Giovani Maciocia - The Penetrating Vessel
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The Penetrating Vessel (Chong mai) is complex as it has many different functions at different levels and affects several organs. In a way, it could be considered to be the origin of the other extraordinary vessels as it originates from between the Kidneys and spreads its Qi over the abdomen, chest and the body at the defensive (wei Qi) level. When this energy arrives at the relevant starting points, it gives rise to the Yin and Yang Linking Vessels (Yin and Yang Wei mai), the Yin and Yang Stepping Vessels (Yin and Yang Qiao mai) and the Girdle Vessel (Dai mai).
In modern Chinese, the word chong means to infuse, charge, rush and dash but it also means a thoroughfare and important place. Chinese books say that in the context of the Chong mai, chong has the meaning of jie (streets), dong (activity and movement), xing (movement) and tong (free passage). All these words and attributes apply to the Penetrating Vessel and it is difficult to choose a single English word for it. I chose the word 'penetrating' as it combines the idea of rushing with that of streets or channels that penetrate the body. The idea of penetrating is also related to the penetration of the membranes (huang) and the channels (jing luo).
Sea of Blood
The Penetrating Vessel is called the Sea of Blood because it is related to the Blood in the uterus and controls the Blood connecting channels.
Sea of the 12 channels
The Penetrating Vessel is called the Sea of the 12 channels because it branches out in many small capillary-like vessels that circulate defensive Qi over the abdomen and chest.
Sea of 5 Yin and 6 Yang organs
The Penetrating Vessel is called the Sea of the 5 Yin and 6 Yang organs as it is a fundamental vessel which connects the Pre-Heaven and the Post-Heaven Qi due to its' connection with Kidneys and Stomach. It is connected to the Kidneys as it originates in that area and distributes essence (jing) all over the body. It is connected to the Stomach as it passes through the point Qichong (ST 30) which is a point for the Sea of Food.
Finally, the Penetrating Vessel is connected to the Spleen, Liver and Kidney channels along which it flows on the inner aspect of the leg, down to the big toe.
Clinical significance of various names of the Penetrating Vessel
1. Sea of Blood
Chapter 33 of the Spiritual Axis says that the Penetrating Vessel is the Sea of Blood (but confusingly calls it the Sea of the 12 Channels); 'The Penetrating Vessel (Chong mai) is the Sea of the 12 Channels; its upper transporting shu point is Dashu UB 11) and its lower transporting points are Shangjuxu (ST 37) and Xiajuxu (ST 39).' Therefore, the points Dashu (UB 11) and the pair Shangjuxu (ST 37) and Xiajuxu (ST 39) are the upper and lower points of the Sea of Blood respectively.
Regarding the pathology symptoms of the Sea of Blood, the same chapter says: 'When the Seas' function harmoniously there is life; when they function against the normal flow there is disease...When the Sea of Blood is in excess, the person has the feeling of the body getting bigger and the person is unable to pin-point the trouble; when the Sea of Blood is deficient, the person has the feeling of the body getting smaller and is unable to pin-point the trouble.'
The above symptoms of fullness and emptiness of the Sea of Blood are rather rare and not clinically important. It is unclear how the above points are connected to the Penetrating Vessel or why they are points of the Sea of Blood. The most important aspect of the Penetrating Vessel being the Sea of Blood is in gynaecology.
The Penetrating Vessel has a deep influence on the gynaecological system because it originates from between the Kidneys, it flows through the uterus, is responsible for the 7-year cycles of women and for the transformation of Kidney essence (jing) into menstrual blood. Being the Sea of Blood means that the Penetrating Vessel affects many Blood pathologies which are extremely common in gynaecological disorders. The Penetrating Vessel is particularly involved in all cases of Blood stasis gynaecological disorders.
To invigorate Blood of the Penetrating Vessel in gynaecology, one needs to use the opening and coupled points, Gongsun (SP 4) and Neiguan (PC 6), together with Siman (KI 14) and Taichong (LV 3).
2. Sea of the 12 Channels
The Penetrating Vessel is also called the Sea of the 12 channels. Since it is both the Sea of Blood and Sea of the 12 Channels, the Penetrating Vessel influences the movement of Qi and Blood in the whole body.
Yang Shang Shan says: 'Under the umbilicus is the motive force (dong Qi) in between the two Kidneys which governs human life and is the root of the 12 channels. This is the Sea of Blood of the Penetrating Vessel, the Sea of the 5 Yin and 6 Yang Organs and of the Sea of 12 channels. It oozes into the Yang, irrigates the essence...it is the motive force below the umbilicus and in the uterus. It moves upwards and downwards, it is the Penetrating Vessel.' Here Chong means 'dong' or 'motive'.
The Penetrating Vessel is also the Sea of the 12 channels because it affects several other channels of the body and it controls the secondary channels over the abdomen and chest.
The concept of streets, avenues and crossroads with regard to the Penetrating Vessel is worth exploring. Chapter 52 of the Spiritual Axis says: 'In the chest, Qi has streets; in the abdomen, Qi has streets; in the head, Qi has streets; in the lower legs, Qi has streets. Therefore if there is a problem with Qi in the head, stop it at the brain; if there is a problem with Qi in the chest, stop it at the front of the chest and at the Back-Transporting points; if there is a problem with Qi in the abdomen, stop it at the Back-Transporting points and at the Penetrating Vessel on the right and left of the umbilicus which is the moving Qi (motive force or dong Qi); if there is a problem with Qi in the lower legs, stop it at Qichong (ST 30) (here called Qijie) and at Chengshan (UB 57).'
From this passage, it is apparent that the Penetrating Vessel controls all the channels of the abdomen and the alternative name of Qichong (ST 30), or avenues of Qi (Qijie), is significant. The Qi of the Penetrating Vessel emerges from the deep abdomen at Qichong (ST 30) and has a powerful effect on the circulation of Qi in the channels of the abdomen. In this context, the Penetrating Vessel is also sometimes called 'Sea of Avenues of the Abdomen'.
Indeed, the Penetrating Vessel extends its influence also on the 'streets' of other body areas, i.e. head, chest and legs. The Penetrating Vessel has a head branch; it disperses in the chest and breasts and has a descending branch in the legs which performs the important function of carrying Yin Qi to the legs.
3. Sea of the 5 Yin and 6 Yang Organs
The Penetrating Vessel can be referred to as the Sea of 5 Yin and 6 Yang organs. This is because it is the extraordinary vessel at the centre of the energetic vortex created by these Zang fu organs. It is the father of all other extraordinary vessels. The Penetrating Vessel is the link between the Pre-Heaven Qi (Kidneys) and the Post-Heaven Qi (Stomach).
Due to its complex pathway, the Penetrating Vessel influences many organs directly. As we have seen, it is directly related to the three Yin channels of the leg; Kidneys, Liver, and Spleen. It is closely connected to the Stomach and the Heart. Therefore, it is related to the Kidney (pre-natal Qi), Stomach and Spleen (post-natal Qi), and the Heart (the Emperor), which are the 'Three Treasures of Essence, Qi and Mind'. It is also closely connected to the Liver channel in the legs and in the abdomen.
The Penetrating Vessel and Blood stasis in gynaecology
The Penetrating Vessel is the Sea of Blood and its' pathology is at the root of many gynaecological problems. The three Blood pathologies that affect the Penetrating Vessel are;
When there is Blood deficiency, a woman may suffer from amenorrhoea or oligomenorrhea. When there is Blood Heat, menstruation may be very heavy. When there is Blood stasis, the periods will be painful and the menstrual blood will be dark with clots.
The Penetrating Vessel is used particularly to invigorate Blood when there is Blood stasis in the uterus. Indeed, this is the pathology of the Penetrating Vessel. Therefore we can use this vessel in any case of Blood stasis in the uterus. The points to use are the opening and coupled points Gongsun (SP 4) and Neiguan (PC 6) together with Siman (KI 14) and Xuehai (SP 10).
The Penetrating Vessel and the female breast
The Penetrating Vessel disperses in the chest and therefore its Qi has a deep influence on the breasts. Being the Sea of the 12 Channels, the Penetrating Vessel influences all channels including the connecting channels. Being the Sea of Blood, the Penetrating Vessel influences the Blood connecting channels. Firstly, the Penetrating Vessel influences the female breast because it disperses in the chest on its way upward to the throat and face.
Secondly, the Penetrating Vessel controls the connecting channels and the female breast is richly irrigated by connecting channels. The anatomy of the female breast was discussed in chapter 16 illustrates the tissues forming the female breast from the Chinese medical perspective. Pathology of Qi stagnation in the Penetrating Vessel affects the breasts causing breast distension and/or pain and in the long term, breast lumps.
Thirdly, the Penetrating Vessel affects the female breast through the membranes (huang). The Penetrating Vessel, together with the Directing Vessel, controls the membranes in the abdomen and chest. The connective tissue within the female breast is part of the membranes and Qi stagnation in the Penetrating Vessel always affects the membranes and therefore the breasts.
As the Penetrating Vessel arises from the uterus (which stores menstrual blood) and by virtue of it being the Sea of Blood and controlling the Blood connecting channels, the Penetrating Vessel is responsible for the production of breast milk after childbirth. Breast milk is a direct transformation of menstrual blood into milk (the Chinese say Blood turns white). As menstruation cease after childbirth, menstrual Blood turns into milk and flows up to the breasts via the Penetrating Vessel.
If the Qi of the Penetrating Vessel stagnates after childbirth, the breast milk may not come out. This is an excess condition of agalactia, i.e. the milk is there but it is difficult to express because of the Qi stagnation. Conversely, if the Blood of the Penetrating Vessel is deficient, the breast milk may be lacking because there is not enough Blood to be transformed into milk. This is a deficient cause of agalactia.
The Penetrating Vessel and the male genital system
All ancient Chinese texts say that the Governing, Directing and Penetrating Vessel either start from the uterus or flow through the uterus. None of these books say where these vessels flow in men. In my opinion, it can be postulated that the prostate is the male organ corresponding to the uterus as its anatomical location and functions appear to support this hypothesis.
In clinical practice, I often use the Penetrating Vessel to treat problems of the penis and prostate in men.
1. The penis
As previously discussed, the Ancestral muscle (Zong Jin), which is influenced by the Penetrating Vessel, can be interpreted as being the penis. If it interpreted as being the rectus abdominis muscles, then the term Zong Jin probably refers to both structures as these muscles
insert on the pubic bone at the root of the penis. The anatomy of the penis supports this hypothesis as the root of the penis (radix penis) lies in the perineum between the inferior fascia of the urogenital diaphragm and the fascia of Colles.
As well as being attached to the fasciae and the pubic rami, it is bound to the front of the symphysis pubis by the fundiform and suspensory ligaments. The fundiform ligament springs from the front of the sheath of the rectus abdominis and the linea alba; it splits into two fasciculi which encircle the root of the penis. The body of the penis (apart from its' root) is closely linked to the pubic bone and the rectus abdominis. The corpora cavernosa penis forms the greater part of the substance of the penis. Their anterior three-fourths lie in intimate opposition with one another, but posteriorley they diverge in the form of two tapering processes, known as the crura, which are firmly connected to the rami of the pubic arch.
Secondly the Penetrating Vessel is the Sea of Blood and the corpus cavernosum are richly supplied with blood on which they rely for normal erection to occur. Normal erection depends on a normal state of the Sea of Blood and therefore the Penetrating Vessel. A Blood deficiency or Blood stasis of the Penetrating Vessel in males will commonly impair erection.
The Penetrating Vessel influences the penis in a third way. As we have seen, the vessel controls the connecting channels. The anatomy of the penis is such that it is richly endowed with connecting channels because it is a structure that is outside of the body.
Fourthly, the Penetrating Vessel influences the penis because it controls the membranes (huang). The corpora cavernosa penis are surrounded by a strong fibrous envelope consisting of superficial and deep fibres which, from the TCM perspective are membranes.
The Penetrating Vessel therefore influences erection in the following way;
a. Being the Sea of Blood, it is responsible for the filling of blood of the corpus cavernosum that determines erection.
b. The Penetrating Vessel is connected to the Post- Natal Qi via ST-30 Qichong which is located near the root of the penis and provides the necessary Qi for erection to occur.
c. The Penetrating Vessel is connected to the Pre-Natal Qi at Huiyin (RN 1), Qixue (KI 13) and Guanyuan (RN 4) and provides the essence (jing) for erection to occur.
d. The Penetrating Vessel controls the membranes (huang) and most of the tissues in the penis are part of the membranes
e. The Penetrating Vessel controls the Ancestral muscles (Zong Jin) which is the penis.
f. The Penetrating Vessel controls the connecting channels in the penis which allow the penis to be filled with blood when erect;
g. The Penetrating Vessel plays an important role in allowing communication between the Heart and the Kidneys and therefore the descending of Heart-Blood to the penis.
The Penetrating Vessel can be used to treat erectile dysfunction. For this purpose, I use the opening and coupled points Gongsun (SP 4) on the left and Neiguan (PC 6) on the right together with Dahe (KI 12), Guanyuan (RN 4), Qihai (RN 6), Xinshu (UB 15) and Shenshu (UB 23). I use Xinshu (UB 15) to tonify and invigorate Blood as the Heart governs Blood and to promote the descending of Heart-Blood to the penis. The descending of Heart-Qi and Heart-Blood to communicate with the Kidneys plays an important role in sexual function.
Interestingly, ancient doctors were aware of the hormonal connection between the testis and beard growth and related this to the Penetrating and Directing Vessels. The ABC of Acupuncture (Jia Yi Jing AD282) says; 'If there is an injury to the sex organs in men, sexual energy is depleted and the man cannot have an erection but the beard does not fall off. By contrast, in eunuchs, the beard falls off, why? That is because in eunuchs the Ancestral muscle (penis) is cut off; this injures the Penetrating Vessel, Blood is depleted, there is accumulation under the skin, the mouth and lips do not receive nourishment and the beard does not grow. In those who are made into eunuchs from birth, the Directing and Penetrating Vessels do not flourish, the Ancestral muscle (penis) does not develop, there is no Qi and no Blood, the mouth and lips do not receive nourishment and therefore the beard does not grow'.
2. The prostate
As previously mentioned, it can be postulated that the male prostate is the organ equivalent to the female uterus. In men, the three vessels that arise in the lower abdomen, the Governing, Directing and Penetrating Vessels all flow through the prostate on their way down to Huiyin (RN 1) . In my opinion, when considering the physiology and pathology of the prostate gland in Chinese medicine, the seminal vesicles should be assimilated with the prostate.
Just as the ovaries in women are related to the Kidney essence, so is the prostate in men as it produces most of the seminal fluid. The prostate and seminal vesicles jointly produce about 90% of seminal fluid. The Governing and Directing Vessels in females represent the Yang and Yin aspect of menstruation. In males, these two vessels both influence the prostate and the production of seminal fluid. Sperm is a form of essence and is part of the Yin essences and therefore related to the Directing Vessel.
Just as ovulation needs heat from Kidney Yang, the production of sperm also needs heat from Kidney Yang and therefore the Governing Vessel. Guanyuan (RN 4) and Mingmen (DU 4) represent the Yin and Yang aspect of Essence respectively. In males, they are both needed for the production of seminal fluid by the prostate.
Prostatic hypertrophy is commonly due to a combination of pathogenic factors such as phlegm, Blood stasis and dampness. Blood stasis in the prostate is always a pathology of the Penetrating Vessel, while phlegm and dampness occur due to stagnation in the connecting channels of the prostate. This is another way in which the Penetrating Vessel plays a role in this pathology as it controls the connecting channels. In addition, there is usually a Kidney deficiency (Yang or Yin) underlying the above pathogenic factors.
I treat prostatic hypertrophy by tonifying the Kidneys, resolving phlegm and dampness and invigorating Blood. The Penetrating Vessel can be used for this purpose by needling its opening and coupled points, Gongsun (SP 4) on the left and Neiguan (PC 6) on the right together with Zhongji (RN 3), Shuidao (ST 28), Siman (KI 14), Guanyuan (RN 4) and Taichong (LV 3).
Giovanni Maciocia has been a TCM practitioner for over 30 years and is an internationally recognized author and teacher. His books are still used as the standard text in NZ acupuncture colleges and as a reference guide by practitioners in most Western countries. In 1996 Giovanni Maciocia was appointed Visiting Professor of the Nanjing University of Traditional Chinese Medicine. The Channels of Acupuncture - Clinical use of the Secondary Channels and Eight Extraordinary Vessels by Giovanni Maciocia is available from Elsevier.
First published in NZRA Journal of TCM, Winter 2006.