The Chongmai Link: Genitalia, Sexual Function, the Nose, Vomeronasal Organ and Pheromones

Gilbert Lambrechts MD1
Philip AM Rogers MRCVS2
1Courseleader of the Belgian Medical Acupuncture Association
2Grange Research Centre, Teagasc, Dunsany, Co. Meath, Ireland

Introduction
If students of acupuncture compare textbooks, they will find that different authors give different information on the same subject. Different textbooks show different functions for some points; some books even differ in their location of the pathways of some Channels. For example, some books show the pathway of the Yangweimai to the ear but others show it behind the ear.

Variation between textbooks makes it very difficult for students to decide which is correct. The basis for these differences is probably because the original Chinese sources differ amongst themselves, depending on the year and region of its origin. In my opinion modern scientific data may help to answer some of these questions.

The path of the Chongmai (Penetrating, or Thorougfare, or Strategic Extra-Vessel) in the face is one of these problems. Some authors mention a branch that travels to the nose; others say that it ends in the eye. Some say that there is no branch to the face. Which is correct? The true connections of the Chongmai have important implications for practitioners.

We will discuss new western research that could explain a connection between the Chongmai pathway and the nose, via Jacobson's (the vomeronasal) Organ.

Sources
Examples of the Chongmai pathway are selected from the following textbooks:

• Anon (Academy for Traditional Chinese Medicine) Précis d’Acupuncture Chinoise, published in China (French edition).First edition 1977, 328pp. Also, An Outline of Chinese Acupuncture (Beijing 1975)
• Solinas H, Auteroche B & Mainville (1990 ) Atlas d’Acupuncture Chinoise.First Edition. Editions Maloine, Paris, 260pp.
• Deadman, Al-Khafaji en Baker (1998 ) A Manual of Acupuncture’.First Edition. Journal of Chinese Medicine Publications,East Sussex, 667pp.
• Maciocia, Giovanni The Foundations of Chinese Medecine , First edition ( 1989 ), Churchill Livingstone, London, 498pp and Obstetrics and Gynaecology , First edition, 1998, Churchill Livingstone, London, 959pp.
• Desoutter B ( 1996 ) Merveilleux Vaisseaux, First edition, Sauramps Editions, Montpellier, 169pp.
• Roustan C. (1978) Traité d’acupuncture, part I, First edition, Masson, Paris,207pp.
• Kespi ( 1982 ) Acupuncture, first edidtion, Maisonneuve, Moulins-Lès-Metz,785pp.
• O’Connor en Bensky ( 1981 ) Acupuncture, a comprehensive Text. Fifth printing 1987, Eastland Press, Seattle, 741pp.
• Helms J (1995 ) Acupuncture Energetics.First edition, Medical Acupuncture Publishers, Berkeley California, 759pp
• Wiseman N & Ye F (1998) A practical Dictionary of Chinese Medicine. First Edition. Paradigm Publications, Brookline Massachussets, 945pp.

Let us look in detail, what these authors show us.=

• Précis d’acupuncture Chinoise Chart (Beijing; also An Outline of Chinese Acupuncture, Beijing, 1975): In the chart, E = ST; Rn = KI; VC = CV. The text says: at the level of the umbilicus the abdominal branch splits and rises bilaterally to the midline, to the throat, where it encircles the lips. Its main points are KI11 to KI21.
  

• Merveilleux Vaisseaux Chart (Desoutter): In the chart, Es = ST; Re = KI; RM = CV. Chongmai starts from ST30-Qichong, with a branch to the leg and one to KI11.This one follows the KI Channel, with a contact to CV07, to go to KI27. From here it goes to the mouth to end in the maxillary sinus ( others say the pharynx).
  

• Acupuncture Chart (Kespi): In the chart, E = ST; Rn = KI; VC = CV. Kespi mentions a branch that comes from KI27 and circles around the mouth to end in the nasal cavity.
  

• Traité d’acupuncture Chart (Roustan): In the chart, Est = ST; Rn = KI; VC = CV. One branch follows the KI Channel and goes from the thorax to the nasal cavity
  

• Acupuncture: A Comprehensive Text Chart (O’Connor & Bensky): In the chart, S = ST; K = KI; Co = CV. The pathway is the same as that of Roustan. So they mention also a pathway to the nasal cavity.
  

• The Foundations of Chinese Medicine Chart (Maciocia), and Obstetrics and Gynaecology in Chinese Medicine (Maciocia): In the chart, Ren = CV. In his book about gynaecology, Maciocia mentions a branch that ends under the eye. He does not mention a nasal branch.

• A Manual of Acupuncture Chart (Deadman, Al-Khafaji & Baker): In the chart, KID = KI and REN = CV. The Chongmai rises along the throat, curves around the mouth and ends under the eye.
  

• Acupuncture Energetics Chart (Helms): In the chart, he uses the standard codes for ST, KI and CV. The pathway gives a branch that curves around the lips, enters the nasal cavity and ends in the eye.
  

• Atlas d'Acupuncture Chinoise Chart (Solinas, Mainville & Auteroche): In the chart, E = ST; Rn = KI; VC = CV. The pathway goes to the upper part of the pharynx and posterior nasal cavity.
  

• A practical Dictionary of Chinese Medicine (Wiseman & Ye 1998): This is probably the most definitive text on Chinese Medicine written in English. It mentions 5 paths of the Chongmai: (1) from the lower abdomen, to the chest and ribs, via the KI channel and CV08; (2) from the chest, to the throat and face, skirting the lips and ending in the nose; (3) from KI11-Henggu (Pubic Bone), to the medial thigh, to the popliteal fossa (BL40-Weizhong, also called Xuexi-Blood Cleft [Li 1987]), to the sole of the foot (KI01 area); (4) from ST30-Qichong (Qi Thoroughfare) to the medial malleolus, to the big toe; (5) from the main course in the pelvis, to the spine, which it ascends. In those details, Wiseman & Ye differ from the 1975 Beijing text (An Outline of Chinese Acupuncture), which specifically list only KI points on the Chongmai (KI11 to KI21).

Discussion
Which pathway on the face is correct?
Although the above authors differ in some other details about the Vessel pathway, whether or not the Chongmai connects to the nose is of great importance to clinicians.

Pheromones
Modern scientific data have proven a link between reproductive-genital-sexual behaviour, the nasal cavity and pheromones. Pheromones are volatile chemicals, secreted in minute amounts by insects and animals. Transmitted in air or water, pheromones act as chemical messengers; they can provoke behavioural or physiological changes in other animals of the same, or different, species.

Mechanisms of pheromone-signalling: To function effectively, a pheromone-signalling system needs three parts; it needs a mechanism:

• to release a chemical impulse, usually from a glandular organ;
• to transmit the chemical message, usually in air or water;
• to receive the chemical message, usually via the olfactory or gustatory organs for smell or taste.

Different types of pheromones
Many types of pheromones have been found in many species of insects and mammals. There are different categories of pheromones:

• Sex attractants: Secretion of these pheromones one can stimulate sexual responses and behavioural changes in the opposite sex
• Alarm pheromones: Secretion of these pheromones can signal danger so that the recipient can adopt appropriate defence posture, or try to escape from the danger.
• Aggregation pheromones: These serve to bring members of a species together, for example to a food source
• Dispersion and territorial pheromones: These are used to mark out a territory for individuals or groups of a species.

Many pheromones have been isolated from insects and mammals, and some have been synthesised. They have many uses, for example, wolf urine to repel smaller mammals, sex-attractants to trap and control insects (like orchard moths and honeybees), and natural musk in the productions of perfumes. Research is ongoing on the use of sex-pheromones in farm animals to aid the detection of oestrus and ovulation, or even to induce it.

Proof that human pheromones exist
Some studies suggest the existence of human pheromones. In 1971, Dr Martha McClintock published an article in ‘Nature’ about the synchronisation of the menstrual cycle with roommates of a school ("the dormitory effect"). Pheromones could be the substances responsible for this observation. It took her until 1998 to prove that it was a chemical substance secreted by the sweat glands that influenced the menstrual cycle. In a group of women the axillary sweat was collected on cotton balls in the pre-ovulatory phase, the ovulatory phase and in the post-ovulatory phase. After impregnation with alcohol, to exclude other odours, a group of subjects were asked to smell from the cotton balls at regular times. Depending on the time of pheromone presentation in the pre– or postovulatory phase, timing of menstruation moved significantly forward or backward. She concluded that the sweat of women contains chemical substances, pheromones, and that through the olfactory system, they can stimulate another female to change her menstruation pattern. By showing in a fully controlled experiment that the timing of ovulation can be manipulated, this study provides definitive evidence of human pheromones. (See more details in the Appendix, below).

Which receptors bind pheromones in the nose?
There is heavy evidence that the vomeronasal organ (also called Jacobson’s organ) acts as the pheromone receptor. It is a little sense organ (part of the "sixth sense") just beside the cartilage of the nasal septum and just beside the olfactory nerve. It is only stimulated by pheromones and not by odours, while the olfactory nerve is only stimulated by odours and not by pheromones.

The vomeronasal organ, in the floor of the nose of horses and cattle, is equipped with an olfactory mucous membrane and is especially developed. Chinese veterinary literature describes very effective acupoints in the roof of the mouth in cattle at the opening of its ducts (the nasopalatine ducts). The points are GV28-01; their indications include bloat, tympany, dyspepsia, disorders of the neonatal sucking reflex. These points give very good results in our experience in treating cattle (Dr. Oswald Kothbauer DVM, Personal communication). Stud male animals (cattle, sheep, horses) exhibit a behavioural reaction, the flehmen reaction, in the presence of females in heat. Sensing of sex-pheromone is said to trigger the reaction. In rats, application of zinc sulphate, or local anaesthetic to the nasal area prevents them from sensing pheromones and prevents sexual synchronisation.

Links of HYPOTHALAMUS , OLFACTORY NERVE and VOMERONASAL ORGAN
Relation with Chongmai
Menstruation and Xue-Blood are inseparable; the Chongmai always is involved in menstrual problems, more then CV. Chongmai, is known also as Xuehai, Blood-Sea (the same name as SP10-Xuehai). It regulates all the Twelve Main Channels and its main function is to regulate menstruation and the distal genitalia, female and male (Wiseman & Ye 1998). Chongmai governs the Xue, while Renmai controls the Qi-Energy. Most TCM texts cited here agree that the Chongmai reaches the head. We suggest that it MUST connect with the nose also.

McClintock's research has proved, pheromones can influence menstruation through the vomeronasal organ in the nose. Following this reasoning, we can suggest that all textbooks should mention this branch of Chongmai to the nose. That connection is in keeping with the most important function of the Vessel in treating disorders of the genitourinary and reproductive systems, and sexuality. In TCM, the Chongmai and Renmai (CV) cooperate to regulate uterine and reproductive function. "The KI is the foundation of the native constitution; the SP provides the material basis of the acquired constitution; the CV unites all the Yin of the body; the Chongmai is a sea of the twelve Channels" (Xu 1984). Through the Chongmai and CV, acupuncture nourishes uterus to adjust the patient's axis function and recover ovulation. (Mo et al 1993).

One can say that this is of no clinical value, but in my practice I saw several cases of menstrual problems together with nasal obstruction, which problems disappeared both after treating Chongmai by SP04 (Gongsun) and PC06 (Neiguan). Also, BL40-Xuexi (on the Chongmai) has been used to treat epistaxis (Li 1987). Also, according to its pathway, pubic pain relates intimately with injury of Chongmai (Lanza 1984).

Conclusion
Textbooks differ in their descriptions of pathways of some Channels and Vessels. This makes it difficult for students and practitioners to choose which one is correct. Modern scientific data may help to solve these problems. We argue that the function of the vomeronasal organ in sensing pheromones, the role of pheromones in sexual expression, the usefulness of the Chongmai in some nasal conditions, strongly suggest a functional link between the Chongmai and the nose. We must continue to search for new data to help to clarify and unify acupuncture theory.

References

• Anon (Academy for Traditional Chinese Medicine) Précis d’Acupuncture Chinoise, published in China (French edition).First edition 1977, 328pp. Also, An Outline of Chinese Acupuncture (Beijing 1975)
• Solinas H, Auteroche B & Mainville (1990 ) Atlas d’Acupuncture Chinoise.First Edition. Editions Maloine, Paris, 260pp.
• Deadman, Al-Khafaji en Baker (1998 ) A Manual of Acupuncture’.First Edition. Journal of Chinese Medicine Publications,East Sussex, 667pp.
• Maciocia, Giovanni The Foundations of Chinese Medecine , First edition ( 1989 ), Churchill Livingstone, London, 498pp and Obstetrics and Gynaecology , First edition, 1998, Churchill Livingstone, London, 959pp.
• Desoutter B ( 1996 ) Merveilleux Vaisseaux, First edition, Sauramps Editions, Montpellier, 169pp.
• Roustan C. (1978) Traité d’acupuncture, part I, First edition, Masson, Paris,207pp.
• Kespi ( 1982 ) Acupuncture, first edidtion, Maisonneuve, Moulins-Lès-Metz,785pp.
• O’Connor en Bensky ( 1981 ) Acupuncture, a comprehensive Text. Fifth printing 1987, Eastland Press, Seattle, 741pp.
• Helms J (1995 ) Acupuncture Energetics.First edition, Medical Acupuncture Publishers, Berkeley California, 759pp
• Wiseman N & Ye F (1998) A practical Dictionary of Chinese Medicine. First Edition. Paradigm Publications, Brookline Massachussets, 945pp.
• Lanza U (1984) [Importance of Chongmai (Strategic Vessel) Channel in pubic pain: Clinical observation of 40 cases of AP in sportsmen]. Rev Fr Med Tradit Chin (105):606-608. Tendon problems in sportsman may be associated with pubic pain. According to the course of Chongmai (Strategic Vessel), pubic pain relates intimately with injury of Chongmai, being manifest at subjective pain with corresponding sensitive spots. 40 cases in occupational sportsmen were treated by EAP + manipulation according to the theory of Chongmai injury. EAP was used at bilateral SP04, 20 min, 5 Hz, to tolerance + LI04 + ST30, 70 Hz, weak stimulation. In earlier sessions, add KI01; later add ST35, KI13, KI04, GB28, ST03 or LV12, SP12 according to the disease condition. Paint and slightly press above-mentioned acupoints and Ashi site with aromatic oil (Juniperus taiwaniana Hayata, Lavandula angustifolia mill, rosemary and almond oil). 3. Paint the Ashi site with the oil, and knead each surrounding muscle and intermuscular membrane with the four fingers evenly to and fro. Manipulate / massage the loin and back. 31/40 cases healed in 20-30 days, and 9 cases were responded favourably.
• Li WB (1987) [Clinical uses of BL40]. Shanxi Tradit Chin Med 3(4):44-45. BL40-Weizhong, was used satisfactorily to treat 5 cases with epistaxis, enuresis, furuncle, psoriasis and eczema. It is a Shu point and the He point of the Foot-Taiyang BL Channel, is also called Xuexi (Blood Xi point). It is used, often by pricking to bleed it, to Clear the Blood, Drain Heat and treat acute back sprain. As it is of specific therapeutic significance, it is also known as the "important point".
• Mo X; Li D; Pu Y; Xi G; Le X; Fu Z (1993) Clinical studies on the mechanism for AP stimulation of ovulation. JTCM Jun 13(2):115-119. Zhejiang Coll of TCM, Hangzhou, PRC. Ovulatory dysfunction is commonly seen in gynaecology. It may cause infertility, amenorrhoea, functional uterine bleeding and a variety of complications. This research according to TCM theory records treating with AP 34 patients suffering from ovulatory dysfunction. Changes in clinical symptoms and some relative targets are reported, plus findings in animal experiments. The effect of AP in improving ovulation and the rationale are discussed. According to TCM theory concerning the generative and physiologic axis of women, this research involved the following points: BL18, BL23, CV04, CV03 and SP06. Reinforcement (Bu Fa) and reducing (Xie Fa) methods of AP enables it to strengthen LV and KI. Through the Chongmai and CV Channels acupuncture nourishes uterus to adjust the patient's axis function and recover ovulation. Treated circa 30 times, the patients' symptoms improved to varying degrees; 35% were markedly improved and the total effective rate was 82%. BBT, VS, CMS, and B ultrasonic picture all improved to some degree. AP may adjust FSH, LH, and E2 in 2 directions and raise the progesterone level, bringing them to normal. Animal experiments confirmed this result. AP may adjust endocrine function of the HPOA of women, thus stimulating ovulation. The results provide some scientific basis for treating and further studying this disorder.
• Xu WB (1984) [Treatment of male infertility by AP]. 2nd Natl Symp Acup-Mox & Acup-Anesth (Beijing):69-70. Patients with infertility caused by oligospermia, immobility of spermatozoon or lengthening the liquefiable time of semen had AP treatment. In TCM theory, male infertility falls in the category of heirless. TCM teaches: "The KI is the foundation of the native constitution; The SP provides the material basis of the acquired constitution; The CV unites all the Yin of the body; the Chongmai is a sea of the twelve Channels". Following those teachings, we selected points mainly from these Channels: KI06, KI03; SP06, SP08 and SP09; ST36; CV06, CV04 and BL23, BL52. These points were divided into two groups, used alternatively every 1-2 d until d 21. Then after an interval of 7-10 d, the second course was begun. The method of lifting, trusting and rotating was used. After Deqi, the needle was retained for 15-20 min. When puncturing CV04 and CV06, it is preferable that Deqi is propagated to the front genitals. After painless inserting of the needle, lift, thrust and turn it until Deqi occurred. In some points, such as CV04 and CV06, the effect would never be marked unless Deqi propagated to the front genital. Then retain the needle for 15-20 min. AP gave good results in 8/11 patients (73%).
  

Appendix:
Key references from Martha McClintocks Pheromone research [from Pubmed Medline]

• Weizenbaum F, McClintock M, Adler N (1977) Decreases in vaginal acyclicity of rats when housed with female hamsters. Horm Behav Jun;8(3):342-7
• McClintock MK (1978) Estrous synchrony and its mediation by airborne chemical communication (Rattus norvegicus). Horm Behav Jun;10(3):264-75.
• McClintock MK, Adler NT (1978) Induction of persistent estrus by airborne chemical communication among female rats. Horm Behav Dec;11(3):414-8.
• McClintock MK (1984) Estrous synchrony: modulation of ovarian cycle length by female pheromones. Physiol Behav May;32(5):701-5. Airborne chemosignals from different phases of the rat's estrous cycle had opposing effects on the timing of the estrous cycle which were consistent with a coupled oscillator model of ovarian synchrony. Preovulatory odors shortened or phase advanced the ovarian cycle, whereas ovulatory odors lengthened or phase delayed the cycle.
• Schank JC, McClintock MK (1992) A coupled-oscillator model of ovarian-cycle synchrony among female rats. J Theor Biol Aug 7;157(3):317-62. Committee on the Conceptual Foundations of Science, University of Chicago, Illinois 60637. The ovarian cycles of female rats become synchronized when they live together, as do the cycles of many other mammals. Ovarian cycles also become synchronized when rats live apart if they share a common air supply, indicating that ovarian-cycle synchrony is mediated by pheromones. We developed a coupled-oscillator model of ovarian-cycle synchrony to test several hypotheses about its pheromonal and neuroendocrine mechanisms and to guide our experimental research. The model spans three levels of organization: the group, the rat, and the neuroendocrine components of the ovarian system. The ovarian system (not the ovaries themselves) are modeled as an oscillating system. Coupling among ovarian systems is mediated by the exchange of two pheromones, one that delays the phase of the ovarian system and one that advances it. Computer simulation experiments showed that this coupled-oscillator model can explain the levels of ovarian-cycle synchrony observed in groups of female rats while, at the same time, matching an empirical distribution of ovarian-cycle lengths. By successfully matching computer simulation data with empirical data, we were able to infer theoretical predictions in a number of areas: (1) effect of initial conditions on the probability that a group will change to different synchrony level and phase relationships, i.e. the transition probability between all synchrony levels and phase relationships; (2) effects of individual differences in pheromone sensitivity on ovarian-cycle synchrony; (3) the timing of pheromone sensitivity during the ovarian cycle; and (4) the existence of partial luteinizing hormone surges, which may cause the "spontaneous" prolonged ovarian cycles associated with ovarian-cycle synchrony. The paper concludes by discussing the integrative role of this model for experimental research. In particular, we focus on the role of this model in interpreting theoretical aspects of ovarian-cycle synchrony as well as for guiding future experimental research into its mechanisms and functions.
• Hedricks CA, Ghiglieri M, Church RB, Lefevre J, McClintock MK (1994) Hormonal and ecological contributions toward interpersonal intimacy in couples. Ann N Y Acad Sci Feb 18;709:207-9. University of Southern California, Los Angeles 90033. PMID: 8154707, UI: 94205835
• Schank JC, McClintock MK (1997) Ovulatory pheromone shortens ovarian cycles of female rats living in olfactory isolation. Physiol Behav Oct;62(4):899-904. Center for the Integrative Study of Animal Behavior, Indiana University, Bloomington 47405, USA. [email protected] McClintock found that female rats living in isolation or in groups synchronized their ovarian cycles, and she proposed a two-pheromone mechanism to explain synchrony: one pheromone shortens cycles and the other lengthens them. Subsequent research revealed that the preovulatory pheromone shortened cycles, whereas the ovulatory pheromone lengthened cycles. Schank and McClintock modeled this mechanism with computer simulation, assuming variability in sensitivity to pheromones during the ovarian cycle, and found that a coupled-oscillator mechanism can synchronize cycles, if pheromone sensitivity is highest around the time of ovulation. In this paper, we report the effects of pulses of ovulatory pheromone on the ovarian cycles of isolated female rats. Donor females were in the ovulatory phase of their cycle and recipient females were in olfactory isolation except during specified phases of their ovarian cycles. Recipient females showed significant shortening in ovarian cycles, with no significant variability in sensitivity to the ovulatory pheromone during the ovarian cycle. We discuss these conflicting results in terms of the experimental context of recipient females and the components and complexities of pheromone signals. PMID: 9284514, UI: 97430213
• McClintock MK (1998) On the nature of mammalian and human pheromones. Ann N Y Acad Sci Nov 30;855:390-2. Department of Psychology, University of Chicago, Illinois 60637, USA. [email protected] Communication by chemical (pheromone) signals is important in many species, including mammals. Chemosensory and hormonal systems can interact in at least two ways: (i) chemosensory input, especially but not exclusively that through the vomeronasal organ, may elicit hormonal release, which, in turn, may facilitate behavioral or physiological responses; and (ii) hormones, especially steroids, may be essential for some responses to chemosensory, including vomeronasal, input. Recent, still controversial reports, suggest that chemosensory communication may occur in humans via a residual vomeronasal organ and that chemosensory/hormonal interactions also operate in humans. In this symposium these matters are examined critically. Johnston explores the concept of pheromone communication and suggests that the notion of a single-chemical 'magic bullet' irresistibly leading to a preprogrammed result is too simplistic despite documented examples of special stimuli acting via the vomeronasal organ. Meredith briefly reviews evidence for hormonal mediation of the effects of vomeronasal input; including a situation where vomeronasal and hormonal facilitation of a behavior appear to be interchangeable--but where vomeronasal input appears important only in inexperienced animals. Wood discusses evidence that the effectiveness of chemosensory input to particular brain nuclei depends critically on the simultaneous presence of a steroid hormone within the same nucleus. Monti-Bloch presents his evidence that steroids may act as gender-specific chemical signals in humans, exciting an electrical response from the residual human vomeronasal organ and affecting human hormone levels. PMID: 9929630, UI: 99128491
• Stern K, McClintock MK (1998) Regulation of ovulation by human pheromones. Nature Mar 12;392(6672):177-9. Department of Psychology, The University of Chicago, Illinois 60637, USA. Pheromones are airborne chemical signals that are released by an individual into the environment and which affect the physiology or behaviour of other members of the same species. The idea that humans produce pheromones has excited the imagination of scientists and the public, leading to widespread claims for their existence, which, however, has remained unproven. Here we investigate whether humans produce compounds that regulate a specific neuroendocrine mechanism in other people without being consciously detected as odours (thereby fulfilling the classic definition of a pheromone). We found that odourless compounds from the armpits of women in the late follicular phase of their menstrual cycles accelerated the preovulatory surge of luteinizing hormone of recipient women and shortened their menstrual cycles. Axillary (underarm) compounds from the same donors which were collected later in the menstrual cycle (at ovulation) had the opposite effect: they delayed the luteinizing-hormone surge of the recipients and lengthened their menstrual cycles. By showing in a fully controlled experiment that the timing of ovulation can be manipulated, this study provides definitive evidence of human pheromones.