《黄帝内经灵枢集注》Vol. 2

When the pulse at the mouth is weak, the Renying pulse is smaller than the Cunkou pulse. Renying and Cunkou are two sites used to compare the strength of the pulse.

The main vessel of the Bladder Foot Taiyang channel begins at the inner corner of the eye, passes upward across the forehead, and meets at the crown of the head. Its branch vessel … If the pulse is neither strong nor weak, treat according to the channel’s usual method. When the pulse is strong, the Renying pulse is twice as forceful as the Cunkou pulse; when the pulse is weak, the Renying pulse is smaller than the Cunkou pulse.

The Bladder Foot Taiyang channel begins at the inner corner of the eye, passes upward across the forehead, and meets at the crown of the head. One of its branches runs from the crown to above the ear. The main vessel runs straight from the crown into the brain and connects with it. It then emerges from the brain and descends through the back of the neck, along the inner side of the shoulders and on either side of the spine, reaching the lower back. It enters the muscles on both sides of the spine, connects with the kidneys, and belongs to the bladder. Another branch descends from the lower back, runs down both sides of the spine, passes through the buttocks, and enters the hollow behind the knee. A further branch separates from the inner side of the shoulder, descends beneath the shoulder blade, runs beside the spine and behind the hip joint, then continues down the outer rear edge of the thigh to join the vessel at the hollow behind the knee. It descends through the calf, passes behind the outer ankle, and runs along the outer side of the foot to the outer side of the little toe.

When this channel is diseased, Qi surges upward, the head aches, the eyes feel as if they might protrude, the neck feels as if it is being pulled upward, the back aches, the lower back feels as if it might break, the thigh cannot bend, the hollow behind the knee tightens, and the calf feels as if it might split. This condition is called “ankle reversal.” This channel governs the sinews. Related disorders include hemorrhoids, malaria, mania and epilepsy, pain at the crown of the head and in the neck, yellowing and tearing of the eyes, nasal congestion or nosebleeds, and pain in the neck, back, lower back, sacrum, hollow behind the knee, calf, and foot. The little toe may also become immobile. To treat these disorders, drain when the pulse is strong and supplement when it is weak. When there is heat, needle promptly; when there is cold, retain the needles longer. When the channel Qi sinks, use moxibustion. If the pulse is neither strong nor weak, treat according to the channel’s usual method. When the pulse is strong, the Renying pulse is twice as forceful as the Cunkou pulse; when it is weak, the Renying pulse is smaller than the Cunkou pulse.

The Kidney Foot Shaoyin channel begins beneath the little toe, runs diagonally to the sole of the foot, and emerges at the Rangu point. In treatment, select points according to the channel’s usual method. When the pulse is strong, the Renying pulse is twice as forceful as the Cunkou pulse; when it is weak, the Renying pulse is smaller than the Cunkou pulse.

The Kidney Channel of Foot Shaoyin begins beneath the little toe and runs obliquely to the sole. It then emerges below the Rangu point, passes behind the inner ankle, and sends off a branch that enters the heel. From there, it ascends along the inner side of the lower leg to the inner side of the hollow behind the knee, then runs up the rear edge of the inner thigh, passes through the spine, and connects with the Kidney and the Bladder.

Its main channel ascends from the Kidney, passes through the Liver and diaphragm, enters the Lungs, travels up along the throat, and branches around the base of the tongue. Another branch emerges from the Lungs, connects with the Heart, and flows into the chest.

When the channel is affected, symptoms may include feeling hungry but having no desire to eat; a dark, withered complexion; coughing up blood-tinged phlegm; and rapid, noisy breathing. Other symptoms may include wanting to rise while seated, blurred vision, a feeling in the heart as if it were suspended, or a sensation like hunger. When Qi is deficient, a person may become easily frightened and feel uneasy, as though someone were coming to seize them. These conditions are called “bone reversal,” referring to disorders of counterflow associated with the Kidney Channel and the bones.

Conditions treated by the Kidney Channel include heat in the mouth, a dry tongue, swelling of the throat, Qi surging upward, dryness and pain in the throat, agitation and heart pain, jaundice, intestinal diarrhea or dysentery, pain in the spine and along the rear edge of the inner thigh, weak or flaccid sinews, coldness in the limbs, a desire to lie down, and heat and pain in the soles of the feet.

To treat these conditions, use draining methods when pathogenic Qi is strong and tonifying methods when healthy Qi is weak. For heat conditions, insert the needle quickly; for cold conditions, retain it longer. When Qi and blood have sunk, use moxibustion. If the condition is neither excessive nor deficient, select points along the channel itself. After moxibustion, the patient should make an effort to eat, loosen their clothes, let their hair down in the ancient manner of caring for the body, and walk leaning on a large staff and wearing heavy shoes. If the channel is excessive, the Cun pulse is twice as strong as the Renying pulse; if it is deficient, the Cun pulse is weaker than the Renying pulse.

The passage beginning “The Heart governs the hand…” repeats material from earlier, describing care after moxibustion and how to judge excess and deficiency by comparing the Cun and Renying pulses: after moxibustion, one should eat, loosen one’s clothes, let one’s hair down, and walk with a staff while wearing heavy shoes. A Cun pulse clearly stronger than the Renying pulse indicates excess, while a weaker Cun pulse indicates deficiency.

The Hand Jueyin Pericardium Channel (the Hand Jueyin channel, which connects with the pericardium) begins in the chest. It emerges and enters the pericardium, then descends through the diaphragm, connecting along the way with the Sanjiao (Triple Burner). Its main course runs from beside the chest to the flank, then descends to a point about three inches below the armpit. It rises to the armpit and travels down the inner upper arm, passing between the Hand Taiyin and Hand Shaoyin channels. It enters the elbow crease, then descends along the space between two tendons in the forearm, enters the center of the palm, and runs along the middle finger to its tip. A branch separates in the palm and runs along the ring finger to its tip.

When this channel is out of balance, symptoms may include heat in the palms, tightness and spasms in the arm and elbow, and swelling below the armpit. In severe cases, there may also be distention and fullness in the chest and flanks, a pounding heartbeat, a flushed complexion, yellowing of the eyes, and continual laughter. Pulse disorders governed by the Hand Jueyin channel also include agitation, heart pain, and heat in the palms.

To treat these conditions, use draining methods when the channel’s Qi and blood are excessive, and tonifying methods when they are deficient. For heat, insert the needle quickly; for cold, retain it for a time. If the Qi and blood are sinking, use moxibustion. When neither is excessive nor deficient, treat according to the channel’s own needling principles. To assess deficiency and excess, compare the cun pulse with the renying pulse: if the cun pulse is twice as strong as the renying pulse, the condition is one of excess; if the cun pulse is weaker than the renying pulse, it is one of deficiency. In ancient pulse diagnosis, the cun and renying were two sites used to compare the relative strength of channel Qi.

The Hand Shaoyang Sanjiao Channel begins at the tip of the ring finger. It ascends through the space between the ring and little fingers, follows the back of the hand to the wrist, then passes outward from the wrist. The text that follows continues describing the course of this channel.

The Triple Burner channel is the Hand Shaoyang channel (the Shaoyang network on the arm). It begins at the tip of the ring finger, the finger beside the little finger, and travels upward through the space between the ring and little fingers. It runs along the back of the hand to the wrist, then ascends between the two bones on the outer forearm, passes through the elbow, and follows the outer upper arm to the shoulder. There it crosses out behind the Foot Shaoyang channel. It enters the supraclavicular fossa, the hollow above the collarbone, spreads through the center of the chest, disperses and connects with the pericardium, then descends through the diaphragm, linking with the Triple Burner along the way.

A branch of the Triple Burner channel also rises from the center of the chest, passes through the supraclavicular fossa to the neck, and connects to the area behind the ear. It then ascends straight upward, emerges above the upper corner of the ear, curves downward across the cheek, and reaches the area beneath the eye socket near the cheekbone. Another branch enters the ear from behind, emerges, and travels toward the front of the ear. It passes through Guest Master, an acupoint in front of the ear now called Shangguan, meets the cheek, and finally reaches the outer corner of the eye.

When the Triple Burner channel is disturbed, symptoms may include deafness, a muffled or unclear sensation in the ear, a swollen and painful throat, or throat obstruction that makes swallowing difficult. The Triple Burner channel governs disorders of Qi movement. Common symptoms include sweating; pain at the outer corner of the eye or in the cheek; pain behind the ear, in the shoulder, upper arm, elbow, or outer forearm; and difficulty moving the ring finger. To treat these conditions, use draining when the illness is excessive and tonifying when the body’s upright Qi is deficient. When there is heat, needle quickly; when there is cold, retain the needles longer. When Qi and Blood have sunk, use moxibustion. If the condition is neither excessive nor deficient, select points along the channel. In examination, if the pulse at Renying, over the carotid artery, is twice as strong as the pulse at Cunkou, at the wrist, the condition is excessive. If the Renying pulse is weaker than the Cunkou pulse, the condition is deficient.

The Gallbladder channel is the Foot Shaoyang channel (the Shaoyang network in the lower limbs). It begins at the outer corner of the eye, ascends to the corner of the head, then descends behind the ear and runs along the neck in front of the Hand Shaoyang channel…

The Foot Shaoyang Gallbladder Channel begins at the outer corner of the eye, ascends to the corner of the forehead, then descends around behind the ear. It follows the neck in front of the Hand Shaoyang Sanjiao Channel, reaches the shoulder, and then turns behind it. After crossing beyond the Sanjiao Channel, it enters the supraclavicular fossa, the hollow above the collarbone.

One branch enters the ear behind it, passes back out in front of the ear, and reaches a point behind the outer corner of the eye. Another branch separates from the outer corner of the eye and descends past Daying, a point on the cheek, where it joins the Hand Shaoyang Channel. It continues below the cheekbone, passes Jiache at the angle of the jaw, and descends along the neck to meet the main channel at the supraclavicular fossa. It then descends into the chest, passes through the diaphragm, connects with the liver and belongs to the gallbladder, and follows the inner side of the ribs to Qijie near the groin. It circles the pubic region and then runs horizontally to Biyan, a hollow near the hip joint.

From the supraclavicular fossa, the main channel descends through the armpit, runs across the chest past the lower ribs at the side of the abdomen, and descends to meet the channel at Biyan. It then follows the outer thigh downward, passes the outer knee and the front of the fibula, and continues to Juegu at the fibula above the outer ankle. From there it reaches the front of the outer ankle and follows the top of the foot to the space between the fourth and fifth toes. Another branch separates from the top of the foot, enters the space between the big toe and second toe, and follows the inner side of the bone cleft at the fork of the big toe to its tip. It then passes back through the toenail and emerges at the hair-bearing tip of the toe.

When this channel is disturbed, symptoms may include a bitter taste in the mouth, frequent sighing, and pain in the chest and flanks that makes it difficult to turn over or lie on one’s side. In severe cases, the face may look dull, as if covered in dust, the skin may lose its luster, and the outer side of the foot may instead feel hot. This is called “Yang Reversal.”

This channel governs disorders related to the bones. Illness along its course may cause headache, pain in the jaw, pain at the outer corner of the eye, swelling and pain at the supraclavicular fossa, swelling under the armpit, and “saber-shaped swelling” and “neck and armpit nodules,” referring to lumps and swellings in those areas. Other possible symptoms include sweating, chills and shivering, malaria, pain in the chest, flanks, thighs, outer knees, lower legs, Juegu, the front of the outer ankle, and joints throughout the body, as well as difficulty moving the fourth and fifth toes.

To treat these disorders, use the reducing method when pathogenic Qi is excessive and the reinforcing method when healthy Qi is weak. For heat patterns, insert the needle quickly; for cold patterns, retain it longer. When Qi and blood have sunk, use moxibustion. If there is no clear deficiency or excess, select points along this channel for treatment. To assess deficiency and excess, compare the Renying pulse at the carotid artery with the Cunkou pulse at the wrist: if the Renying pulse is twice as strong as the Cunkou pulse, the condition is excessive; if it is weaker than the Cunkou pulse, the condition is deficient.

The Foot Jueyin Liver Channel begins where the fine hairs grow in a cluster on the big toe. It runs upward along the upper edge of the foot to a point one cun above the medial malleolus, then ascends past a point eight cun above the medial malleolus, crossing behind the Foot Taiyin Spleen Channel. Continuing upward, it passes along the inner side of the knee and thigh, enters the pubic region, passes the external genitals, and reaches the lower abdomen. It connects laterally with the stomach, belongs to the Liver, and links with the Gallbladder. It then passes through the diaphragm, spreads between the ribs, ascends behind the throat into the nasopharynx, connects with the vessels inside the eyes, and rises to the forehead, where it meets the Governing Vessel at the crown of the head.

One branch of this channel descends from the vessels of the eye to the inside of the cheek and circles the inside of the lips. Another branch separates from the Liver, passes through the diaphragm, and ascends to enter the Lungs.

When this channel is disordered, symptoms may include lower back pain and an inability to bend forward or backward. Men may develop a hernia, while women may experience swelling in the lower abdomen. In severe cases, the throat becomes dry and the complexion turns dull, as though covered in dust, losing its usual luster. Other conditions governed by the Liver Channel include fullness in the chest, vomiting, diarrhea in which food is passed undigested, fox-like hernia, involuntary urination, and difficulty urinating.

To treat these conditions, excess channel Qi is drained and deficiency is supplemented. For heat, the needles are inserted and withdrawn quickly; for cold, they are retained longer. When Qi and blood have sunk, moxibustion is used. When there is neither excess nor deficiency, treatment follows the points of the channel itself. Excess channel Qi means that the pulse at the cun position is twice as strong as the pulse at the renying position; deficient channel Qi means that the cun pulse is weaker than the renying pulse.

When the Qi of the Hand Taiyin Lung Channel is severed, the skin and body hair become dry and withered. The Hand Taiyin circulates Qi and blood and nourishes the skin and body hair with warmth. When Qi and blood can no longer nourish them, the skin and body hair dry out. As fluids are depleted from the skin and the spaces between the joints, the nails become dry and the body hair falls out or breaks. The falling and breaking of body hair indicates that the hair has begun to deteriorate first. If the illness worsens on a Bing day, death may follow on a Ding day, because Fire overcomes Metal.

When the Qi of the Hand Shaoyin Heart Channel is severed, the vessels become obstructed. When the vessels are obstructed, blood can no longer circulate, and the hair loses its luster. A face black as lacquered firewood therefore indicates that the blood has begun to fail first. If the illness worsens on a Ren day, death may follow on a Gui day, because Water overcomes Fire.

When the Qi of Foot Taiyin is cut off, its channels can no longer nourish the muscles. The lips and tongue are the root of the muscles. When the channels cease to nourish them, the muscles become slack; as they slacken, the tongue wastes away and the philtrum—the groove beneath the nose and above the upper lip—swells. Once the philtrum is swollen, the lips turn outward. Outward-turning lips show that the muscles have already begun to fail. The illness worsens on a jia day and death follows on an yi day: this is the Wood phase overcoming the Earth phase.

When the Qi of Foot Shaoyin is cut off, the bones become withered. Foot Shaoyin is the channel associated with winter. It runs deep within the body and nourishes the bone marrow. When the bones lose this nourishment, the muscles can no longer attach to them. As bone and flesh cease to hold together, the muscles grow slack and contract. The teeth then appear longer and become coated, while the hair loses its luster. Dull hair shows that the bones have already begun to fail. The illness worsens on a wu day and death follows on a ji day: this is the Earth phase overcoming the Water phase.

When the Qi of Foot Jueyin is cut off, the sinews and channels fail and break down. Foot Jueyin is the Liver channel, and the Liver is associated with the sinews. The sinews gather at the genitals, while the channels extend to the root of the tongue. When the channels cease to nourish them, the sinews tighten; this tightness pulls on the tongue and testicles. Blue-green lips, a curled tongue, and retracted testicles therefore show that the sinews have already begun to fail. The illness worsens on a geng day and death follows on a xin day: this is the Metal phase overcoming the Wood phase.

When the Yin Qi of all five organs is cut off, the vessels around the eyes begin to shift, and blurred vision follows. If the condition worsens rapidly, it also pulls on the tongue and testicles, causing the lips to turn blue-green, the tongue to curl, and the testicles to retract—signs that the sinews have already begun to fail. Blurred vision shows that the will and spirit, stored by the Kidneys, have begun to fail. After this happens, death usually follows in about a day and a half.

When the Yang Qi of all six bowels is cut off, Yin Qi loses its connection with the intestines, and the skin’s pores open, releasing terminal cold sweat. A person examined in the morning may die by evening; one examined in the evening may die the following morning.

The Twelve Channels run deep between the muscles and are usually invisible. The only section that can normally be seen is where the Foot Taiyin Channel passes above the outer ankle, because no tissue covers it there. The other vessels that rise to the surface and can often be seen are all collateral vessels, branches that separate from the channels.

Among the Six Channels, the collateral vessels of the Hand Yangming and Hand Shaoyang begin between the five fingers and extend upward to the elbows. After drinking alcohol, defensive Qi (the Qi that moves through the body’s surface and protects it) first flows through the skin and fills the collateral vessels. The collaterals therefore become full first. Only after defensive Qi has become abundant does nutritive Qi (the Qi that moves through the vessels and nourishes the body) fill them, causing the channels to become greatly replete.

When an unusual pulse suddenly appears, it is because pathogenic Qi has lodged in the vessel and become trapped at its two ends. If the pulse does not beat, heat will develop; if it is not firm, it will sink and become hollow. Its signs differ from those of other pulses, so they can be used to identify which vessel is abnormal.

Lei Gong asked, “How can one distinguish channels from collateral vessels?” The Yellow Emperor replied, “The channels are usually invisible. Their deficiency or excess must be examined through the Qi Mouth, the pulse at the wrist. Any vessel that can be seen is a collateral vessel.”

Lei Gong said, “I still do not understand the principle.” The Yellow Emperor replied, “Collateral vessels do not pass through the spaces between major joints. They must wind along more out-of-the-way routes and eventually enter the tissue beneath the skin. The places where the collaterals converge can all be seen on the body’s surface. Therefore, when needling a collateral vessel, pierce where it gathers. If blood has accumulated heavily within a collateral, drain it promptly even when there is no obvious gathering, so that the pathogenic Qi is expelled with the blood. If blood remains in the collateral vessels, Bi syndrome will develop—a disorder marked chiefly by pain, numbness, or impaired movement of the limbs.”

When examining the superficial connecting vessels, a bluish color usually indicates Cold and may also signal pain; red indicates Heat. When there is Cold in the stomach, the connecting vessels at the thenar eminence—the raised area at the base of the thumb—often appear blue. When there is Heat in the stomach, they turn red. If the vessels suddenly turn black, it shows that impediment, in which the circulation of Qi and Blood is obstructed, has persisted for a long time. If red, black, and blue appear together, Cold and Heat are intermingled. If the vessels are blue and short, this indicates a deficiency of Qi.

When using acupuncture to treat illnesses involving Cold and Heat, treatment often involves places where the connecting vessels contain more blood. Needling should be done every other day, bleeding the vessels until the blood has been fully released, and then regulating the body’s deficiency and excess. If the connecting vessels are fine and short, this indicates a deficiency of Qi. Using a reducing method—an acupuncture technique for expelling pathogenic influences—in this situation may cause tightness in the chest. Severe tightness may lead to fainting and loss of speech. If tightness occurs, have the patient sit down immediately.

The collateral vessel of the Hand Taiyin channel is called Lieque. It branches from the channel above the wrist, follows the Hand Taiyin channel into the palm, and spreads across the thenar eminence. In an excess condition, the outer side of the palm feels hot; in a deficient condition, the person yawns repeatedly and may have urinary incontinence or frequent urination. To treat it, select Lieque, located half a cun above the wrist, where the collateral vessel branches off and connects with the Hand Yangming channel.

The collateral vessel of the Hand Shaoyin channel is called Tongli, and is located one and a half cun above the wrist. In an excess condition, the outer side of the palm feels hot; in a deficient condition, the person yawns repeatedly and may have urinary incontinence or frequent urination. To treat it, select the point half a cun above the wrist, where the collateral vessel branches off and connects with the Hand Yangming channel.

The collateral vessel of the Hand Shaoyin channel is called Tongli, and is located one and a half cun above the wrist. It branches upward, follows the channel into the heart, connects with the root of the tongue, and links to the vessels of the eyes. In an excess condition, there is a distending fullness beneath the chest; in a deficient condition, the person cannot speak. To treat it, select the point one cun behind the palm, where the collateral vessel branches off and connects with the Hand Taiyang channel.

The collateral vessel of the Hand Jueyin Pericardium channel is called Neiguan. It is located two cun above the wrist, branching from between the two tendons. It follows the channel upward, connects with the pericardium, and links to the heart system. In an excess condition, there is heart pain; in a deficient condition, the head and neck become stiff. Select the point between the two tendons.

The collateral vessel of the Hand Taiyang channel is called Zhizheng. It is located five cun above the wrist and connects inward with the Hand Shaoyin channel. Another branch travels upward to the elbow and then links with Jianyu, a shoulder point. In an excess condition, the joints become loose and the elbow cannot move; in a deficient condition, warts or sores and scabs the size of a fingernail may appear. To treat it, select the point at Zhizheng.

The collateral vessel of the Hand Yangming channel is called Pianli. It lies three cun above the wrist and branches off to connect with the Hand Taiyin channel. One branch travels up the arm, passes through Jianyu, a shoulder point, then ascends to the cheek and connects with the teeth. Another branch enters the ear and joins the ancestral vessels, the channels that converge in the ear. When pathogenic influence predominates in the collateral vessel, tooth decay and deafness may occur. When Qi and Blood are deficient, the teeth become cold, numb, and uncomfortable, as though blocked. Treatment is to needle Pianli.

The collateral vessel of the Hand Shaoyang channel is called Waiguan. It lies two cun above the wrist, winds around the outer arm, and enters the chest, where it joins the Heart Master channel, the Hand Jueyin Pericardium channel. When pathogenic influence predominates, the elbow becomes cramped. When Qi and Blood are deficient, the arm cannot be drawn inward. Treatment is to needle Waiguan.

The collateral vessel of the Foot Taiyang channel is called Feiyang. It lies seven cun above the outer ankle and branches off to connect with the Foot Shaoyin channel. When pathogenic influence predominates, nasal congestion, headache, and back pain occur. When Qi and Blood are deficient, nasal congestion and nosebleeds may occur. Treatment is to needle Feiyang.

The collateral vessel of the Foot Shaoyang channel is called Guangming. It lies five cun above the outer ankle and branches off to connect with the Foot Jueyin channel, while also extending downward to connect with the top of the foot. When pathogenic influence predominates, reversal may occur, with symptoms such as cold limbs and disordered Qi movement. When Qi and Blood are deficient, the legs become weak and unable to support the body, so that a person cannot rise from sitting. Treatment is to needle Guangming.

The collateral vessel of the Foot Yangming channel is called Fenglong. It lies eight cun above the outer ankle and branches off to connect with the Foot Taiyin channel. One branch travels upward along the outer side of the shin, connects with the head and neck, and joins the Qi of the various channels; it then descends to connect with the throat. If Qi surges upward in counterflow, the throat may become obstructed and the voice may suddenly fail. When pathogenic influence predominates, mania or epilepsy may occur. When Qi and Blood are deficient, the feet become weak and unable to draw inward, and the muscles of the shins become wasted. Treatment is to needle Fenglong.

The collateral vessel of the Foot Taiyin channel is called Gongsun. It lies one cun behind the joint at the base of the big toe and branches off to connect with the Foot Yangming channel. One branch enters the body and connects with the intestines and stomach. When counterflowing Qi surges upward, cholera may occur, a condition described in ancient texts as acute vomiting and diarrhea. When pathogenic influence predominates, severe pain occurs in the intestines. When Qi and Blood are deficient, the abdomen becomes distended and full. Treatment is to needle Gongsun.

The collateral vessel of the Foot Lesser Yin channel is called “Great Bell.” It passes behind the medial malleolus, circles around the heel, and sends one branch toward the Foot Greater Yang channel. Another branch follows the channel upward and connects with the pericardium; downward, it passes along the outer side through the lumbar spine. When this vessel is diseased, Qi surging upward causes distress and agitation. In an excess pattern, urination is obstructed or difficult; in a deficiency pattern, there is lumbar pain. Treatment should be taken at the point where this collateral vessel branches off.

The collateral vessel of the Foot Reverting Yin channel is called “Worm Trench.” It lies five cun above the medial malleolus and sends one branch toward the Foot Lesser Yang channel. Another branch runs upward along the shin to the testicles and connects with the penis. When this vessel is diseased, Qi surging upward causes swollen, painful testicles and sudden-onset hernia. In an excess pattern, the penis remains erect and does not subside; in a deficiency pattern, sudden itching occurs. Treatment should be taken at the point where this collateral vessel branches off.

The collateral vessel of the Conception Vessel, which runs along the midline of the front of the body, is called “Tail Screen.” It descends from the dove’s tail, the area below the xiphoid process of the sternum, and spreads across the abdomen. In an excess pattern, the abdominal skin is painful; in a deficiency pattern, it itches and there is a desire to scratch. Treatment should be taken at the point where this collateral vessel branches off.

The collateral vessel of the Governing Vessel, which runs along the midline of the back of the body, is called “Long Strength.” It ascends on both sides of the spine to the neck and spreads across the head. Descending toward the shoulder blades, its branches on either side turn toward the Foot Greater Yang channel and enter and pass through the areas alongside the spine. In an excess pattern, the back is stiff; in a deficiency pattern, the head feels heavy and unsteady. Examine both sides of the spine for abnormalities, and treat at the point where this collateral vessel branches off.

The Spleen channel’s great collateral vessel is called “Great Enveloping.” It begins at the Yuanye point, three cun below the armpit, and spreads across the chest and flanks. In an excess pattern, the whole body is painful; in a deficiency pattern, the limbs and all the joints are slack and weak. If blood vessels are visible, spreading like a net, they should also be treated through the Spleen’s great collateral vessel.

In these fifteen collateral vessels, an excess pattern makes the vessels visible, while a deficiency pattern makes them sink from view. If they cannot be seen at the usual location, look above and below it. Since the channels are distributed differently in each person, the points where the collateral vessels branch off also vary.

Pronunciation notes: “Great Bell” is pronounced “wu”; “thigh bone” is pronounced “pai”; “shin” is pronounced “han”; “distress and agitation” is pronounced “dan-dan”; “oblique” is pronounced “xie”; “turbid” is pronounced “tu-hun-qie”; “growth” is pronounced “you.”

Textual notes: In the first item, the character transcribed as “vessel” may be a corruption of the character for “clothing.” In the second item, the character transcribed as “wall” originally read “astringent”; the reading “wall” follows the Zhao edition.

The graph “mai” is suspected to have been “fu” in the original text.

The original graph “qiang” was “se”; it has been changed to “qiang” on the basis of the Zhaofu Jujingtang edition.

The original graph “xi” was “lian”; it has been changed to “xi” on the basis of chapter one of volume two of the Jia Yi Jing.

The original graph “tuan” was “chuai”; it has been changed to “tuan” on the basis of Wang Bing’s commentary on “Jue Lun” in the Suwen. “Tuan” refers to the calf.

The original graph “wan” was “wan”; it has been changed to “wan” on the basis of the Zhaofu Jujingtang edition. “Wan” refers to the region of the stomach.

In chapter one of volume two of the Jia Yi Jing, the graph “jin” appears as “gu.”

“Entering between the little toe and the next toe” appears in Wang Bing’s commentary on “Jue Lun” in the Suwen as “emerging at the tips of the little toe and the next toe.” “The next toe” refers to the fourth toe, beside the little toe.

The graph “zhu” is missing from the original text and has been supplied on the basis of volume eight of the Taisu.

In “then the vessels do not flow freely,” the third chapter of volume three of the Maijing has twelve additional characters after “flow freely”: “The Shaoyin is the Heart vessel; the Heart is where the vessels converge.”

The phrase “the sinews are severed” appears in difficulty twenty-four of the Nanjing as “the sinews contract and pull.” The third chapter of volume three of the Maijing has twelve additional characters after “flow freely”: “The Shaoyin is the Heart vessel; the Heart is where the vessels converge.”

In chapter one of volume two of the Jia Yi Jing, the graph “qi” appears as “qi.”

In the section “Distinctions and Differences in the Channels and Network Vessels” in volume nine of the Taisu, the graph “wai” appears as “nei.”

In chapter one of volume two of the Jia Yi Jing, the two graphs “jing jing” appear as “xun jing.”

Huangdi Neijing Lingshu Jizhu, volume six, chapter eleven: “Jingbie.”

The Yellow Emperor asked Qibo, “I have heard that human beings correspond to the Dao of Heaven. Within the body are the five zang organs, which correspond to the five tones, five colors, five seasons, five flavors, and five directions. Outside them are the six fu organs, which correspond to the six pitch standards. The six pitch standards establish the relationships among the Yin-Yang channels, and correspond to the twelve months, twelve earthly branches, twelve solar terms, twelve waterways, and twelve time periods. The twelve channels likewise correspond to these. This is how the five zang and six fu organs accord with the Dao of Heaven.

“The twelve channels concern human life, the formation of illness, its treatment, and its onset. They are the starting point for learning medicine and a central subject of study for skilled physicians. Inexperienced physicians think they are easy to understand, while accomplished physicians recognize their difficulty. How do the channels divide and join, emerge and enter?”

After bowing, Qibo replied, “That is a clear and perceptive question. This is what inexperienced physicians often overlook and accomplished physicians study in depth. Allow me to explain it fully.

“A branch of the regular foot Taiyang channel (foot Taiyang Bladder channel) enters the popliteal fossa, the hollow behind the knee. One branch descends past the coccyx and sacrum, and, about five inches from the anus, branches into the anus. It connects with the urinary bladder, then spreads to the kidneys and runs along either side of the spine to reach and spread through the heart region. Another branch runs straight upward along the spine, emerges at the nape, and joins the foot Taiyang channel. This is a joining pathway of a single channel.

“The regular foot Shaoyin channel (foot Shaoyin Kidney channel) reaches the popliteal fossa, then branches toward and joins the foot Taiyang channel. It ascends to the kidneys, emerges near the fourteenth vertebra, and connects with the Dai channel, which encircles the waist and abdomen. A branch that runs straight upward connects with the root of the tongue, then emerges at the nape and joins the foot Taiyang channel. This is one point of union. Branches of Yin channels can all be regarded as parts of their regular channels.”

The primary channel of the Foot Shaoyang Meridian (one of the main channels among the twelve meridians) passes around the thigh and enters the pubic region, where it joins the Foot Jueyin Meridian. Another branch enters the space between the lower ribs, runs along the inner side of the chest, and connects with the gallbladder. From the gallbladder channel, it spreads upward into the liver, passes through the heart, then ascends alongside the throat. It emerges from the middle of the lower jaw, spreads across the face, and connects with the ocular network—the vessels linking the eyes and brain—before finally joining the Foot Shaoyang Meridian at the outer corner of the eye. The primary channel of the Foot Jueyin Meridian branches from the top of the foot and ascends to the pubic region, where it joins the Foot Shaoyang Meridian. It then runs together with that meridian’s branch. This is the second pair of channels that join.

The primary channel of the Foot Yangming Meridian ascends to the thigh, enters the abdominal cavity, and connects with the stomach. Its channel Qi spreads to the spleen and ascends to reach the heart. It runs upward along the throat, emerges through the mouth, then ascends to the area around the root and bridge of the nose. It loops back to connect with the ocular network and finally joins the Foot Yangming Meridian. The primary channel of the Foot Taiyin Meridian ascends to the thigh and joins the Foot Yangming Meridian. It then ascends with that meridian’s branch, gathers at the throat, and passes through the middle of the tongue. This is the third pair of channels that join.

The primary channel of the Hand Taiyang Meridian runs downward and branches from the shoulder joint. It enters the armpit, reaches the heart, and connects with the small intestine. The primary channel of the Hand Shaoyin Meridian branches separately from between two tendons in the armpit, connects with the heart, and ascends to the throat. It emerges on the face and joins the meridian at the inner corner of the eye. This is the fourth pair of channels that join.

The primary channel of the Hand Shaoyang Meridian runs upward and branches from the crown of the head. It enters the supraclavicular fossa, the hollow above the collarbone, then descends to reach the Triple Burner, one of the six fu organs in Chinese medicine that encompasses functional regions of the chest and abdomen. Its channel Qi spreads through the chest. The primary channel of the Hand Jueyin Meridian, also called the Heart Master Meridian, branches from a point three inches below the armpit and enters the chest. Another branch connects with the Triple Burner, then ascends along the throat and emerges behind the ear, joining the Hand Shaoyang Meridian below the Wangu, the raised bone behind the ear. This is the fifth pair of channels that join.

Note: The source text contains a repeated passage after “the primary channel of the Hand Shaoyin Meridian.” The interpretation above follows the coherent sequence of the meridian text.

The main channel of the Hand Yangming channel (one of the twelve principal channels) ascends from the hand along the chest and breast area. It branches off at Jianyu, an acupoint on the shoulder, enters beneath the collarbone, passes through the Large Intestine and connects with the Lung, then ascends along the throat. It emerges at Quepen, the hollow above the collarbone, and joins the Foot Yangming channel.

The main channel of the Hand Taiyin channel branches off at Yuanye, in the armpit, and runs in front of the Hand Shaoyin channel. It enters and circulates through the Lung, then spreads to the Hand Taiyang channel. It then ascends and emerges at Quepen, follows the throat upward, and joins the Hand Yangming channel. These are the six pairings among the channels of the hand.

Pronunciation notes: “Kao” is pronounced “ku mao qie”; “gang,” “hu gong qie”; “yi,” “shang yi qie”; and “han,” “xia hu qie.”

Chapter Twelve: The Channels of Water.

The Yellow Emperor asked Qibo, “The body’s twelve meridians correspond outwardly to the twelve river channels and connect inwardly with the five zang organs and six fu organs. The twelve river channels differ in size, depth, width, and length. The five zang and six fu organs differ in height and size, and in how much food and drink they can hold. How do these differences correspond to the meridians?

“The river channels receive water and carry it along. The five zang organs gather and store a person’s Shen (spirit), Qi (vital energy), Hun (ethereal soul), and Po (corporeal soul). The six fu organs receive food and drink and move it along; they also receive Qi and distribute it. The meridians receive blood, circulate it, and nourish the whole body. When treating these conditions together, what should be done? How deep should the needles go, and how many cones of moxa should be burned—one cone being one unit of moxibustion? Can you explain this to me?”

Qibo replied, “An excellent question! The sky is so high that it cannot be measured, and the earth so vast that it cannot be surveyed. That is the kind of matter we are discussing. People live between Heaven and Earth, within the Six Directions—above, below, and the four quarters. Their height and breadth are beyond human power to measure.

“Yet in a person eight chi tall, the flesh and skin are right before us: they can be measured, touched, and examined from the outside. After death, the body can also be opened and inspected. In this way, we can observe whether the five zang organs are firm or fragile; the size of the six fu organs; how much food and drink they can hold; the length of the meridians; whether the blood is clear or turbid; and the amount of Qi. We can also see which of the twelve meridians have much blood and little Qi, which have little blood and much Qi, which have plenty of both, and which have little of both. Each of these conditions follows general patterns.

“When treating with acupuncture and moxibustion, the Qi of each meridian should be regulated separately. Do all such treatments follow these usual correspondences?”

The Yellow Emperor said, “I have listened to these words and find them pleasing to the ear, but I still do not truly understand them. I hope you will explain the principles to me in full.”

Qibo replied, “These teachings show that human beings can take part in the workings of Heaven and Earth and correspond with Yin-Yang, so they must be examined carefully.

The Foot Taiyang channel (the Taiyang meridian of the foot) corresponds externally to the Qing River and connects internally with the bladder, through which fluids circulate. The Foot Shaoyang channel corresponds externally to the Wei River and connects internally with the gallbladder. The Foot Yangming channel corresponds externally to the sea and connects internally with the stomach. The Foot Taiyin channel corresponds externally to the lake and connects internally with the spleen. The Foot Shaoyin channel corresponds externally to the Ru River and connects internally with the kidneys. The Foot Jueyin channel corresponds externally to the Mian River and connects internally with the liver.

The Hand Taiyang channel corresponds externally to the Huai River and connects internally with the small intestine, through which fluids are distributed. The Hand Shaoyang channel corresponds externally to the Luo River and connects internally with the triple burner. The Hand Yangming channel corresponds externally to the Yangtze River and connects internally with the large intestine. The Hand Taiyin channel corresponds externally to the Yellow River and connects internally with the lungs. The Hand Shaoyin channel corresponds externally to the Ji River and connects internally with the heart. The Hand Heart Master channel—that is, the Hand Jueyin channel—corresponds externally to the Zhang River and connects internally with the pericardium.

These relationships involve the five viscera, the six bowels, and the twelve channels. The waters of the channels have sources externally and places of reception internally; inside and outside connect with one another, like a ring with neither beginning nor end. The body’s channels work in the same way.

Thus, Heaven belongs to Yang and Earth to Yin. The body above the waist corresponds to Heaven, and the body below the waist corresponds to Earth. North of the sea is Yin; north of the lake is Yin within Yin. South of the Zhang River is Yang; the area between the Yellow River to the north and the Zhang River to the south is Yin within Yang. The area between the Luo River to the south and the Yangtze River to the north is the greatest Yang, where Yang energy is at its strongest. This explains Yin and Yang with reference to one region. That is why it is said that human beings can correspond with Heaven and Earth.”

The Yellow Emperor asked: The courses of rivers and streams correspond to the channels in the human body. They differ in length and depth, and their volumes of water and blood also vary. How should one adjust needling to account for these differences?

Qibo replied: The Foot Yangming channel, or Stomach channel, is where the Qi and blood of the five zang organs and six fu organs converge. Its channel is relatively large, with abundant blood and vigorous, hot Qi. If the Foot Yangming channel is not needled deeply enough, pathogenic Qi will not disperse. The needle should also be retained, and the reducing method applied as appropriate. Needle the Foot Yangming channel to a depth of six fen and retain the needle for ten breaths; needle the Foot Taiyang channel to five fen and retain it for seven breaths; the Foot Shaoyang channel to four fen and retain it for five breaths; the Foot Taiyin channel to three fen and retain it for four breaths; the Foot Shaoyin channel to two fen and retain it for three breaths; and the Foot Jueyin channel to one fen and retain it for two breaths.

The Yin and Yang channels in the hands lie close to the pathways through which Qi and blood circulate, so Qi arrives quickly. Needling depth in these channels should not exceed two fen, and the needle should not be retained for more than one breath. One must also judge flexibly according to a person’s age, stature, and build, whether large or small, thin or stout. This is called following the natural order, and the same applies to moxibustion. If moxibustion exceeds what is appropriate and the heat is too strong, the bones will become brittle and the channels sluggish. Excessive needling, in turn, will deplete upright Qi.

The Yellow Emperor asked again: Can the thickness of the channels, the amount of blood, the thickness of the skin, the firmness or fragility of the muscles, and the size of the hollow behind the knee all be used as measures for needling?

Qibo replied: These measures should be based on a person of average constitution, whose muscles are not noticeably wasted and whose Qi and blood are not weakened. If someone is extremely thin and has already lost muscle, how can the same measures used for an ordinary person apply? Examine, palpate, and press carefully; observe the patient’s cold and heat and the strength or weakness of their Qi and blood; then adjust the needling accordingly. To treat each person in this way is to treat them appropriately.

The sinew channel of the Foot Taiyang (the muscle and connective tissues associated with the Foot Taiyang channel) begins above the little toe, joins the outer ankle, then runs diagonally upward to the knee. One branch descends along the outer side of the foot to the heel, then ascends along the heel to join the popliteal fossa (the hollow behind the knee). Another branch joins the outer calf and runs upward to the inner side of the popliteal fossa. After joining there, it continues upward to the buttock, then runs along both sides of the spine to the nape.

One branch enters and joins the root of the tongue. A direct branch joins the occipital bone (the bone at the base of the back of the skull), ascends to the head, then descends to the face and joins the nose. Another branch forms a network of sinews above the eyes and descends to join the cheekbone. Yet another ascends from the back outer side of the armpit and joins the shoulder joint. Another branch enters the armpit, then ascends and emerges from the supraclavicular hollow (the depression above the collarbone), joining the prominent bone behind the ear. A further branch emerges from the supraclavicular hollow and runs diagonally upward to the cheekbone.

When this sinew channel is diseased, symptoms may include pulling discomfort in the little toe, swelling and pain in the heel, spasms in the popliteal fossa, backward arching and rigidity of the back, tension in the sinews of the nape, inability to raise the shoulder, pulling in the armpit, and twisting pain at the supraclavicular hollow, sometimes making it impossible to turn the head to either side.

Treatment uses rapid needling with a heated needle. The number of treatments is guided by the patient’s relief, and the needle is applied at the site of pain. The classical text calls this condition “mid-spring Bi disorder.”

The sinew channel of Foot Shaoyang begins at the fourth toe, the toe beside the little toe. It ascends to the outer ankle, then runs up the outer side of the lower leg and attaches to the outer knee. One branch separates near the head of the fibula and travels up the thigh: its front branch attaches above the Futu point, while its rear branch connects to the buttock.

The main channel ascends beneath the ribs and through the lower rib area, then runs toward the front of the armpit, drawing in the chest and breasts before finally connecting to Quepen, the hollow above the collarbone. Another section rises from the armpit, passes through Quepen and in front of the Taiyang channel (Foot Taiyang), then travels behind the ear to the corner of the forehead, where it meets at the crown. It then descends to the chest and breasts and connects to Quepen. It also rises from the armpit, passes through Quepen and in front of the Foot Taiyang channel, travels behind the ear to the corner of the forehead, meets at the crown, and then descends to the jaw, connecting to the cheekbone. A further branch attaches at the outer corner of the eye, forming a connection along the outer side of the eye.

When this sinew channel becomes diseased, the fourth toe is pulled and goes into spasm, triggering spasms on the outer side of the knee. The knee cannot bend or straighten, and the sinews behind it become taut. The tension also pulls the thigh forward and the buttock backward. The pain may then extend upward to the ribs, lower rib area, Quepen, chest and breasts, and neck, where the associated sinews become constricted. If the condition extends from the left side to the right, the right eye cannot open. The sinew channel ascends beyond the right corner of the forehead and runs alongside the Qiao channel, which is associated with limb movement and the opening and closing of the eyelids; the left-side sinew channel connects with the right side. Thus, an injury to the left corner of the forehead can prevent the right foot from moving. This is called “the interweaving of the connecting sinews.”

Treatment uses a heated needle, inserted quickly, stopping when the patient feels relief, with points selected at the site of pain. This condition is called “Mengchun Bi,” or impediment disorder corresponding to the first month of spring.

The sinew channel of Foot Yangming begins at the middle three toes. It ascends to connect across the top of the foot, then runs diagonally upward and outward, passes the fibula, and attaches to the outer side of the knee. Continuing upward, it connects near the hip joint, follows the ribs, and attaches to the spine. Its direct course runs up the lower leg and attaches at the knee. A branch connects beside the bone on the outer side of the knee and joins the sinew channel of Foot Shaoyang. Another direct course ascends to connect near the hip joint, follows the ribs, and attaches to the spine; another runs up the lower leg to the knee, with a branch connecting to the outer side of the knee and meeting the sinew channel of Foot Shaoyang.

The direct course of the sinew channel also ascends past Futu, the raised muscle on the front of the thigh, and connects to the thigh. It gathers at the genitals, then continues upward into the abdomen and spreads out, finally gathering at Quepen, the hollow above the collarbone. It then ascends to the neck, passes along both sides of the mouth, and converges near the cheekbone. It descends to connect with the nose, then ascends to join the sinew channel of Foot Taiyang. The sinew channel of Foot Taiyang spreads like a net above the eyes, while that of Foot Yangming spreads below them. Another branch connects the cheek to the area in front of the ear.

When the sinew channel of Foot Yangming is affected, the middle three toes may pull on the lower leg, the sinews may contract, and the foot may twitch and become stiff. There may also be spasms at Futu, swelling along the front of the thigh, hernia, and tension in the abdominal sinews that pulls toward Quepen and the cheek. The corner of the mouth may also suddenly become crooked. When the sinews contract, the eyes cannot close; when heat causes them to slacken, the eyes cannot open.

When the sinews in the cheek are affected by cold, they contract and pull the cheek, causing the corner of the mouth to shift to one side. Heat makes the sinews slack and weak, so they cannot draw together, which can also cause the mouth to become crooked. For treatment, apply horse ointment to the side where the sinews are contracted. Mix powdered cinnamon with white liquor and apply it to the slackened side, then use a mulberry-wood hook to draw the face back into alignment. Burn fresh mulberry wood to ash and place it in a pit, making the pit a suitable height for sitting. Then use horse ointment to warm and press the contracted cheek. At the same time, drink good liquor and eat roasted meat; those who do not drink should still try to drink as much as they can. Strike the area three times.

Alternatively, treat it with a heated needle, inserting it quickly. Repeat the treatment until the symptoms ease, selecting the points according to where the pain is located. This condition is called “Late Spring Bi syndrome.”

The sinew vessel of the Foot Taiyin begins on the inner side of the tip of the big toe. It ascends and binds at the medial malleolus, the bony prominence on the inner side of the ankle. A branch that runs straight upward connects with the auxiliary bone on the inner side of the knee, travels up the inner thigh, and binds at the hip root. It gathers at the genital region, then passes upward through the abdomen and binds around the navel. It runs along the inner abdomen, binds at the ribs, and spreads through the chest. A branch that turns inward attaches to the spine.

When this sinew vessel is diseased, symptoms include pulling discomfort in the big toe; pain at the medial malleolus; painful contraction of the sinews; pain in the auxiliary bone on the inner side of the knee; and pulling pain from the inner thigh to the hip. The genital region may have twisting, constricting pain. Pain in the lower body may pull toward the navel and both flanks, and may extend to the chest and the inner side of the spine. Treatment uses a heated needle applied quickly. The number of treatments is guided by the relief of symptoms, and points are selected at the painful areas. This condition is called “Mengqiu Bi” (a Bi disorder arising in early autumn).

The sinew vessel of the Foot Shaoyin begins beneath the little toe. It runs alongside the sinew vessel of the Foot Taiyin, slants toward the area below the medial malleolus, and binds at the heel. After meeting the sinew vessel of the Foot Taiyang, it ascends and binds below the auxiliary bone on the inner side of the knee. It then runs alongside the sinew vessel of the Foot Taiyin, travels up the inner thigh, and binds at the genital region. It ascends along the inner side of the spine, beside the muscles on either side of it, reaches the neck, and binds at the occipital bone, below the back of the head, where it meets the sinew vessel of the Foot Taiyang.

When this sinew vessel is diseased, the sinews on the soles of the feet may contract. Pain and contraction may also occur along its course and at the places where it binds. Disease in this vessel mainly causes epilepsy, convulsions, and spasms. When the disorder is on the outer side, the body cannot bend forward; when it is on the inner side, the body cannot lean backward. Thus, a disorder in the Yang aspect causes the back and lower back to arch backward, preventing the body from bending forward; a disorder in the Yin aspect prevents the body from leaning backward. Treatment uses a heated needle applied quickly. The number of treatments is guided by the relief of symptoms, and points are selected at the painful areas. For disorders on the inner side, treatment should also include hot compresses, guided movement, and medicinal remedies. If the sinews are damaged and twisted, and the twisting recurs and worsens, the condition is difficult to treat. This condition is called “Zhongqiu Bi” (a Bi disorder arising in mid-autumn).

The sinew vessel of Foot Jueyin (associated with the Foot Jueyin Liver channel) begins above the big toe. It ascends and gathers in front of the inner ankle, then follows the lower leg upward and gathers below the supporting bone on the inner side of the knee. It continues up the inner thigh, gathers at the genitals, and connects with the other sinew vessels.

When this sinew vessel is diseased, there is a pulling discomfort above the big toe, and pain in front of the inner ankle, at the supporting bone on the inner side of the knee, and along the inner thigh. The sinew vessel may become tense and spasm. The genitals may also lose their normal function. If the condition is caused by internal injury, erection may be impossible. If it is caused by cold, the genitals contract; if by heat, they become relaxed and extended and cannot draw inward. Treatment should promote the free movement of fluids and clear the Qi in the genital region. If the symptoms include sinew spasms, use a fire needle (a heated needle for acupuncture) to puncture promptly, repeating until the symptoms ease and selecting points wherever there is pain. This condition is called “Late-Autumn Bi,” a type of Bi disorder named according to the ancient months.

The sinew vessel of Hand Taiyang (associated with the Hand Taiyang Small Intestine channel) begins above the little finger and gathers at the wrist. It ascends along the inner forearm and gathers behind the pointed bone on the inner side of the elbow. Plucking this spot sends a sensation to the area above the little finger. The sinew vessel continues upward and gathers in the armpit. One branch ascends from the back of the armpit, passes around the shoulder blade, and follows the neck upward. It emerges in front of the Taiyang channel and attaches to the Wangu bone behind the ear (the bony prominence behind the ear). Another branch enters the ear, while a third runs directly upward, emerging above the ear before descending to attach to the lower jaw and then ascending to connect with the outer corner of the eye.

When this sinew vessel is diseased, there is a pulling discomfort in the little finger and pain behind the pointed bone on the inner side of the elbow. The pain extends upward along the inner forearm to the armpit; the armpit and its rear side also hurt, and the pain may reach the shoulder blade and neck. There may be ringing and pain inside the ear, with pain extending to the lower jaw and eye, causing the eye to close; after a while, vision returns. When the sinews of the neck become tight, they may weaken and become slack, and the neck may swell. For alternating sensations of cold and heat in the neck, use a fire needle to puncture promptly, repeating until the symptoms ease and selecting points wherever there is pain. If there is swelling, puncture the swollen area repeatedly.

A branch of this sinew vessel ascends from the angle of the lower jaw, follows the front of the ear to the outer corner of the eye, then passes upward across the lower jaw and attaches at the corner of the forehead. Pain may occur along its course, accompanied by pulling and spasms. Treatment likewise uses a fire needle for prompt puncturing, repeated until the symptoms ease and applied wherever there is pain. This condition is called “Midsummer Bi,” a type of Bi disorder named according to the ancient months.

The sinews of the Hand Shaoyang (shǒu shàoyáng zhī jīn) begin at the tip of the ring finger and converge at the wrist. They run up the forearm and gather at the elbow, then ascend along the outer side of the upper arm to the shoulder and turn toward the neck, where they join the sinews of the Hand Taiyang. One branch passes through the bend of the cheek and penetrates to attach at the root of the tongue. Another branch ascends past the gums, runs in front of the ear, and connects to the outer corner of the eye. It then rises over the lower jaw and terminates at the horn of the head. When disease occurs, the parts traversed by these sinews twitch and contract, and the tongue may curl. Treatment uses heated needles applied swiftly, continuing until the effect is achieved, and points are selected at the site of pain. This is called "Late Summer Bi" (jìxià bì), a category of bi (obstruction) syndrome corresponding to the final phase of summer.

The sinews of the Hand Yangming (shǒu yángmíng zhī jīn) begin at the tip of the index finger and converge at the wrist. They run up the forearm and gather at the outer side of the elbow, then ascend into the upper arm and attach at the shoulder. One branch wraps around the shoulder blade and runs along both sides of the spine. The straight portion ascends from Jianyu (Shoulder Bone, a point where an acupoint and the sinews meet) to the neck. Another branch ascends to the cheek and attaches at the cheekbone. The straight portion passes in front of the Hand Taiyang channel, rises to the horn of the head, enters the head, and then descends to the right side of the lower jaw. When disease occurs, the parts traversed by these sinews ache and cramp, the shoulder cannot be raised, and the neck cannot turn from side to side. Treatment uses heated needles applied swiftly, continuing until the effect is achieved, and points are selected at the site of pain. This is called "Early Summer Bi" (mèngxià bì), a category of bi syndrome corresponding to the early phase of summer.

The sinews of the Hand Taiyin (shǒu tàiyīn zhī jīn) begin above the thumb, run along the fingers, and converge behind the Yuji (fish-belly eminence, the raised area at the base of the thumb). They then run up along the outer side of the radial pulse site (cùnkǒu) and through the forearm to the center of the elbow. Continuing along the inner side of the upper arm, they reach the armpit, pass through the Quepen (supraclavicular hollow above the collarbone), and attach at the front of the shoulder. They continue downward into the chest, spread through and penetrate the diaphragm, join with the region below it, and reach the jìxié (lower flank beneath the ribs). When disease occurs, the parts traversed by these sinews twitch and ache. In severe cases, xībēn (an ancient term for a chest condition marked by accumulation and difficult breathing) may develop, with flank tightness and blood-vomiting. Treatment uses heated needles applied swiftly, continuing until the effect is achieved, and points are selected at the site of pain. This is called "Mid-Winter Bi" (zhòngdōng bì), a category of bi syndrome corresponding to the middle phase of winter.

The sinews of the Hand Jueyin channel (shou jueyin jing) begin at the middle finger and run alongside the sinews of the Hand Taiyin channel (shou taiyin jing). They converge at the inner side of the elbow, rise along the inner upper arm, and gather in the armpit, from where they spread downward to the flanks on both the front and back of the ribs. A branch enters the armpit, spreads through the chest, and gathers at the arm. When illness arises, the area traversed by the sinew is affected by pulling, contraction, and cramping (zhuan jin). Forward extension may cause chest pain and shortness of breath. Treatment uses a heated needle inserted quickly. Once symptoms ease, stimulation may be moderately stopped, and the site of pain serves as the point of treatment. This condition is called "meng dong bi" (Early-Winter Bi), a type of bi (painful obstruction) named for the beginning of winter.

The sinews of the Hand Shaoyin channel (shou shaoyin jing) begin at the inner side of the little finger and gather at the sharp bone on the ulnar side of the wrist. They rise to join at the inner side of the elbow, enter the armpit, meet the Hand Taiyin channel, and form connections around the breast. This condition is also called "meng dong bi" (Early-Winter Bi).

The sinews of the Hand Shaoyin channel begin at the inner side of the little finger and gather at the sharp bone on the ulnar side of the wrist. They rise to join at the inner side of the elbow, enter the armpit, meet the Hand Taiyin channel, and connect around the breast before gathering in the chest. From there they descend along the arm and link to the navel. When illness arises, a sense of tightness develops within the body, and an accumulation called "fu liang" (Crouching Beam) forms beneath the heart. As the condition pulls downward, the elbow becomes tight, as though bound in a net. The area traversed by the sinew is affected by pulling, cramping, and pain. Treatment uses a heated needle inserted quickly. Once symptoms ease, stimulation may be moderately stopped, and the site of pain serves as the point of treatment. If the condition develops into fu liang with vomiting of blood or pus, it cannot be treated.

Disorders of the sinews (jingjin, the muscles and sinews linked to the channels) cause the sinews to contract when exposed to cold, so the body arches backward. When exposed to heat, the sinews slacken and cannot contract, and the genitals become limp and unusable. Tightness on the yang side causes the body to arch backward, while tightness on the yin side causes the body to bend forward and be unable to straighten. A heated needle used in shallow insertion treats tightness caused by cold. If heat has caused the sinews to slacken and lose the ability to contract, a heated needle should not be used. This condition is called "ji dong bi" (Late-Winter Bi), a type of bi named for the end of winter.

When the sinews of the Foot Yangming channel (zu yangming jing) and the Hand Taiyang channel (shou taiyang jing) become tight, the mouth and eyes are drawn askew, the genitals become limp and unusable. Tightness on the yang side causes the body to arch backward, and tightness on the yin side causes it to bend forward and be unable to straighten. A heated needle treats tightness caused by cold. When heat causes the sinews to slacken and lose the ability to contract, a heated needle must not be used. This condition is called "ji dong bi" (Late-Winter Bi).

When the sinews of the Foot Yangming and Hand Taiyang channels become tight, the mouth and eyes may be drawn askew, the corners of the eyes pulled tight, so that one cannot quickly turn to look. The treatment methods are the same as described above.

(4) The character xi (knee) is omitted in the original text and has been supplied based on the "Jing Tiao" (Sinew Channels) chapter, volume 13, of the Taisu (Plain Basis).

(5) The character xia ("below") is written as shang ("above") in the "Jing Tiao" chapter, volume 13, of the Taisu.

(6) The character meng ("eldest") is written as zhong ("second") in the "Jing Tiao" chapter, volume 13, of the Taisu.

(7) The character zhong ("second") is written as meng ("eldest") in the "Jing Tiao" chapter, volume 13, of the Taisu.

(8) The character zou ("to run") is written as zu ("foot") in the "Jing Tiao" chapter, volume 13, of the Taisu.

Huangdi Neijing Lingshu Jizhu (Collected Commentaries on the Spiritual Pivot of the Yellow Emperor's Inner Classic), volume 8.

"Gu Du" (Measurements of the Bones), chapter 14.

The Yellow Emperor consults Bo Gao on this matter. The Taisu, volume 13, "Jing Tiao," reads meng ("eldest") at this point.

(8) The character zou ("to run") is written as zu ("foot") in the "Jing Tiao" chapter, volume 13, of the Taisu.

Huangdi Neijing Lingshu Jizhu, volume 8.

"Gu Du," chapter 14.

The Yellow Emperor asked Bo Gao, "The Maidu (Measures of the Vessels) discusses the lengths of the jingmai (meridians). How were these measurements determined?"

Bo Gao replied, "One first measures the size, width, and length of the bones and joints of the body, and the measures of the meridians are determined from these."

The Yellow Emperor said, "I would like to know the standard dimensions of the ordinary human body. For a person seven chi five cun tall, what are the sizes and lengths of the bones and joints in each part?"

Bo Gao replied, "The circumference of the large bone of the head is two chi six cun. The chest measures four chi five cun around, and the waist four chi two cun. From the hairline's covered edge to the neck is one chi two cun, and from below the hairline to the chin is one chi. From below the Adam's apple to the middle of the quepen (the hollow at the base of the neck) is four cun, and from the quepen to the lower end of the sternum is nine cun. If this distance exceeds the standard, the lungs are large; if it falls short, the lungs are small. From the lower end of the sternum to Tianshu (an acupoint beside the navel) is eight cun. If it exceeds the standard, the stomach is large; if it falls short, the stomach is small. From Tianshu to Hengu (the area of the pubic bone) is six and a half cun. If it exceeds the standard, the ileum is broad and long; if it falls short, it is narrow and short. Hengu itself is six and a half cun in length.

"From the upper edge of Hengu to the inner upper edge of the thigh bone is one chi eight cun. From the upper edge to the lower edge of the inner thigh bone is three and a half cun. From its lower edge to the inner ankle is one chi three cun, and from the inner ankle to the ground is three cun. From the back of the knee to the junction of the instep and the lower leg is one chi six cun, and from there to the ground is three cun. Thus, when the measures around the bones are larger than the standard, they are excessive; when smaller, they are deficient.

"From below the forehead corner to the zhugu (the area of the collarbone) is one chi; passing beneath the armpit to the unseen portion is four cun; from the armpit to the jihe (the lower side of the flank) is one chi two cun; from the jihe to the bishu (the hip joint) is six cun; from the bishu to the center of the knee is one chi nine cun; from the knee to the outer ankle is one chi six cun; from the outer ankle to Jinggu (the bone on the outer side of the foot) is three cun; and from Jinggu to the ground is one cun.

"The distance behind the ear, corresponding to Wangu (the bony protrusion behind the ear), is nine cun wide. The distance in front of the ear, corresponding to Ermen (an acupoint in front of the ear), is one chi three cun wide. The distance between the two cheekbones is seven cun. The width between the two breasts is nine and a half cun, and between the two thighs is six and a half cun. The foot is one chi two cun long and four and a half cun wide.

"From the shoulder to the elbow is one chi seven cun; from the elbow to the wrist is one chi two and a half cun; from the wrist to the base of the middle finger, the length of the finger's joints, is four cun; and from the joint to the fingertip is four and a half cun. From below the nape of the neck at the hairline to the spine is two and a half cun. The spine from the lüGu (the back bone) down to the coccyx comprises twenty-one segments and measures three chi in length. Each segment above is one and one-quarter cun, with the remainder falling below. Therefore, counting downward, the seven segments up to the lüGu total nine and seven-eighths cun. These are the standard dimensions of the ordinary human skeleton, and they are the basis for determining the lengths of the meridians.

"Thus, in observing how the meridians appear on the body: when a meridian lies near the surface, feels firm, and shows clearly with a large caliber, it generally indicates abundant blood. When it is fine and sunken beneath the skin, it generally indicates abundant qi."

Chapter Fifteen: The Fifty Cycles (Wushi Ying)

The Yellow Emperor (Huangdi) asked: "I would like to know how the Qi of the human body completes fifty circuits in one day and night."

Qi Bo replied: "One full revolution of the heavens passes through the twenty-eight lunar mansions (ershiba xiu), the star divisions the ancients defined. Each mansion is reckoned as thirty-six parts, making one thousand and eight parts in all. The Qi of the human body also completes one circuit in correspondence with these twenty-eight mansions. The meridians (jingmai) are distributed above and below, left and right, and front and back, forming twenty-eight channels whose total length throughout the body is sixteen zhang and two chi, matching the twenty-eight mansions. The clepsydra (loukou), an ancient water-dripping timekeeper, releases one hundred ke in a day and night, and this is used to divide day from night.

With each exhalation, the pulse beats twice and the Qi advances three cun. With each inhalation, the pulse again beats twice and the Qi advances three cun. One exhalation and one inhalation together advance the Qi six cun. After ten breaths, the Qi has advanced six chi, and the heavens have moved two fen.

After two hundred and seventy breaths, the Qi has traveled sixteen zhang and two chi. The Qi is continuous within the body, completing one circuit, while the clepsydra has dripped two ke and the heavens have moved twenty-five fen. After five hundred and forty breaths, the Qi has completed two circuits, the clepsydra has dripped four ke, and the heavens have moved forty fen. After two thousand seven hundred breaths, the Qi has completed ten circuits, the clepsydra has dripped twenty ke, and the heavens have moved five mansions and twenty fen.

After thirteen thousand five hundred breaths, the Qi has circulated fifty times within the body. The clepsydra has dripped one hundred ke, and the heavens have completed all twenty-eight mansions, so the day and night are over and the circulation of the meridians is complete. What is called jiaotong (interconnection) refers to the meridians' Qi joining end to end to form one complete cycle. Therefore, when the fifty circuits are fully accomplished, a person may enjoy their natural span of years (tiannian). In total, the Qi travels eight hundred and ten zhang."

Chapter Sixteen: Ying Qi (Nutritive Qi)

The Yellow Emperor said: "The route of Ying Qi (nutritive Qi) begins with food and drink (yinshi shuigu), the nourishment taken in. Therefore, when the fifty circuits are fully accomplished, a person may enjoy their natural span of years; in total, the Qi travels eight hundred and ten zhang."

The Yellow Emperor (Huangdi) said: The circulation of yingqi (nutritive qi, the refined energy that moves through the jingmai, or meridians, and nourishes the whole body) is rooted in drawing out the essence of food and drink (shuigu). After food enters the stomach, this refined qi is conveyed to the lungs, then distributed throughout the body and dispersed outward. The purest portion travels along the meridians without interruption, returning again and again in a cycle. This is the constant pattern by which Heaven and Earth move.

Yingqi begins in the Hand Taiyin Lung Meridian and flows into the Hand Yangming Large Intestine Meridian, rising as it goes. It then enters the Foot Yangming Stomach Meridian, descends to the top of the foot, passes between the big toes, joins the Foot Taiyin Spleen Meridian, and rises to the thigh. From the spleen it flows to the heart. It then follows the Hand Shaoyin Heart Meridian out from the armpit, along the arm to the little finger, where it joins the Hand Taiyang Small Intestine Meridian. From there it rises again past the armpit, emerges at the inner side of the cheekbone, reaches the inner corner of the eye, climbs to the crown of the head, and descends behind the neck to join the Foot Taiyang Bladder Meridian. It continues down the spine to the buttocks, runs on to the tip of the little toe, passes under the sole of the foot, enters the Foot Shaoyin Kidney Meridian, and rises to the kidneys.

From the kidneys yingqi flows to the heart, spreading outward through the chest. It follows the Hand Jueyin Pericardium Meridian out from the armpit, enters the palm between the two tendons of the arm, and reaches the tip of the middle finger. It then returns to the tip of the ring finger, joins the Hand Shaoyang Sanjiao (Triple Burner) Meridian, and rises to Danzhong, the point between the two breasts in the chest, dispersing through the Triple Burner, the three body cavities (upper, middle, and lower) recognized in traditional Chinese medicine. From the Triple Burner it flows into the Foot Shaoyang Gallbladder Meridian, emerges at the side of the ribs, and descends to the top of the foot. From there it passes between the big toes, joins the Foot Jueyin Liver Meridian, and rises to the liver.

From the liver, yingqi rises to the lungs, travels up the throat, enters the openings of the nasopharynx, and reaches the depths of the nasal cavity, where it disperses through the Triple Burner. It then repeats the course: from the Triple Burner to the Gallbladder Meridian, out at the ribs, down to the top of the foot, between the big toes, joins the Liver Meridian, up to the liver, then to the lungs, up the throat, through the nasopharynx, and into the depths of the nasal cavity.

A branch ascends across the forehead and crown, then descends along the back of the neck and the spine into the sacrum, the lower end of the spine where it meets the pelvis. This is the Du Meridian (Dumai, the Governing Vessel). Yingqi also follows the channels connected with the genitals, passes through the pubic hair, enters the navel, and rises through the abdominal cavity into the Quepen, the hollow above the collarbone. It then descends to flow into the lungs and finally emerges again from the Hand Taiyin Lung Meridian. This is the route of yingqi, and it is also the regular pattern by which the qi and blood in the meridians flow in their smooth and reverse directions.

The Yellow Emperor (Huangdi) said, "I wish to understand the lengths of the pulse channels." Qibo replied: The six yang channels of the hand, running from the hand to the head, are each five chi long, for a total of three zhang for the six. The six yin channels of the hand, running from the hand to the chest, are each three chi and five cun long, for a total of two zhang and one chi. The six yang channels of the foot, running from the foot up to the head, are each eight chi long, for a total of four zhang and eight chi. The six yin channels of the foot, running from the foot to the chest, are each six chi and five cun long, for a total of three zhang and nine chi. The Qiao channels (Qiaomai), which govern the movement of the feet and the opening and closing of the eyes, run from the foot to the eye, each seven chi and five cun long, so the two together measure one zhang and five chi. The Du (Dumai) and Ren (Renmai) channels, the two that run along the midline of the front and back of the body, are each four chi and five cun long, for a total of nine chi. Taken together, these add up to sixteen zhang and two chi, which form the principal pathways along which Qi circulates through the body.

The channels (jing) run deep within the body. Branches that leave the main channels and connect with them horizontally are called luo (collaterals), and the fine offshoots that split from the collaterals are called sun luo (minute collaterals). If blood and Qi are congested in the minute collaterals and stagnant blood appears, the condition should be needled and treated promptly. Where the collaterals are congested, the draining method should be used to disperse the excess. Where the channels are deficient and weak, herbal medicines should be taken to nourish and supplement them.

The internal condition of the Five Viscera can often be discerned through the seven sensory orifices above—the eyes, ears, nose, mouth, tongue, and others. The Qi of the lungs communicates with the nose; when lung function is balanced, the nose can distinguish fragrant from foul odors. The Qi of the heart communicates with the tongue; when heart function is balanced, the tongue can distinguish the five flavors. The Qi of the liver communicates with the eyes; when liver function is balanced, the eyes can distinguish different colors. The Qi of the spleen communicates with the mouth; when spleen function is balanced, the mouth can discern the flavors of the five grains. The Qi of the kidneys communicates with the ears; when kidney function is balanced, the ears can distinguish different sounds.

When the Five Viscera are out of balance, the seven orifices do not function freely. When the Six Bowels are out of balance, pathogenic Qi remains in the body and can form sores and swellings. When pathogenic Qi invades the Six Bowels, the Yang channels lose their harmony. When the Yang channels are out of harmony, Qi stagnates; as stagnant Qi accumulates further, Yang Qi becomes excessive. Excess Yang Qi impedes the movement of Yin Qi. When the Yin channels cannot flow freely, blood stagnates; once blood has stagnated, Yin Qi also becomes excessive.

When Yin Qi is excessive, Yang Qi can no longer nourish and circulate: this is called “Closure.” When Yang Qi is excessive, Yin Qi can no longer nourish and circulate: this is called “Blockage.” When both Yin and Yang are excessive and can no longer nourish and circulate one another, the condition is called “Closure and Blockage.” People with this condition often do not live out their allotted lifespan.

The Yellow Emperor asked, “Where does the Qiao vessel begin and end? What Qi nourishes the eyes through it?” Qibo replied, “The Qiao vessel is a branch of the Foot Shaoyin channel. It begins behind Rangu, ascends along the inner ankle, passes up the inner thigh and enters the genital region. It then ascends along the inner chest, enters the supraclavicular fossa, and rises in front of Renying, where the carotid artery can be felt pulsing. It enters the cheekbone region and connects to the inner canthus, the corner of the eye nearest the nose. There it joins the Taiyang channel and the Yang Qiao vessel, then continues upward. When Yin and Yang Qi meet and nourish the eyes in turn, the eyes stay moist. When they lack sufficient nourishment from Qi and blood, the eyes cannot close.

The Yellow Emperor asked, “Why does Qi circulate only through the five Zang organs and not nourish the six Fu organs?” Qibo replied, “Qi cannot remain still; it must circulate, just as water flows without stopping and the sun and moon move without rest. The Yin channels nourish the five Zang organs, and the Yang channels nourish the six Fu organs. Their circulation repeats without beginning or end, and its pattern is difficult to determine. Qi that overflows during this circulation flows inward to fill the Zang and Fu organs, and outward to nourish the Couli—the textures and spaces between the skin and muscles.”

The Yellow Emperor asked again, “The Qiao vessels include the Yin Qiao and Yang Qiao. When diagnosing by feeling the pulse, which vessel should be examined?” Qibo replied, “For men, examine the Yang Qiao vessel; for women, examine the Yin Qiao vessel. The vessel examined in this way is called a channel; the other is called a network vessel.”

The Yellow Emperor asked Qibo, “Where do people obtain Qi? Where do Yin and Yang Qi meet? What is called nutritive Qi, and what is called defensive Qi? Where does nutritive Qi arise, and where does defensive Qi converge? The movement of Qi differs in the elderly and the vigorous, and the places where Yin and Yang circulate differ as well. I would like to hear the principles behind this.”

Qibo replied, “People obtain Qi from food and drink. After food enters the stomach, it is conveyed to the lungs, and from there the five zang organs and six fu organs all receive Qi. The clear, light part of Qi becomes nutritive Qi; the turbid part becomes defensive Qi. Nutritive Qi circulates within the vessels, while defensive Qi circulates outside them. Nutritive Qi moves in an unbroken cycle, completing fifty circuits before joining up again. Yin and Yang Qi flow through one another like a ring, with no beginning or end.

“Defensive Qi circulates twenty-five circuits in the Yin aspect and twenty-five in the Yang aspect, corresponding respectively to night and day. When defensive Qi reaches the Yang aspect, a person wakes; when it reaches the Yin aspect, a person falls asleep. At midday, Yang Qi is at its strongest; this is called ‘double Yang.’ At midnight, Yin Qi is at its strongest; this is called ‘double Yin.’ Greater Yin, which governs the inner aspect, governs within; Greater Yang, which governs the outer aspect, governs without. Each circulates twenty-five circuits, together corresponding to day and night.

“At midnight, Yin Qi is at its strongest, then gradually declines. At dawn, Yin Qi is nearly spent, and Yang Qi begins to take over. At midday, Yang Qi is at its strongest; after sunset, it gradually declines. At nightfall, Yang Qi is nearly spent, and Yin Qi begins to take over. At midnight, Yin and Yang Qi meet. At that time, everyone is asleep; this is called ‘the union of Yin.’ After dawn, Yin Qi has receded, and Yang Qi begins to circulate. This cycle never ceases, following the same principles as the movements of Heaven and Earth.”

The Yellow Emperor asked, “Why can elderly people not sleep at night? Why do the young and vigorous not doze during the day?” Qibo replied, “The young and vigorous have abundant Qi and blood, supple, moist muscles, and unobstructed channels for Qi. Their nutritive and defensive Qi circulate normally, so they are alert during the day and sleep soundly at night. The elderly have depleted Qi and blood, with dry, withered muscles and obstructed channels for Qi. The Qi of the five zang organs interferes with itself; nutritive Qi is reduced, and defensive Qi circulates poorly within the body. As a result, they lack alertness during the day and have difficulty sleeping at night.”

The Yellow Emperor said, “I would like to know where Ying Qi, the refined energy that flows through the vessels, and Wei Qi, the energy that flows outside the vessels and protects the body, each originate, and what routes they follow.”

Qibo replied, “Ying Qi originates in the Middle Burner, the area between the chest and abdomen centered on the Spleen and Stomach’s transforming and transporting functions. Wei Qi originates in the Lower Burner, the area of the lower abdomen.”

The Yellow Emperor asked, “Where does each of the Three Burners begin?”

Qibo replied, “The Upper Burner starts at the upper opening of the Stomach. It ascends along the throat, passes through the diaphragm, and spreads through the chest. It then extends toward the armpits and follows the course of the Hand Taiyin channel, the Lung channel. From there it turns to the Hand Yangming channel, the Large Intestine channel, ascends to the tongue, and then descends to the Foot Yangming channel, the Stomach channel. The Qi of the Upper Burner usually circulates together with Ying Qi: it makes twenty-five circuits in the Yang aspect and twenty-five in the Yin aspect. After fifty circuits in all, it reunites with the Hand Taiyin channel.”

The Yellow Emperor asked again, “Some people develop a fever, and sweat as soon as food enters the Stomach, before their Qi has settled. Sometimes the sweat appears on the face, sometimes on the back, and sometimes on only one side of the body. Why does this sweat not leave by the usual route of Wei Qi?”

Qibo replied, “This happens when a person is exposed to pathogenic wind from outside. The Cou Li, the pores and interstices between the skin and muscles, open in response; the skin and body hair become warm, and the Cou Li release fluids. Wei Qi then slips out through these openings instead of following its usual route. Wei Qi is naturally swift and free-flowing, so it escapes whenever it encounters an opening. This kind of sweating is therefore called ‘leakage.’”

The Yellow Emperor asked, “I would like to understand what the Middle Burner transforms and produces.”

Qibo replied, “The Middle Burner is connected to the stomach and lies behind the Upper Burner. It receives food and drink, filters them and expels the waste, transforms them through steaming into fluids, and extracts their refined substances. It then transports these refined substances to the vessels of the lungs, where they are transformed into blood to nourish the body. Nothing is more important than this. Blood can therefore circulate on its own within the channels and vessels; this function is called ‘Nourishing Qi’ (Ying Qi), the Qi that flows within the vessels and nourishes the body.”

The Yellow Emperor asked, “Blood and Qi have different names but are essentially the same. How should I understand this?”

Qibo replied, “Nourishing Qi and Defensive Qi are both refined Qi, while blood is spirit Qi. So although blood and Qi have different names, they fundamentally belong to the same category. For this reason, someone who has lost too much blood must not be made to sweat, and someone who has lost too much sweat must not be made to lose blood. If a person loses both blood and sweat, their life may be in danger.”

The Yellow Emperor asked, “I would like to understand what the Lower Burner transforms and produces.”

Qibo replied, “The Lower Burner branches into a passage connected to the ileum, the final section of the small intestine, and leading to the bladder. Fluids seep through this passage into the bladder. Food and drink usually remain together in the stomach. Once transformed into waste, they descend together into the large intestine and enter the Lower Burner. The fluids are filtered out and flow through the Lower Burner into the bladder.”

The Yellow Emperor asked, “When people drink wine, it too enters the stomach. Before the grain has been digested and transformed into waste and descended into the large intestine, why is urine passed first?”

Qibo replied, “Wine is a liquid made from grain. Its nature is swift and clear, so although it enters the stomach after the grain, it is discharged before the liquid transformed from the grain.”

The Yellow Emperor said, “Well said. I have heard that the Upper Burner is like mist, the Middle Burner like a bubbling pool, and the Lower Burner like a drainage channel. This is precisely what those descriptions mean.” The three images describe how the Upper Burner disperses Qi and fluids like drifting mist; how the Middle Burner digests food and drink and produces refined substances like water churning and bubbling; and how the Lower Burner discharges fluids and waste like water flowing through a channel.

Treatise on the Qi of the Four Seasons, Chapter 19

The Yellow Emperor asked Qibo, “The climate differs in each of the four seasons, and the various illnesses that arise each have their own causes. What should guide the choice of acupuncture and moxibustion? Some editions write ‘treasure’ instead of ‘determine.’”

Qibo replied, “The Qi of each season has its own domain, and acupuncture and moxibustion should be guided by the meridian points—the points along the meridians. In spring, select the meridians, blood vessels, and the spaces between the muscles. For severe illness, insert the needle deeply; for mild illness, insert it shallowly. In summer, select meridians with abundant Qi and blood, as well as the minute collaterals that branch off from the meridians. Needle between the muscles, with the tip passing through the skin. In autumn, select the Shu points along the meridians. When pathogenic Qi is in the six Fu organs, select the He points, where the meridians converge with the organs. In winter, select the Jing-Well and Ying-Spring points, the first two categories of the Five Shu points; insert the needle deeply and retain it for a long time.”

When warm malaria strikes without sweating, needle the fifty-nine points. For swelling and distension of the skin caused by Wind pathogen, select the fifty-seven points. To remove stagnant blood from the skin, puncture and let out as much as possible.

For undigested diarrhea, supplement the upper points of the three Yin meridians and the Yinlingquan point. Retain the needles for a long time, stopping only after the heat has circulated. If cramping affects a Yang meridian, treat the Yang meridian; if it affects a Yin meridian, treat the Yin meridian. In either case, needle promptly.

To treat edema, first select the point three inches below Huan’gu and puncture it with a lance-shaped needle, an ancient, broad type of needle. After puncturing, use a tubular instrument to draw out the fluid, then insert the needle and repeat the procedure to expel the pathogenic cause of the edema. The procedure must be performed steadily: if the response beneath the needle comes slowly, the patient will feel distressed; if it comes quickly, the patient will feel calm. Ask about the patient’s condition as well. Stop once a single treatment has cleared the edema. Medicine that promotes urination and relieves obstruction should be taken while needling. Do not eat while taking the medicine, or take the medicine while eating. Eat no other foods; continue this regimen for 135 days.

If Bi syndrome—numbness, pain, and similar symptoms in the limbs—persists despite prolonged treatment, and Cold pathogen does not disperse, select Zusanli immediately. If the bones are wasted and bowel movements are obstructed, also select Zusanli: drain when pathogenic Qi is strong, and supplement when healthy Qi is deficient. For people with leprosy, an ancient term for illnesses resembling leprosy, first needle the swollen area, then use a sharp needle on the affected part and press to expel the pathogenic Qi. Stop once the swelling subsides. Follow the prescribed diet and eat no other foods.

If there is frequent rumbling in the abdomen, Qi surges up into the chest, breathing becomes difficult, and the person cannot stand for long, this indicates that pathogenic Qi is lodged in the large intestine. Needling may be applied at the Yuan point associated with the umbilical region and abdomen, at Upper Great Void (Shanglian), and at Zusanli.

If pain in the lower abdomen pulls on the testicles and extends to the lower back and spine, surging upward toward the heart, this indicates pathogenic Qi in the small intestine. The small intestine is connected to the testicles; its pathway runs upward along the spine, passes through the liver and lungs, and connects with the vessels surrounding the heart. When pathogenic Qi becomes strong, it causes Qi to counterflow upward, surge into the intestines and stomach, disturb the liver, spread into the depths of the abdomen, and gather around the navel. Therefore, take the Yuan point associated with the umbilical region to disperse the pathogenic Qi; needle the Taiyin channel to strengthen upright Qi; take the Jueyin channel to direct counterflowing Qi downward; take Lower Great Void (Xialian) to expel the pathogenic Qi; then massage and press the channels through which it has passed, bringing the flow of Qi into harmony.

If a person vomits easily, the vomit tastes bitter, and they often sigh and feel uneasy, as though afraid someone is coming to seize them, this indicates pathogenic Qi in the gallbladder and upward counterflow of stomach Qi. Leakage of bile makes the mouth taste bitter, while stomach Qi counterflowing upward causes bitter-tasting vomit; this is therefore called “gallbladder vomiting.” Take Zusanli to bring the counterflowing stomach Qi downward; then needle the blood vessels of the Shaoyang channel to calm the gallbladder Qi rising in counterflow. Treat according to whether the condition is deficient or excessive, thereby dispelling the pathogenic Qi.

If food and drink cannot be swallowed and the chest and diaphragm feel blocked, this indicates pathogenic Qi in the stomach region. If it is in the upper stomach, needle to direct it downward; if it is in the lower stomach, disperse and expel it. Pain and swelling in the lower abdomen, together with inability to urinate, indicate that pathogenic Qi is obstructing the Triple Burner and preventing the waterways from flowing freely. Take the great luo of the Taiyang channel and examine the small collaterals of the Jueyin channel. If the collaterals are knotted and stagnant, with blood stasis and swelling spreading upward to the stomach region, take Zusanli.

Observe the complexion to determine whether the pathogenic influence is dispersing or gathering again. Also examine the color of the eyes to judge whether the illness persists. Assess the body’s form and attend to the movement or stillness of the pulse. Examine both the Qikou, the pulse at the wrist used to assess the Yin channels, and Renying, the pulse at the carotid artery used to assess the Yang channels. A pulse that is hard, forceful, and slippery indicates that the illness is worsening day by day; a soft pulse indicates that it is about to ease. When pathogenic influences in all the channels have become fully manifest, the illness will usually be cured within three days.

Wind impediment (the original text has “feng zhi,” with “zhi” understood here as an impediment syndrome). The character “zhi” is pronounced as “qie”; “tong” is pronounced the same as “tong.” In “zhu bi,” “zhu” is pronounced as “zhi lüe qie,” and “bi” as “bi.” In “rui zhen,” “rui” is pronounced as “yu hui qie” and means sharp or keen-edged.

Collected Annotations on the Spiritual Pivot of the Yellow Emperor’s Inner Canon, Volume Eight

1. The character “zhong”: In Su Wen, Volume Thirteen, “Sinew Channels,” it is written as “can.”

2. “Twenty-five”: In Su Wen, Volume Twelve, “The Five Circulations of Nutritive Qi,” it is written as “twenty.”

3. “Moving upward”: In the first volume of the Jia Yi Jing, below line ten, the two characters “to the face” are added.

4. The character “he”: The original text has “li”; it has been changed to “he” on the basis of the Zhaofu Jujingtang edition.

5. The character “down”: At the beginning of Volume Twenty-Four of Su Wen, it is written as “up.”

6. “Must be firm”: In “Miscellaneous Needling” in Volume Thirteen of Su Wen, the two characters “bind it” appear after “firm.” Judging from the meaning, the phrase may instead have been written as “you must pierce it quickly.”

7. The character “lai”: It may have been intended as “ci”; the later occurrence of “lai” may be the same.

8. The character “zhu”: The original text has “jia”; it has been changed to “zhu” on the basis of the Zhaofu Jujingtang edition.

Collected Annotations on the Spiritual Pivot of the Yellow Emperor’s Inner Canon, Volume Nine

Chapter Twenty: “The Five Evils”

When pathogenic Qi enters the Lung, the symptoms include skin pain, chills and fever, rebellious Qi with rapid, labored breathing, sweating, and the shoulders and back pulling when coughing. Needles may be inserted into the acupoints on the outer front of the chest and beside the third and fifth vertebrae on the back (the original text has a variant reading: “the third section of the back and the five zang,” with one edition reading “five foreheads”). Press rapidly with the hand, then insert the needle where the pressure feels relieving. The acupoint at the supraclavicular hollow may also be used to disperse pathogenic Qi.

When pathogenic Qi enters the Liver, the symptoms include pain in both flanks, chill in the abdomen, blood stasis within the body, pain that is easily tugged by movement, occasional swelling of the joints, and swelling of the feet. Needle Xingjian to open the area below the flanks; supplement Zusanli to warm the Stomach; needle the blood vessels to disperse stasis; then treat the bluish vessels beside the ear to ease the tugging pain.

When pathogenic Qi enters the Spleen and Stomach, the muscles become painful. When Yang Qi is excessive and Yin Qi deficient, the Stomach feels hot and hunger comes easily. When Yang Qi is deficient and Yin Qi excessive, the Stomach feels cold, with rumbling in the intestines and abdominal pain. If both Yin and Yang are excessive, or both deficient, alternating signs of cold and heat occur. These conditions can all be brought into balance by regulating Zusanli.

When pathogenic Qi enters the Kidney, the symptoms include bone pain, Yin impediment (deep-seated impediment pain whose location is often hard to feel by pressing), abdominal distension, lower back pain, difficulty passing stool, pain in the shoulders, back, and neck, and occasional dizziness. Treat Yongquan and Kunlun. If vessels showing blood stasis are visible, drain the stagnant blood completely.

When pathogenic Qi enters the Heart, the symptoms include heart pain, a tendency to sadness, and occasional dizziness and collapse. Regulate the corresponding acupoints according to whether the pathogenic Qi is excessive or deficient.

Chapter Twenty-One: Cold and Heat Disorders

When the skin is affected by cold and heat, the person feels unable to lie close to the mat; the hair becomes dry and scorched, the nose dries out, and sweating stops. Treat the collateral points of the Three Yang meridians to supplement the Hand Taiyin meridian (the Lung meridian).

When the muscles are affected by cold and heat, they become painful; the hair becomes dry and scorched, and the lips dry out.

When cold and heat occur in the skin, the patient finds it difficult to bear contact with the bed or mat. The hair becomes dry and scorched, the nose dries out, and sweating ceases. In this case, treat the collateral vessels branching from the Three Yang meridians, and supplement the Hand Taiyin meridian (the Lung meridian of the Hand Taiyin).

When cold and heat occur in the muscles, the muscles ache, the hair becomes dry and scorched, the lips dry out, and sweating ceases. In this case, bleed points on the Three Yang meridians of the lower limbs, then supplement the Foot Taiyin meridian (the Spleen meridian of the Foot Taiyin) to promote sweating.

When cold and heat occur in the bones, the patient cannot sit or lie still, and sweat pours out without stopping. If the teeth have not yet withered, treat the collateral vessel of the Shaoyin meridian on the inner thigh. If the teeth have withered, the condition is critical and cannot be treated. Bone reversal, a disorder of counterflow caused by cold and heat in the bones, is the same.

Bone impediment, a painful impediment disorder affecting the bones, makes it difficult to raise the joints and causes pain, profuse sweating, and restlessness. Treat the meridians of the Three Yin (another text reads “Three Yang”) and use supplementation.

If the body is injured and loses a great deal of blood, then is exposed to wind and cold, or if the person falls from a height and the limbs become limp and weak, unable to lift, the condition is called “body slackness.” Treat the meeting point of three meridians in the lower abdomen, below the navel. “Threefold junction” refers to where the Yangming and Taiyin meridians meet below the navel: the Guanyuan point, three cun below the navel.

If reversal impediment, an impediment disorder caused by Qi counterflow, involves Qi surging up into the abdomen, treat the collateral vessels of the Yin and Yang meridians, choosing the sites according to the main symptoms. Drain the Yang meridians and supplement the Yin meridians.

The pulsating artery at the side of the neck is the Renying point, which belongs to the Foot Yangming meridian and lies in front of the sternocleidomastoid muscle. The point behind this muscle belongs to the Hand Yangming meridian and is called Futu. The next meridian to the side belongs to the Foot Shaoyang meridian, and its point is called Tianyou; the one farther to the side belongs to the Foot Taiyang meridian, and its point is called Tianzhu. The pulsating artery in the armpit belongs to the Hand Taiyin meridian, and its point is called Tianfu.

When Yang Qi surges upward, causing headache, fullness in the chest, and difficulty breathing, treat the Renying point. For sudden loss of voice and obstructed breathing, treat the Futu point and prick the collateral vessels at the root of the tongue to release blood. For sudden deafness, with Qi obstructed in the ears and impaired hearing and sight, treat the Tianyou point. For sudden cramping of the sinews, epilepsy, dizziness, and inability to support the body on the feet, treat the Tianzhu point. For sudden internal heat and Qi counterflow, when the Qi of the liver and lungs clash and blood pours from the nose and mouth, treat the Tianfu point. These five locations are collectively called the “Five Sites of Tianyou.”

A collateral vessel of the Hand Yangming channel enters the cheekbone region and spreads to the teeth. It is called Daying. This point may be used for decay and pain in the lower teeth. If the Hand Yangming channel presents with aversion to cold, use the reinforcing method; if there is no aversion to cold, use the reducing method. A collateral vessel of the Hand Taiyang channel enters the cheekbone region and spreads to the teeth. It is called Jiaosun. It may be used for decay and pain in the upper teeth; it lies beside the nose, in front of the cheekbone. When illness occurs, use the reducing method if the pulse is excessive and forceful, and the reinforcing method if it is deficient and weak. Another account says to locate the point beside the outer edge of the nose.

A collateral vessel of the Foot Yangming channel runs beside the nose and enters the face. It is called Xuanlu, connects with the mouth, and lies opposite the root of the eye. On examination, locate the abnormal area and take the point there: use the reducing method for excess and the reinforcing method for deficiency. If the symptoms worsen after treatment, increase the corresponding reinforcement. A collateral vessel of the Foot Taiyang channel leads to the nape. Use the reinforcing method when there is weakness. Another account says to locate the point beside the outer edge of the nose.

A collateral vessel of the Foot Yangming channel runs beside the nose and enters the face. It is called Xuanlu, connects with the mouth, and lies opposite the root of the eye. On examination, locate the abnormal area and take the point there; use the reducing method for excess and the reinforcing method for deficiency. If the condition worsens after treatment, strengthen the reinforcement. A collateral vessel of the Foot Taiyang channel runs along the nape and enters the brain, connecting directly with the root of the eye. It is called the “eye network.” This point may be used for headache and eye pain; it lies between the two tendons at the back of the neck. After the collateral vessel enters the brain, a branch connects with the Yin and Yang Qiao vessels, which regulate movement of the limbs and the opening and closing of the eyelids. The Yin and Yang vessels meet one another: the Yang vessel enters the Yin vessel, and the Yin vessel emerges from the Yang vessel. They meet at the outer corner of the eye. When Yang Qi is abundant, the eyes open; when Yin Qi is abundant, they close.

For heat syncope, caused by pathogenic heat or an imbalance of Yang that makes the limbs cold, take points on the Foot Taiyin and Foot Shaoyang channels and retain the needles. For cold syncope, caused by cold pathogens or insufficient Yang that makes the limbs cold, take points on the Foot Yangming and Foot Shaoyin channels, and retain the needles in both cases. For a slack, protruding tongue with drooling, accompanied by restlessness and a feeling of oppression in the chest, take points on the Foot Shaoyin channel. For bouts of shivering, trembling of the jaw, inability to sweat, abdominal distention, and restlessness with chest oppression, take points on the Hand Taiyin channel.

For needling deficiency, insert the needles when Qi and blood are dispersing or declining; for needling excess, insert them when Qi and blood are surging. In spring, take the collaterals; in summer, the interstices and spaces between the muscles; in autumn, the Qi opening—the site at the wrist where the pulse is examined and points are taken; in winter, the channel transport points. Point selection in all four seasons should accord with the season. The collaterals mainly treat skin disorders; the interstices, muscle disorders; the Qi opening, disorders of the sinews and vessels; and the channel transport points, disorders of the marrow and the Five Zang organs.

There are five areas of the body where abscesses are prone to develop: the Futu, the raised muscle on the front of the thigh, is the first; the calf is the second; the back is the third; the Back-Shu points of the five zang organs, where the Qi of the organs and bowels flows to the body’s surface, are the fourth; and the neck is the fifth. Abscesses in any of these five areas may be fatal.

When an illness begins in the arm, first needle the Hand Yangming and Hand Taiyin channels to induce sweating. When it begins in the head, first needle the Foot Taiyang channel at the nape to induce sweating. When it begins in the lower leg, first needle the Foot Yangming channel to induce sweating. Both the Hand Taiyin and Foot Yangming channels can be used to bring on sweating. Thus, if excessive sweating follows needling a Yin channel, use the Yang-channel method to stop it; if excessive sweating follows needling a Yang channel, use the Yin-channel method to stop it.

Improper needling can cause harm. If the needle is correctly placed but not withdrawn in time, Jing-Qi will leak out. If the needle is withdrawn before reaching the site of the illness, pathogenic Qi will gather. When Jing-Qi leaks out, the illness worsens and the person becomes frightened and unsettled; when pathogenic Qi gathers, an abscess may form.

Chapter Twenty-Two: Mania

The outer corner of the eye, near the outer side of the cheek, is called the outer canthus, or sharp canthus. The corner near the nose is called the inner canthus. The upper corner of the eye is the outer canthus, and the lower corner is the inner canthus.

At the onset of manic illness, the patient first feels unhappy, with a heavy, painful head; when raising the eyes to look, the eyes become red. In a severe attack, the mind becomes agitated and confused. Observe the complexion, then needle the Hand Taiyang, Hand Yangming, and Hand Taiyin channels. Stop when the color of the blood at the needle site changes.

At the onset of manic illness, if the corners of the mouth are drawn to one side, accompanied by crying out, labored breathing, and palpitations, examine the Hand Yangming and Hand Taiyang channels. If the left side is contracted, needle the right side; if the right side is contracted, needle the left. Stop when the color of the blood at the needle site changes.

At the onset of manic illness, if the body first bends backward and becomes rigid, followed by pain in the spine, examine the Foot Taiyang, Foot Yangming, and Foot Taiyin channels, as well as the Hand Taiyang channel. After needling, stop when the color of the blood at the needle site changes.

To treat epilepsy, one should stay with the patient regularly and observe which areas are suitable for treatment. During an attack, look for places on the body showing an abnormal response, prick them to draw blood, and collect it in a gourd vessel. When the patient has another attack, if the blood pulses on its own, this indicates that the illness has manifested. If it does not pulse, apply twenty moxa cones to the coccyx, counting one cone for each piece of moxa burned. “Qiong bone” here means the sacrum.

In bone epilepsy, where the pathogenic influence chiefly affects the bones, the cheeks, teeth, and the spaces between the acupuncture points and muscles are swollen and full, while the bones remain emaciated. The patient sweats, feels distressed, often vomits large amounts of foamy saliva, and shows signs of Qi descending and leaking away. This condition cannot be treated.

In sinew epilepsy, where the pathogenic influence chiefly affects the sinews, the patient is fatigued, and the sinews and vessels are cramped and rigid. Needle the major channel at the back of the neck, where the Dazhui point is located. If the patient frequently vomits foamy saliva and Qi descends and leaks away, the condition cannot be treated.

In vessel epilepsy, where the pathogenic influence chiefly affects the vessels, the patient suddenly collapses, and the vessels in the limbs become distended and slack. If the vessels are full, needle them all to release blood. If they are not full, apply moxibustion along the Taiyang channels on both sides of the neck, at the Dai vessel in the waist three cun from the waist, and at the spaces between the muscles and the source points, which correspond to the internal organs. If the patient frequently vomits foamy saliva and Qi descends and leaks away, the condition cannot be treated. According to the original text, sudden epilepsy presenting like madness cannot be saved.

At the onset of madness, the patient is easily saddened, forgetful, irritable, quick to anger, and often fearful. This illness is caused by grief and hunger. For treatment, select points on the Hand Taiyin and Hand Yangming channels and release blood until its color changes; the illness will then subside. Also select points on the Foot Taiyin and Foot Yangming channels.

When madness first breaks out, the patient sleeps little and feels no hunger. They consider themselves wise and superior, believe themselves talented and of high status, and enjoy insulting others, day and night without cease. For treatment, select points on the Hand Yangming, Hand Taiyang, and Hand Taiyin channels, as well as beneath the tongue and on the Foot Shaoyin channel. Examine the vessels in these areas and needle wherever there are clear signs of excess. Areas without signs of excess need not be needled.

Rambling incoherently, feeling fearful and unsettled, laughing often, enjoying singing and dancing, and behaving uncontrollably without being able to stop are usually caused by extreme fright. In treatment, select points on the Hand Yangming, Hand Taiyang, and Hand Taiyin channels.

If, during an episode of madness, a person sees illusions, hears phantom voices, and often shouts, the cause is Qi deficiency. In treatment, select points on the Hand Taiyang, Hand Taiyin, Hand Yangming, and Foot Taiyin channels, as well as points on the head and both cheeks.

Madness accompanied by increased appetite, frequent visions of ghosts and spirits, and a desire to laugh that remains unexpressed is usually caused by having experienced immense joy. In treatment, first select points on the Foot Taiyin, Foot Taiyang, and Foot Yangming channels, then points on the Hand Taiyin, Hand Taiyang, Hand Yangming, and Foot Taiyin channels, as well as points on the head and both cheeks. The classic also records that for this kind of illness, treatment should begin with the Foot Taiyin, Foot Taiyang, and Foot Yangming channels, followed by the Hand Taiyin, Hand Taiyang, and Hand Yangming channels.

When madness has begun recently and has not yet reached the degree described above, first needle the pulsating vessels on either side of the Ququan point on the inner knee. If the vessels are full, let blood; observe the condition after a short while. If it has still not improved, select points according to the usual method, then apply twenty cones of moxa over the sacrum.

When illness arises from Wind Evil disrupting the flow, the limbs suddenly swell, the body feels heavy and fatigued, and the person often feels cold. When hungry, they become agitated; after eating their fill, they are prone to unusual changes. Select points on the Hand Taiyin channel and its interior-exterior partner, the Hand Yangming channel, as well as points on the Foot Shaoyin and Foot Yangming channels. If the flesh feels cold, select Ying-Spring points; if the bones feel cold, select Jing-Well or Jing-River points.

During an attack of Jue Ni (a disorder caused by the reversal and disruption of Qi and blood), both feet suddenly stiffen, the chest feels as though it is about to split open, and the intestines and abdomen feel as though they are being cut with a knife. The person is distressed and unable to eat, and both large and small pulses are rough and sluggish. When the body is warm, select the Foot Shaoyin channel; when it is cold, select the Foot Yangming channel. Use reinforcing technique when the body is cold and reducing technique when it is hot.

Jue Ni may also manifest as abdominal fullness and rumbling intestines.

When Qi flow becomes disordered, causing abdominal distension and fullness, rumbling in the intestines, and tightness in the chest that makes breathing difficult, needle the lower part of the chest. If coughing pulls at the arms through pain in the flanks, press the corresponding acupoints on the back by hand. Press until the patient feels relief; this often eases the symptoms quickly.

If urination is obstructed and the patient cannot pass urine, use a long needle to prick the Foot Shaoyin and Foot Taiyang channels, as well as the area above the sacrum. If Qi flow rises counter to its proper course, select the Foot Taiyin, Foot Yangming, and Foot Jueyin channels. In severe cases, also select the pulsating points on the Foot Shaoyin and Foot Yangming channels.

If Qi is weak and insufficient, the body trembles, breathing is short, the bones ache, the body feels heavy, and the patient is listless, weary, and unable to move, tonify the Foot Shaoyin channel. If breathing is short and the breath cannot be sustained, so that even slight activity leaves the patient exhausted, also tonify the Foot Shaoyin channel and lance stagnant collateral vessels to let blood.

The “Pronunciation and Meaning Notes” explains the sounds and meanings of several characters: “juan” in “juanluan” is pronounced “quan”; “kan” is pronounced “gan” and refers to a person whose face has turned yellow and whose body has grown thin from hunger; “xi” is pronounced “xi” and here means to laugh.

Treatise on Heat Diseases, Chapter Twenty-Three

Hemiplegia is a condition in which one side of the body cannot move and is accompanied by pain, while speech remains unchanged and the mind is clear. The disease lies between the skin and the muscles. It may be treated with a large needle: tonify what is deficient and drain what is excessive. The condition may then improve.

The signs of fei disease are that the body is not in pain, but the limbs cannot be controlled freely. The mind is somewhat disordered, though not severely, and the patient can still express their meaning to some extent. This condition can be treated; if it becomes so severe that the patient cannot speak, it is difficult to treat. When the disease first arises in the Yang aspect and later enters the Yin aspect, treat the Yang aspect first, then the Yin aspect, using shallow needling.

On the third day of a heat disease, if the Qi-mouth pulse is calm and the Renying pulse is agitated, needle all the Yang channels and perform the “Fifty-Nine Needlings,” a method for clearing and draining pathogenic heat, to purge the heat and bring forth sweat. At the same time, support the Yin aspect and tonify what is deficient. If heat is severe throughout the body and the pulses at both the Yin and Yang positions are motionless, do not needle. When needling is appropriate, treat promptly; if sweat still does not emerge, continue to drain the heat. The instruction not to needle applies because signs of impending death have already appeared.

On the seventh or eighth day of a heat disease, if the pulse at the mouth of the vessel beats rapidly and briefly (another edition reads “wiry”), needle at once; sweat may then emerge of its own accord. Needle shallowly between the thumb and index finger.

On the seventh or eighth day of a febrile illness, if the pulse is faint and thready, the patient has blood in the urine and a dry mouth, and even slight movement brings on panting and short, labored breathing (another version reads, “the pulse is taut”), needle promptly. Sweating may begin on its own after needling. Needle shallowly at the point between the thumb and index finger.

On the seventh or eighth day of a febrile illness, if the pulse is faint and thready and there is also blood in the urine and a dry mouth, the patient may die within a day and a half. If the pulse pauses intermittently, it is called an intermittent pulse, and the patient may die within a day. If a patient with a febrile illness has already sweated but the pulse remains agitated, with panting and a return of the fever, do not needle the skin. Severe panting signals danger of death.

On the seventh or eighth day of a febrile illness, if the pulse is hurried but neither scattered nor rapid and frequent, the patient may sweat within the next three days. If there is still no sweat after three days, there is a danger of death on the fourth day. If the patient has not sweated at all before this, do not needle the Couli, the skin’s texture and the sites of the sweat pores.

At the onset of a febrile illness, if the first symptoms are skin pain, nasal congestion, and facial swelling, treat the skin with the first needle, a type of acupuncture needle, and use the “Fifty-Nine Needlings,” a group of methods for treating febrile illnesses. If the nasal symptoms are severe, treat through the Lung channel. If treatment through the Lung is not possible, treat through the organ associated with Fire, which corresponds to the Heart.

At the onset of a febrile illness, if the first symptoms are bodily stiffness and tightness, fever that feels better when leaning against something, agitation in the heart, and dryness of the lips, mouth, and throat, treat the skin with the first needle and the Fifty-Nine Needlings. If there is abdominal distension, dry mouth, and cold sweat, treat through the vessels governed by the Heart. If treatment through the Heart is not possible, treat through the organ associated with Water, which corresponds to the Kidneys.

During a febrile illness, if the throat is dry, the patient drinks a great deal, is easily startled, and cannot get up when lying down, and also has fever that feels better when leaning against something, agitation in the heart, and dryness of the lips, mouth, and throat, treat the muscles with the sixth needle and the Fifty-Nine Needlings. If there is a disorder at the outer corners of the eyes, treat the muscles governed by the Spleen. If treatment through the Spleen is not possible, treat through the organ associated with Wood, which corresponds to the Liver.

During a febrile illness, if the face is bluish, the head is painful, and the hands and feet are restless, treat between the sinews with the fourth needle, and needle the areas where the limbs are cold and numb. If there are symptoms such as spasms in the sinews and tearing eyes, treat the sinews governed by the Liver. If treatment through the Liver is not possible, treat through the organ associated with Metal, which corresponds to the Lungs.

During a febrile illness, if the patient is repeatedly startled and develops convulsions, drawing movements in the hands and feet, and mental disturbance, treat the vessels with the fourth needle, quickly draining excess pathogenic Qi. If there is madness and hair loss, treat the blood vessels governed by the Heart. If treatment through the Heart is not possible, treat through the organ associated with Water, which corresponds to the Kidneys.

When a heat illness causes heaviness in the body, pain in the bones and joints, deafness, and drowsiness, treatment may begin with the bones. Use the fourth needle and apply the “fifty-nine needling sites”—a set of fifty-nine acupuncture points used to treat heat illness. If the bone disorder affects the heart, do not look for its cause solely in Kidney Water; “Water” here refers to the kidneys.

When a heat illness causes heaviness in the body, bone pain, deafness, and drowsiness, treatment may begin with the bones, using the fourth needle and the fifty-nine needling sites. If the bone disorder also leads to loss of appetite, teeth grinding, and bluish ears, seek the cause in the kidneys. Do not attribute it to Spleen Earth; “Earth” here refers to the spleen.

If, during a heat illness, the person cannot tell where the pain is, is deaf, cannot control the body, and has a dry mouth, while Yang heat is intense and the Yin aspect is somewhat cold, this indicates that the heat has penetrated deep into the bone marrow. The condition is difficult to treat and the prognosis is grave.

Headache, pain at both temples, and pain in the blood vessels around the eyes during a heat illness, accompanied by a tendency to nosebleeds, point to a disorder of the Jue-heat type. Treat with the third needle, distinguishing according to the condition whether pathogenic Qi is excessive or healthy Qi is deficient, and whether the pattern is cold or hot, replete or vacuous.

When a heat illness causes heaviness in the body and heat in the intestines, use the fourth needle. Needle the shu points and the points between the toes, drawing channel Qi from the Stomach collateral—the channel connected with the stomach—until Qi arrives at the needle.

For a heat illness with cramping pain beside the navel and fullness in the chest and flanks, select Yongquan and Yinlingquan, use the fourth needle, and needle the relevant area inside the throat.

When inducing sweat during a heat illness, if the condition permits sweating and the pulse is also harmonious, select Yuji, Taiyuan, Dadu, and Taibai. The reducing method can clear heat, while the reinforcing method can promote sweating. If sweating is excessive, needle the transverse vessel above the inner ankle to stop it.

If sweating has occurred during a heat illness but the pulse remains agitated and forceful, this indicates that the Yin pulse has become depleted to the utmost, and the prognosis is grave. If the pulse settles after sweating, the prognosis is better. When the pulse remains large and agitated and a corresponding reaction is also present at Taibai, the reducing method can clear heat and the reinforcing method can induce sweating. If sweating is excessive, needle the transverse vessel above the inner ankle to stop it.

If sweating has occurred during a heat illness but the pulse remains agitated and forceful, this indicates that the Yin pulse has become depleted to the utmost, and the prognosis is grave. If the pulse settles after sweating, the prognosis is better. During a heat illness, a large, agitated pulse that persists without any sweating indicates that the Yang pulse has become depleted to the utmost, and the prognosis is grave. If sweating follows a large, agitated pulse and the pulse gradually settles, the prognosis is better.

There are nine critical conditions in febrile illness for which needling must not be used. The first is an inability to sweat, pronounced redness of the cheekbones, and hiccups. The second is diarrhea with severe abdominal distension. The third is blurred vision with a persistent fever. The fourth is fever with abdominal distension in an elderly person or an infant. The fifth is an inability to sweat accompanied by vomiting blood or blood in the stool. The sixth is ulceration at the root of the tongue with a persistent fever. The seventh is coughing, nosebleeds, and an inability to sweat, with sweating that does not reach the feet. The eighth is heat in the bone marrow. The ninth is fever with convulsions, the back arching backward, limbs twitching, and the jaws clenching and grinding the teeth. None of these nine conditions should be treated with needling.

The “fifty-nine needling points” refers to a set of acupuncture locations used to treat febrile illness. Take three points on each of the outer and inner sides of both hands, for a total of twelve. Take one point in each space between the five fingers, for a total of eight. Select corresponding points on both feet. On the head, take three points on each side, one inch inside the hairline and three fen to the side, for a total of six. Then, three inches inside the hairline, take five points on each side, for a total of ten. Take one point each in front of the ears, behind the ears, and beneath the mouth, and one at the midline of the nape, for a total of six. Take one point each at the crown, Xinhui (a point at the front of the crown), the hairline, and Lianquan (a point at the front of the neck); take two points each at Fengchi and Tianzhu (both points at the back of the neck).

For fullness in the chest with rapid breathing, needle the point at the tip of the big toe on the Foot Taiyin Spleen Channel, about the width of a chive leaf from the edge of the toenail. For a cold condition, retain the needle for a while; for a heat condition, withdraw it quickly. Stop needling once the Qi dynamic descends.

For sudden, severe pain from a heart-related hernia, needle points on the Foot Taiyin Spleen Channel and Foot Jueyin Liver Channel, and prick the stagnant collaterals to release blood.

For a swollen, painful, obstructed throat, a curled tongue, dry mouth, restlessness or pain in the heart, or pain along the inner arm that prevents raising the hand to touch the head, needle the point near the nail of the finger beside the little finger—the ring finger—about the width of a chive leaf from its tip.

For red, painful eyes, with the pain beginning at the inner corner, needle a point on the Yin Heel Vessel.

When wind causes convulsions and the body arches backward, together with paralysis, a curled tongue, dry mouth, restlessness or pain in the heart, or pain along the inner arm that prevents raising the hand to touch the head, needle the point near the nail of the ring finger, about the width of a chive leaf from its tip.

For red, painful eyes, with the pain beginning at the inner corner, needle a point on the Yin Heel Vessel.

Wind-induced convulsions, in which the body stiffens and bends backward, are treated first by needling the Foot Taiyang channel and the point in the hollow behind the knee. If visible blood vessels are present, prick them to let the blood. If the patient has internal cold, also needle Zusanli.

For inability to urinate, needle the Yin Heel vessel and the point behind the joint at the base of the big toe, where three hairs grow. If visible blood vessels are present, prick them to let the blood.

When a man shows symptoms resembling Gu disease, or a woman symptoms resembling Ju disease, and the body, waist, and back feel as though they are coming apart, with no desire to eat, first needle Yongquan to let the blood. Then examine the vessels on the top of the foot; if they are engorged, prick all the visible vessels to let the blood.

Pronunciation notes: “Jing” is pronounced ju jing qie; “Jin,” ju jin qie; and “Xie,” jie.

Chapter 24: Reversal Disorders

When reversal causes headache, the face looks swollen, and the heart feels troubled, needle the Foot Yangming and Foot Taiyin channels.

When reversal causes headache and pain in the vessels of the head, accompanied by sorrow and a tendency to weep, observe the pulsating vessels in the head. If their pulse is abnormally strong, prick them to release stagnant blood. Then treat the Foot Jueyin channel.

When reversal causes headache with a heavy, painful head, needle the five rows of points on the head, five points in each row. Needle the Hand Shaoyin channel first, then the Foot Shaoyin channel.

When reversal causes headache and frequent forgetfulness, with no clearly defined painful spot even when pressed, needle the pulsating vessels on both sides of the head and face. Then needle the Foot Taiyin channel.

When reversal causes headache that begins with pain in the neck and is followed by discomfort in the lower back, needle Tianzhu first, then the Foot Taiyang channel.

When reversal causes severe headache and pulsating vessels swell and become hot in front of and behind the ears, prick these vessels to release the blood. Then needle the Foot Shaoyang channel.

True headache is severe pain that reaches into the brain, with the hands and feet cold up to the joints. This condition cannot be cured.

If a blow or fall causes a headache and stagnant blood within the body, do not needle the usual acupuncture points. If the muscles are injured and the pain has not eased, needle near the injury; do not select a distant point.

There is a kind of headache that should not be needled: it is a severe Bi disorder whose symptoms recur every day. Needling may lessen the condition somewhat, but cannot cure it.

For cold and pain on one side of the head, first needle the Hand Shaoyang and Hand Yangming channels, then the Foot Shaoyang and Foot Yangming channels.

Jue heart pain that spreads to the back, comes and goes in spasms, and feels as though something is striking the heart from behind, with the body bent and lying face down, is kidney heart pain, a pain arising from disorders of the kidney channel. Needle Jinggu and Kunlun first. If the pain persists after needling, then needle Rangu.

Jue heart pain accompanied by abdominal distension, chest oppression, and especially severe heart pain is stomach heart pain, pain related to the stomach. Needle Dadu and Taibai.

Jue heart pain that feels like an awl driven into the heart, with intense pain, is spleen heart pain, pain related to the spleen. Needle Rangu and Taixi.

Jue heart pain with a greyish-blue complexion, like that of a dying person, and an inability to breathe comfortably all day is liver heart pain, pain related to the liver. Needle Xingjian and Taichong.

Jue heart pain that causes no apparent discomfort when lying still, but worsens with movement, without any change in complexion, is lung heart pain, pain related to the lung. Needle Yuji and Taiyuan.

When true heart pain (severe pain originating in the heart itself) progresses to cold hands and feet, with coldness reaching the joints and very severe pain, an attack in the morning may lead to death by evening, and an attack in the evening may lead to death by morning.

When heart pain is clearly caused by an accumulation within the body, one should not needle it, nor should one needle the shu points.

For intestinal parasitic accumulations and worm masses (worm bodies or abdominal lumps formed by parasitic accumulation), as well as jiaowei (a type of intestinal worm disease described by the ancients), small needles should not be used. If there is pain in the heart and abdomen that comes and goes, with lumps within the abdomen that gather and disperse, pain that wanders between upper and lower regions, abdominal heat, and a craving for water with salivation, this is jiaowei. For treatment, gather the mass with the hand and press it firmly so that it cannot move, then insert a large needle and keep it in place for a long time. Only when the worm is no longer moving should the needle be withdrawn. If there is abdominal distension and pain, with signs of the condition appearing in the upper part of the body, this too belongs to this category of conditions.

For deafness with an inability to hear, one should needle points within the ear. For tinnitus, one should needle the pulsating vessel in front of the ear. Ear pain for which needling is not appropriate indicates pus within the ear, or dry earwax blocking it, so that sound cannot be heard.

Deafness with an inability to hear sounds may be treated by needling inside the ear, and tinnitus by needling the artery that pulses in front of the ear. When ear pain makes needling inappropriate, the cause may be pus within the ear or dry earwax (erting, earwax), which prevents hearing. To treat deafness, one may needle at the junction of the nail and flesh of the finger beside the little finger, selecting points on the hand first and then points on the foot. To treat tinnitus, one may needle at the junction of the nail and flesh of the middle finger: for tinnitus in the left ear, use the right hand, and for tinnitus in the right ear, use the left hand, again beginning with the hand and then proceeding to the foot.

When the thigh and hip (bi) cannot be raised, the patient should lie on their side for the points to be selected. The needle is inserted at the shuhe point near the hip joint, using a round-sharp needle (one with a relatively fine tip and slender shaft), not a large needle.

When pathogenic qi descends and causes blood in the stool, the Ququan (Qu Quan) point may be selected.

When fengbi (Wind Bi, painful obstruction caused by wind) persists without healing, the patient feels as though the feet are treading on ice, and at other times as though they are immersed in hot soup. The thighs and calves experience numbness and pain that wander from place to place. The patient is troubled in the heart and suffers headaches, sometimes vomiting and at other times feeling fullness in the chest. Sweating follows a spell of dizziness, and over time the eyes may grow blurred. Emotionally, the patient alternates between sorrow, joy, and fear, accompanied by shortness of breath and a sense of disharmony. If such an illness continues to progress, death will follow within three years.

The Phonetic Glosses and Collation Notes explain the pronunciation and meaning of several characters and the textual differences among various editions. Among them, erting is glossed as earwax.

If disease appears first and disordered qi (qi) movement follows, treat the original disease. If disordered qi movement comes first and illness follows, also treat the original disorder. If someone is first chilled and then falls ill, or falls ill first and then shows signs of cold, treat the original cause. Likewise, if heat arises first and illness follows, or illness comes first and heat signs appear, treat the original cause. If diarrhea appears first and other illnesses develop afterward, regulate the diarrhea first and then treat the other illnesses.

If illness appears first and distension of the abdomen follows, treat the abdominal fullness as the subsequent branch (biao) manifestation. If illness appears first and diarrhea follows, treat the original disease. If abdominal distension comes first and mental vexation (xinzhong fanmen) follows, also treat the original disease.

Some diseases involve guest qi (keqi), meaning a temporary invasion of pathogenic qi that differs from the underlying pattern, while others involve same-type qi (tongqi), a pathogenic qi that matches the existing pattern. When urination and defecation are obstructed, treat the branch first. When they flow freely, treat the root (ben) first.

When the disease's momentum is excessive, treat the root first and then the branch. When the momentum is deficient, treat the branch first and then the root. One must carefully examine how severe the condition is before deciding on treatment. When the condition is mild, root and branch can be treated together; when it is severe, one should focus exclusively on one aspect. If urinary and bowel obstruction comes first and other illnesses follow, treat the original obstruction first.

Chapter 26: Miscellaneous Disorders

When reversed counterflow qi (jueni zhi qi) ascends along the spine with pain that extends all the way to the crown of the head, with heaviness of the head, blurred vision, and stiffness of the lower back and spine, needle the blood vessels in the popliteal fossa of the Foot Taiyang (zu taiyang) channel. These refer to the visible vessels at the back of the knee.

When reversal occurs with fullness in the chest, swelling of the face, moist lips with drooling, and sudden difficulty speaking that becomes complete loss of speech in severe cases, treat the Foot Yangming (zu yangming) channel.

When reversed qi surges upward into the throat and prevents speech, with cold hands and feet and constipation, treat the Foot Shaoyin (zu shaoyin) channel.

When reversal produces rumbling in the abdomen, usually accompanied by cold qi, with gurgling sounds in the bowels and difficulty with defecation and urination, treat the foot channels.

Cold limbs and a distended abdomen with a gurgling sensation inside are mostly caused by cold qi. For difficulty urinating and defecating, select points on the Foot Taiyin (Zu Taiyin) channel, the Spleen channel.

For a dry throat, heat in the mouth, and a sticky feeling as if holding glue, select points on the Foot Shaoyin (Zu Shaoyin) channel, the Kidney channel.

For knee pain, needle Dubi (Calf's Nose) point, a point on the knee, using a round-pointed needle (a needle with a rounded tip, suitable for therapeutic puncture). After insertion, pause briefly, then needle again at intervals. The needle body should be as fine as a yak hair, and there is no need to hesitate when needling the knee.

For throat bi (obstruction and swelling of the throat and similar conditions), if the patient cannot speak, select points on the Foot Yangming (Zu Yangming) channel, the Stomach channel. If the patient can still speak, select points on the Hand Yangming (Shou Yangming) channel, the Large Intestine channel.

For malaria, if attacks come without thirst and recur every other day, select the Foot Yangming channel. If the patient is thirsty and attacks occur daily, select the Hand Yangming channel.

For toothache without aversion to cold drinks, select the Foot Yangming channel. With aversion to cold drinks, select the Hand Yangming channel.

For deafness without pain, select the Foot Shaoyang (Zu Shaoyang) channel, the Gallbladder channel. For deafness with pain, select the Hand Yangming channel.

For nosebleed that does not stop and discharges clotted blood, select the Foot Taiyang (Zu Taiyang) channel, the Bladder channel. For discharge of clotted blood, select the Hand Taiyang (Shou Taiyang) channel, the Small Intestine channel. If bleeding continues, needle the area below Wangu point. If it still does not stop, needle the blood vessels in the popliteal fossa (the hollow behind the knee) to let blood.

For lower back pain, if the area above the painful site feels cold, select the Foot Taiyang and Foot Yangming channels. If the area above the painful site feels hot, select the Foot Jueyin (Zu Jueyin) channel, the Liver channel. If the pain is so severe that the patient cannot bend forward or lean back, select the Foot Shaoyang channel. For heat in the chest with shortness of breath, select the Foot Shaoyin channel and the blood vessels in the popliteal fossa.

For irritability and loss of appetite with a voice that grows progressively weaker, needle the Foot Taiyin channel. For irritability with excessive talking, needle the Foot Shaoyang channel.

For cheek pain, needle the Hand Yangming channel and let blood from the vessel at the cheek where the pulse is most prominent.

For nape pain with inability to bend or tilt the head, needle the Foot Taiyang channel. For inability to turn the head to look sideways, needle the Foot Shaoyang channel.

For cheek pain, needle the Hand Yangming channel and let blood from the vessel at the cheek where the pulse is most prominent.

For nape pain with inability to bend or tilt the head, needle the Foot Taiyang channel. For inability to turn the head to look sideways, needle the Hand Taiyang channel, the Small Intestine channel.

For lower abdominal distension with qi rushing upward to the stomach, and even to the chest and heart, with alternating chills and fever and difficult urination, select the Foot Jueyin channel.

For abdominal distension, constipation, and an enlarged abdomen, with qi rising to the chest and throat and producing a panting wheeze, select the Foot Shaoyin channel.

For abdominal distension with indigestion, gurgling in the abdomen, and inability to defecate, select the Foot Taiyin channel.

For heart pain radiating to the lower back, accompanied by a feeling of nausea, select the Foot Shaoyin channel.

For heart pain with abdominal distension, discomfort in the abdomen, and constipation, select the Foot Taiyin channel.

Zhoubi (Circulating Bi) Syndrome, Chapter Twenty-Seven

When heart pain radiates to the back and the breath is obstructed, needle the points of the Foot Shaoyin channel (the Foot Shaoyin Kidney channel). If the pain still does not ease, then take the points of the Hand Shaoyang channel (the Hand Shaoyang Sanjiao channel).

When heart pain radiates to the lower abdomen, with distension of the lower abdomen, pain that shifts up and down without a fixed location, and difficulty urinating and defecating, needle the points of the Foot Jueyin channel (the Foot Jueyin Liver channel).

When heart pain radiates to the back, with shortness of breath and labored breathing, needle the Foot Shaoyin channel. If it still does not ease, then take the Hand Shaoyang channel.

When heart pain radiates to the lower abdomen, with distension of the lower abdomen, pain that shifts up and down without a fixed location, and difficulty urinating and defecating, needle the Foot Jueyin channel.

When heart pain is accompanied by shortness of breath and insufficient breath, needle the points of the Hand Taiyin channel (the Hand Taiyin Lung channel).

For heart pain, needle at the Nine Joints (jiujie). After pressing, insert the needle at the spot that was pressed, and the pain will ease immediately. If it still does not ease, search for the site of the pain at the related points above and below. Once it is found, treat it, and the pain will ease immediately.

For neck pain, needle the pulsating vessel at the Quzhou site of the Foot Yangming channel (the Foot Yangming Stomach channel) to draw blood, and the pain will ease immediately. If it still does not ease, massage the Renying (Renying) point on the channel, and the pain will ease immediately.

When qi rises counterflow, needle the depression in front of the chest and the pulsating vessels of the lower chest.

For abdominal pain, needle the pulsating vessels on either side of the navel. After needling, press the site, and the pain will ease immediately. If it still does not ease, needle the Qijie (Qijie) point, then press again after needling, and the pain will ease immediately.

If the limbs are numb and cold, as though bound and blocked, release the binding quickly, twice a day. Those with numbness will recover within ten days. Do not interrupt treatment until the illness is cured.

For hiccups, one may lightly tickle the nasal cavity with a grass stem to provoke a sneeze, and the hiccups will stop. If breathing stops, quickly receive and draw in the breath, and the condition will ease immediately. One may also use startling to stop the hiccups.

Zhoubi (Circulating Bi Syndrome), Chapter Twenty-Seven

Huangdi (the Yellow Emperor) asked Qibo: "When Zhoubi (a bi-syndrome in which pain travels along the channels through the body, moving up and down the body) occurs in the body, the pain shifts upward and downward, following the channels, and responds from left to right with almost no pause. I would like to know, when this pain occurs in the blood vessels……"

The Yellow Emperor asked Qi Bo: "When Zhoubi (circumambulating impediment) arises, the pain moves up and down the body along the channels of the jingmai (meridians), and the two sides of the body answer each other, with the pain shifting forward and back at short intervals and almost no pause. I want to know whether this pain lies within the blood vessels or between the muscles, and why it happens. The pain moves so quickly that there is no time to insert the needle, and by the time one tries to determine the site for treatment, the pain has already stopped. What causes this?"

Qi Bo replied: "This is Zhongbi (multiple impediments), not Zhoubi."

The Emperor said: "Please tell me about Zhongbi."

Qi Bo replied: "Zhongbi arises in different parts of the body, appearing at times and subsiding at others. The location of the pain keeps changing, rising and falling. It may answer from left to right or from right to left, but it does not travel around the body. It flares up for a while and then rests."

The Emperor said: "Good. How should it be needled?"

Qi Bo replied: "In treating this illness, even after the pain has stopped, one must needle the places where it had hurt, so that it does not return."

The Emperor said: "Good. Please tell me what Zhoubi is like."

Qi Bo replied: "Zhoubi arises within the blood vessels. The pain moves up or down along the jingmai, and it does not shift from side to side. Instead, it passes along the corresponding sites of the channels."

The Emperor asked: "How should it be needled?"

Qi Bo replied: "When the pain moves from above downward, first needle the lower site it is about to pass through, and then needle the upper site, so that the pathogenic qi can disperse. When the pain moves from below upward, first needle the upper site it is about to pass through, and then needle the lower site, so that the pathogenic qi can disperse."

The Emperor said: "Good. Where does this pain come from, and why is it given this name?"

Qi Bo replied: "Wind, cold, and damp pathogens invade the muscles at the surface of the body and press and gather there, forming fine fluid. When the fluid meets cold, it congeals. Once congealed, it presses against the muscles and splits them apart, and this produces pain. While the pain is present, a person's attention gathers at the painful spot, and the area becomes warm. Once it is warm, the pain eases. After the pain subsides, qi and blood in the affected area circulate poorly, and impediment pain then arises somewhere else. In this way the pattern repeats again and again."

The Yellow Emperor said, "Well said! I now understand the principle. The pathogenic influence has not penetrated the internal organs, nor has it spread to the surface of the skin. It stays between the divisions of the muscles (fenfen), so the true qi (zhenqi) cannot circulate throughout the body. This is why it is called circumambulating bi (zhoubi). In treating bi syndromes, one must first carefully examine the Six Channels (liujing) to which the affected area belongs and determine whether those channels are deficient or excess. At the same time, one should observe whether the great collaterals (dàluò) are obstructed by stagnant blood, or whether the pulse qi is weak and the vessels are empty, and then treat each condition accordingly. Warm compresses may be used to free the flow of qi and blood. Where the sinews are tense, rigid, and restricted in movement, the channels should be cleared by following their course."

The Yellow Emperor said, "Well said! Having understood the principle, I also know how to proceed. The nine needles (Jiu Zhen) are to be used to regulate disorders caused by imbalance of yin and yang in the twelve channels."

The character pronounced "xu" is read as "xu," meaning "empty" or "void."

Chapter 28: Oral Questions (Kouwen)

While the Yellow Emperor was at leisure, he dismissed his attendants and asked Qi Bo, "I have already heard the discourse in the Nine Needles on the adverse and favorable movements of yin and yang and on the contents of the Six Channels, and I have now heard all of it. I would like to hear some of the teachings passed down orally as well."

Qi Bo rose from his seat, bowed twice to the Emperor, and said, "This is an excellent question. These teachings were transmitted orally by my former masters."

The Emperor said, "Please tell me."

Qi Bo replied, "The onset of all diseases is related to wind, rain, cold, heat, changes in yin and yang, joy and anger, and diet and daily routine. A sudden fright or terror also causes the blood and qi to scatter and yin and yang to fall into disorder. The circulation of qi and blood in the channels is then blocked, and the vessels fail to remain clear. When yin and yang qi rebel and fall into disorder, the defensive qi (weiqi) stagnates, the channels grow empty, and the circulation of blood and qi loses its order, so the body's normal state is broken. As for matters that cannot be explained by the classic texts alone, let me describe the specific methods."

The Yellow Emperor asked: Why do people yawn? Qi Bo replied: Wei qi (the qi that circulates through the body and guards the surface of the skin) moves along the outside of the body during the day and turns inward at midnight. Yin governs the night and the lower part of the body, while yang governs the upper part. When yin qi gathers below and yang qi has not yet fully receded, yang draws qi upward, and yin draws it downward. As yin and yang pull against each other above and below, a person yawns repeatedly. When yang qi is exhausted and yin qi is abundant, a person closes their eyes and sleeps. When yin qi is exhausted and yang qi is abundant, a person wakes. In treatment, drain the Foot Shaoyin channel (the Kidney channel) and tonify the Foot Taiyang channel (the Bladder channel).

The Yellow Emperor asked: Why do people hiccup? Qi Bo replied: After food enters the stomach, stomach qi carries it upward to the lungs. If cold qi that had lingered in the stomach returns there together with newly arrived grain qi, the old and new qi disturb one another, normal qi collides with pathogenic qi, and the counterflowing qi gathers and rises out of the stomach. This produces hiccupping. In treatment, tonify the Hand Taiyin channel (the Lung channel) and drain the Foot Shaoyin channel.

The Yellow Emperor asked: Why do people make a "xi" sound? Qi Bo replied: This happens when yin qi is excessive and yang qi is weak, so yin qi moves rapidly while yang qi moves sluggishly. Yin and yang qi clash and fall into disorder, and the gathered qi rises out of the stomach, which produces hiccupping. In treatment, tonify the Hand Taiyin channel and drain the Foot Shaoyin channel.

The Yellow Emperor asked again: Why do people make a "xi" sound? Qi Bo replied: This happens when yin qi is excessive and yang qi is weak, with yin qi moving rapidly and yang qi moving sluggishly, and yin qi so strong that yang qi is cut off. In treatment, tonify the Foot Taiyang channel and drain the Foot Shaoyin channel.

The Yellow Emperor asked: Why do people shiver and feel cold? Qi Bo replied: When cold qi invades the skin and yin qi predominates while yang qi is deficient, the body trembles and shivers. In treatment, tonify all the yang channels.

The Yellow Emperor asked: Why do people belch (ai qi)? Qi Bo replied: Cold qi lodges in the stomach, and the disordered qi disperses upward from below and then leaves through the stomach, which produces belching. In treatment, tonify the Foot Taiyin channel (the Spleen channel) and the Foot Yangming channel (the Stomach channel). Another view holds that one should tonify the Meiben point instead.

The Yellow Emperor asked: Why do people sneeze? Qi Bo replied: When yang qi is balanced and smooth, it fills the heart and then exits through the nose, which produces a sneeze. In treatment, tonify the Ying point of the Foot Taiyang channel (one of the Five Transporting Points, through which qi flows along the channel) and the Meiben point. Another view holds that one should tonify the Meishang point instead.

The Yellow Emperor asked why people yawn. Qi Bo replied that when stomach qi is insufficient, the various channels (jingmai) grow weak, and when the channels weaken, the sinews and vessels become slack and lose their strength. Slackened sinews affect the heart qi, and when qi is expelled through the nose, a sneeze results. One should supplement the Rong points of the Taiyang channel (the points where channel qi gathers), as well as the points at the root of the eyebrows. Another view holds that the points lie above the eyebrows.

The Yellow Emperor asked again why people yawn. Qi Bo replied that when stomach qi is insufficient, the various channels grow weak, and when the channels weaken, the sinews become slack. After the sinews relax, a person expends qi while walking and exerting effort, and the qi cannot be restored in time, so one yawns. One should apply the supplementing method to the points between the muscles, according to where the illness lies.

The Yellow Emperor asked why people weep and have runny noses when they grieve. Qi Bo replied that the heart is the master of the five zang and six fu organs, the eyes are where the major channels converge and the passage through which fluids rise, and the mouth and nose are the gates through which breath enters and leaves. Grief and sorrow disturb the heart qi, and a disturbed heart qi stirs the five zang and six fu organs. When the organs are disturbed, the major channels are affected too, and the fluid passages open, so one weeps and the nose runs. Fluids serve to nourish the Jing (essence) and moisten the orifices. When the eyes' fluid passage opens, tears flow. If the weeping does not stop and the fluid is exhausted, the essence is no longer nourished and the eyes lose their sight, a condition called duojing (depletion of essence). One should supplement the Tianzhu point at the nape of the neck and the channels beside the neck, six points in all.

The Yellow Emperor asked why people sigh deeply. Qi Bo replied that worry and overthinking cause the heart connections (the vessels linking to the heart) to become tense, and tense heart connections narrow the airway. When the airway is narrowed and obstructed, one sighs deeply to release the breath. One should select points on the Hand Shaoyin channel, the Hand Jueyin Heart-Master channel, and the Foot Shaoyang channel, and retain the needles for a period.

The Yellow Emperor asked why people drool. Qi Bo replied that all food and drink enter the stomach. When there is heat in the stomach, parasites become active. When the parasites stir, stomach qi loosens, and loosened stomach qi causes the Lianquan point (where sublingual fluid gathers and wells up) to open, so saliva flows out. One should supplement the Shaoyin channel.

The Yellow Emperor asked: Why do people hear ringing in their ears? Qi Bo replied: The ears are where the various meridians (jingmai) converge. When the stomach is empty, the meridians gathering at the ears also grow weak, and the Qi (qì) and blood flow downward. If some of the branch channels are thereby depleted, tinnitus arises. In treatment, one may needle and supplement the Guest-Host point (Kezhuren, also known as Shangguan), along with the point at the junction of the nail root and the flesh of the thumb.

The Yellow Emperor then asked: Why do people involuntarily bite their own tongues? Qi Bo replied: This happens when disordered Qi rushes upward and the Qi of several meridians surges up together. When the Qi of the Shaoyin (shàoyīn) channel rushes upward, one bites the tongue; when the Qi of the Shaoyang (shàoyáng) channel rushes upward, one bites the cheek; when the Qi of the Yangming (yángmíng) channel rushes upward, one bites the lips. One should determine which meridian is the principal cause and then supplement it.

The text returns to the question of involuntary tongue biting. Qi Bo again replied that it is caused by disordered Qi rushing upward, with the Qi of several meridians surging up together.