Journal of Chinese Medicine | Issue 128 | February 2022

The Divergent Pathways (Jing Bie): Background and Application

The Divergent Pathways (Jing Bie):

Background and Application
Brechtje Sebregts

Abstract

Ling Shu (Divine Pivot) Chapter 11 is the oldest written source that mentions
the divergent pathways (jing bie). Current theories about the use of the
divergent pathways are based on interpretations of this chapter and clinical
experience. Whilst the Ling Shu only describes the course of the 12 divergent
pathways, contemporary authors and teachers have presented their own
understandings and methods of treatment. In the experience of this author,
the divergent pathways are an effective method for the treatment of chronic
complaints. This article introduces the basic theory of the divergent pathways
with a detailed presentation of the sixth divergent pair and an illustrative case
study. It has been adapted from a chapter of the author’s recently published
book Divergent Trajectories - Backgrounds and Applications in Practice.

Keywords
Channels, divergent pathways, jing bie, Ling Shu Chapter 11, Large Intestine, Lung

Introduction

Ling Shu (Divine Pivot) Chapter 11 is the starting preceding 22 centuries. Tadashi Irie, Kodo Seki, Shigeji
point for understanding the divergent pathways. The Naomoto, Jeffrey Yuen, Miki Shima, David Twicken and
fact that a whole chapter is devoted to the divergent Josef Müller have all contributed to this development. They
pathways suggests that this part of the meridian system is all describe different methodologies whilst emphasising the
important. At the same time, this text raises many questions clinical relevance of this part of the meridian system. Their
due to its limited description of these meridians. In the understandings are based on years of clinical observation,
chapter, after a short introduction, Qi Bo describes the oral and written transmission from a long tradition of Daoist
divergent pathways in terms of six yin-yang pairs. For each masters (in the case of Jeffrey Yuen) as well as modern
divergent pathway, the region where the pathway branches interpretations of classical texts.
off from the primary meridian is described, along with the
course of the pathway and the region where the pathway Function
re-joins the primary meridian. No further description of
function, diagnostic methods, pathology or methodology Although the Ling Shu does not describe the specific
is described. This has led to considerable variation in the functions of the divergent pathways, some of the sources
use of the divergent pathways. named above state that they play a role in keeping
There has been more innovation in methods of working pathogens away from the zangfu organs. There are different
with the divergent pathways in the past 40 years than in the interpretations about how this is done, by the meridian

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 Journal of Chinese Medicine | Issue 128 | February 2022
The Divergent Pathways (Jing Bie): Background and Application

system overall and the divergent pathways in particular. included to illustrate how the divergent pathways can be
The following description of this process is based on a applied in practice.
synthesis of Chapter 56 of the Su Wen (Basic Questions) This pair of divergent pathways can be used to treat
and Yuen, Twicken and Shima's interpretations. complaints related to the Large Intestine fu, Lung zang
The divergent pathways have the capacity to store or problems along the course of these pathways. Some of
pathogens along their trajectory. This process of storage is the complaints associated with the divergent pathway of
known as keeping the pathogen in latency. The pathogen the Large Intestine overlap with those of the Lung. This
will remain latent until the body can remove it or until is because they form a pair. In the vast majority of cases,
latency can no longer be maintained. The preservation the complaints are chronic and periods of exacerbation
of latency depends on the condition of the essences: jing alternate with periods of remission. No clear pattern is
(essence), xue (blood), jin (thin fluids), ye (thick fluids), discernable in terms of the duration of these phases.
qi and yang. If the essences are sufficient, the body can
store the pathogen and keep it in latency. The patient will Physical indications
not necessarily describe any specific complaints if the Large Intestine
pathogen is stored in latency, although this will adversely • complaints along the course of the pathway: stiffness,
affect the circulation of qi and blood, gradually restricting pain, immobility, weakness or numbness of the
physical and mental-emotional movement. For example, shoulder and arm
a person may become more and more irritable, or start • chronic pathologies of the Large Intestine and Lung
to notice restricted range of motion in a joint. If there is including:
free circulation of qi and blood, then the body may be able – respiratory complaints: cough, wheezing, shortness
to remove the pathogen itself. However, if the essences of breath or chest pain
decrease, the body will no longer be able to store the – digestive complaints involving diarrhoea, borborygmi,
pathogen and the patient will experience symptoms as constipation or abdominal pain
the body attempts to eliminate it. This results in chronic – skin complaints accompanied by itching, redness, dry
and intermittent complaints that vary in frequency and or scaly skin
intensity. Such pathology is a specific indication for the use – throat-related symptoms: swollen throat, sore throat,
of divergent pathways in treatment. The divergent pathways difficulty swallowing, hoarseness, rattling in the
are therefore indicated for chronic musculoskeletal pain, throat, swollen lymph nodes
chronic diseases of the skin and the sense orifices (eyes, – pathologies involving the nose: stuffy nose, persistent
ears, nose and mouth), chronic organ diseases and chronic runny nose, sneezing and itching of the nose
mental-emotional problems. Asking about a patient's
complaints is one of the primary diagnostic methods for Lung
determining whether there is a pathogen in the divergent • complaints along the course of the pathway: pain of
pathways. The 12 divergent pathways are distinguished the upper arm, shoulder and/or elbow, limited range of
according to the specific physical and mental-emotional motion of the arm, and difficulty opening the hand
complaints that occur when a pathogen is located in a given • chronic pathologies of the Lung and Large Intestine
pathway. In this article the specific indications for the Large including:
Intestine and Lung divergent pathways are presented, along – respiratory complaints: coughing, coughing up
with points and a treatment method for the Large Intestine. phlegm or blood, shortness of breath or wheezing,
chest pain, oedema in the lungs
Indications – excessive sweating, oedema of the limbs, dry skin, dry
mucous membranes
Included below is a description of the sixth divergent pair: – throat-related symptoms: swollen throat, sore throat,
the Large Intestine and the Lung, including an overview of difficulty swallowing, hoarseness, rattling in the
the physical and mental-emotional complaints related to throat, swollen lymph nodes
this pair and a treatment protocol for the Large Intestine – pathologies of the nose: nosebleeds
divergent pathway. Before treatment it is important to
determine whether there is any deficiency in the essences Mental-emotional indications
that may be preventing the pathogen from being stored or Mental-emotional complaints involving the divergent
removed. If so, tonify these essences before undertaking pathways of the Large Intestine and Lung involve grief
the first step in the protocol. If there is no deficiency, (bei) and worry (you). In the course of everyday life, people
immediately begin with the first step. A case study is experience loss. The extent of this loss varies, from minor

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Journal of Chinese Medicine | Issue 128 | February 2022
The Divergent Pathways (Jing Bie): Background and Application

loss of belongings to major loss of loved ones. When a The divergent pathway of the Large Intestine
person is in balance, they can accept such loss and let go.
Grief is a normal response to loss. It is usually caused by an Chapter 11 of the Ling Shu describes the course of the
unpleasant, painful or disappointing situation of loss, or by divergent pathway of the Large Intestine as follows:
drastic changes to daily routines and ways of life that have
provided comfort, security and stability. Grief can take The primary of the hand yang ming travels from the hand to
many forms, including sadness and heartbreak. It is the the breast. A divergence at the shoulder joint enters the neck
price that we must pay for being able to love. Sometimes bone. From here it descends to the large intestine, homing to
grief is experienced as being traumatic, and can be difficult the lungs. It then ascends and travels toward the throat to
to resolve. The patient may not be able to process the grief emerge at the supraclavicular fossa to unite with the yang
despite the passage of time. If the patient is overwhelmed ming.
by grief, they may not know what to do anymore or not have - Chace & Shima, 2005, p. 30
the strength or the will to act. Their qi disappears, leaving a
void. In the words of the Su Wen:

When one is sad, then the heart connection is tense.

The lobes of the lung spread open and rise and the upper
burner is impassable.
The camp [qi] and the guard [qi] do not disperse.
Heart qi is in the center.
Hence, the qi dissipates.
- Unschuld & Tessenow, 2011, p. 595

Worry (you) also affects the Lung and Large Intestine.

Worrying is a form of thinking about the future in a way that
makes the patient anxious or concerned. It is contrary to the
Figures 1a & 1b: The divergent pathway of the Large Intestine as
movement of life. The term ‘you’ implies oppression, a lack described in the Ling Shu with the confluence and trajectory points
of circulation, contraction and immobilisation. The top of
the character you contains the head, the middle contains
the Heart and the bottom contains the trailing legs. Thus, Acupuncture points
the patient lives with problems in the head and the Heart. The Ling Shu describes the regions where the divergent
Qi slows down, and Lung qi stagnates. pathways begin and end. In order to treat the divergent
If the patient cannot stop worrying or is stuck in their pathways, acupuncture points are chosen in these zones.
grief process, they can be withdrawn and gloomy. They These points are known as the confluence points. The
may maintain a happy exterior in an effort to convince lower confluence point is the start of the divergent pathway
themselves and others that everything is okay. Privately, and the upper confluence point is its end point.
however, they may be consumed with grief. Sadness and
grief directly affect the centre of vitality. Chapter 8 of the Lower confluence point: Quchi LI-11
Ling Shu states: Upper confluence point: Futu LI-18

In the state of sadness and affliction (bei ai) one is moved to In addition to the confluence points, Yuen and Twicken
the centre, there is a drying up and interruption and life is lost. include trajectory points in their divergent pathway
- Larre & Rochat de la Vallée, 2005, p. 125 treatments. These are primary meridian points that lie
along the course of the divergent pathways and that are
The divergent pathways of the Large Intestine and Lung suitable for pathologies of these pathways. Given the
should be considered when patients are affected by these general way that the pathways' courses are described, it
emotional states. is not surprising that a variety of trajectory points have
emerged. The selections here remain faithful to the Ling
Shu descriptions. It is only necessary to add one or two
trajectory points to divergent pathway treatments to make
treatment more effective. Decide which of the following

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 Journal of Chinese Medicine | Issue 128 | February 2022
The Divergent Pathways (Jing Bie): Background and Application

points are the most appropriate of the divergent pathway Quepen ST-12 (Empty Basin or Broken Bowl)
by correlating their functions with the patient's physical Quepen ST-12 is used to resolve stagnation causing
or mental-emotional complaints. They can be needled shoulder pain that radiates to the neck, upper arm pain,
unilaterally according to the location of the complaint. inability to raise the arm and deafness. Quepen ST-12 also
allows Lung qi to descend in cases involving chest and
Jianyu LI-15 (Shoulder Bone) upper warmer complaints, including coughing, shortness
Due to its location, Jianyu LI-15 is often used as a trajectory of breath, fullness in the chest and swollen glands. When
point for shoulder and arm complaints such as stiffness, palpating this point, practitioners may feel a lack of muscle
pain, immobility, weakness of the shoulder and numbness tone and often perceive a void. In such cases the ‘bowl’ is
in the upper arm. It promotes movement of qi and blood in broken and life energy is flowing away. Quepen ST-12 can
the upper arm and shoulder. This restriction of movement be used to mend the bowl, so that the patient can collect
with pain is analogous to being stuck in grief or loss. In such their qi and resume living.
cases, Jianyu LI-15 can help a person let go of the past.
Tianshu ST-25 (Celestial Pillar)
Dazhui DU-14 (Great Hammer) Tianshu ST-25 regulates the qi of the intestines and removes
As a trajectory point of the divergent pathway of the stasis in the lower burner. It can be used for complaints such
Large Intestine, Dazhui DU-14 is not used to treat physical as diarrhoea, borborygmi, constipation and abdominal
complaints. For mental-emotional complaints, the point can pain. A pillar provides strength and a solid foundation.
be used when the patient is stuck or experiences persistent Thus, this point provides the patient with a stable centre
negative emotions (e.g. they feel gloomy or depressed and in case of excessive worry. This prevents the patient from
have started to behave accordingly). The patient may no losing their grounding. From a stable centre, they can
longer spend time with others or engage in fun activities orientate themselves and continue along their life path.
because they do not derive enjoyment from them. Dazhui
DU-14 can be used to break these behavioural patterns. The Treatment plan
goal is for the patient to re-engage, see people again and
discover that life has much to offer. The following step-by-step treatment plan was inspired
by the theories and methods of Seki, Shima, Helms, Yuen,
Zhongfu LU-1 (Middle Palace) Twicken and Müller. The order of the steps is important.
Zhongfu LU-1 makes qi descend and clears the chest in
cases of coughing, shortness of breath, coughing blood Step 1: Needle the lower confluence point Quchi LI-11 on the
and pus, wheezing and chest pain. Persistent sadness may left, then on the right. Then, repeat the process for the upper
also obstruct the descending movement of qi. Shallow confluence point Futu LI-18, first on the left, then on the right.
breathing or feeling short of breath may indicate that the
patient is unable to let go if there is grief and loss. As a Step 2: Use one or two appropriate trajectory points for the
result, there is no room to let in anything new. Sadness can pathology being treated. Select the point(s) based on the
lead the patient to no longer make new contacts because location of the complaint, palpation of the trajectory points
they are aware that there is much to lose. Zhongfu LU-1 and information gleaned from talking with the patient.
softens this feeling of isolation and alleviates sadness that In this way, the trajectory point(s) corresponding to the
has persisted for too long. The patient's chest feels free and patient's current needs can be determined.
their breathing becomes normal again; they can take their
first steps towards processing their grief. Step 3: If the pulse become tight at the superficial level
in a given position during the treatment of the divergent
Wuyi ST-15 (Room Screen) pathway, needle the jing-well point Shangyang LI-1.
This point is used to treat physical complaints of the Lung.
It allows rebellious qi to descend and clears the chest to Case study
alleviate coughing, wheezing, shortness of breath and chest
pain. Pressure on the chest is often felt when there is not When Cathy, aged 54, entered my clinic, I noticed that she
enough space for one’s own needs and feelings. Just as a had considerable redness in her face, especially besides her
screen divides a room and creates a feeling of privacy, Wuyi nostrils. She said that it was not only the skin on her face that
ST-15 can offer protection from external stimuli and allow was red and chapped. She pulled up her sleeve and showed me
the patient room for their own needs and feelings. a large, similarly red and dry spot on her right wrist, around
Yangxi LI-5. She told me that there were periods when her skin

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Journal of Chinese Medicine | Issue 128 | February 2022
The Divergent Pathways (Jing Bie): Background and Application

issues had been less severe. Cathy did not know what caused and in specific aspects of the meridians and organs (zangfu).
her skin to worsen. After some thought, she mentioned her Two weeks later, I saw Cathy again. Her bowel
work. She had been self-employed for four years and worked movements had improved: she was now passing stools
alongside two other women. Their working relationship was every two days that did not smell much anymore. The
turbulent. ‘That's how it goes, unfortunately,’ she said. It was conversation turned to the red and dry spots on her skin,
not only Cathy's skin that was bothering her. Her nasal passages which were still evident. I explained that the redness and
were full of mucus, sometimes for days at a time, sometimes heat that she experienced had to do with waste and toxins in
for several weeks. In addition, Cathy had been constipated her body. An appropriate metaphor would be a full rubbish
for several months. Every four to five days she passed strong- bin that cannot be emptied. As a result, the bin stinks and
smelling stools; this had occurred at other periods in her life. the rubbish rots. Cathy's constipation was the physical
I used a combination of four diagnostic methods: asking manifestation of that full bin. I cautiously brought up the
about complaints, pulse diagnosis, abdominal diagnosis and topic of work. Cathy admitted that she clung to the past
kinesiological testing. Based on the location and the chronic in the form of people or objects that she could not let go
and intermittent nature of her symptoms, I determined that of to make way for something new. She knew that this
Cathy's complaints involved a pathogen in the divergent situation was not healthy for her. Cathy said that letting go
pathway of the Large Intestine. I also diagnosed deficiency was difficult for her as this would lead to a change in who
of qi, which was preventing her body from holding the she was, which was scary. This prevented her from seeing
pathogen in latency. new possibilities and new sources of inspiration.
I first needled Qihai REN-6 to tonify qi, and the mu I started the next treatment by opening the Du Mai
point of the Large Intestine, Tianshu ST-25, to move qi (Governing Vessel), Houxi SI-3 on the right and Shenmai
in the colon. In the same BL-62 on the left. This
treatment, I added the would help Cathy stand on
divergent pathway of the Based on the location and the her own feet with a straight
Large Intestine. First, I
needled the two lower
chronic and intermittent nature of her back and show who she was
and what she wanted. Full
confluence points: Quchi symptoms, I determined that Cathy's of yang, the Du Mai could
LI-11 on the left and on
the right. Then, I needed
complaints involved a pathogen in give her life movement and
firmness. I combined the
the two upper confluence the divergent pathway of the Large Du Mai with the divergent
points: Futu LI-18 on the
left and then on the right.
Intestine. pathway of the Large
Intestine. I needled the
I did not use trajectory lower and upper confluence
points of the pathway of the Large Intestine in this points first and then added Dazhui DU-14 as a trajectory
treatment, as they would not have added anything for the point, to enable Cathy to consider the possibility of working
treatment of her complaints. Locally, I used Yingxiang LI-20 with other people. I added Tianshu ST-25 to provide Cathy
to relieve Cathy's congested nose. I explained at the end of with a stable centre from which to break down the calcified
the treatment how she could massage Hegu LI-4 herself. patterns and relationships, enabling her to grow and develop.
J.R. Worsley nicknamed this point 'the great eliminator' In the four treatments that followed, I kept tonifying her
because of its powerful clearing effect on blockages of the qi and stimulating movement in the Large Intestine, both
Large Intestine, which removes toxins and other waste. physically and mentally. In the seventh treatment I diagnosed
In treatment of the divergent pathways, diagnostic that she had sufficient essences and I used the divergent
methods act as a feedback mechanism. Improvements in, pathway of the Large Intestine again to support the body in
for example, pulse or hara indicate a positive treatment getting rid of the pathogen which was located within it.
outcome. So 10-20 minutes would be allowed to elapse At the following treatment, the redness on her face and
before noticing signs of improvement. As soon as no further right wrist was barely visible and the constipation had
improvements are observed, the needles can be removed. improved. Based on the four diagnostic methods, I
In the vast majority of cases, instantaneous improvement determined there no longer was a pathogen in the divergent
in the patient's complaints should not be expected; in some pathway of the Large Intestine. Cathy told me how she was
cases, however, these are immediately observable. In most dealing with her situation at work. She talked to her
cases, a gradual reduction of symptoms occurs, which usually colleagues and shared her qualms about their working
manifests itself in the days following a treatment. The changes relationship. She indicated that she would look for another
reflect a general improvement in the patient's functioning job and that she did not want to continue as she had before.

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The Divergent Pathways (Jing Bie): Background and Application

The rhythm and peristaltic movement of clearing and Kaatz, D. (2011). Characters of Wisdom – Taoist Tales of the Acupuncture
letting go had returned. Points. (E-book) The Petite Bergerie Press

Larre, C. & Rochat de la Vallée, E. (2003). The Secret Treatise of the Spiritual
Orchid. Monkey Press: London
Brechtje Sebregts is a Dutch acupuncturist. She has studied
constitutional meridian therapy, five-phase acupuncture Larre, C. & Rochat de la Vallée, E. (2005). The Seven Emotions. Monkey
and Japanese acupuncture. She has run her own practice for Press: London
12 years and specialises in the treatment of psychosomatic
Maciocia, G. (2005). The Foundations of Chinese Medicine. Churchill
complaints. She is also a teacher and gives masterclasses Livingstone: London
at her Centrum Sebregts, is a lecturer at the Traditional
Chinese Medicine Academie and a guest lecturer at Matsumoto, K. & Birch, S. (1988). Hara Diagnosis: Reflections on the Sea.
Qing Bai and several other educational institutions in the Paradigm Publications: Brookline, Massachusetts (USA), 387
Netherlands. For more information on this approach to the
Matsumoto, K. & Euler, D. (2012). Kiiko Matsumoto’s Clinical Strategies,
divergent pathways, see her book Divergent Trajectories Vol.1. David Euler, 299
- Backgrounds and Applications in Practice available at
www.centrumsebregts.nl and via Amazon. She can be Müller, J.V. (2004). Den Geist verwurzeln. Verlag Müller und
contacted at info@centrumsebregts.nl Steinicke: München

Müller, J.V. (2018). Den Geist verwurzeln. Band 3. Verlag Müller und
Bibliography Steinicke: München
Cecil-Sterman, A. (2012). Advanced Acupuncture. A Clinical
Manual. First edition. Classical Wellness Press: New York Müller, J.V. (2020). Den Geist verwurzeln. Band 4. Verlag Müller und
Chace, C., Blalack, J. & Schaefer, J. (2007). Lurking Pathogens: Three Steinicke: München
modern Approaches. The Lantern, 4, 2-3, pp. 17-27, pp. 40-45
Scheid, V. (2014). Transmitting Chinese Medicine: Changing Perceptions
Chace, C. & Blalack, B. (2006). Lurking Pathogens: A Case Study from of Body, Pathology and Treatment in Late Imperial China, Asian Medicine,
the late Qing Dynasty. The Lantern, 3, 1-2, 23-37 and 40-45 8(2), 299-360.

Chace, C. (2009). The Merging of Ways, an Approach to Understanding Scheid, V. (2018). Promoting free flow in the networks: Reimagining the
the Channel Divergences in Meridian Style Therapy. The Lantern, 6-2, 14-21 body in early modern Suzhou, History of science, 56 (2), 131-16

Chace, C. & Shima, M. (2011). Exposition on the Eight Extraordinary Vessels: Shima, M. & Chace, C. (2001). Channel Divergences: Deeper Pathways
Acupuncture, Alchemy and Herbal Medicine. Eastland Press: Seattle of the Web. Blue Poppy Press: Boulder

Chace, C. (2018). Fantasy Maps and How to Use Them: Rooting Channel Solinas, H., Mainville, L. & Auteroche, B. (1998). Atlas of Chinese
Divergence Theory in Palpatory Experience. Journal of Chinese Medicine, Acupuncture: Meridians and Collaterals. 3-8-3 Publishing Canada
118, pp. 5-13
Sommers, D. (2007). De Chinese fascinatie voor de geest. Uitgeverij Libra
Deadman, P. & Al-Khafaji, M. (2007). A Manual of Acupuncture. Second & Libris: Veghel
edition. Journal of Chinese Medicine Publications: Hove
Twicken, D. (2014). Divergent Channels – Jing Bie: A Handbook for
Denmai, S. (2003). Finding Effective Acupuncture Points. Eastland Clinical Practice and Five Shen Nei Dan Inner Meditation. Singing Dragon:
Press: Seattle London (UK)

Ellis, A., Wiseman, N. & Boss, K. (2012). Grasping the Wind. Paradigm Twicken, D. (2015). The Luo Collaterals: A Handbook for Clinical Practice
Publications: Brookline and Treating Emotions and the Shen and the Six Healing Sounds. Singing
Dragon: London
Farrell, Y. (2016). Psych-emotional Pain and the Eight Extraordinary Vessels.
Singing Dragon: London (UK) Unschuld, P. (2016). Huang Di Nei Jing Ling Shu: The Ancient Classic on
Needle Therapy. University of California Press: Berkeley
Hicks, A., Hicks, J. & Mole, P. (2011). Five Element Constitutional
Acupuncture. Churchill Livingstone: London Wang Ju-Yi & Robertson, J. (2008). Applied Channel Theory in Chinese
Medicine: Wang Ju-yi’s Lectures on Channel Therapeutics. Eastland
Jarrett, L.S. (2015). The Clinical Practice of Chinese Medicine. Spirit Path Press: Seattle
Press: Stockbridge
Yuen, J.C. (n.d.). The Divergent Channels of Classical Chinese
Jensen, A.M., Stevens, R. & Burls, A. (2014). Developing the evidence for Medicine [DVD]. ACCM
kinesiology-style manual muscle testing: A series of diagnostic test accuracy
studies. Elsevier: London

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