《黄帝内经灵枢集注》

The Collected Commentaries on the Numinous Pivot of the Yellow Emperor’s Inner Classic is a text included in the Scripture of Nourishing Life through Great Clarity in the Chinese Daoist Canon.

The work has a preface and consists of thirteen volumes, arranged by chapter. Its contents include the nine needles, channels and collaterals, nutritive Qi and defensive Qi, diseases and patterns of the viscera and bowels, cold and heat, mania, methods of acupuncture, and measurements of the human skeleton. The chapters in each volume are as follows:

• Volume One: “The Nine Needles and the Twelve Sources,” Chapter One
• Volume Two: “The Root Transport Points,” Chapter Two; “Explaining the Small Needle,” Chapter Three; “Disease Patterns of the Viscera and Bowels Caused by Pathogenic Qi,” Chapter Four
• Volume Three: “Roots and Knots,” Chapter Five; “Longevity and Early Death, Hardness and Softness,” Chapter Six; “The Official Needles,” Chapter Seven
• Volume Four: “The Root of the Spirit,” Chapter Eight; “Beginning and Ending,” Chapter Nine
• Volume Five: “The Channels,” Chapter Ten
• Volume Six: “The Divergent Channels,” Chapter Eleven; “The Channels of Water,” Chapter Twelve
• Volume Seven: “The Sinew Channels,” Chapter Thirteen
• Volume Eight: “Measurements of the Bones,” Chapter Fourteen; “Fifty Circulations,” Chapter Fifteen; “Nutritive Qi,” Chapter Sixteen; “Measurements of the Pulses,” Chapter Seventeen; “The Meeting of Nutritive and Defensive Qi,” Chapter Eighteen; “Qi of the Four Seasons,” Chapter Nineteen
• Volume Nine: “The Five Pathogenic Influences,” Chapter Twenty; “Cold and Heat Diseases,” Chapter Twenty-One; “Mania,” Chapter Twenty-Two; “Heat Diseases,” Chapter Twenty-Three; “Reversal Diseases,” Chapter Twenty-Four
• Volume Ten: “The Root of Disease,” Chapter Twenty-Five; “Miscellaneous Diseases,” Chapter Twenty-Six; “Peripheral Bi Syndrome,” Chapter Twenty-Seven; “Questions from the Mouth,” Chapter Twenty-Eight
• Volume Eleven: “Transmission from the Teacher,” Chapter Twenty-Nine; “Determining Qi,” Chapter Thirty; “The Intestines and Stomach,” Chapter Thirty-One; “How Ordinary People Can Abstain from Food,” Chapter Thirty-Two; “Treatise on the Seas,” Chapter Thirty-Three; “The Five Disruptions,” Chapter Thirty-Four; “Treatise on Distension,” Chapter Thirty-Five
• Volume Twelve: “The Five Types of Urinary Retention and the Distinctions among Body Fluids,” Chapter Thirty-Six; “The Five Observations and Five Agents,” Chapter Thirty-Seven; “Reversal and Compliance, Corpulence and Emaciation,” Chapter Thirty-Eight; “Treatise on Blood Networks,” Chapter Thirty-Nine; “Yin and Yang, the Clear and the Turbid,” Chapter Forty
• Volume Thirteen: “How Yin and Yang Are Linked to the Sun and Moon,” Chapter Thirty-Seven; “Reversal and Compliance, Corpulence and Emaciation,” Chapter Thirty-Eight; “Treatise on Blood Networks,” Chapter Thirty-Nine; “Yin and Yang, the Clear and the Turbid,” Chapter Forty

Volume 13: “Yin and Yang as the System of the Sun and Moon” (41), “The Transmission of Illness” (42), “Wicked Influences Giving Rise to Dreams” (43), “Following Qi: Dividing the Day into Four Seasons” (44), and “External Inference” (45).

Volume 14: “Five Transformations” (46) and “The Inherent Constitution” (47).

Volume 15: “On Prohibitions and Prescriptions” (48), “The Five Colors” (49), “On Courage” (50), “Back-Shu Points” (51), and “Protective Qi” (52).

Volume 16: “On Pain” (53), “The Natural Span of Life” (54), “Counterflow and Following” (55), “The Five Flavors” (56), “Water Swelling” (57), and “Wicked Winds” (58).

Volume 17: “Irregularities in Protective Qi” (59), “The Jade Tablet” (60), “Five Prohibitions” (61), and “The Movement of the Channels” (62).

Volume 18: “A Discussion of the Five Flavors” (63) and “The Twenty-Five Types of Yin and Yang” (64).

Volume 19: “The Five Tones and Five Flavors” (65), “The Beginning of the Hundred Illnesses” (66), “The Practice of Needling” (67), “The Upper Diaphragm” (68), and “Sorrow and Anger, and the Loss of Speech” (69).

Volume 20: “Cold and Heat” (70), “Wicked Influences Lodging in the Body” (71), and “Connecting with Heaven” (72).

Volume 21: “The Functions of the Organs” (73), “On Illness and Diagnosis by the Wrist” (74), and “The True and False in Needling” (75).

Volume 22: “The Circulation of Protective Qi” (76), “The Nine Palaces and Eight Winds” (77), and “A Treatise on the Nine Needles” (78).

Volume 23: “On the Year’s Dew and Winds” (79), “On Great Delusion” (80), and “Abscesses and Sores” (81).

Preface to Collected Commentaries on the Yellow Emperor’s Inner Classic: Numinous Pivot.

In ancient times, the Yellow Emperor composed the Inner Classic (Neijing) in eighteen scrolls: nine scrolls of the Spiritual Pivot (Lingshu) and nine of the Basic Questions (Suwen). These are the work’s original divisions. Of the two, only the Basic Questions has circulated widely among the people. Yue Ren, that is, Bian Que, grasped some of the Inner Classic’s teachings and wrote the Classic of Difficult Issues (Nanjing). Huangfu Mi gathered and arranged related materials to compile the Jia Yi Classic. Most later medical writings derive from these works. Yet some of their claims are sound and others are not, so they cannot all be treated as standards for later generations to follow.

For example, the Nanyang Book on Saving Lives says that “counterflow coughing” means “hiccups.” The Spiritual Pivot Classic explains that when newly ingested grain Qi enters the stomach and struggles with the cold Qi already there, hiccups occur. Comparing the two accounts makes it possible to judge how they relate.

Again, the sixty-fifth chapter of the Classic of Difficult Issues broadly sets out the essential meaning of the Spiritual Pivot’s “Root Transport” chapter. Yet people sometimes describe it as “circulation and infusion,” the movement and conveyance of Qi through the channels. The Spiritual Pivot Classic says that the “joints” are places where Shen Qi moves in and out; they are not flesh, skin, sinew, or bone. It also says that Shen Qi is the upright Qi. The paths along which Shen Qi moves in and out are called “circulation and infusion.” The well, spring, stream, river, and sea points—the five categories of points along the channels—belong to “Root Transport.” Examining these passages together makes clear that the two concepts differ greatly.

It is regrettable that the Spiritual Pivot has been lost for a long time, leaving people unable to study it deeply. Physicians should read medical books. There are certainly people who have read them but still cannot practice medicine; yet I have never heard of anyone becoming a physician without reading them. A person who neither reads medical books nor has inherited medical knowledge can do more harm by killing patients than with a club or blade. That is why the ancients said that children who do not read medical books cannot be called filial.

My abilities are mediocre. From childhood into adulthood, I devoted myself to studying medicine and gained some understanding of its principles. Presuming too much, I consulted and collated various medical books, then revised the nine scrolls of the Spiritual Pivot preserved in my family’s collection. They contain eighty-one chapters. I also supplemented and revised the pronunciation notes and explanations, adding them at the end of the scrolls, and compiled the work into twenty-four volumes. I hope that those who cherish life and wish to save others will find the book easy to understand when they open it, and will avoid making errors.

I have set out the relevant circumstances in a formal document and reported them to the appropriate authorities. Following instructions from higher authorities, I also submitted a request for the transport commissioner’s office to appoint officials to review the work, then sent the manuscript to the Palace Library and the Directorate of Education. Now, Song has gone out of his way to seek out renowned physicians and ask them to examine and check the text further, so that it will not mislead later generations. This work will bring many benefits, and its value is clear from the purpose for which it was undertaken.

In the midsummer of the year yiyou in the Shaoxing era of the Southern Song, on the fifteenth day of the fifth lunar month in 1155, this inscription was written by Shi Song, a native of Jin Guan, in the area of present-day Chengdu.

Collected Commentaries on the Huangdi Neijing Lingshu, Volume One

“The Nine Needles and the Twelve Origins,” Chapter One: Taking Heaven as the Model

The Yellow Emperor asked Qibo, “I care for the people and collect taxes from them. I feel for them when they lack the means to support themselves and are often troubled by illness. I wish to spare them the harmful effects of medicines and avoid using stone lancets—the stone tools of antiquity for piercing or cutting the skin. Instead, I would use fine needles to open the channels, harmonize Qi and blood, and restore normality where their circulation turns against or follows its course, and where it enters, leaves, and meets. I hope to pass this method on to later generations. It must therefore be explained clearly and set down in rules, so that it may endure without being lost, and be easy to practise and remember. The contents of each chapter must be distinguished, the interior and exterior clarified, and the principles from beginning to end made clear, so that every method has a definite form. First, compile the Needle Classic. I wish to understand its principles.”

Qibo replied, “Allow me to set these principles out step by step, arranging them under clear headings, from one to nine. Let us begin with the principles of needling. The principles for treating illness with fine needles are easy to state, but difficult to master. A superficial physician looks only at the body’s outward form; a skilled physician grasps Jing, Qi, and Shen. How subtle this is! The body’s vital Qi and pathogenic Qi meet at the gateways of the channels. If one cannot discern what is happening there, how can one know the source of illness?

“The subtle art of needling lies in grasping the right moment and the speed of insertion. A superficial physician merely attends to the points; a skilled physician grasps the moment when the Qi mechanism stirs. Changes in the Qi mechanism always occur at the channel points. The Qi within a point is still and subtle: when it arrives, do not forcefully meet it; when it departs, do not pursue it. Those who know how to grasp the Qi mechanism must not miss the moment by even the slightest margin. Those who do not understand its principles will not comprehend them, no matter how often they ask. Knowing when the Qi mechanism comes and goes allows one to judge when to insert the needle. Superficial physicians are at a loss about this; only the skilled can understand its mysteries.

“When the Qi mechanism departs, it is called ‘reversal’; when it arrives, it is called ‘following.’ Understand reversal and following, and you can needle correctly without hesitation. Insert the needle as the Qi departs, and you can drain it—how could this fail to make it deficient? Insert the needle as the Qi arrives, and you can supplement it—how could this fail to make it abundant? Whether you meet or follow the Qi, attend carefully to the patient’s condition and regulate it accordingly. That concludes the principles of needling.”

Whenever acupuncture is used, weakness should be replenished, congestion should be dispersed, long-standing stagnation should be cleared, and excessive pathogenic Qi should be drained. The Essentials says: “Insert the needle slowly and withdraw it quickly: this is tonification. Insert it quickly and withdraw it slowly: this is draining.” To determine whether to tonify or drain, observe changes in Qi, as though it were both present and absent. Compare the patient’s condition before and after treatment, as though the disorder still remained and yet had already vanished. The key to deficiency and excess lies in the exquisite use of the Nine Needles, the nine kinds of acupuncture instruments used in antiquity. Both tonification and draining are carried out through needling.

The draining method is to hold the needle, insert it, pause briefly, then withdraw it while dispersing Yang Qi, allowing pathogenic Qi to drain away with the needle. The patient will feel as though Qi is dissipating. Draining also includes pressing the needle hole before removing the needle. This is called “warming within”; it prevents blood from dispersing outward and Qi from escaping. The tonification method is to insert the needle in accordance with the movement of Qi. During needling, remain focused and attentive, and use a gentle touch, as lightly as a mosquito or gadfly settling on the skin. The needle should seem to pause as it enters, then be withdrawn quickly, like a bowstring snapping. Coordinate the left hand with the right to keep Qi gathered. Close the outer opening of the needle hole, and the body’s upright Qi will be strengthened. Be sure not to let blood stagnate; if stasis is found, clear it promptly.

The key to holding the needle is to keep the hand steady and firm. Align the fingertips and insert the needle straight into the point, without angling it to either side. Focus the mind on the finest details and attend to the patient’s condition. Examine the blood vessels carefully so that needling will not go awry. Just before inserting the needle, pay attention to the movement of Yang Qi and to the defensive Qi on both sides of the body. Keep your attention undivided as you judge changes in the illness. The blood vessels lie near the acupoints, where Qi is conveyed, and run across them horizontally. Examine them closely so they can be clearly distinguished; when palpated, they feel relatively firm.

The nine kinds of needle have different shapes. The first is called the chán needle and is one cun and six fen long; the second is the yuán needle, also one cun and six fen long; the third is the dī needle, three cun and a half long; the fourth is the fēng needle, one cun and six fen long; the fifth is the pí needle, four cun long.

The nine types of needles each have a different shape. The first is called the chán needle, measuring one cun and six fen in length; the second, the round needle, also measures one cun and six fen; the third, the dī needle, is three cun and a half long; the fourth, the sharp-edged needle, measures one cun and six fen; the fifth, the pī needle, is four cun long and two and a half fen wide; the sixth, the round-pointed needle, measures one cun and six fen; the seventh, the fine needle, is three cun and six fen long; the eighth, the long needle, is seven cun long; and the ninth, the large needle, is four cun long.

The chán needle has a broad head and a sharp point. It is used to disperse and drain Yang Qi. The round needle has an egg-shaped tip. It is rubbed between the spaces in the muscles without injuring them, to disperse Qi in the spaces between tissues. The dī needle has a tip as sharp as a grain of millet or panicled millet. It is used mainly to press on the channels without piercing the flesh, guiding the channel Qi. The sharp-edged needle has a three-sided blade and is used to treat ailments that have resisted treatment for a long time. The pī needle ends in a blade like a sword and is used to drain large amounts of pus. The round-pointed needle is as thick as the hair of a yak’s tail; its shaft is round and pointed, and slightly thicker in the middle. It is used to treat sudden-onset ailments. The fine needle has a tip like a mosquito’s mouthparts. It is inserted quietly and slowly, then left in place gently for a longer time to regulate the channel Qi and treat painful impediment. The long needle has a sharp tip and a thin shaft, allowing it to penetrate deeply. It is used to treat impediment deep within the body. The large needle has a tip shaped like the end of a staff, with a slightly rounded point. It is used to disperse fluid accumulated around the joints.

These are all nine types of needles and their uses.

When pathogenic Qi enters the channels, pathogenic Qi that floats near the surface can be expelled through the shallower vessels, while turbid Qi lodged in the middle can be expelled through the vessels in that region. If the needle is inserted too deeply, it may instead draw the pathogenic Qi farther inward and worsen the illness. The skin, flesh, sinews, and vessels each have their own place, and the appropriate site and method of needling differ accordingly. Choose the method to suit the location of the illness; do not needle indiscriminately. If what is already deficient is further harmed, or what is already excessive is made more so, the illness will worsen.

If needling mistakenly injures any of the five vessels, it may cause death; injuring three vessels may leave a person frightened and deranged. Damage to Yin Qi may be fatal, while damage to Yang Qi may cause madness. These are the harms that needling can bring about.

If the Qi beneath the needle has not yet arrived, there is no need to count how many times you have needled. Once the Qi arrives, withdraw the needle; do not continue needling. Each needling method has its proper application, and the way of needling varies accordingly; treatment should suit the specific circumstances. The essentials of needling are that Qi arrive beneath the needle and that an effect be seen. When the treatment takes hold, it is like wind scattering the clouds and the sky suddenly clearing. This is the principle of needling.

The Yellow Emperor asked: “From which places do the channel Qi of the five zang and six fu organs enter and emerge?” Qibo replied: “Each of the five zang organs has five Shu points, making twenty-five in all; each of the six fu organs has six Shu points, making thirty-six. The twelve channels and fifteen collaterals make twenty-seven pathways through which channel Qi moves up and down. Where channel Qi emerges is called a ‘Jing’ well; where it flows is called a ‘Ying’ spring; where it pours in is called a ‘Shu’ stream; where it travels is called a ‘Jing’ river; and where it gathers is called a ‘He’ sea. The places traversed by the Qi of these twenty-seven pathways are all associated with the Five Shu points. There are altogether 365 places where the body’s joints and articulations meet. Grasp the essentials, and they can be explained in a single sentence; without understanding them, one’s explanation grows ever more complicated. The ‘joints and articulations’ spoken of here are places where spirit and Qi move, enter, and emerge, not merely the points where skin, flesh, sinews, and bones meet.”

By observing a patient’s complexion and eyes, one can understand whether Qi is scattered or gathered again. By examining whether the body is balanced and listening to the patient’s movements and stillness, one can distinguish upright Qi from pathogenic Qi. In needling, the right hand inserts and maneuvers the needle, while the left supports and steadies the site. Once the Qi arrives beneath the needle, withdraw it.

Before administering acupuncture, one must first examine the pulse and assess the strength of the body’s vital energy and the severity of the illness. Only then should treatment begin. If the Qi of the five zang organs has already become depleted within the body, yet one instead tonifies the body’s exterior, the method runs counter to the condition. When needling, the right hand guides and advances the needle, while the left hand supports and controls it. Once Qi arrives—that is, once a sensation of Qi is felt beneath the needle—the needle should be withdrawn.

If the Qi of the five zang organs has already become depleted within the body, yet one instead tonifies the exterior, this is called “depletion compounded”—further exhausting the body’s vital energy—and it will inevitably lead to death. At the end of life, the patient appears calm. If treatment proceeds against the direction of the illness, the points selected will be beneath the armpits and on the front of the chest. If the Qi of the five zang organs has already become depleted at the body’s exterior, yet one instead tonifies the interior, this is called “counterflow reversal”—a disruption of the movement of Qi—and it too will inevitably lead to death. At the end of life, the patient appears restless. When treatment runs counter to the condition, the points selected will be at the ends of the limbs.

If needling accidentally injures a vital area and the needle is not withdrawn promptly, Jing and Qi will leak out. If the needle is withdrawn promptly after such an injury, Qi will gather. When Jing and Qi leak out, the illness worsens and the patient becomes even more fearful and weak; when Qi gathers, an abscess or sore may form.

Each of the five zang organs corresponds to six fu organs. Together, the six fu organs have twelve source points, associated with the source Qi of the organs and bowels. These points are located at the “Four Gates,” key sites associated with the twelve source points. The Four Gates can treat diseases of the five zang organs. When one of the five zang organs is diseased, treatment should be directed to the twelve source points, because through these points the five zang organs receive the Qi and flavors gathered from the body’s 365 joints.

Diseases of the five zang organs are reflected in the twelve source points, each of which has its own location. By understanding where the source points are and observing the changes that appear there, one can determine what harm has come to the five zang organs.

The Lung belongs to “Minor Yin within Yang,” and its source point—the point where the Qi of an organ or bowel channel gathers, and which can be used in treatment—is Taiyuan. There are two such points, one on each side. The Heart belongs to “Greater Yang within Yang,” and its source point is Daling, also found on both sides. The Liver belongs to “Minor Yang within Yin,” and its source point is Taichong, found on both sides. The Spleen belongs to “Utmost Yin within Yin,” and its source point is Taibai, found on both sides. The Kidneys belong to “Greater Yin within Yin,” and their source point is Taixi, found on both sides.

The source point of the Gao is at Jiuwei, with one point. The source point of the Huang is at Boyang—that is, the Qihai point—with one point. These twelve source points govern the treatment of diseases of the five zang organs and six fu organs. For abdominal distension, points on the three Yang channels may be selected. For illnesses such as undigested food in the stool and diarrhea, points on the three Yin channels may be selected.

A disease of the five zang organs is like a thorn lodged in the body, dirt clinging to it, a knot tied tight, or a blockage. However long a thorn has been lodged, it can still be pulled out; however long dirt has accumulated, it can still be washed away; however long a knot has been tied, it can still be undone; and however long a blockage has persisted, it can still be cleared. Some say that a long-standing illness cannot be treated with acupuncture. This is wrong. A skilled acupuncturist treats illness as one would pull out a thorn, wash away dirt, undo a knot, or clear a blockage. However long the illness has persisted, it can still be cured. To say it cannot be treated is to admit that the right method has not yet been mastered.

When needling to treat heat patterns, proceed as cautiously as someone testing hot water with a hand. When needling to treat cold or cool patterns, use a slow, cautious technique, like a traveler reluctant to move forward. For a condition in the Yin aspect caused by a pathogenic influence of Yang, select Xialing Sanli (the Zusanli point) and needle straight in without making unnecessary movements. Stop once the channel Qi descends; if it has not descended, treat the condition again. For a disorder located high up and internally, select Yinlingquan; for one located high up and externally, select Yanglingquan.

“Wanchen”: This may be read as “yu” or “yun,” or pronounced according to the fanqie spelling “yu-ruan.” “Li”: pronounced according to the fanqie spelling “mo-gao,” and also read as “hao.” “Zai shu”: pronounced according to the fanqie spelling “chun-yu.” “Chan”: pronounced according to the fanqie spelling “chu-xian.” “Di”: read as “di.” “Pi”: read as “pi.” In “meng hui,” the character “hui” is pronounced according to the fanqie spelling “xia-diao-hui.” In “qu san mai zhe kuang,” the character “kuang” is pronounced according to the fanqie spelling “qu-wang.” A note: here, “kuang” means insufficiency. In “bo yang,” the first syllable is pronounced according to the fanqie spelling “pu-mo”; the second according to “niao-lang,” and may also be read as “yu-sang.” “Liu”: a note: the Nanjing Classic writes this as “liu.” “Xing”: read as “ying”; it refers to a weak flow of water.

Collected Annotations to the Yellow Emperor’s Inner Classic: Spiritual Pivot, Volume One

1. “Yi qi zhang”: In the reprinted edition of the Great Simplicity, scroll 21, “The Essentials of the Nine Needles,” this reads “yi qi pian zhang.”

2. “Ying”: The Jingjitang edition from the Zhao residence reads “ni.”

3. “Ru”: The original text reads “yi”; it has been changed to “ru” on the basis of volume 3, section 24 of the A-B Classic.

4. “Kuang”: The original text reads “wei”; it has been changed to “kuang” on the basis of the Jingjitang edition from the Zhao residence.

Collected Annotations to the Yellow Emperor’s Inner Classic: Spiritual Pivot, Volume Two

The Shu Points

The Yellow Emperor asked Qibo: “In acupuncture, one must understand the starting and ending points of the twelve channels, where their collateral branches divide, how Qi and blood gather and move at the five transport points, how the six bowels correspond with the channels, how channel Qi enters and leaves with the seasons, where Qi from the five viscera flows through, and the measures of channel width, needling depth, and the relative height and position of the acupoints. I would like to hear you explain these matters.”

Qibo said: “Let me explain them in order. Qi of the Lung channel emerges at the Shaoshang point. Shaoshang is on the inner side of the tip of the thumb. It is a Jing-Well point and belongs to Wood in the Five Phases. Channel Qi flows to the Yuji point. Yuji is at the thenar eminence of the palm and is a Ying-Spring point. Channel Qi pours into the Taiyuan point. Taiyuan lies in a hollow one cun behind the thenar eminence and is a Shu-Stream point. Channel Qi travels to the Jingqu point. Jingqu is at the Cun-kou, where the pulse beats continuously; it is a Jing-River point. Channel Qi enters the Chize point. Chize is at the artery in the middle of the elbow and is a He-Sea point. All these points belong to the Hand Taiyin channel.”

The Qi of the Hand Jueyin channel emerges at Zhongchong. Zhongchong is at the tip of the middle finger. It is a Jing-Well point and belongs to Wood. The Qi flows to Laogong, located in the middle of the palm on the inner side of the joint at the base of the middle finger. This is the Ying-Spring point. It then enters Daling, in the hollow between the two bones at the back of the wrist. This is the Shu-Stream point. Next it moves to Jianshi, between the two tendons about three cun behind the wrist. When the channel’s pulse Qi is affected by illness, it reaches this point; when there is no illness, it does not manifest here. This is the Jing-River point. Finally, it enters Quze, in the hollow of the crease on the inner side of the elbow, accessible when the elbow is bent. This is the He-Sea point. This is the Hand Jueyin channel.

The Qi of the Hand Shaoyin channel emerges at Zhongchong. Zhongchong is at the tip of the middle finger. It flows to Jingqu, located at the cun-kou, the pulse-taking point at the wrist, where the channel’s pulse Qi moves without stopping. This is the Jing-River point. Finally, it enters Chize, where an artery pulses in the middle of the elbow. This is the He-Sea point. This is the Hand Taiyin channel.

The Qi of the Foot Jueyin channel emerges at Dadun. Dadun is at the end of the big toe, near the three hairs at the base of the toenail. It is a Jing-Well point and belongs to Wood. The Qi flows to Xingjian, between the big toe and the second toe. This is the Ying-Spring point. It then enters Taichong, in a hollow about two cun above Xingjian. This is the Shu-Stream point. Next it moves to Zhongfeng, in a hollow about one and a half cun in front of the inner ankle. The foot can be moved to help locate the point. This is the Jing-River point. Finally, it enters Ququan, in a hollow on the inner side of the knee, below the supporting bone and above the large tendon, accessible when the knee is bent. This is the He-Sea point. If the channel Qi of the Foot Jueyin becomes disordered and counterflowing, it stagnates and cannot flow freely; once harmonized, it can flow through.

The Spleen Channel begins at Yinbai. Yinbai is on the inner side of the tip of the big toe. It is a Well point and belongs to Wood in the Five Phases. The channel passes through Dadu, in the hollow behind the joint at the base of the big toe, which is a Spring point. It then flows into Taibai, on the inner side of the foot below the navicular bone, which is a Stream point. Next it passes through Shangqiu, in the hollow below the inner ankle, which is a River point. Finally, it enters Yinlingquan, in the hollow below the inner side of the tibia. It can be located with the leg straight and is a Sea point. This is the Foot Taiyin Channel.

The Kidney Channel begins at Yongquan. Yongquan is on the sole of the foot. It is a Well point and belongs to Wood in the Five Phases. The channel passes through Rangu, below the navicular bone, which is a Spring point. It then flows into Taixi, in the hollow behind the inner ankle and above the heel bone, which is a Stream point. Next it passes through Fuliu, two cun above the inner ankle, where a pulse can be felt; this is a River point. Finally, it enters Yingu. Yingu is on the inner side of the knee, beneath the large tendon and above the smaller tendon behind the tibia. It responds to pressure and is easier to locate when the knee is bent. It is a Sea point. This is the Foot Shaoyin Channel.

The Bladder Channel begins at Zhiyin. Zhiyin is at the tip of the little toe. It is a Well point and belongs to Metal in the Five Phases. The channel passes through Tonggu, on the outer side of the joint at the base of the little toe, just in front of it; this is a Spring point. It then flows into Shugu, in the hollow behind that joint, which is a Stream point. Next it passes through Jinggu, below the large bone on the outer side of the foot, which is an Original point. It then passes through Kunlun, behind the outer ankle and above the heel bone, which is a River point. Finally, it enters Weizhong, at the center of the back of the knee. Bend the knee to locate it. It is a Sea point. This is the Foot Taiyang Channel.

The Gallbladder Channel begins at the Qiaoyin point. Qiaoyin is at the tip of the fourth toe. It is a Jing-Well point and belongs to Metal. Channel Qi flows to the Xiaxi point, located between the fourth and fifth toes. It is a Ying-Spring point. Qi then flows to the Linqi point, in a hollow on the top of the foot about one and a half inches upward. It is a Shu-Stream point. The channel next passes through the Qiuxu point, in a hollow below and in front of the outer ankle. It is the Yuan-Source point. Channel Qi continues to the Yangfu point, above the outer ankle on the front of the fibula, near Juegu (the lower end of the fibula). It is a Jing-River point. Finally, the channel enters the Yanglingquan point, in a hollow on the outer side of the knee that can be located when the leg is straight. It is a He-Sea point. This is the course of the Foot Shaoyang Gallbladder Channel and its points.

The Stomach Channel begins at the Lidui point. Lidui is at the tip of the second toe. It is a Jing-Well point and belongs to Metal. Channel Qi flows to the Neiting point, between the second and third toes. It is a Ying-Spring point. Qi then flows to the Xiangu point, in a hollow on the top of the foot between the second and third metatarsal bones, about two inches upward. It is a Shu-Stream point. The channel next passes through the Chongyang point, in a hollow on the top of the foot about five inches upward. It is the Yuan-Source point and can be located by moving the foot. Channel Qi continues to the Jiexi point, in a hollow about one and a half inches above Chongyang. It is a Jing-River point. Finally, the channel enters the Xialing point, also known as Zusanli. Xialing is three inches below the knee, on the outer side of the tibia. It is a He-Sea point. Three inches farther down is the Shanglian point of Juxu; three inches below that is the Xialian point of Juxu. The Large Intestine corresponds to Shanglian, and the Small Intestine to Xialian. Both the Large Intestine and the Small Intestine belong to the Stomach, so both are part of the Foot Yangming Stomach Channel.

Above, the Triple Burner Channel joins with the Hand Shaoyang Triple Burner Channel and begins at the Guanchong point. Guanchong is at the tip of the fourth finger. It is a Jing-Well point and belongs to Metal.

The Qi of the Sanjiao Channel (the Hand Shaoyang Channel) joins with Hand Shaoyang and emerges at Guanchong. Guanchong is at the tip of the ring finger. It is a Jing-Well point and belongs to Metal among the Five Phases. The Qi then flows to Yemen, between the ring and little fingers, a Ying-Spring point; next it pours into Zhongzhu, in the hollow behind the knuckle on the back of the hand, a Shu-Stream point. It passes through Yangchi, in a hollow above the wrist, the Yuan-Source point; then travels to Zhigou, in the hollow between the two bones three cun above the wrist, a Jing-River point; and finally enters Tianjing, in a hollow above the large bone on the outer side of the elbow. Tianjing can be located only with the elbow bent, and is a He-Sea point. Jing-Well, Ying-Spring, Shu-Stream, Yuan-Source, Jing-River, and He-Sea are different categories of points along the channel.

The lower Shu point of the Sanjiao Channel lies in front of the big toe and behind the Foot Shaoyang Channel. It appears on the outer side of the popliteal fossa and is called Weiyang. Weiyang is a Luo-Connecting point of the Foot Taiyang Channel. The Sanjiao Channel belongs to Hand Shaoyang. Sanjiao is governed by the Qi of Foot Shaoyang and Taiyin (some versions read “Yang”), and connects with a branch of the Foot Taiyang Channel. The channel branches off five cun above the ankle, passes through the calf, and emerges at Weiyang. It runs alongside the main channel of Foot Taiyang, enters and connects with the bladder, and constrains the lower Jiao, the body’s lower cavity and organs. When the Sanjiao is in excess, urination becomes obstructed; when deficient, involuntary urination occurs. Involuntary urination should be treated with a reinforcing method, while obstructed urination calls for a reducing method.

The Hand Taiyang Small Intestine Channel joins with Hand Taiyang and emerges at Shaoze. Shaoze is at the tip of the little finger. It is a Jing-Well point and belongs to Metal among the Five Phases. The Qi then flows to Qiangu, in a hollow on the outer side of the hand in front of the knuckle, a Ying-Spring point; next it pours into Houxi, on the outer side of the hand behind the knuckle, a Shu-Stream point. It passes through Wangu, in front of the wrist bone on the outer side of the hand, the Yuan-Source point; then travels to Yanggu, in a hollow below the ulnar styloid process at the wrist, a Jing-River point; and finally enters Xiaohai. Xiaohai lies in a hollow at the outer edge of the large bone on the inner side of the elbow, half a cun from the end of the bone. It can be located with the arm extended and is a He-Sea point. These are all points on the Hand Taiyang Channel.

The Large Intestine channel joins above with the Hand Yangming channel. Its channel Qi emerges at Shangyang, at the tip of the index finger. Shangyang is a Jing-Well point and belongs to Metal in the Five Phases. The channel Qi then flows to Erjian, before the proximal end of the second metacarpal, where it becomes a Ying-Spring point; it next enters Sanjian, beyond the proximal end of the second metacarpal, where it becomes a Shu-Stream point. It passes through Hegu, the Yuan-Source point in the cleft between the thumb and index finger, then travels to Yangxi, a Jing-River point in the hollow between the two tendons at the wrist. Finally, it enters Quchi, the He-Sea point in the hollow beside the bone on the outer side of the elbow, which can be located when the elbow is bent. This is the course of the Hand Yangming channel.

These are the acupoints associated with the five Zang organs and six Fu organs: each of the five Zang has five, for a total of twenty-five; each of the six Fu has six, for a total of thirty-six. The channel Qi of all six Fu organs begins in the Foot Three Yang channels and joins the channels of the hands above.

In the hollow above the clavicle is the Ren Vessel point called Tiantu. Beside the Ren Vessel, the first row of palpable pulses belongs to the Foot Yangming channel and is called Renying; the second row belongs to the Hand Yangming channel and is called Futu; the third belongs to the Hand Taiyang channel and is called Tianchuang; the fourth belongs to the Foot Shaoyang channel and is called Tianrong; the fifth belongs to the Hand Shaoyang channel and is called Tianyou; and the sixth belongs to the Foot Taiyang channel and is called Tianzhu. The pulse at the center of the neck belongs to the Du Vessel and is called Fengfu. The artery in the armpit belongs to the Hand Taiyin channel and is called Tianfu; the point three cun below the armpit belongs to the Hand Heart-Master channel (Hand Jueyin channel) and is called Tianchi.

Needling Shangguan makes it difficult to open the mouth and impossible to yawn; needling Xiaguan makes a person yawn and then struggle to open the mouth. Needling Dubi makes it difficult to straighten the leg after bending it; needling the two Guan points makes it difficult to bend the leg after straightening it.

The Foot Yangming channel passes near Shangguan. Needling Shangguan makes it difficult to open the mouth and impossible to yawn; needling Xiaguan makes a person yawn and then struggle to open the mouth. Needling Dubi makes it difficult to straighten the leg after bending it; needling the two Guan points makes it difficult to bend the leg after straightening it.

The vessel Qi of the Foot Yangming channel passes by the pulsating artery beside the throat; its acupoints are on the chest. The acupoints of the Hand Yangming channel lie outside those of the Foot Yangming channel, short of the angle of the cheek, about one cun away. The acupoints of the Hand Taiyang channel are at the angle of the cheek. Those of the Foot Shaoyang channel are below the ear, behind the angle of the cheek. The Hand Shaoyang channel passes behind the ear and ascends to above Wangu. The Foot Taiyang channel runs between the large tendons at the nape of the neck and reaches the hairline. The artery at the Yin-cun area is near the Wuli acupoint; this is a place where needling the Five Shu points is prohibited.

The Lung corresponds with the Large Intestine. The Large Intestine is the fu organ that transports and expels waste. The Heart corresponds with the Small Intestine, the fu organ that receives and holds food. The Liver corresponds with the Gallbladder, the fu organ that stores essential fluids. The Spleen corresponds with the Stomach, the fu organ that receives the Five Grains. The Kidney corresponds with the Bladder, the fu organ that stores fluids. The Shaoyin channel belongs to the Kidney, and the Kidney connects upward with the Lung; thus, the Kidney governs both the Kidney and Lung organs. The Triple Burner is the fu organ that forms the body’s waterways, through which fluids circulate. It connects with the Bladder and is a “solitary fu organ,” with no paired zang organ. These are the correspondences among the six fu organs.

In spring, select the Luo vessels, the Ying points of the channels, and the places where the major channels meet the muscles. For severe conditions, needle more deeply; for mild conditions, needle more shallowly. In summer, select the Shu points of the channels, as well as the Sun Luo collaterals and superficial areas of the muscles and skin. In autumn, select the He points of the channels; otherwise, follow the method used in spring. In winter, select the Jing-Well points and the locations of the Shu points, needle deeply, and retain the needles for a time. This is the sequence for needling in accordance with the changing seasons. One must also consider where the channel Qi is located, where pathogenic factors have lodged, and which treatments suit the zang-fu organs. When sinews cramp and convulse, have the patient stand while needling; this can quickly ease the symptoms. In flaccidity and reversal (weakness of the limbs, rebellious Qi, or cold extremities), have the patient extend the limbs before needling; this can quickly bring relief.

“Easy to state” means that the content can readily be expressed in words; “difficult to grasp” means that these principles are not easy to truly master. Those who attend only superficially to the body’s form know merely how to treat by following fixed needling methods. A skilled physician, by contrast, observes whether a person’s Qi and Blood are excessive or deficient, and on that basis decides whether to tonify or reduce.

“The meeting of Shen and guest” refers to the meeting of Upright Qi and pathogenic Qi. “Shen” means Upright Qi, and “guest” means pathogenic Qi. “At the gate” means that pathogenic Qi moves through the gateways by which Upright Qi enters and leaves. Before signs of illness appear, one must first determine which meridians are involved by the pathogenic Qi and Upright Qi. To identify the root of an illness, one must first determine which meridian is affected, and whether to needle at the point where the two meet or at the corresponding location. The original text repeats its explanations of “Shen and guest,” “at the gate,” and related terms, but the meaning remains the same.

The subtlety of needling lies in mastering five kinds of change and the speed or slowness of needling. Here, “speed or slowness” refers to the pace of inserting and manipulating the needle. A superficial physician attends only to bodily parts such as the limbs, without understanding how Qi and Blood, or Upright Qi and pathogenic Qi, move and interact. A skilled physician masters the pivot of needling—that is, knows how to wait upon the changes in Qi. The activity of Qi does not stray from the spaces where the meridians and acupoints lie. The physician must discern whether Qi is deficient or excessive and regulate the pace of needling accordingly. Though the movement of Qi is subtle and still, once needling has elicited Qi, the physician must remain focused and keep watch so that it does not disperse.

When Qi is abundant, do not needle against its force in order to tonify; when Qi is deficient, do not chase after its force in order to reduce. The movement of Qi is fleeting, and one must not hesitate even for an instant. If Qi does not stir after needling, this shows that the physician does not understand the essentials of tonification and reduction. If Blood and Qi have already been depleted, Qi will also be unable to descend smoothly. Understanding the coming and going of Qi makes it possible to distinguish whether its movement is contrary or smooth, and whether it is abundant or deficient. Only by grasping the proper moment for treatment can one know when it is appropriate to select an acupoint and needle.

A superficial physician is dull and unenlightened, unable to perceive the subtle, hidden changes in the movement of Qi. The marvel lies in the skilled physician’s ability to grasp the essentials of needling independently and understand their full meaning. “Going” indicates that Qi is deficient and weak, and is therefore called contrary; “coming” indicates that Qi is moving smoothly and also signals the moment when needling may be used to elicit Qi.

Those who do not understand the essentials of needling are dull and unenlightened, unable to perceive the subtle, profound changes in the movement of Qi. How refined these essentials are—only a few people can fully grasp them. “What goes is contrary” refers to Qi that is weak and faint; scant Qi is a sign of reversal. “What comes is compliant” refers to harmony between the body and the movement of Qi; harmony is a sign of compliance. Once one understands reversal and compliance, one can needle correctly without hesitation—that is, one knows where to select the points. “Meet it and drain it” is the draining method; “follow it and replenish it” is the reinforcing method.

“Where there is deficiency, make it full” means that when the pulse at the Qi gate is weak, one should use the reinforcing method. “Where there is fullness, drain it” means that when the pulse at the Qi gate is forceful, one should use the draining method. “Where there is stagnant blood, remove it” means clearing blood that has become obstructed in the vessels. “Where pathogenic Qi prevails, empty it” means draining pathogenic Qi wherever it is excessive in the meridians.

“Slow in, quick out, and it becomes full” means inserting the needle slowly and withdrawing it quickly. “Quick in, slow out, and it becomes empty” means inserting the needle quickly and withdrawing it slowly. As for fullness and emptiness, to seem to have Qi and yet not have it refers to Qi being present in an excess condition and absent in a deficiency condition. To observe the movement of Qi before and after needling, as though it had vanished and yet remained, means discerning whether Qi is deficient or excessive and the order of reinforcing and draining, and determining whether Qi has already descended or is still present. The changes in fullness and emptiness brought about by needling, as though something were gained and then lost, mean that with the reinforcing method one feels as if something has been gained, while with the draining method one feels as if something has been lost.

When Qi moves within the vessels, the statement that pathogenic Qi is in the upper region means that when it invades the body, it is located higher up; thus pathogenic Qi is above. Turbid Qi is in…

The changes in fullness and emptiness brought about by needling, as though something were gained and then lost, mean that with the reinforcing method one feels as if something has been gained, while with the draining method one feels as if something has been lost.

The distribution of Qi through the channels can be understood as follows. “Evil Qi is above” means that when pathogenic Qi invades the body, it often first attacks the upper regions. “Turbid Qi is in the middle” means that after food enters the stomach, its refined essence is carried upward to the lungs, while the more turbid portion remains in the stomach and intestines. When cold and heat are out of balance, or eating and drinking are unrestrained, illness arises in the stomach and intestines; hence the phrase “turbid Qi is in the middle.” “Clear Qi is below” means that cold, damp earth Qi enters the body, usually beginning at the feet; hence the phrase “clear Qi is below.”

Needling the shallow, sunken places along the collaterals can draw pathogenic Qi out. If the illness is in the upper body, treatment should be taken from the upper region. Needling within the channels can also draw pathogenic Qi out; one should select the He point of the Yangming channel, an important acupoint where channel Qi gathers. If the needle is inserted too deeply, however, pathogenic Qi may follow it inward and sink into the body. This is because a disease located at the surface should not be treated with deep needling; if the needle goes too deep, pathogenic Qi may take the opportunity to penetrate inward. The skin, flesh, sinews, and vessels each have their corresponding regions: this means that each channel has its own domain of influence and connection.

Needling the Five Vessels may lead to death. This refers to cases where illness lies within and vital Qi is deficient: if one focuses only on forcefully draining the pathogenic Qi at the surface, and even drains away the Qi of all the Yin channels, vital Qi will be harmed. Needling the Qi of the Three Yang channels can also be dangerous. If too much Qi is drained from them, the patient may become extremely weak and mentally listless. “One who depletes Yin dies” means that repeatedly needling the Wuli point at the cubit region five times may damage Yin Qi and cause death. “One who depletes Yang becomes deranged” means that excessive depletion of Yang Qi may bring on madness.

Observe the patient’s complexion and eyes to judge whether Qi and blood are dispersing or recovering; then examine the body’s build and the patient’s behavior both in movement and at rest. A skilled physician can discern the Five Colors in the eyes and examine the size, slowness, rapidity, smoothness, or roughness of the pulses at the inch and cubit positions, using these signs to judge the illness. To distinguish pathogenic Qi from upright Qi is to identify the different causes of illness, such as vacuous pathogenic winds and upright winds.

The right hand guides the needle’s insertion, while the left hand holds the needle and helps control it; this refers to the needle’s entry and withdrawal. Once Qi arrives, the needle should be withdrawn: after tonifying or draining, needling should stop when the movement of Qi has been harmonized. The key to regulating Qi is to remain focused from beginning to end. Points where the channels intersect are distributed throughout the body. The “three hundred and sixty-five intersections” refers to the places where the collaterals distribute and pour Qi and blood into the joints throughout the body.

When the Qi of the five viscera has been cut off from within, this means that the breath coming from within, which should reach the Cun-kou pulse, can no longer get there. If, at this point, one instead needles the affected area on the body’s exterior and the point where it meets a Yang channel, then leaves the needles in to draw in Yang Qi, this is done as a matter of caution.

The 365 points where channels and collaterals meet are places where the Qi of the collaterals flows in and nourishes the joints.

When the Qi of the five viscera has been cut off from within, this means that the breath coming from within can no longer reach the Cun-kou pulse. If, instead, one needles the affected area on the body’s exterior and the point where it meets a Yang channel, then leaves the needles in to draw in Yang Qi, once the Yang Qi arrives, the body’s interior becomes even more depleted. As this depletion worsens, the person will die. At death, the body has no strength to move and so lies still.

When the Qi of the five viscera has been cut off from without, this means that the breath coming from outside can no longer reach the Cun-kou pulse. If, instead, one needles the Shu points at the extremities of the limbs, where channel Qi is conveyed and gathers, then leaves the needles in to draw in Yin Qi, once the Yin Qi arrives, Yang Qi will enter in the opposite direction. When Yang Qi flows counter to its proper course, the person will die. At death, Yin Qi is excessive, so the body becomes restless and agitated.

Therefore, observe the eyes. The Qi of the five viscera causes the five colors to appear in the eyes. When the gaze is clear, the voice will sound clear and full of spirit. If the voice differs from its usual sound, this too is a change to note when assessing the illness.

Pronunciation notes

“Bi ran” describes a state of fullness; “huang ran” describes a state of frenzy or confusion. In “shen na,” the final syllable is pronounced “na.”

“The Forms of Illness Caused by Pernicious Qi in the Zang-Fu,” Part Four: Correspondence with the Seasons

The Yellow Emperor asked Qibo, “What happens when pernicious Qi enters the human body?” Qibo replied, “Pernicious Qi attacks the upper part of the body.” The Yellow Emperor asked, “Is there a fixed boundary between the upper and lower parts?” Qibo replied, “Above the body’s midline is where pernicious Qi attacks; below the midline is where dampness attacks. Thus, pernicious Qi does not enter the body according to any fixed, unchanging rule: if it enters the Yin aspect, it flows into the Fu organs; if it enters the Yang aspect, it flows into the channels.”

The Yellow Emperor asked, “Although Yin and Yang have different names, in substance they belong to the same category. They connect above and below, their channels link with one another, and their circulation continues without end. External pathogens enter the body, sometimes attacking the Yin aspect and sometimes the Yang, in different places above, below, left, and right. Why is this?”

Qibo replied, “The Yang channels converge on the face. When a person is weak, has just exerted themselves, or sweats after eating and the interstices—the skin’s texture and pores—are open, they are vulnerable to external pathogens. If a pathogen enters through the face, it travels down the Foot Yangming channel; if it enters through the nape, it travels down the Foot Taiyang channel; if it enters through the cheek, it travels down the Foot Shaoyang channel. A pathogen entering the chest, back, or flanks likewise enters the corresponding channels.”

The Yellow Emperor asked again, “What happens when a pathogen enters the Yin aspect?”

Qibo replied, “A pathogen entering the Yin aspect usually begins in the arms and lower legs. The skin on the inner sides of the arms and lower legs is thin, and the muscles are soft and moist, so these areas are vulnerable to wind pathogens, especially the Yin channels.”

The Yellow Emperor asked, “Will this injure the zang-fu organs?”

Qibo replied, “A wind pathogen entering the body does not necessarily affect the zang-fu organs. When a pathogen enters a Yin channel, if the Qi of the organs is strong, the pathogen cannot remain there and instead retreats into the fu organs. Thus, a pathogen entering the Yang aspect circulates through the channels; one entering the Yin aspect shifts into the fu organs.”

Huangdi asked: When pathogenic qi enters the internal organs, what effects does it cause?

Qibo replied: Worry and fear injure the heart. Exposure to cold, together with drinking cold beverages, injures the lungs. These two kinds of cold interact, chilling the body both inside and out, so the qi of the lungs rebels and moves upward. After a fall or a plunge, stagnant blood may remain in the body. If the person then becomes intensely angry, qi surges upward and cannot descend; it gathers below the ribs and injures the liver. Being struck or falling, engaging in sexual activity while drunk, or being exposed to wind while sweating can injure the spleen. Lifting heavy loads with great effort, excessive sexual activity, or bathing in water after sweating can injure the kidneys.

Huangdi asked: What happens when the Five Organs are invaded by wind pathogens?

Qibo replied: Pathogens can enter the body only when both Yin and Yang qi are affected.

Huangdi said: Well said.

Huangdi then asked Qibo: The head and face and the body are connected by bones and sinews, and their qi and blood flow into one another. Why is it that when the weather is so cold that the ground cracks and freezes, people sometimes find their hands and feet too sluggish to move, yet leave their faces uncovered?

Qibo replied: The qi and blood of the twelve channels and 365 collaterals all flow upward to the face and reach the openings of the eyes, ears, and nose. Pure Yang qi rises to the eyes, enabling sight; branch qi reaches the ears, enabling hearing; ancestral qi rises to the nose, enabling the sense of smell; and the more turbid qi in the stomach reaches the tongue, enabling taste. Fluids produced from qi also rise to moisten the face. In addition, the skin of the face is relatively thick and its muscles firm, so extreme cold and heat are less likely to harm it.

Huangdi asked: Once pathogenic qi enters the body, what symptoms does illness produce?

Qibo replied: When vacuous pathogenic qi attacks the body, a person feels waves of cold and the body trembles. When normal pathogenic qi attacks, the symptoms are mild. They often first appear in the complexion, while the body itself is not easily aware of them. The sensations are faint and uncertain, as though the illness were not yet serious.

The Yellow Emperor asked, “When pathogenic influences enter the body, what signs appear as illness develops?” Qibo replied, “When deficient pathogenic influences invade, a person feels cold and shivers, and the body trembles as well. When proper influences invade, the illness is mild. At first, it shows only in the complexion, while the body itself feels no marked change. The signs seem present and absent, as though they come and go; they leave no clear trace, making their nature difficult to determine.” The Yellow Emperor said, “Well said.”

The Yellow Emperor asked Qibo, “I have heard that learning about illness by observing the complexion is called ‘clarity’; learning about it by examining the pulse is called ‘spirit’; and asking about the illness and determining its location is called ‘skill.’ I would like to know how observation, pulse examination, and inquiry together can give a complete understanding of the illness.” Qibo replied, “The complexion, pulse, and condition of the skin along the forearm from wrist to elbow should correspond with one another, like a drumbeat and its echo; they must not contradict each other. This is also like the relationship between a tree’s roots and branches: when the roots die, the leaves wither. In the same way, the complexion, pulse, bodily form, and muscles should confirm one another. Understanding just one of these may be called ‘skill’; understanding two may be called ‘spirit’; only understanding all three deserves to be called both subtle and clear-sighted.”

The Yellow Emperor said, “Please explain the principle fully.” Qibo replied, “A greenish complexion should correspond to a wiry pulse; a reddish complexion, to a hooked pulse; a yellow complexion, to an intermittent pulse; a pale complexion, to a floating, hairlike pulse; and a dark complexion, to a deep, stone-like pulse.” These pulse names are classifications made in ancient Chinese medicine according to the shape and qualities of the pulse.

The Yellow Emperor said, “Please explain this in greater detail.” Qibo replied, “The complexion and pulse should correspond: green with a wiry pulse, red with a hooked pulse, yellow with an intermittent pulse, white with a floating, hairlike pulse, and black with a deep, stone-like pulse. If a particular complexion appears without its corresponding pulse, and instead the pulse appears that overcomes it, the illness may be critical. If the pulse and complexion stand in a generating relationship, the illness may improve.”

The Yellow Emperor asked Qibo, “What changes arise in the Five Viscera, and what signs of illness correspond to them?” Qibo replied, “Only by first distinguishing the correspondences between the five colors and the five pulses can one tell the conditions apart.” The Yellow Emperor asked, “Once the colors and pulses have been distinguished, how should one proceed?” Qibo replied, “By observing qualities of the pulse such as whether it is slow, rapid, fine, large, slippery, or rough, one can determine how the illness is changing.”

The Yellow Emperor asked, “How should one combine the pulse with the condition of the skin in making a diagnosis?”

Qibo replied, “When the pulse is rapid, the skin at the cubit position is tense; when the pulse is relaxed, the skin there is also slack. When the pulse is fine and weak, the skin at the cubit position is drawn in and thin, and Qi is also deficient. When the pulse is forceful and large, the skin there is raised. When the pulse is slippery, the skin there is also smooth; when the pulse is rough and choppy, the skin there is also coarse and rough. These changes may be mild or severe.

“Therefore, one skilled at examining the skin at the cubit position need not rely solely on the pulse at the inch position; one skilled at examining the pulse need not rely solely on the complexion. A physician who combines the signs of the skin at the cubit position, the pulse, and the complexion is of the highest rank. A superior physician can cure nine out of ten people. One who uses only two of these methods is of middle rank; a middle-ranking physician can cure seven out of ten. One who uses only one method is of lower rank; a lower-ranking physician can cure six out of ten.

The Yellow Emperor then asked, “Please explain what illnesses correspond to pulses that are relaxed, rapid, fine and weak, forceful and large, slippery, or rough and choppy.”

Qibo replied, “I will explain the disorders of the five viscera. If the Heart pulse is extremely rapid, there may be convulsions and the body may arch backward like a bow. If it is slightly rapid, there may be heart pain extending to the back and loss of appetite. If the pulse is extremely relaxed, there may be bouts of manic laughter. If it is slightly relaxed, there may be a Fuliang—a kind of accumulation below the heart described in ancient times—which shifts up and down and may sometimes cause vomiting of blood. If the pulse is extremely large, there may be obstruction in the throat. If it is slightly large, there may be Heart impediment, with pain extending to the back and frequent tearing. If the pulse is extremely fine and weak, retching may occur; if it is slightly fine and weak, there may be Xiaodan, a wasting thirst disorder. If the pulse is extremely slippery, there may be thirst; if it is slightly slippery, there may be a Heart hernia, an ancient term for pain in the heart and abdomen, with pain extending to the navel and rumbling in the lower abdomen. If the pulse is extremely rough and choppy, the voice may be lost; if it is slightly rough and choppy, there may be blood overflow, Weijue—a kind of reversal disorder described in ancient times—ringing in the ears, and Dian illness, a disorder involving abnormal mental or conscious states.”

When the lung pulse is extremely rapid, manic disorders are commonly seen. If the pulse is somewhat rapid, there may be cold and heat in the lungs, with fatigue, coughing, and coughing up blood, affecting the lower back, back, and chest. There may also be nasal polyps that obstruct breathing. When the lung pulse is extremely slow, excessive sweating is common. If the pulse is somewhat slow, there may be weakness and wasting, wind affecting one side of the body, or persistent sweating below the head. When the lung pulse is extremely forceful and large, swelling of the calves is common. If the pulse is somewhat large, there may be lung Bi (an illness caused by obstruction of lung Qi), affecting the chest and back and causing sensitivity to sunlight. When the lung pulse is extremely fine and small, diarrhea is common. If the pulse is somewhat small, there may be Xiao-dan (a disorder marked by excessive thirst, eating, and urination, with progressive weight loss). When the lung pulse is extremely slippery and flowing, there is often Xi-ben, with Qi rising upward (shortness of breath and Qi surging upward). If the pulse is somewhat slippery, there may be bleeding from the upper or lower body. When the lung pulse is extremely rough and stagnant, vomiting blood is common. If the pulse is somewhat rough, there may be Shu-lou (lumps or fistulas in the neck or armpits), with illness in the neck and armpit region. The lower part of the body cannot withstand the illness affecting the upper part, and the affected areas are prone to aching.

When the liver pulse is extremely rapid, speech is often difficult, or the person may not wish to speak. If the pulse is somewhat rapid, there may be Fei-qi (a mass that forms beneath the ribs), shaped like an overturned cup. When the liver pulse is extremely slow, vomiting is common. If the pulse is somewhat slow, there may be Shui-jia Bi, a disorder associated with the retention of fluids, masses, and obstruction. When the liver pulse is extremely forceful and large, internal abscesses are common, along with a tendency to vomit and nosebleeds. If the pulse is somewhat large, there may be liver Bi (an illness caused by obstruction of liver Qi), with contraction of the genitals and pain pulling into the lower abdomen when coughing. When the liver pulse is extremely fine and small, excessive drinking of water is common. If the pulse is somewhat small, there may be Xiao-dan. When the liver pulse is extremely slippery and flowing, Hui-shan (a disorder involving painful swelling of the scrotum or groin) is common. If the pulse is somewhat slippery, there may be urinary incontinence. When the liver pulse is extremely rough and stagnant, Yi-yin (a disorder in which fluids collect in the skin and limbs) is common. If the pulse is somewhat rough, there may be convulsions, spasms of the sinews, and sinew Bi.

When the spleen pulse is extremely rapid, convulsions of the limbs are common. If the pulse is somewhat rapid, there may be Ge-zhong, a disorder in which food becomes lodged around the diaphragm: food or drink is swallowed and then vomited, followed by thin, clear frothy saliva. When the spleen pulse is extremely slow, weakness and coldness of the limbs are common. If the pulse is somewhat slow, there may be wind-related wasting and weakness: the limbs cannot move, but consciousness remains clear, and the person feels as though they are not ill. When the spleen pulse is extremely forceful and large, sudden collapse is common. If the pulse is somewhat large, there may be a hernia, or a large amount of pus and blood inside the abdomen, with the affected area outside the intestines and stomach. When the spleen pulse is extremely fine and small, alternating chills and fever are common. If the pulse is somewhat small, there may be Xiao-dan. When the spleen pulse is extremely slippery and flowing, Hui-long (a disorder associated with difficulty urinating and painful swelling of the scrotum) is common. If the pulse is somewhat slippery, there may be heat in the abdomen caused by parasites, roundworms, or scorpion-like creatures. When the spleen pulse is extremely rough and stagnant, intestinal abscesses are common. If the pulse is somewhat rough, there may be internal abscesses, with a large amount of pus and blood in the abdomen and the affected area outside the intestines and stomach; substantial pus and blood may also be discharged from below.

When the Kidney pulse is extremely rapid, there may be bone-related epilepsy, a disorder associated with bone illness and convulsions. If the pulse is only somewhat rapid, there may be deep reversal, in which Qi and blood circulate poorly and the limbs grow cold, or running-piglet, a sensation of Qi surging upward from the lower abdomen. The feet may be unable to bend or straighten, and urination and bowel movements may be obstructed. When the pulse is extremely slow, the back may hurt as though it were broken. If it is only somewhat slow, there may be a condition called “cavernous”: food cannot be digested, and is vomited soon after being swallowed.

When the pulse is extremely large, there may be impotence. If it is only somewhat large, there may be stone water, a disorder involving fluid accumulation in the abdomen. A heavy, distended fullness extends from below the navel to the lower abdomen and upward to the pit of the stomach. The ancients considered this disorder difficult to treat. When the pulse is extremely small, there may be severe diarrhea. If it is only somewhat small, there may be wasting-thirst, a disorder of the consumptive-thirst type.

When the pulse is extremely slippery, there may be a disorder involving urinary blockage and scrotal swelling. If it is only somewhat slippery, there may be bone withering, in which the bones are weak and powerless: after sitting down, the person cannot stand, and when standing up, cannot see what is before the eyes. When the pulse is extremely rough, a severe abscess may develop. If it is only somewhat rough, menstruation may cease, or there may be a deep-seated hemorrhoid.

The Yellow Emperor asked, “When illness presents these six changes, how should one apply acupuncture?” Qibo replied, “A rapid pulse is commonly associated with cold; a slow pulse, with heat. A large pulse usually indicates an excess of Qi and a deficiency of blood; a small pulse indicates deficiency of both Qi and blood. A slippery pulse usually indicates that Yang Qi is predominant, with mild signs of heat. A rough pulse usually indicates excess blood and deficient Qi, with mild signs of cold.

“Therefore, for disorders with a rapid pulse, insert the needle relatively deeply and retain it for a long time. For disorders with a slow pulse, needle shallowly and withdraw the needle quickly to disperse pathogenic heat. For disorders with a large pulse, drain the Qi slightly, but do not draw blood. For disorders with a slippery pulse, needle shallowly and withdraw the needle quickly to disperse excessive Yang Qi and eliminate pathogenic heat.

“For disorders with a rough pulse, place the needle in the channels and determine how long to retain it according to whether the movement of Qi and blood is in harmony or contrary; ordinarily, retain it for a relatively long time. Before needling, press and rub the site, tracing it with the fingers. After withdrawing the needle, immediately press the needle opening so that no blood flows out, thereby harmonizing the channels. In disorders with a small pulse, Yin-Yang and both bodily form and Qi are deficient. Acupuncture is not appropriate; instead, nourish the person with sweet-tasting medicines.”

The Yellow Emperor asked: I have heard that the Qi of the five zang organs and six fu organs flows from the Ying, Shu, and He points. By what route does this Qi enter the body? Once inside, what parts does it connect with and pass through? Please explain the principle.

Qibo replied: These are collateral branches of the Yang channels that enter the body and connect with their corresponding fu organs.

The Yellow Emperor asked: Do the Ying, Shu, and He points each have their own function?

Qibo replied: The Ying and Shu points are chiefly used to treat disorders of the channels on the body’s surface; the He points are used to treat disorders of the internal fu organs.

The Yellow Emperor asked: How should disorders of the fu organs be treated?

Qibo replied: Select the corresponding He point.

The Yellow Emperor asked: What are the names of the He points?

Qibo replied: The He point of the Stomach is Zusanli; that of the Large Intestine is Shangjuxu; that of the Small Intestine is Xiajuxu; that of the Sanjiao is Weiyang; that of the Bladder is Weizhong; and that of the Gallbladder is Yanglingquan.

The Yellow Emperor asked: How should these points be located?

Qibo replied: To locate Zusanli, point the top of the foot downward. To locate Shangjuxu and Xiajuxu, raise the foot. To locate Weiyang, bend and straighten the leg to find the point; to locate Weizhong, bend the leg. To locate Yanglingquan, keep the knee straight and the muscles tense, and find the point on the outer side of the knee, opposite Weiyang. To locate points on the outer channels, extend the limbs and follow the channels to find them.

The Yellow Emperor asked: I would like to learn about disorders of the six fu organs.

Qibo replied: Heat in the face indicates a disorder of the Foot Yangming channel. An unusual color in the collateral vessels at the thenar eminence indicates a disorder of the Hand Yangming channel. If the vessels on the tops of both feet are hard and raised, or sunken, this indicates a disorder of the Foot Yangming channel; these are signs of the Stomach channel.

When the Large Intestine is diseased, there is severe pain in the intestines and rumbling bowel sounds. If the person is exposed to cold in winter as well, diarrhea and pain around the navel may occur, and the person cannot stand for long. These signs resemble those of a Stomach disorder; Shangjuxu may be selected for treatment.

When the Stomach is diseased, the abdomen is distended and full, and there is pain in the epigastrium—the upper abdomen, below the heart—which extends upward to both flanks.

When the stomach is diseased, symptoms may include abdominal distention and fullness, pain in the stomach area (upper abdomen) that pulls upward toward both flanks, a blocked sensation in the chest, diaphragm, and throat, and difficulty swallowing food. The Zusanli point may be selected for treatment.

When the small intestine is diseased, symptoms may include lower abdominal pain, pain extending through the lower back to the testicles, and frequent urges to defecate with difficulty passing stool. The area in front of the ear may feel hot, or markedly cold; sometimes only the shoulder feels hot. The space between the little finger and ring finger may feel hot, and the related channels may appear sunken. These are signs of disease in the Hand Taiyang channel (Small Intestine channel). The Xiajuxu point may be selected for treatment.

When the Sanjiao is diseased, the abdomen may feel distended and full, especially with hardness in the lower abdomen, along with difficulty and urgency in urination. If fluids overflow into the tissues, edema may occur; if fluids remain in the body, they may cause distention and fullness. During examination, observe the major connecting vessel outside the Foot Taiyang channel (Bladder channel). This vessel lies between the Foot Taiyang and Foot Shaoyang channels (Gallbladder channel), and it may also be assessed through the pulse. Select the Weiyang point for treatment.

When the bladder is diseased, one side of the lower abdomen may become swollen and painful. Pressing it by hand may bring on the urge to urinate, but the person cannot pass urine. The shoulder may feel hot, or the related channels may appear sunken. The outer side of the little toe, and the areas behind the tibia and ankle bone, may also feel hot or show sunken channels. The Weizhong point may be selected for treatment.

When the gallbladder is diseased, the person may sigh frequently, have a bitter taste in the mouth, and vomit bile that has remained overnight. There may be restless palpitations below the heart, accompanied by a feeling of being afraid that someone is coming to seize them. The throat may feel obstructed, and the person may often spit saliva. Examine the beginning and end of the Foot Shaoyang channel (Gallbladder channel), and observe whether any channels appear sunken; apply moxibustion at sunken areas. If there are symptoms of alternating cold and heat, select the Yanglingquan point for treatment.

The Yellow Emperor asked, “Is there a definite method for acupuncture?” Qibo replied, “When needling these conditions, you must accurately reach the Qi points—the points where channel Qi flows and that are suitable for needling. Do not needle the knotted places in the muscles. When the needle reaches a Qi point, it can follow the course of the channel; when it reaches a knotted place, it only causes pain in the skin. If tonification and draining are used in reverse, the condition will worsen. If the needle strikes a tendon, the tendon will slacken, but the pathogenic Qi will not be expelled. Instead, it will contend with the body’s righteous Qi, causing disturbance before remaining in the body. If you use the needle carelessly, you can turn a proper treatment into its opposite.”

[Textual notes: One version reads “in the shoulder and back” instead of “in the chest and back”; another reads “down its channel” instead of “also reaches its channel.”]

The pathogenic influence enters the chest and back (another edition reads “shoulders and back”), and also enters the corresponding meridians (another edition reads “descends into the meridians”). The term “turbid fluids” means that nao is turbid and ze is liquid. After the pathogenic influence enters, it makes the body’s fluids turbid and viscous. “Enters but does not lodge” is written in another edition as “enters but cannot be accommodated”; it means that the pathogenic influence enters the body but cannot settle or be contained there.

The scripture also includes names of certain illnesses and notes on how to pronounce particular characters. “Chizong” refers to spasms of the sinews and vessels, with the hands and feet drawn taut. “Jie” is pronounced “jie,” and “hui” is pronounced “yue.” “Xiben” is pronounced “ben.” “Suan” is pronounced “suan,” “jia” as “jia,” “tui” as “hui,” and “pu” as “fu.” “Hui” refers to a long worm in the abdomen, while “ge” refers to a wood-boring insect. “Chui” is pronounced “chui,” “wei” as “mei,” and “yu” as “chong.” “Gao” refers to the testicles. “Jue reversal of the linking vessels” refers to counterflow in either the Yin Linking Vessel or the Yang Linking Vessel. In meridian theory, these two vessels connect and support the body’s meridians.

Collected Annotations to the Yellow Emperor’s Inner Canon: Numinous Pivot, juan 2

The following are collation notes describing differences among editions:

1. The original order of the two characters “zhe zhong” was reversed; corrected on the basis of the Zhaofu Jujingtang edition.

2. The original text had “Yang” instead of “Yin”; corrected on the basis of the third occurrence in juan 1 of the Jia Yi Jing.

3. The original text had “zhi” instead of “zhu”; corrected on the basis of the Zhaofu Jujingtang edition.

4. The two characters “pronunciation notes” were absent from the original; added following the format of the preceding section. The same applies below.

5. The original text had “zhe” instead of “zai”; corrected on the basis of the Zhaofu Jujingtang edition.

6. In the Zhaofu Jujingtang edition, the character “shang” appears as “gong.”

7. In the Zhaofu Jujingtang edition, the character “xie” appears as “zhuo.”

8. The original text had “dao” instead of “ni”; corrected on the basis of “Pathogenic Influence Intruding” in juan 27 of the Tai Su.

9. The original text had “bo” instead of “bai”; corrected on the basis of the Zhaofu Jujingtang edition.

10. “Pathogenic Influence Intruding” in juan 27 of the Tai Su omits the character “tian.” The Zhaofu Jujingtang edition writes “qi” instead of “re” and reads it together with the following text.

11. In the third occurrence in juan 3 of the Mai Jing, “shan” appears as “pi.”

The Yellow Emperor said, “The Qi of Heaven and Earth responds and interacts; cold and warmth alternate. In the movement of Yin and Yang, which predominates, Yin or Yang? Yin moves according to even numbers, and Yang according to odd numbers. When illness arises in spring and summer, Yin Qi is scant and Yang Qi abundant, leaving Yin and Yang out of balance. Should one tonify or drain? When illness arises in autumn and winter, Yang Qi is scant and Yin Qi abundant. Yin is flourishing and Yang is weakening, so the stems and leaves of plants wither, and rainwater gathers and flows downward. When Yin and Yang transform into one another, should one drain or tonify?

The kinds of pathogenic Qi that stray from the normal course of the meridians are numerous beyond counting. If one does not understand the roots and junctions of the meridians—the key points where meridian Qi begins and converges—the functions of the Five Zang and Six Fu organs will be impaired. The body will be like a gate and pivot that have broken, unable to open and close as they should. Qi and blood will leak outward, and Yin and Yang will fall into severe imbalance. At that point, acupuncture can no longer restore their balance through tonification and drainage.

The essence of the Nine Needles, the ancient methods of acupuncture, lies in understanding ‘beginning and ending’: the patterns of Qi and blood moving through the meridians and the changes that mark their course from start to finish. Once these principles are understood, the essentials of acupuncture can be stated in a single sentence. Without them, the Way of acupuncture cannot be mastered.”

The Foot Greater Yang channel (Foot Greater Yang Bladder channel) begins at the Zhiyin point and connects to the Gate of Life. Here, “Gate of Life” refers to the eyes. The Foot Bright Yang channel begins at the Lidui point and connects to the great forehead, the area near the front of the ear and the temples. The Foot Lesser Yang channel begins at the Qiaoyin point and connects to the ear cavity. The Greater Yang channel governs opening, the Bright Yang channel governs closing, and the Lesser Yang channel governs the pivot that regulates movement.

When the function of “opening” is impaired, the muscles and joints lose their nourishment, and acute conditions may arise suddenly. Acute conditions are therefore treated by selecting points on the Greater Yang channel and determining whether the illness involves excess or deficiency. The loss of nourishment in the muscles and joints means that the flesh and skin become dry, wasted, and weak. When the function of “closing” is impaired, Qi cannot circulate steadily, and weakness and atrophy may result. Such conditions are treated by selecting points on the Bright Yang channel and distinguishing excess from deficiency. When Qi has nowhere to settle, the upright Qi has stagnated and pathogenic Qi has lodged in the body by taking advantage of the weakness. When the function of the “pivot” is impaired, the joints become unsteady, and the feet feel unstable when standing. Joint instability is treated by selecting points on the Lesser Yang channel and distinguishing excess from deficiency. The joints become unsteady because they are lax and cannot hold themselves together. The text also says that bone disorders may be treated through the Bright Yang channel, while still distinguishing excess from deficiency. When Qi fails to circulate properly, upright Qi has stagnated and pathogenic Qi has remained in the body. Treatment should also investigate the root of the illness.

The Foot Greater Yin channel (Foot Greater Yin Spleen channel) begins at the Yinbai point and connects to the Great Granary, meaning the stomach. The Foot Lesser Yin channel (Foot Lesser Yin Kidney channel) begins at the Yongquan point and connects to the Jade Spring. The Foot Reverting Yin channel (Foot Reverting Yin Liver channel) begins at the Dadun point and connects to the Jade Essence, as well as to the Central Chest, the area between the breasts. The Greater Yin channel governs opening, the Reverting Yin channel governs closing, and the Lesser Yin channel governs the pivot that regulates movement.

When the function of “opening” is impaired, the Spleen and Stomach’s transformation and transportation of food and fluids are obstructed, leading to conditions such as diaphragm obstruction. Diaphragm obstruction refers to impaired Qi movement between the chest and abdomen, along with disordered passage and transformation of food. Treatment involves selecting points on the Greater Yin channel and determining whether there is excess or deficiency. Impaired “opening” causes illness because Qi is insufficient. When the function of “closing” is impaired, Qi declines and the person becomes prone to sorrow. Sorrow is treated by selecting points on the Reverting Yin channel and distinguishing excess from deficiency. When the function of the “pivot” is impaired, the channels and vessels become knotted and obstructed. This obstruction is treated by selecting points on the Lesser Yin channel and distinguishing excess from deficiency. Any knotted obstruction should be examined in terms of deficiency.

The Foot Taiyang channel begins at Zhiyin, passes through Jinggu and then Kunlun, and continues upward to Tianzhu and Feiyang. The Foot Shaoyang channel begins at Qiaoyin, passes through Qiuxu and then Yangfu, and continues upward to Tianrong and Guangming. The Foot Yangming channel begins at Lidui, passes through Chongyang and then Xialing, and continues upward to Renying and Fenglong.

The Hand Taiyang channel begins at Shaoze, passes through Yanggu and then Shaohai, and continues upward to Tianchuang and Zhizheng. The Hand Shaoyang channel begins at Guanchong, passes through Yangchi and then Zhigou, and continues upward to Tianyou and Waiguan. The Hand Yangming channel begins at Shangyang, passes through Hegu and then Yangxi, and continues upward to Futu and Pianli. Along these twelve channels, any place where channel Qi is abundant and the connecting vessels are full should be selected for treatment.

Over the course of one day and night, Qi circulates through the channels fifty times, nourishing the essence and Qi of the five viscera. When the pulse does not conform to this pattern, the condition is called “wild life.” The term “fifty circuits” means that all five viscera receive nourishment from Qi. In examining the pulse, press the pulse at the wrist and count its beats. If it beats fifty times without a pause, this shows that all five viscera are nourished by Qi and can circulate their essence and Qi.

If the pulse pauses once after every forty beats, this indicates that one visceral organ lacks Qi; a pause after every thirty beats indicates that two organs lack Qi; after every twenty, that three lack Qi; after every ten, that four lack Qi. A pause before ten beats indicates that all five organs lack Qi. This foretells that life is nearing its end. The key to the judgment lies in “beginning and ending,” the rules governing the beginning and end of the circulation of Qi and Blood through the channels. Fifty beats without a pause is normal. To infer when Qi in the five viscera will be exhausted and judge whether life will be cut short, observe whether the pulse suddenly speeds up or slows down, or whether its beats suddenly become more or less frequent.

The Yellow Emperor said, “I understand the principles of needling people with different constitutions: the size of their joints, the firmness or softness of their muscles, the thickness of their skin, the clarity or turbidity of their blood, the smoothness or obstruction of their Qi (vital energy), the length of their pulses, the amount of blood they have, and the distribution of their channels. These all concern ordinary people. But what of nobles and rulers sustained by rich food? Their bodies are delicate, their muscles soft, and their Qi and blood flow rapidly and smoothly. When needling them, can the speed of insertion and withdrawal, the depth of insertion, and the number of treatments be the same as for ordinary people?”

Qibo replied, “Their usual rich and refined diet differs from the coarse, plain food of those who eat beans and leaves such as huò. Their constitutions naturally cannot be treated as identical. When Qi flows smoothly, it can escape quickly after needling; when Qi flows sluggishly, it escapes more slowly. If the Qi is forceful, use a smaller needle. For those with soft muscles and rapidly flowing Qi and blood, the speed and depth of needling and the number of treatments likewise cannot be exactly the same as for others. When Qi flows smoothly, the needle should be small and inserted shallowly; when Qi is sluggish, it should be larger and inserted more deeply. After deep insertion, the needle can remain in place longer; after shallow insertion, it should be withdrawn promptly. Thus, when needling ordinary people, one may insert the needle more deeply and leave it in place longer. When needling nobles and others with delicate constitutions, one should needle shallowly and proceed gently. This is because their Qi and blood flow rapidly and smoothly.”

The Yellow Emperor asked, “What opposing or corresponding relationships exist between a person’s bodily constitution and the strength of their Qi and blood, and the abundance or decline of pathogenic influences?”

Qibo replied, “When the body’s vital Qi is deficient but pathogenic Qi is abundant, the pathogen has the upper hand, and one should promptly use the draining method to dispel it. When the body’s vital Qi is abundant but pathogenic Qi is deficient, one should promptly use the reinforcing method to support the vital Qi. When both the body’s vital Qi and pathogenic Qi are deficient, this means that both Yin and Yang Qi are depleted, and needling should not be used. If one needles anyway, the deficiency will become more severe, Yin and Yang Qi will be further depleted, Qi and blood will dry up, the Five Viscera will become empty, and the sinews, bones, and marrow will also deteriorate. The elderly may die as a result, while even those in their prime may struggle to recover. When both the body’s vital Qi and pathogenic Qi are abundant, this is called an excess of both Yin and Yang. One should promptly drain the pathogen and regulate deficiency and excess. Thus, the saying ‘drain what is in excess and reinforce what is deficient’ refers to this principle.”

Therefore, if one does not understand the relative strength and direction of the vital Qi and pathogenic Qi when needling, they may become locked in conflict. If the pathogen is already predominant but one instead applies reinforcement, the balance between deficiency and excess will be disrupted. So remember: drain what is in excess and reinforce what is deficient.

If one practices acupuncture without understanding the proper or contrary flow of Qi and blood through the channels, the body’s healthy Qi and pathogenic Qi will struggle against each other. If the body is already replete but one still uses tonification, the Qi of Yin and Yang will spill outward, the stomach and intestines will become distended, the liver and lungs will become congested within the body, and the circulation of Yin and Yang will fall into disorder. If the body is already weak but one instead uses draining, the channels will become even more depleted and Qi and blood will be exhausted. The stomach and intestines will contract and become blocked, the skin will grow thin and cling to the bones, the hair will wither, the complexion will become haggard, and death will ultimately result. The key to needling, therefore, lies in understanding how to harmonize Yin and Yang. When Yin and Yang are harmonized, Jing and Qi become abundant and clear, the body and Qi work in concert, and Shen can remain settled within.

Thus, a superior physician brings the movement of Qi into balance; a middling physician throws the channels into disorder; and an inferior physician exhausts Qi and blood, endangering life. Inferior physicians in particular must be careful. One must closely examine disorders of the five viscera, the responses shown by the five pulses, whether the channels and network vessels are deficient or replete, and whether the skin is soft or rough before needling.

“Guyao” is read as “yao”; “piaohan” describes someone fierce and vigorous; the “qi” in “yang dao qi” is read as “ji.” “The Sixth Chapter on Longevity and Early Death, Hardness and Softness, and the Six Laws” is the title of the chapter.

The Yellow Emperor asked Shao Shi, “I have heard that people’s constitutions may be firm or yielding, weak or strong, short or tall, and that they are also divided into Yin and Yang. I would like to understand the principles behind this.”

Shao Shi replied, “Within Yin there is Yin, and within Yang there is Yang. Only by distinguishing Yin and Yang can acupuncture be applied appropriately; only by understanding where an illness originates can treatment be properly guided. Carefully examine how the illness began, match treatment to the season, and take account of the internal organs—the Five Zang and Six Fu—as well as the body’s surface, including its sinews, bones, and skin. Thus there is Yin and Yang inside the body, and Yin and Yang on its surface: the Five Zang organs inside belong to Yin, and the Six Fu organs to Yang; on the surface, the sinews and bones belong to Yin, and the skin to Yang.

“So, for illness in Yin within Yin, needle the Ying and Shu points of the Yin channels; for illness in Yang within Yang, needle the He points of the Yang channels; for illness in Yin within Yang, needle the Jing points of the Yin channels; and for illness in Yang within Yin, needle the Luo vessels. These are specific points along the channels, classified by the ancients according to their location and function for use in acupuncture treatment.

“Illness in Yang is called ‘Wind’; illness in Yin is called ‘Bi’; when both Yin and Yang are affected, it is called ‘Wind-Bi.’ A distinct pathological change without pain belongs to the domain of Yang; pain without any visible pathological change belongs to the domain of Yin. Pain without a visible change means that Yang Qi remains intact while Yin has been damaged. Yin should be treated promptly, without attacking Yang. A visible pathological change without pain means that Yin remains intact while Yang has been damaged. Yang should be treated promptly, without attacking Yin.

“When both Yin and Yang change, the signs come and go, and the heart is troubled and restless, this is called ‘Yin overpowering Yang.’ This illness belongs neither to an exterior pattern nor to an interior pattern, and it may not last long.”

The Yellow Emperor asked Bo Gao, “I have heard that disorders affecting the body’s form and Qi arise in different sequences. How do these relate to the body’s responses inside and out?”

Bo Gao replied, “Wind and cold damage the body’s form; worry, fear, and anger damage Qi. When Qi is damaged, illness develops in the internal organs. When cold pathogens damage the body’s form, illness shows up in the form itself. When wind pathogens damage the sinews and vessels, those too develop corresponding symptoms. This is how the body’s form and Qi, and the inside and outside of the body, correspond to one another.”

The Yellow Emperor asked, “How should one use acupuncture in treatment?”

Bo Gao replied, “For an illness that has lasted nine days, acupuncture about three times; for one that has lasted a month, about ten times. Illnesses vary in duration, and their locations may be near or far, but in each case the severity can be gradually reduced by following this principle. If chronic Bi syndrome—an obstruction syndrome that does not resolve over a long period, often causing numbness, pain, or difficulty moving the limbs—persists, examine the blood vessels visible at the surface and release the stagnant blood within them.”

The Yellow Emperor asked again, “How does the ease or difficulty of treatment differ between illness of the external body and illness of the internal organs?”

Bo Gao replied, “If illness first affects the body’s form and has not yet entered the internal organs, the course of acupuncture treatment may be half as long as the illness has lasted. If illness first affects the internal organs and only later appears in the body’s form, the course of acupuncture treatment should be twice as long as the illness has lasted. This is how internal and external illnesses correspond in the ease or difficulty of treatment.”

The Yellow Emperor asked Bohgao, “I have heard that people’s bodies may be loose or taut, their Qi may be strong or weak, their bones large or small, their muscles firm or frail, and their skin thick or thin. How can these features be used to judge whether someone will live a long or short life?”

Bohgao replied, “Those whose bodies and Qi are well matched live long; those in whom they are out of balance tend to live less long. Those whose skin and muscles are well matched live long; those in whom they are not tend to live less long. When the strength of the blood, Qi, and channels exceeds the body’s wear and tear, a person will generally live long. If the blood, Qi, and channels are too weak to support the body, the person will generally live less long.”

The Yellow Emperor asked, “What does it mean for the body to be loose or taut?”

Bohgao replied, “People with full-bodied physiques and relaxed skin live long; those whose bodies are full but whose skin is taut tend to live less long. A full-bodied physique with a firm, forceful pulse is a favorable sign. If the body is full but the pulse is thin and weak, it shows that the Qi has declined, and the situation is dangerous. If the body is full but the cheekbones are not prominent, the bones are small; people with small bones tend to live less long. A full-bodied physique with firm, clearly defined large muscles, such as those on the thighs, indicates strong muscles and generally a long life. If the large muscles lack definition and firmness, they are frail, and the person will generally live less long. These are signs of inborn constitution. They let us observe the body, assess whether the Qi is strong or weak, and estimate whether life will be long or short. One must understand these principles: only then can one infer the condition of the Qi from the body, and use that understanding to examine the sick and judge whether they will live or die.”

The Yellow Emperor said, “I have heard that one can judge whether a life will be long or short, but I do not know how to estimate its length.”

Bohgao replied, “If a person’s ‘foundation wall’ is low and does not reach the proper height, their life often lasts less than thirty years. If illness or other factors also affect them, they may not live to twenty.”

The Yellow Emperor asked, “How can the relationship between the strength of the body and the Qi be used to judge whether life will be long or short?”

Bohgao replied, “When a person is healthy, if the Qi is stronger than the demands placed on the body, they will generally live long. But if illness has caused the body to waste away and the muscles to wither, the person may die even if the Qi seems stronger than the body. If the demands placed on the body exceed what the Qi can support, the situation is dangerous.”

The Yellow Emperor asked, “I have heard that there are three different methods of needling. What are they?” Bo Gao replied, “One is needling the nutritive Qi, one is needling the defensive Qi, and one is needling cold impediment lodged in the meridians.” The Yellow Emperor asked, “How is each of these methods carried out?” Bo Gao said, “Needling the nutritive Qi means letting blood flow out. Needling the defensive Qi means allowing Qi to escape. To treat cold impediment, use warmth to drive out the cold pathogen.”

The Yellow Emperor asked, “What illnesses do disorders of the nutritive Qi, defensive Qi, and cold impediment cause?” Bo Gao replied, “A disorder of the nutritive Qi can cause alternating chills and fever, reduced Qi, disrupted blood flow, and an abnormal movement of Qi and blood upward and downward. A disorder of the defensive Qi can cause pain from Qi that comes and goes; it may also cause fullness and discomfort in the chest and abdomen, and rumbling in the intestines. This is caused by wind and cold invading the stomach and intestines. When the pathogen of cold impediment remains lodged in the body, it can cause recurring pain, numbness of the skin, and dulled sensation.”

The Yellow Emperor asked, “How should warmth be used to treat cold impediment?” Bo Gao replied, “After needling ordinary people, apply a warm compress heated over a fire. For nobles or people of high status, use a medicinal compress.”

The Yellow Emperor asked, “How exactly is a medicinal compress prepared?” Bo Gao replied, “Take twenty sheng of pure wine, one sheng of Sichuan pepper, one jin of dried ginger, and one jin of cinnamon bark. Chop the four ingredients and soak them in the wine. Then take one jin of cotton wadding and four zhang of fine white cloth, and place them in the wine as well. Warm the wine by burying it in horse manure, seal the opening so that no vapor can escape, and leave it to steep for five days and five nights. Remove the cloth and wadding and let them dry, then soak them in the wine again until all the liquid has been used. Each time, leave them soaking for a full day before taking them out to dry. Then spread the medicinal residue and wadding together on the cloth and make six or seven layered warming pads, each six or seven chi long.

“When using them, heat the pads over charcoal made from mulberry wood and apply them to the areas affected by cold impediment that have been needled, allowing the heat to penetrate the affected tissue. When a pad cools, heat it again and reapply it, repeating this thirty times. After the patient sweats, use the pad to wipe the body, also repeating this thirty times. Then have the patient get up and walk around indoors, avoiding exposure to wind. Apply this medicinal warming treatment after each needling session, and the illness can be cured. This is what is called ‘internal warming.’”

“Cheekbone” is pronounced quán; it refers to the area on either side of the face, below the eyes. When the abdominal fat is firm, apply a heated cloth and press it against the area. Stop after thirty applications. Once sweating begins, wipe the body with a cloth, again stopping after thirty passes. Then get up and walk around indoors, taking care not to be exposed to drafts. Apply the heated cloth after each needling, and the illness will be cured. This is what is called “internal heat.”

The Seventh Method of Official Needling: Xing

The key to needling is knowing how to use each kind of needle correctly. Each of the nine needles has its own purpose, and each length and size is suited to particular conditions. If the wrong needle is used, the illness cannot be dispelled.

If the illness is superficial but the needle is inserted deeply, normal muscle tissue will be damaged, and sores may form on the skin. If the illness is deep but the needle is inserted only shallowly, the pathogenic influence cannot be expelled and may gather locally into a large abscess. If the illness is mild but a large needle is used, too much Qi will be drained, which is harmful. If the illness is severe but a small needle is used, the pathogenic influence cannot be expelled sufficiently, and treatment will fail. Using the wrong needle may drain too much Qi from someone with a severe illness, while failing to dispel a mild illness. The consequences of improper needling have been explained above; what follows describes when each kind of needle is suitable.

For an illness in the skin that shifts from place to place, use a chán needle—a shallow-needling needle with a relatively sharp tip—at the affected area. Do not needle patches where the skin is pale. For an illness between the muscles, use a yuán needle, whose tip is rounded and blunt. For illness in the channels that causes persistent obstruction, use a fēng needle with a sharp tip. For an illness in the vessels that shifts from place to place, also use a chán needle at the affected area, but do not needle patches where the skin is pale.

If the Qi in the vessels is deficient and needs to be supplemented, use a dī needle, which has a relatively blunt tip, at points such as the Jing-Well and Ying-Spring points and at the places where the channels convey Qi. If an illness produces a large amount of pus, use a pí needle, shaped like a sword tip and used to drain pus. For sudden attacks of obstructive Qi, use a yuánlì needle, with a sharp tip and a relatively rounded shaft. For persistent pain from obstruction, use a háo needle, which is fine and long. For illness deep within the body, use a long needle. For swelling that blocks the joints, use a large needle. For pathogenic influences lodged in the Five Viscera at fixed locations, use a fēng needle to drain at points such as the Jing-Well and Ying-Spring points and at the places where the channels convey Qi; choose the timing of treatment according to the seasons.

There are nine methods of acupuncture, used to address nine kinds of disorders.

The first is “shu needling”: needling the Ying and Shu points along the meridians, as well as the Shu points associated with the five Zang organs. The Ying and Shu points are points along the meridians, while the Zang Shu points are linked to the five Zang organs.

The second is “distal needling”: when the disorder is in the upper body, points are selected in the lower body, and the Shu points of the six Fu organs are needled.

The third is “meridian needling”: needling the collateral vessels where they gather along the major meridians, as well as the pathways followed by the meridians.

The fourth is “collateral needling”: needling the blood vessels within the fine collaterals.

The fifth is “cleft needling”: needling the spaces between the divisions of the muscles.

The sixth is “strong draining needling”: using a pi needle—a broad-shaped instrument used to make an incision and drain pus—to treat large abscesses.

The seventh is “hair-thin needling”: inserting the needle shallowly into the skin to treat superficial Bi disorders, such as numbness and pain caused by pathogenic Qi lingering at the body’s surface.

The eighth is “contralateral needling”: when the disorder is on the left, points are selected on the right; when it is on the right, points are selected on the left.

The ninth is “heated needling”: heating the needle before insertion to treat Bi disorders.

There are twelve categories of needling methods, corresponding to the twelve meridians.

The first is “paired needling”: press the corresponding points on the front of the chest and the back to locate the painful area, then insert one needle at each point, front and back. This is used to treat heart Bi syndrome, in which pathogenic Qi obstructs the heart meridian and causes Bi pain. Insert the needles from the sides of the affected areas.

The second is “responsive needling”: this is used when pain shifts from place to place, moving up and down. Insert the needle and leave it in place while the left hand searches along the path of the moving pain. Once the painful spot is found, remove the needle and insert it at that spot.

The third is “spreading needling”: insert the needle straight in beside the affected area, then lift it and move it forward and backward to loosen tense sinews and vessels. This is used to treat sinew Bi syndrome, in which pathogenic factors cause stiffness and pain in the sinews and vessels.

The fourth is “three-point needling”: insert one needle at the center and two more on either side. This is used to treat conditions caused by Cold that has invaded only superficially. Also called “three needlings,” it can be used for Bi syndromes in which pathogenic Qi has not penetrated deeply.

The fifth is “radiating needling”: insert one needle at the center and one at each of four surrounding points, keeping the needles shallow. This is used to treat conditions caused by Cold over a broad area.

The sixth is “straight needling”: first lift the skin, then insert the needle. This is used to treat Cold lodged at the body’s surface.

The seventh is “draining needling”: insert and withdraw the needle straight, with little lifting or movement, and penetrate deeply. This is used to treat conditions in which pathogenic Qi is strong and the body is feverish.

The eighth is “short needling”: this is used to treat bone Bi syndrome, in which pathogenic Qi obstructs the bones and causes pain. Slowly rock the needle as it is inserted deeper until it reaches the edge of the bone, then move it up and down.

The ninth is “floating needling”: insert the needle shallowly from the side. This is used to treat tense muscles accompanied by signs of Cold.

The tenth is “Yin needling”: needle corresponding points on the left and right sides. This is used to treat Cold reversal, in which Cold causes the limbs to become cold. The text specifically notes that Cold reversal can be treated at the Foot Shaoyin meridian behind the ankle.

The eleventh is “adjacent needling”: insert one needle straight into the affected area, then insert another from the side. This is used to treat Bi syndrome in which pathogenic Qi has remained for a long time.

The twelfth is “rapid needling”: insert and withdraw the needle rapidly and repeatedly, keeping it shallow and causing bleeding. This is used to treat abscesses and swellings: localized conditions involving redness, swelling, and pus.

When the vessels lie deep and cannot be seen, insert the needle gently and retain it for a longer time, so that the needle’s Qi reaches the vessels. When the vessels are superficial, do not pierce them directly. First press them closed, then insert the needle, preventing Jing and Qi from escaping while allowing only pathogenic Qi to be expelled.

The “three insertions that bring forth Grain Qi”—the body’s vital energy produced from food—refer to this process: first, insert the needle shallowly through the skin to expel Yang pathogens; second, insert it a little deeper, beneath the skin and close to the muscles but not yet into the spaces between them, to expel Yin pathogens; when the needle reaches those spaces, Grain Qi appears. The Classic of Needling Methods describes this same process: first needle shallowly to drive out pathogens and stir the Blood and Qi; then needle more deeply to draw out Yin pathogens from within; finally, needle deepest to guide forth Grain Qi.

Therefore, anyone who practices needling but does not understand how seasonal changes affect the body, or how Qi waxes and wanes and deficiency and excess arise, cannot be considered a qualified physician.

There are five needling methods, each corresponding to one of the Five Zang organs.

The first is half needling: insert the needle shallowly and withdraw it at once, without injuring the muscles, as if plucking a hair. It regulates the Qi of the skin and corresponds to the lungs.

The second is leopard-spot needling: needle at several points on the left and right, front and back of the body, aiming to reach the vessels. It regulates stagnant Blood in the channels and vessels and corresponds to the heart.

The third is joint needling: insert the needle straight in on both sides, reaching the tendons. It treats tendon impediment, such as tightness and pain in the sinews, and must be performed carefully without drawing Blood. It is also called deep-pool needling; another account calls it qi needling. This method corresponds to the liver.

The fourth is joined-valley needling: make separate insertions on the left and right, like a chicken’s foot, reaching the spaces between the muscles. It treats muscle impediment, such as numbness or pain in the muscles, and corresponds to the spleen.

The fifth is transport needling: insert and withdraw the needle straight, penetrating deeply to the bone. It treats bone impediment, such as numbness or pain in the bones, and corresponds to the kidneys.

The Yellow Emperor asked Qibo: “Whenever acupuncture is practiced, one must first understand a person’s ‘spirit.’ Blood, the vessels, nutritive Qi, defensive Qi, and the mental spirit are vital elements stored in the Five Zang organs. If they are excessively depleted and leave the places where they are stored, essence and Qi are harmed, the hun and po souls become unsettled, intention and will are confused, and the mind and thoughts cannot concentrate. Is this innate, or is it caused by the person? What are De (Virtue/Power), Qi (vital energy), life, Jing (essence), Shen (spirit), hun, po, heart, intention, will, thought, intelligence, and deliberation? Please explain how these are related.” Here, “spirit” is a general term in Chinese medicine for mental and conscious activity; “nutritive Qi” and “defensive Qi” are traditional medical terms for different functional forms of Qi in the body.

Qibo replied: Heaven endows human beings with De (Virtue/Power); Earth endows them with Qi (vital energy). De and Qi flow into and join with each other, and life arises from this. At its beginning, life is called Jing (essence), the subtle material that forms the living body. When two essences unite, this is called Shen (spirit), the activity of life and the awareness of the mind. What moves back and forth with Shen is called Hun (the soul associated with mental activity); what attaches to Jing and enters and leaves with it is called Po (the soul associated with perception and instinct). The capacity to receive external things and respond to them is called the heart. When the heart holds something in mind, this is called intention; when intention focuses on something, this is called purpose; when purpose repeatedly explores changes, this is called thought; when thought pursues and plans further, this is called deliberation; and when deliberation enables one to handle things properly, this is called wisdom.

Therefore, those who are wise in preserving life must follow the changes of the four seasons and adapt to cold and heat; regulate emotions of joy and anger, and establish a settled daily routine; keep Yin-Yang in balance and harmonize strength with gentleness. In this way, harmful influences will not enter, and life can be prolonged.

Thus, prolonged shock, fear, worry, and contemplation damage Shen. When Shen is harmed, one becomes fearful and unsettled, emotions slip out of control, and it is difficult to stop them. Grief that becomes knotted within depletes Jing-Qi and harms life. Excessive joy exhausts and scatters Shen-Qi, leaving it unable to gather itself. Sorrow and worry obstruct the movement of Qi. Great anger throws a person into confusion and makes self-regulation impossible. Fear agitates Shen-Qi, leaving it unsettled and unable to collect itself.

Shock, fear, worry, and contemplation in the heart damage Shen. When Shen is harmed, fear becomes disordered; the muscles waste away and their tissue is lost, the hair becomes dry and withered, and the complexion grows dull. Death may come in winter. When the Spleen is burdened by sorrow and worry that cannot be relieved over a long period, it damages intention. When intention is harmed, the mind becomes confused and thoughts disordered; the limbs grow weak, the hair becomes dry and withered, and the complexion grows dull. Death may come in spring. Grief that becomes knotted within the Liver damages Hun. When Hun is harmed, behavior becomes erratic and one becomes forgetful; the mind cannot focus, making it difficult to act with propriety. The genitals may contract, the sinews may cramp, and movement around the ribs may become impaired. The hair becomes dry and withered, and the complexion grows dull. Death may come in autumn. Excessive joy in the Lungs damages Po. When Po is harmed, behavior becomes erratic and the mind takes no interest in other people; the skin becomes dry, the hair becomes dry and withered, and the complexion grows dull. Death may come in summer. Unrelenting great anger in the Kidneys damages purpose. When purpose is harmed, one readily forgets what one said earlier, and the back and lower back can no longer bend and straighten freely. The hair becomes dry and withered, and the complexion grows dull. Death may come in late summer, the final month of summer.

Prolonged fear that cannot be dispelled can damage Jing and Qi. When Jing and Qi are damaged, symptoms such as aching bones, weakness or coldness in the limbs, and sometimes involuntary seminal emission may occur. The five Zang organs store Jing and Qi and must not be damaged. Once harmed, they can no longer keep Jing and Qi secure, leading to Yin deficiency. Yin deficiency deprives the body of Qi’s support; when Qi is exhausted, life is in danger. Therefore, the practitioner of acupuncture should observe the patient’s appearance and demeanor to judge whether the spirit, Hun, Po, and other aspects are intact. If these foundations of body and mind have already been damaged, acupuncture cannot treat the condition.

The liver stores blood, and the Hun resides in the blood. When liver Qi is weak, a person is prone to fear; when liver Qi is excessive, they are prone to anger. The spleen stores nutritive Qi, and the Yi resides in it. When spleen Qi is weak, the limbs lack strength and the functions of the five Zang organs become disordered. When spleen Qi is excessive, the abdomen becomes distended, and urination and bowel movements become difficult. The heart stores the vessels, and the Shen resides in them. When heart Qi is weak, a person is prone to sorrow; when heart Qi is excessive, they laugh incessantly. The lungs store Qi, and the Po resides in it. When lung Qi is weak, the nose is blocked, breathing is difficult, and the breath is short. When lung Qi is excessive, breathing becomes rapid and noisy, the chest feels distended, and the person can only raise their head to gasp. The kidneys store Jing, and the Zhi resides in it. When kidney Qi is weak, coldness or counterflow of Qi may occur; when kidney Qi is excessive, the body becomes distended and the functions of the five Zang organs become unsettled. In diagnosis and treatment, one must carefully distinguish the conditions of the five Zang organs, determine whether the Qi of each organ is deficient or excessive, and then regulate it with care.

Pronunciation note: In menluan, the character men is pronounced “men.” In chuti, chu is pronounced “chi-lü” and ti is pronounced “ta-de”; the phrase means to be startled or afraid.

The principles of acupuncture lie in the teachings of the Zhongshi (“Beginning and End”). Once one understands the changes in the beginning and end of Qi in the Yin and Yang channels, the Five Zang organs can serve as the framework for distinguishing Yin from Yang. Yin governs the Five Zang organs, while Yang governs the Six Fu organs. Yang Qi is received at the extremities of the limbs, and Yin Qi is received by the Five Zang organs. Thus, to drain, one inserts the needle against the direction in which channel Qi flows; to supplement, one inserts it in the direction of the flow. Understanding the principles of opposing and following allows channel Qi to be harmonized. To harmonize channel Qi, Yin and Yang must be brought into communication. The Five Zang organs belong to Yin, and the Six Fu organs belong to Yang. These teachings should be passed down to later generations and solemnly safeguarded with an oath sealed in blood. Those who honor them will prosper; those who slight them will fall. Anyone who abandons the proper way and acts recklessly will surely meet with disaster.

I follow the Way of Heaven in explaining the essential meaning of the Zhongshi. This text takes the channels as its guiding framework. By examining the Cunkou pulse at the wrist and the Renying pulse at the carotid artery, one can determine whether Yin and Yang are excessive or deficient, harmonized or out of balance. In this way, one grasps the Way of Heaven. A healthy person is one who has no illness. In a healthy person, the Cunkou and Renying pulses change with the four seasons, correspond to each other in their rise and fall, and move in harmony; the Qi of the Six Channels shows neither obstruction nor abnormal throbbing; warmth and coolness at the body’s extremities and trunk are in balance; and the person’s build, muscles, blood, and breath are in proportion. This is what is meant by a healthy person.

In someone with deficient Qi, the pulses at both Cunkou and Renying are weak and do not correspond to the pulses at the wrist and forearm. This shows that both Yin and Yang are deficient. Supplementing Yang may deplete Yin Qi; draining Yin may cause Yang Qi to escape. In such cases, one may nourish the person with sweet-tasting medicines, but must not use medicines that are too potent. Moxibustion should also be avoided. If the condition does not improve and draining is continued, the Qi of the Five Zang organs will be damaged.

If the Renying pulse is twice as strong as the Cunkou pulse, the illness lies in the Foot Shaoyang Channel. If it is twice as strong and also agitated, the condition is serious, and potent medicines should be used. Do not apply moxibustion in such cases. If the illness persists and draining is continued, the Qi of the Five Zang organs will be damaged.

When the pulse at the welcoming point (the pulse at the carotid artery in the neck) is twice as strong as usual, the illness is in the Foot Shaoyang channel. If the pulse is also forceful, rapid, and agitated, the illness is in the Hand Shaoyang channel. When the pulse is three times as strong, the illness is in the Foot Taiyang channel; if it is also rapid and agitated, the illness is in the Hand Taiyang channel. When it is four times as strong and the pulse is broad and rapid, this is called “Yang overflow” (Yang Qi surging outward). The condition is then called “external blockage,” as Yang Qi is obstructed on the outside.

When the pulse at the wrist (the pulse at the cun-kou position) is twice as strong as usual, the illness is in the Foot Jueyin channel. If the pulse is also forceful, rapid, and agitated, the illness is in the Hand Heart-Master channel—that is, the Hand Jueyin Pericardium channel. When the wrist pulse is three times as strong, the illness is in the Foot Shaoyin channel; if it is also rapid and agitated, the illness is in the Hand Shaoyin channel. When it is four times as strong, and the pulse is broad and rapid, this is called “Yin overflow” (Yin Qi surging inward). The condition is then called “internal closure,” as Yin Qi is blocked within. Internal closure prevents Qi and blood from circulating. It is a critical condition that is difficult to treat.

When both the welcoming pulse and the Taiyin pulse at the wrist are more than four times as strong as usual, this is called “blockage and separation”: Yin and Yang Qi obstruct one another. The prognosis is poor, and life will be short.

When the welcoming pulse is twice as strong as usual, drain the Foot Shaoyang channel and supplement the Foot Jueyin channel, draining twice for each supplementation, and treat once a day. Carefully examine and verify the pulse during treatment. Insert the needles sparingly and shallowly; stop treatment once the breathing has become harmonious.

When the welcoming pulse is three times as strong as usual, drain the Foot Taiyang channel and supplement the Foot Shaoyin channel, draining twice for each supplementation, and treat once every two days. Carefully examine and verify the pulse at each treatment. Insert the needles sparingly and shallowly, and stop once the breathing has become harmonious. When the welcoming pulse is four times as strong as usual, drain the Foot Yangming channel and supplement the Foot Taiyin channel, draining twice for each supplementation, and treat twice a day. Carefully examine and verify the pulse at each treatment. Insert the needles sparingly and shallowly, and stop once the breathing has become harmonious.

When the pulse at the wrist, a site used for pulse diagnosis, is twice as vigorous as usual, drain the Foot Jueyin channel and supplement the Foot Shaoyang channel. Supplement twice and drain once, treating with needles once a day. Before each treatment, carefully palpate the pulse and observe the effect. Insert the needles gently and at points higher on the body; stop once the flow of Qi is harmonized.

When the wrist pulse is three times as vigorous as usual, drain the Foot Shaoyin channel and supplement the Foot Taiyang channel. Supplement twice and drain once, treating with needles every other day. Each time, carefully palpate the pulse and observe the effect. Insert the needles gently at points higher on the body, and stop once the flow of Qi is harmonized.

When the wrist pulse is four times as vigorous as usual, drain the Foot Taiyin channel and supplement the Foot Yangming channel. Supplement twice and drain once, treating with needles twice a day. Each time, carefully palpate the pulse and observe the effect. Insert the needles gently at points higher on the body, and stop once the flow of Qi is harmonized. Treatment is given twice a day because the Taiyang channel governs the stomach, where the grain Qi is abundant, so treatment can be given twice daily.

When both the pulse at the neck, a site used to examine the pulse, and the wrist pulse show an excess in the Foot Taiyin channel, drain the Foot Taiyin channel and supplement the Foot Yangming channel. Supplement twice and drain once, treating with needles twice a day. Each time, carefully palpate the pulse and observe the effect. Insert the needles gently at points higher on the body, and stop once the flow of Qi is harmonized. Treatment is given twice a day for the same reason: the Taiyang channel governs the stomach, where the grain Qi is abundant, so treatment can be given twice daily.

If both the neck pulse and the wrist pulse become more than three times as vigorous as usual, this is called “Yin and Yang both overflowing.” In such a case, if the channels are not opened, the blood vessels will become obstructed, leaving Qi with nowhere to circulate. It will stagnate in the body and go on to damage the Five Zang organs. If moxibustion is applied at this point, the condition will instead change and develop into other disorders.

The principle of needling is this: once the flow of Qi is harmonized, stop. Supplementing Yin and draining Yang makes a person’s voice and breathing stronger, and the senses of hearing and sight clearer. If treatment proceeds in the opposite direction, Qi and blood will fail to circulate normally.

“Qi arriving and producing an effect” means that after draining, the pulse should become more yielding: its size remains much as before, but it is no longer firm. If it remains as firm as before, the illness has not yet been dispelled, even if an effect seemed apparent just then. After supplementation, the pulse should become firmer: its size remains much as before, but it is firmer than it was. If it remains much as before but is not firm, the illness has not yet been dispelled, even if the person felt better just then. Supplementation therefore makes Qi and blood abundant, while draining weakens pathogenic Qi. Even if the pain does not ease immediately after needling, the illness will certainly subside.

One must first understand the disorders governed by each of the twelve channels. Only then can one grasp the principles of needling set out in the “Beginning and Ending” chapter. In this way, Yin and Yang Qi will not become confused with one another, and deficiency and excess will not be mistaken for one another; treatment should follow the channel corresponding to the condition.

Treating various diseases with acupuncture usually requires three insertions before Grain Qi—the vital energy produced by the Spleen and Stomach to nourish the whole body—arrives. Only then can one discern the disorders arising in the Twelve Channels and grasp the principles of acupuncture set out in the “Beginning and End” chapter. Yin and Yang Qi must not be allowed to transform into one another, and deficiency and excess must not be confused. Treatment should target the corresponding channel.

During acupuncture, disordered pathogenic Qi mixes and intermingles, reversing the positions of Yin and Yang and throwing the flow of channel Qi into disorder; the depths and superficial layers are also affected. When Qi and blood fail to move in accord with the seasons, pathogenic Qi becomes lodged and spreads, and the needle must be used to drive it out. The first insertion expels pathogenic Qi from the Yang aspect; the second expels it from the Yin aspect; the third brings Grain Qi. Once Grain Qi arrives, acupuncture should stop. The arrival of Grain Qi means that the reinforcing method fills what is deficient, while the reducing method empties what is congested. Even if only the pathogenic Qi has been expelled and Yin and Yang have not yet fully harmonized, the patient will feel some improvement. Thus the reinforcing method turns deficiency into sufficiency, while the reducing method turns excess into deficiency. Even if the pain does not ease immediately after needling, the illness will decline.

When Yin Qi is excessive and Yang Qi deficient, first reinforce Yang, then reduce Yin, so that Yin and Yang are brought into harmony. When Yin Qi is deficient and Yang Qi excessive, first reinforce Yin, then reduce Yang, to restore their harmony.

Between the big toe and the second toe, three pulses can be felt; their deficiency or excess must be carefully distinguished. If the condition is one of deficiency, reducing Yang Qi and then reducing Yin Qi in an attempt to restore harmony will only deepen the deficiency and worsen the illness. In treating such conditions, assess the pulses with the fingers: if a pulse is full and rapid, apply the reducing method promptly; if it is weak and slow, apply the reinforcing method. Using the opposite method will worsen the condition. Of the three pulse positions, the Yangming pulse is above, the Jueyin pulse is in the middle, and the Shaoyin pulse is below.

Points on the chest should be selected on the chest, and points on the back on the back. For weakness in the shoulder or scapular region, select points in the upper part of the body. For swelling beneath the tongue, known as a double tongue, use a lancet-shaped needle to pierce the tongue pillar, at the site of the lingual frenulum. If the arm can bend but cannot straighten, the disorder lies in the sinews; if it can straighten but cannot bend, the disorder lies in the bones. When the disorder lies in the bones, attend to the bones; when it lies in the sinews, attend to the sinews.

When needling, if Qi on one side is full, insert the needle more deeply and apply less pressure to the needle opening, allowing pathogenic Qi to leave as fully as possible. If Qi on one side is deficient, needle shallowly to regulate and nourish the channels, then press the needle opening promptly to prevent pathogenic Qi from entering. When pathogenic Qi arrives, the pulse is rapid and tense; when Grain Qi—the upright Qi produced from food and nourishing the body—arrives, the pulse is slow and calm. If the pulse is full, needle deeply to drain its Qi. If the pulse is deficient, needle shallowly so that Jing and Qi do not escape, nourishing the channels while expelling pathogenic Qi. Painful disorders generally present with a full pulse.

Thus, disorders above the waist are chiefly governed by the Hand Taiyin (Lung) and Hand Yangming (Large Intestine) channels; disorders below the waist are chiefly governed by the Foot Taiyin (Spleen) and Foot Yangming (Stomach) channels. For a disorder in the upper body, points may be selected on the lower body; for one in the lower body, points may be selected higher up. For a disorder of the head, points on the feet may be selected; for a disorder of the waist, points in the popliteal hollow—the bend behind the knee—may be selected. When illness originates in the head, the head feels heavy; when it originates in the hand, the arm feels heavy; when it originates in the foot, the foot feels heavy. Treatment should begin by needling the source from which the pathogenic influence arose.

In spring, Qi is in the skin and body hair; in summer, it is in the skin; in autumn, it is between the muscles; in winter, it is in the sinews and bones. When needling disorders in these locations, the depth of insertion should be determined according to the season. For people with a heavy build, use the standards for autumn and winter; for those who are thin and weak, use the standards for spring and summer.

Pain belongs to Yin. If pressing the painful area with the hand does not relieve it, that too belongs to Yin, and the needle should be inserted deeply. Disorders in the upper body belong to Yang, and those in the lower body belong to Yin. Itching belongs to Yang and should be treated with shallow needling.

If a disease begins in a Yin channel, first treat the Yin channel, then the Yang channel. If it begins in a Yang channel, first treat the Yang channel, then the Yin channel. When needling heat reversal, caused by pathogenic heat, retaining the needle may make the patient feel cold; when needling cold reversal, caused by pathogenic cold, retaining the needle may make the patient feel hot. To treat heat reversal, needle the Yin channels twice and the Yang channels once; to treat cold reversal, needle the Yang channels twice and the Yin channels once. “Two Yin” means needling the Yin channels twice; “one Yang” means needling the Yang channels once.

As an illness persists, pathogenic Qi penetrates deeper. When needling to treat such illnesses, insert the needles more deeply and retain them longer, then needle again the following day. Before treatment, first regulate both sides of the body and clear stagnant blood from the channels; these are the essentials of needling.

Whenever needling, observe the patient’s physique and breathing. If the body and muscles have not yet wasted away, but the breath is weak and the pulse agitated, with disordered Qi movement and cold, convulsed hands and feet, use crossed needling (needling the channels or points opposite the affected side). Scattered Qi can be gathered, and congealed Qi can be dispersed.

During needling, have the patient remain quietly in a secluded place, and observe changes in their Shen. Close the doors and windows so the mind is undisturbed by the outside world. Keep the Shen guarded and the mind focused; do not listen to other people’s voices, so that Jing and Qi can be gathered. Make the mind entirely still and direct attention to the needling. Needle shallowly and retain the needle, using gentle, superficial techniques to distract the patient; stop once Qi arrives—the sensation of Qi beneath the needle. Carefully control the needle’s insertion and withdrawal, allowing neither Qi to escape nor pathogenic Qi to enter. This is called attaining Qi.

Acupuncture has a number of contraindications. Do not receive acupuncture just after sexual intercourse, and do not have sexual intercourse just after acupuncture. Do not receive acupuncture after drinking alcohol, and do not drink after acupuncture. Do not receive acupuncture when you have just become angry, and do not become angry after acupuncture. Do not receive acupuncture when you are exhausted, and do not overexert yourself afterward. Do not receive acupuncture just after eating your fill or when hungry, and afterward do not eat too much or go hungry. Do not receive acupuncture when thirsty, and afterward do not let yourself become excessively thirsty. After a great shock or fright, first let your breathing settle before acupuncture is administered.

Those who arrive by carriage should rest outdoors first, for about the time it takes to eat a meal, before receiving acupuncture. Those who have walked a long distance should sit and rest first, for about the time it takes to walk ten li. There are twelve such contraindications in all. In these conditions, the pulse is easily disrupted, the breath becomes scattered, and the Ying Qi and Wei Qi—the two kinds of Qi that circulate within the body and protect its surface—fall out of balance; the flow of the channels also becomes disordered. Acupuncture at such a time may drive a pathogenic influence from the Yang aspect deeper into the Yin aspect, or cause one from the Yin aspect to emerge into the Yang aspect, allowing the pathogenic influence to arise again. If an unskilled practitioner fails to recognize these conditions, the treatment harms the body: the physical form is invaded by pathogenic influences, the brain and marrow are gradually depleted, fluids cannot be generated, and the vital essences of the Five Flavors are lost. This is called “loss of Qi.”

When the Qi of the Taiyang channel is depleted, the eyes roll upward, the body arches backward, the hands and feet convulse, and the face turns pale. The skin loses its normal condition, and then sweat escapes. Once the sweat is lost, death follows.

When the Qi of the Shaoyang channel is depleted, deafness occurs and the joints throughout the body become slack. The ocular network—the channel linking the eyes to the brain—is severed. Death follows a day and a half after this network is severed; at death, the face is bluish white.

When the Qi of the Yangming channel is depleted, the mouth and eyes twitch involuntarily. The person is easily startled and speaks incoherently, and the face turns yellow. If the Qi of the channels above and below becomes congested and cannot circulate, death follows.

When the Qi of the Shaoyin channel is depleted, the face turns black, the teeth appear elongated and become coated with grime, and the abdomen becomes distended and blocked. The body is obstructed from top to bottom, and death follows.

When the Qi of the Jueyin channel is depleted, heat arises within the body, the throat becomes dry, urination is frequent, and the mind is agitated. In severe cases, the tongue curls and the testicles retract; death follows.

When the Qi of the Taiyin channel is depleted, the abdomen becomes distended and blocked, breathing is difficult, and the person often belches and vomits. During vomiting, the Qi mechanism surges upward and the face turns red. If there is no upward surge, the body is obstructed from top to bottom; the face turns black, the skin and hair become withered, and death follows.

This section explains several pronunciations and textual variants. In “mou ci,” the character mou is pronounced jiu; in “yin luo,” luo is pronounced shu; and in “chi chang,” chang has a level tone. The phrase “men nei nü wai” (“men inside, women outside”) appears in the Nanjing as “men wai nü nei” (“men outside, women inside”).

The scripture says: If the complexion turns red while the illness has not yet become disordered, this means the meridians above and below are still not flowing freely. When the upper and lower regions are blocked, the complexion turns black, the skin and hair become parched and withered, and death ultimately follows.

The textual notes point out that some passages in the Taisu differ from the corresponding text in this work. For example, zao (“restless”) appears as mai (“pulse”), and taiyang (“Greater Yang”) as taiyin (“Greater Yin”). Some editions omit the characters jian (“diminish”) and yi (“by”), which the editors supplied from the Jia Yi Jing or the Taisu. In some editions, zhi (“it”) is replaced by bu (“not”). In light of the surrounding context, “shu er qu shang” may instead have been intended as “shu qu zhi shang.” These notes record textual emendations among different transmitted editions.

The ending identifies the volume and chapter: this is volume five of the Huangdi Neijing Lingshu Jizhu, and the chapter is “Jingmai,” chapter ten.

Lei Gong asked the Yellow Emperor to explain the principles of acupuncture described in The Prohibition of the Channels. Acupuncture, he said, should begin with the channels: one must understand the routes and measures by which Qi and blood circulate, and distinguish how the channels connect with the five internal organs and the six organs at the body’s surface. The Yellow Emperor replied that when a person first takes shape, Jing (essence) forms first. Once Jing is abundant, the brain and marrow develop. The bones support the body, the channels carry Qi and blood, the sinews strengthen the body, and the flesh protects it like a wall. After the five grains enter the stomach, the channels become unobstructed, allowing Qi and blood to circulate.

Lei Gong then asked how the channels begin to form. The Yellow Emperor answered that the channels are essential for discerning life and death, treating many kinds of illness, and regulating weakness and excess in the body; for this reason, they must be thoroughly understood.

The Hand Taiyin Lung Channel, one of the twelve channels and connected to the lungs, begins in the Middle Burner, the region of the chest and abdomen where the spleen and stomach are located. It descends to connect with the large intestine, then curves back around the entrance to the stomach. From there it rises through the diaphragm and belongs to the lungs. From the lung system, it runs sideways to the armpit, then descends along the inner side of the upper arm, passing in front of the Hand Shaoyin Heart Channel and the Hand Jueyin Pericardium Channel before reaching the inner elbow. It then continues down along the inner side of the forearm.

The Hand Taiyin Lung Channel, a channel running through the arm and connected with the lungs, begins in the Middle Burner, the area of the spleen and stomach in the upper abdomen. It descends to connect with the large intestine, then returns upward along the entrance to the stomach, passes through the diaphragm, and connects with the lungs. From the lung system—the area connecting the lungs and throat—it extends sideways beneath the armpit, then runs down the inner upper arm, in front of the Hand Shaoyin Heart Channel and the Hand Jueyin Pericardium Channel. It reaches the inner elbow, continues along the inner forearm, and enters the Cun Kou, the pulse area at the wrist, beside the lower edge of the radius. From there it runs upward to Yu, the raised area at the base of the thumb, follows the Yuji, the muscle on the palm side of the thumb’s base, and ends at the tip of the thumb. A branch separates behind the wrist, runs directly to the inner side of the index finger, and ends at its tip.

When this channel is disturbed, symptoms may include fullness in the lungs, distension in the chest and diaphragm, wheezing and coughing, and pain in the hollow above the collarbone. In severe cases, the person crosses both arms over the chest and becomes mentally clouded. This condition is called “arm reversal,” a disorder in which Qi and blood flow abnormally through the channels of the arms.

This channel governs disorders of the lungs, including coughing, rebellious Qi with wheezing, thirst, irritability, fullness in the chest, pain along the front of the inner upper arm and forearm, coldness and numbness in the arms, or heat in the palms.

When the channel Qi is excessive, symptoms may include pain in the shoulders and back, aversion to wind and cold, sweating, and an increased susceptibility to wind. Urination may be frequent but scant. When the channel Qi is deficient, there may be pain in the shoulders and back, aversion to cold, shortness of breath, difficulty drawing a full breath, and abnormally colored urine.

Treatment should be chosen according to whether the condition is deficient or excessive, cold or hot: drain when the channel Qi is excessive and supplement when it is weak; use rapid needling for heat conditions and retain the needles longer for cold conditions; use moxibustion when the channel Qi has sunk. When there is neither excess nor deficiency, treat by selecting points along this channel. Channel Qi is considered excessive when the Cun Kou pulse is three times stronger than the Renying pulse; when the channel Qi is deficient, the Cun Kou pulse is weaker than the Renying pulse.

The Large Intestine Channel of Hand Yangming begins at the tip of the index finger. It travels upward along the thumb side of the finger, passes through Hegu (the point between the thumb and index finger), and enters between two tendons. It then ascends along the outer forearm, passes the outer elbow and the anterolateral side of the upper arm, and reaches the shoulder. Passing the front edge of the acromion, it ascends to a point above the prominent vertebrae at the back of the neck, then descends into Quepen (the hollow above the collarbone), connects with the Lungs, crosses the diaphragm, and belongs to the Large Intestine.

A branch of the channel ascends from Quepen to the neck, crosses the cheek, enters the lower gums, then turns back toward the face and circles along both sides of the mouth. The two sides meet at the philtrum: the channel on the left connects to the right, and the channel on the right connects to the left. It finally ascends to the area beside the nostrils.

When the channel’s circulation is disrupted, toothache and swelling of the neck may occur. The Large Intestine Channel governs disorders related to bodily fluids, so its associated ailments also include yellowing of the eyes, dry mouth, nasal congestion or nosebleeds, throat obstruction and pain, pain in the front of the shoulder and upper arm, and pain or restricted movement in the index finger. When channel Qi is excessive, the areas along its course become hot and swollen; when Qi is deficient, they become cold and tremble, and the body cannot return to normal. To treat these conditions, use reducing methods when channel Qi is excessive and reinforcing methods when it is deficient. For heat, use rapid needling; for cold, retain the needles. When Qi and blood sink, use moxibustion. If there is neither excess nor deficiency, select points along the channel itself. Excess is indicated when the pulse at Renying (the pulse at the Renying point on the neck) is three times stronger than the pulse at Cunkou (the pulse at the wrist). In deficiency, the Renying pulse is weaker than the Cunkou pulse.

The Stomach Channel of Foot Yangming begins at the meeting point beside the root of the nose and connects nearby with the channel of the Bladder of Foot Taiyang. (Another version of the text reads “binds to” instead of “connects with.”) It descends along the outer side of the nose, enters the upper gums, then turns back toward the face and circles both sides of the mouth. It descends to meet at Chengjiang (the point below the lower lip), then follows the edge of the lower jaw backward, passes Daying, and continues along the area of Jiache.

The Stomach channel of Foot-Yangming begins at the center of the root of the nose, where it connects with the Taiyang channel beside it. It descends along both sides of the nose, enters the upper gums, then turns back, passes beside the mouth, and circles the lips. It descends to meet at Chengjiang, the point directly below the lower lip. From there, it runs along the lower edge behind the jaw to Daying, then travels upward across the cheek to the front of the ear. It passes through Kerenzhu, also called Shangguan, follows the hairline, and reaches the forehead.

One branch descends from the area in front of Daying, passes through Renying, follows the throat into Quepen, the hollow above the collarbone, then descends through the diaphragm, connects with the Stomach, and links with the Spleen. A second branch runs directly downward from Quepen, following the inner side of the breast and passing beside the navel before entering Qijie, the area near the groin. Another branch descends from the Stomach’s opening, follows the inner side of the abdominal cavity to Qijie, and joins the preceding channel. It then continues downward past Biguan and Futu to the center of the knee, runs down the outer side of the lower leg, passes over the top of the foot, and enters the inner side of the middle toe. A further branch separates below the knee, three cun down, and descends to the outer side of the middle toe. One more branch separates on the top of the foot, enters the space between the big toe and second toe, and emerges at the tip of the big toe.

When this channel is disordered, symptoms may include chills and shivering, frequent groaning and yawning, and a dark complexion. In severe cases, the person may be averse to people and firelight. The sound of wood may cause alarm and agitation, making the person want only to shut the doors and windows and remain alone. In more severe cases, the person may climb to high places and sing, strip off their clothes, and run about; rumbling in the abdomen and abdominal distension may also occur. This pattern is called “calf reversal,” referring to a disorder associated with the rebellious flow of channel Qi in the lower legs.

The Stomach channel governs the movement of Qi and Blood. Related disorders include mania, malaria, fever with profuse sweating, nasal congestion or nosebleeds, deviation of the mouth, sores on the lips, swelling of the neck, throat obstruction and pain, abdominal distension or edema, and swelling and pain in the knee. Pain may also occur along the channel’s course through the chest, breasts, Qijie, thigh, Futu, outer lower leg, and top of the foot; the middle toe may also become difficult to move.

When the channel’s Qi is abundant, the front of the body becomes hot. When there is excess in the Stomach, food is digested quickly, hunger comes easily, and the urine turns yellow. When the channel’s Qi is deficient, the front of the body becomes cold and shivery; if the Stomach is cold, the abdomen becomes distended and full. In treatment, drain excess patterns and supplement deficiency patterns. For heat patterns, insert the needles quickly; for cold patterns, retain them longer. Moxibustion may be used when Qi and Blood have sunk. When neither excess nor deficiency predominates, treat according to the usual method for this channel. To determine whether the condition is deficient or excessive, compare the Renying pulse at the carotid artery with the Cunkou pulse at the wrist: if the Renying pulse is three times stronger than the Cunkou pulse, the condition is excessive; if it is weaker, the condition is deficient.

The Foot Greater Yin Spleen Channel begins at the tip of the great toe. Where the channel lies in a depression, apply moxibustion. When the pulse is neither excessive nor deficient, treat according to the channel’s usual method. If the Renying pulse is three times greater than the Cunkou pulse, the channel is excessive; if the Renying pulse is smaller than the Cunkou pulse, the channel is deficient.

The Foot Greater Yin Spleen Channel starts at the tip of the great toe and ascends along the boundary between the red flesh and the skin on the inner side of the toe. It passes behind the navicular bone, then rises along the front of the inner ankle and enters the inner side of the lower leg. Following the back of the tibia, it crosses in front of the Foot Reversal Yin Liver Channel and continues upward along the front of the inner thigh. It enters the abdomen, connects with the Spleen, and links to the Stomach. It then ascends through the diaphragm, passes alongside the throat, connects to the root of the tongue, and spreads beneath the tongue. A branch separates from the Stomach, ascends through the diaphragm, and flows into the Heart.

When the channel’s Qi is abnormal, symptoms may include stiffness at the root of the tongue; vomiting upon eating; pain in the epigastrium; abdominal distension; and frequent belching. The person feels relief after defecating or passing gas, as though the illness has eased, and may also feel heaviness in the body. Spleen-related disorders governed by the Foot Greater Yin Spleen Channel also include pain at the root of the tongue, difficulty moving the body freely, loss of appetite, vexation in the chest, cramping pain in the pit of the stomach, loose stools, abdominal masses or diarrhea, inability to urinate, jaundice, inability to lie down comfortably, and swelling and coldness along the inner thigh and knee when forced to stand. The great toe may also be difficult to move freely.

To treat these disorders, use the reducing method when the channel is excessive and the reinforcing method when it is deficient. Treat heat promptly; when there is cold, retain the needle longer. Apply moxibustion where the channel lies in a depression. When the channel is neither excessive nor deficient, treat according to its usual method. If the Cunkou pulse is three times greater than the Renying pulse, the channel is excessive; if the Cunkou pulse is smaller than the Renying pulse, the channel is deficient.

The Hand Lesser Yin Heart Channel emerges from the Heart and connects with the Heart network, the vessels linked to the Heart. If there is heat, treat promptly; if there is cold, retain the needle longer. Apply moxibustion where the channel lies in a depression. When the channel is neither excessive nor deficient, treat according to its usual method. If the Cunkou pulse is three times greater than the Renying pulse, the channel is excessive; if the Cunkou pulse is smaller than the Renying pulse, the channel is deficient.

The Hand Lesser Yin Heart channel begins in the heart, belongs to the network connecting the heart, passes downward through the diaphragm, and connects with the small intestine. One branch ascends from this network, runs alongside the throat, and reaches the network connected with the eyes. The main channel turns upward from the heart network, passes through the lungs, then descends and emerges from the armpit. It runs along the inner back edge of the upper arm, behind the Hand Greater Yin Lung channel and the Hand Reverting Yin Pericardium channel. Continuing downward, it passes the inner elbow and follows the inner back edge of the forearm to the sharp bone on the little-finger side behind the palm, a prominent bone at the wrist. It enters the inner back edge of the palm and runs along the inner side of the little finger to its tip.

When the Qi of the Heart channel is abnormal, symptoms may include a dry throat, heart pain, and thirst with a desire to drink. This condition is called “arm reversal,” a disorder caused by the counterflow or blockage of Qi and blood in the arm channels. Conditions governed by the Heart channel also include yellowing of the eyes, pain in the ribs and sides, pain or cold reversal along the inner back edge of the upper arm and forearm, and heat or pain in the center of the palm. To treat these conditions, use draining when pathogenic Qi is excessive and tonifying when upright Qi is deficient. When there is heat, needle quickly; when there is cold, retain the needles longer. When the Qi and blood of the channel are sinking, use moxibustion. If the condition is neither excessive nor deficient, select points according to the channel’s usual method. When pathogenic Qi is excessive, the radial pulse at the wrist is twice as strong as the pulse at the side of the neck; when upright Qi is deficient, the radial pulse is weaker than the neck pulse.

The Hand Greater Yang Small Intestine channel begins at the tip of the little finger and runs upward along the outer side of the hand, passing the wrist and between the prominent bones there. It then ascends along the lower edge of the forearm bone, passes between the two tendons at the inner elbow, and continues along the outer back edge of the upper arm. It emerges at the shoulder joint, circles behind the shoulder blade, meets the channel at the top of the shoulder, and enters the supraclavicular hollow above the collarbone, where it connects with the heart. It then descends along the throat, passes through the diaphragm, reaches the stomach, and belongs to the small intestine. The passage in the classic that repeats the route from the forearm to the small intestine describes the same channel pathway.

One branch ascends from the supraclavicular hollow along the neck, passes through the cheek, reaches the outer corner of the eye, then turns and enters the ear. Another branch separates from the cheek, ascends past the cheekbone, reaches the nose, and then the inner corner of the eye, before running obliquely to connect with the cheekbone area.

When the Qi of the Small Intestine channel is abnormal, symptoms may include a sore throat, swelling of the jaw, inability to turn the head, and pain in the shoulder as though it were being pulled out and in the upper arm as though it were about to break. Conditions governed by the Small Intestine channel also include deafness, yellowing of the eyes, swelling of the cheeks, and pain in the neck, jaw, shoulder, upper arm, elbow, and along the outer back edge of the forearm. To treat these conditions, use draining when pathogenic Qi is excessive and tonifying when upright Qi is deficient. When there is heat, needle quickly; when there is cold, retain the needles longer. When the Qi and blood of the channel are sinking, use moxibustion. If the condition is neither excessive nor deficient, select points according to the channel’s usual method. The final sentence of the classic says that when pathogenic Qi is excessive, the pulse at the side of the neck is twice as strong as the radial pulse.