with other Divergents and redirected to be stored in the joints. The most common is the Yin/Yang pair which every Divergent connects with, but the Liver and Gall Bladder Divergents, after connecting to the Liver Zang then ascend to the Heart where a Pathogen could be diverted again and emerge through the Heart or Pericardium Divergent at the underarm.

[Note: I have translated the character 肘, usually "elbow", as "joints in the arm" because it often has other meanings which make better sense theoretically and clinically. It is derived from ⼨ ("inch, the position of the wrist where the pulse is taken"), sometimes means a "pork shoulder" today, and in the Praying Mantis form 分身八肘 ("dividing the body into eight elbows") it refers to any short distance striking joint including shoulders, hips and knees. Theoretically it makes more sense for these Pathogens to be expressed in either the wrists, where the Yuan-Source points are located, or the shoulders where the Divervents emerge. Clincally, the wrists, hands and shoulders are far more common targets for athritis than the elbows.]

Another piece of evidence is taken from Su Wen, ch. 63, which describes how Pathogens penetrating from the exterior can become stuck in the Channel and Network system before reaching the Zangfu.

"When Evil settles in the body, it will first lodge in the skin and hair (皮毛).
If it stays there and does not leave then it enters and lodges in the Grandchild Collaterals (孫絡 Sun Luo).
If it stays there and does not leave then it enters and lodges in the Blood Vessels (絡脈 Luo Mai).
If it stays there and does not leave, then it enters and lodges in the Meridians (經絡 Jing Luo).
It will then connect internally to the Five Zang (五藏 Wu Zang) and scatter in the Intestines and Stomach (腸胃 Chang Wei),
Yin and Yang are affected, and the Five Zang (五藏 Wu Zang) are harmed.

When the Evil is in the skin (皮 Pi), which is superficial to the Five Zang (五藏 Wu Zang), then the Meridians (經 Jing) can be cured.

When the Evil is in the skin (皮 Pi), it lodges in the Grandchild Collaterals (孫絡 Sun Luo),
If it remains and does not leave, there is obstruction and pain (閉塞不通 Bi Se Bu Tong) and it cannot enter the Meridians (經 Jing),
It overflows in the Great Collaterals (大絡 Da Luo) and causes Strange Diseases (奇病 Qi Bing)."

This reference to the "Granchild Collaterals (孫絡 Sun Luo)" and "Great Collaterals (大絡 Da Luo)" have made some suggest must refer to a second set of Luo, similar to the regular Luo, with a similar function, and connect this to the Divergent Meridians. Whereas the "Grandchild Luo" relate to the small capillaries that permeate and nourish the Sinews, located just under the Cutaneous Regions (skin and hair) and more superficial to the main Luo Network and Primary Meridian system, while the Big Luo relate to a second set that branch off from further along the Primary Meridian and penetrate deeper, to hold Pathogens that have progressed beyond containment by the regular Luo and are threatening to progress along the Meridian and affect the functioning of the Zangfu.

The problem with this model is that the Ling Shu ch. 11, which states the Divegent Pathways, has the Liver and Large Intestine Divergents branch at the Yuan-Source point, before the Luo, requiring a few amendements to the classic text, or exceptions to the general theory, to make this work. It seems more likely that Great Luo refer to the main Luo Mai and larger visible veins, as opposed to the Grandchild Luo which are the small capillaries. The defining characteristic of Luo is their visibility, which the Divergents are not due to their depth, which raises the question of why the author of Su Wen ch. 63 chose to use the word 絡 Luo instead of 經 Jing, unless they were referring to a large, visible vessel.

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Divergent Treatments

For treatment Yuen's followers draw upon the Ling Shu ch. 7, which suggests using "triple needling" to first draw out Yang Evils from the skin, then to pierce again to release Yin Evils. Yuen's system suggests this means to obtain Deqi at three different levels with a single needle. These take the form of either Deep-Superficial-Deep (DSD), or Superficial-Deep-Superficial (SDS) needling techniques. The aim of DSD is to return an active Pathogen to latency by stimulating the Yuan Qi at the deep level, raising it to the superficial level of the Wei Qi where it can grasp the Pathogen and send it into dormancy at the deep level. These treatments should be supported by stengthening herbs and points to provide the resources to achieve latency. SDS by contrast aims to release a Latent Pathogen from the deep level by first stimulating the Wei Qi at the superficial level, sending it down to where the Latent Pathogen is stored and then drawing it up to the superficial Sinews where it can be released. This should be supported by clearing the Sinews to remove obstructions to release, usually with Gua Sha. Deqi is obtained at each level in a different manner, vibrating to resonate with the Yuan Qi at the deep level and shaking or circling to resonate with the Wei Qi at the superficial level. In all cases the intention to treat a Divergent Meridian is initated by needling the Opening and Confluent points at the two ends of the Divergent.

Another treatment interpretation by Jacques Pialoux is to tonify the Jing-Well point on the opposite side followed by reducing the He-Sea point of the channel, then the Opening point and Confluent Point of the particular Divergent. He names these three the Entry, Penetrating and and Hui-meeting points of the Divergent.

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A Different Approach to Latency

All of these systems are speculative and have little textual evidence to support them so a great deal of creativity can be employed in their application. Both systems involve using the Opening and Confluent points which makes them difficult to approach when so many of the Confluent Points are in the eye socket. In my experience patients are not keen to have these points needled even when they do have an eye disorder, so convincing them to needle their eyes when you are treating arthritis in their hip is practically impossible to get consent for. In addition, the Opening and Confluent points was an innovation created for the Extraordinary Vessels, popularised in the Ming dynasty and not found in Nei Jing protocols.

However, the basic principle of releasing Latent Pathogens through a superficial-deep-superficial treatment protocol can be applied with other methods without requiring specific Divergent Protocols and still remain faithful to the classics by following these steps:

1. Release the Sinews with massage, Gua Sha or superficial needling to resolve any superficial (Yang) obstructions (Ling Shu ch. 7) from the Exterior. This helps separate the Sinew level Pathogens from the deeper Retained Pathogens, and facilitates their release by clearing the more superficial Sinews.
2. Next, needle the points which did not respond to massage deeply, obtaining Deqi (grasping the Evil Qi) and retain. Moxa on the needle can also be used if its a Yin Pathogen, and cupping over a needle could be used to create a stronger drawing out effect.
3. As you remove the needle, the Pathogen may either be resolved, or drawn towards the superficial Sinews where it can be released with another round of exterior techniques, that also function to check if it is resolved. External liniments can also be applied now or taken home to continue the Exterior release.

The idea of returning a Pathogen to latency does not seem to part of the classics, except as something the body does automatically when confronted with a Pathogen it cannot expel. The quote from Ling Shu ch. 71 suggests that retention of a Pathogen is not a desirable thing. If it is required, it will be because the patient lacks the strength to eject the Pathogen and the simplest protocol will be to strengthen them until they can, whether by herbs, acupuncture or massage.

The order of the Divergents, I agree with Yuen, is related to the order of resources consumed by the Pathogen in the joints. However, I disagree with the resources allocated to them. Instead I go by the quote in Ling Shu ch. 71, and the governances given in Su Wen ch. 9. Therefore:

1. The Kidneys govern the Bones
2. The Liver governs the Sinews
3. The Spleen governs the Flesh
4. The Heart governs the Blood
5. The Lung governs the Meridians

Indicating that a Latent Pathogen will first damage the bones, then cause stiffness of the Sinews and joints. More severe damage will affect the flesh leading to weakness and muscle wastage, then the Blood causing numbness and pain. Finally the channels themselves will become obstructed preventing the flow of Qi and Blood leading to a complete loss of function. This basically outlines the progression of arthritis.

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Divergents as Communicating Vessels

If the Divergents are not simply holding cells for Pathogens then they must serve another purpose. One possibility is that they are connecting channels, enabling the sharing of resources. The Dao De Jing, ch. 77 says:

The way of heaven,
Is it not like stretching a bow?
What is high up is pressed down,
What is low down is lifted up;
What has surplus is reduced,
What is deficient is supplemented.
The way of heaven,
It reduces those who have surpluses,
To supplement those who are deficient. (trans. Chen, 1989)

This suggests an explanation for the quote that the Divergents keep "man in harmony with the Dao of Heaven" and implies another use is to redistribute resources when one system is Empty and another is Full. In order to do this, the practitioner would reduce the full Organ, clear any blockages along the intended pathway, signal where the Divergents meet to exchange resources and finally tonify the weak Organ.

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Alchemical Connections

Another possibility is that the Divergent Channels do not have points assigned to them because they represent the meridian mechanics of Neidan practices, rather than acupuncture. Support for this idea comes from the Ling Shu ch. 11 statement that they keep "people in harmony with the Dao of Heaven" (人之合於天道也) and are of interest only to the refined. The purpose of Neidan practice is to refine the Three Treasures (Jing, Qi & Shen) in order to harmonise with the Dao. This model would suggest that the order of the Divergent Vessels relates to the stages of the Alchemical Work which can be summarised as:

築基 (Zhuji)
Laying the Foundations
煉精化氣 (Lian Jing Hua Qi)
Refining Jing into Qi
煉氣化神 (Lian Qi Hua Shen)
Refining Qi into Shen
煉神還虛 (Lian Shen Huan Xu)
Refining Shen to return to Emptiness
煉虛合道 (Lian Xu He Dao)
Refining Emptiness to unite with the Dao

Their sequence could also represent the alchemical process, starting with Water and cultivation of Jing before moving to Wood and Earth which represent Qi and the cultivation of health. Following Earth is Fire, Shen, and the real alchemical work of refining the metals beginning. First this occurs with the intensity of Sovereign Fire, corresponding to the Martial Fire phase of the alchemical process, followed by the gentler Ministerial Fire which corresponds to the Civil Fire pase, before finishing with the refinement of the Metals. Although this appears to be an awkward shifting of the usual Five Phase progression, if placed as compass points with Earth in the centre, then it actually represents a cycle moving from the North to the East, through the centre, and then to the South and West. It is therefore just a clockwise rotation around the compass, with Earth placed between Wood and Fire, instead of between Fire and Metal. Alchemically this makes more sense since it is through the action of Water that Wood grows, and it is through the action of Fire that Metals are extracted and refined, thus representing Yin and Yang phases of the work. Upon reaching the stage of refining the metals, the natural order is reversed: Cinnabar (☲ Li, associated with Yang in the South) yields its central line to become Mercury (☷ Kun, True Yin in the East), while Black Lead (☵ Kan, associated with Yin in the North), yields White Lead (☰ Qian, True Yang in the West). Again, the cycle ends at Metal. True Yin and True Yang can then be compounded to form the Elixir.

Among the Divergent Meridians, the first is the Bladder and Kidneys which represent setting up the foundation. The Bladder Divergent's trajectory represents the physical components estabishing the tripod (鼎 Ding) with a cross-legged position, touching the ground with the sitting bones and coccyx, establishing a straight spine, and sealing the "Lower Magpie Bridge" (下鵲橋) by clenching the anus. The trajectory of the Kidney Divergent suggests setting up the crucible in the lower abdominal cavity and completing the foundational setup by sealing the "Upper Magpie Bridge" (上鵲橋), touching the tongue on the roof of the mouth.

The second Divergent Meridian group are the Gallbladder and Liver whose trajectories enter the pubic region suggesting a connection with Jing, and then proceeding to connect with the Front Mu points. This represents the first stage of the process, "Refining Jing into Qi" and restoring health to the body through the nourishment of the Zangfu. This stage of Wood represents the gathering of the fuel for the fire and the ingredients from all the different elements represented by the various Zangfu.

The third group of Divergent Meridians are the Stomach and Spleen, the organs of Qi, representing the action of refining Qi. Earth in the alchemy of the Zhouyi Cantong Qi sits at the centre and represents the unity of the other elements and their ability to conjoin. This is reflected in the position of the Stomach and Spleen Divergents at the centre of the process with two other elements either before and after.

The fourth set of Divergent Meridians are the Small Intestine and Heart. These represent the refinement of Shen. The Sovereign Fire represents the fierce "Yang Fire" stage of the alchemical process. While the previous pairs followed each other and differ only slightly, in this division the Yin and Yang pairs of Divergences take opposite pathways, branching away from the Heart. The Yang Divergent (Small Intestine) descends and the Yin Divergent (Heart) ascends. This may be a representation of the Pure Yin being extracted from Yang (the central Yin line of Li ☲) which then descends, and the Pure Yang being extracted from Yin (the central Yang line from Kan) which then ascends.

The fifth set of Divergent Meridians are the San Jiao and Pericardium. The San Jiao is an unique organ said to have "a function but not form" and therefore represents the return to Emptiness. It is notable that these are the first Divergents that do not enter the Heart, representing the stage at which the mind has been transcended as emptiness is obtained. As the milder Ministerial Fire, it represents the gentler "Yin Fire" stage of the alchemical process. The ascension of the San Jiao Divergent to the top of the head may also represent the ascent of the spirit to leave the body through the top of head, often seen in images of Daoist meditators suggesting the miraculous feats supposed to be possible at this level of cultivation. Meanwhile the descent of these Divergents through the San Jiao may represent the process of forming the Immortal Embryo (聖胎 Sheng Tai) in the Lower Dantian.

The final group of Divergent Meridians are the Large Intestine and Lung. The Large Intestine is said in the Su Wen ch. 8 as "transmitter of the Way" (傳道) so this group represents "uniting with the Dao." These also belong to the element of Metal and may refer to the final alchemical stage of compounding the pure metals of Mercury (Pure Yin) and White Lead (Pure Yang) to return to the original unity. The Lung as the final Divergent channel may also represent practices like Embryonic Breathing (胎吸 Taixi) where external breathing appears to have stopped and the practitioner is said to breathe entirely through internal circulation. It may also be represent the refinement of the Po (魄 corporeal-soul), the ceasation of bodily decay and the attainment of immortality (仙 Xian).

Therefore, the Divergents can be seen as a representation of the stages of Neidan. Their connection with the sense organs represent the turning inward of the senses, and the internal pathways are where sensations are observed during inner seeing and listening. These may have been a precursor to the Extraordinary Vessels which are more commonly used in Neidan practice and acupuncture today, or as a complement to them, providing more practical instruction which links to the Primary Meridian system, while the Extraordinary Vessels represent the reversal of creation to return to the undifferentiated unity of the Dao.

One major caveat of this interpretation is that Neidan is a much more recent concept than the Lingshu, with the earliest text on Neidan being the Zhouyi Cantong Qi, attributed to Wei Boyang from 2^nd century AD, but more likely written in the 5^th or 6^th centuries, and the idea of refining the Three Treasures comes from the 13^th Century Book of Balance and Harmony by Li Daochun over a millenium after the Ling Shu was written. However, Ge Hong attributed a now lost text called the Neijing to Wei Boyang, making it possible that this chapter was a section of a proto-alchemical self-cultivation technique taken from this earlier work and ending up in the Huangdi Neijing instead due to their similar titles. Many of the practices that became incorporated into Neidan, such as Reverting the Semen to Nourish the Brain (還精補腦 Huan Jing Bu Nao), Breath Control (胎息 Taixi) and Swallowing Saliva (胎食 Taishi) to extend life, and Escaping the Mortal Body (屍解 Shijie) to attain Immortality (仙 Xian), were present in the Han Dynasty and texts like the Neiye from the 4^th century BCE describe meditational self-cultivation practices working on the Three Treasures (精 Jing, 氣 Qi and 神 Shen). It is entirely possible that the Divergents represent a proto-alchemical system describing internal pathways of self-cultivation and mystical ascention in terms of the meridians that would eventually become Neidan.

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Since there is so much speculation on their uses, I have just provided the descriptions of the Divergent pathways given in the Ling Shu ch. 11, along with points that seem to match these locations. Since there is no formal attribution of points, these are my own approximations. Additional points can also be added if they coincide with the trajectory, especially where it says that the Divergent travels up or down a line of the trunk, neck or head, or disperses into the chest, abdomen or the three Jiao. I have only included a few main points that govern those regions but others could also be included, especially if pain or obstruction is felt on palpation.

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Reference Notes: (click to display)