《黃帝內經素問補註釋文》Vol. 12

The Yellow Emperor asked, “How should one prepare decoctions and fermented grain drinks from the five grains?”

Here, “decoction” refers to a light liquid, while fermented grain drinks are beverages such as grain wine.

Qibo replied, “Cook rice, using rice stalks for fuel. The rice should be whole, and the stalks should be sturdy. ‘Whole’ means choosing sound, unbroken grains; ‘sturdy’ means using stalks that are firm and tough. Whole grains produce a clear drink. Tough stalks make a strong fire that heats quickly, so the preparation is ready sooner.”

The Yellow Emperor asked, “Why is that?”

Qibo explained, “Because the rice receives the balance of Yin and Yang from Heaven and Earth and is suited to its growing environment, it can develop fully. If harvested at the proper time, its stalks will be sturdy. Rice grows in flooded fields and belongs to Yin, yet it is nourished by sunlight. It grows and ripens through the joining of Yin and Yang. In autumn, the weather turns cool and frost and dew form; the rice is gathered in winter. Thus, when it is harvested at the right time, its stalks are sturdy.”

The Yellow Emperor asked, “The sages of antiquity devised decoctions and fermented grain drinks, yet once they had made them, they did not use them. Why?”

Qibo replied, “The ancient sages prepared decoctions and fermented grain drinks in advance, keeping them in reserve. Out of compassion for the people, they made preparations against illness at its earliest onset, explaining these methods and having them ready for unexpected circumstances. In high antiquity, although decoctions were prepared, they were not taken, because the sages valued preventing illness before it arose. They were kept on hand and had no need to be used.

“By the middle ages, people’s virtue had gradually declined, and pathogenic influences often invaded the body. People took these decoctions and fermented grain drinks and still received good results. This was because people’s hearts were then still relatively close to the right way, so the remedies often worked.”

The Yellow Emperor asked, “Why, in our own time, are these methods alone not always enough to cure illness?”

Qibo replied, “Today, treatment must attack the illness from within the body with medicines, and treat it from the surface with stone lancets, needles, and moxibustion. ‘Stone lancets’ refers to stone medical tools used in antiquity to puncture or scrape the body; needling and moxibustion are the corresponding methods of acupuncture. Treatments today are different from those of ancient times.”

The Yellow Emperor then asked, “Some people become physically weak and their Qi and Blood are depleted, yet treatment has no effect. Why?”

Qibo replied, “Because their ‘spirit cannot be put to use’—the body’s Shen Qi cannot function. The Yellow Emperor asked, “What does ‘the spirit cannot be put to use’ mean?” Qibo said, “The way of needles and stone tools means treatments such as needling and stone lancets.”

It is not enough to speak only of the wonders of needling and stone probes—stone tools used in ancient times for puncturing, cutting, or pressing in treatment. Why? Because the patient’s will runs counter to the physician’s treatment.

The patient’s spirit cannot focus, and the mind is unsettled, so the illness cannot be cured. The patient’s conduct strays from the proper path, weakening and dissipating the innate, true Qi. This is the same reason.

The Newly Collated Corrected Text says: “On checking, the Complete Yuanqi Edition reads, ‘The spirit advances, the will and mind are settled, and so the illness can be cured’; the Great Simplicity reads, ‘The spirit strays, the will and mind scatter, and so the illness cannot be cured.’”

Now Jing and Qi have been damaged, the spirit has scattered, and the Qi of the nutritive and defensive systems—which circulates within and around the body and provides nourishment and protection—can no longer be gathered back in. Why is this so? Desires have no end, and worries and troubles follow one after another. As a result, Jing and Qi grow weak and damaged, nutritive Qi becomes stagnant, defensive Qi declines, and the spirit leaves the body. The illness then cannot be cured.

The spirit is the source of life, while the nutritive and defensive systems govern Qi. When Qi loses its governor and the source of life is continually depleted, Shen cannot remain within the body. How, then, could the illness be cured?

The Yellow Emperor said: When an illness first begins, its symptoms are extremely subtle and hidden; a pathological knot must first form in the skin. Now, skilled physicians all say, “The illness has already taken shape.” This is called a reversal in the course of the illness: needling and stone probes can no longer cure it, and even the finest medicine can no longer take effect in time. These physicians already know how to treat illness and follow the rules of treatment. The patient’s relatives and siblings, whether near or far, hear the patient’s condition and voice every day and see the patient’s complexion every day. Yet the illness still cannot be cured. How, then, can one say that treatment did not begin early enough?

The Newly Collated Corrected Text says: “On checking other editions, some write the character ‘leisure’ as ‘to say.’”

Qibo said: The illness is the root, and the physician is the branch. If root and branch do not come together, pathogenic Qi will not submit. This is what is meant.

In other words, physician and patient cannot come together. The physician may be the patient’s relative or sibling, yet even when they understand the patient’s condition, emotion or doubt may make them unwilling to accept treatment. If they distrust the physician from the outset, do not believe in the wonders of needling and moxibustion, and refuse medicinal treatment, then no matter how clearly the principles of medicine are explained, how skilled the physician is, or how thorough the treatment, what can the physician do if the patient will not accept it?

The Treatise on the Distinctions of the Five Viscera says: One should not discuss profound medical principles with those who cling to ghosts and spirits; one should not discuss refined medical arts with those who abhor needling and stone probes. If patients refuse treatment, their illness may not be cured; if treatment is forced on them, it is difficult for it to work. These are all cases in which physician and patient cannot come together, so pathogenic Qi cannot be made to retreat and submit. And what do patients abhor besides needling and moxibustion? They may refuse medicine as well.

The Newly Collated Corrected Text says: “On checking the Treatise on Transforming the Spirit and Changing the Qi, it reads, ‘When root and branch have been identified, pathogenic Qi then submits.’”

The Yellow Emperor said: Can there be cases in which illness does not begin in the fine hairs or the skin, but instead the Yang Qi of the Five Viscera has already been exhausted?

The Newly Collated Corrected Text says: “On checking the Complete Yuanqi Edition and the Great Simplicity, both have ‘injured’ where this text has ‘Yang,’ meaning that the Yang Qi of the Five Viscera has already been damaged.”

Body fluids, the water within the body, fill the skin. The lung’s Po, its housed spirit, is left isolated and without support. Yin essence is damaged within, while Yang Qi is depleted outside. The body swells so much that clothing can no longer fit against it. These conditions make the pulses at the extremities of the limbs rapid, with a corresponding throbbing in the chest. Water Qi is obstructed within, and edema appears on the body’s surface. How should this be treated?

The illness did not begin in the fine hairs or the skin; it arose within the body. Yin Qi is excessive inside, while Yang Qi has declined and cannot enter the abdomen. Thus the Yang Qi of the Five Zang organs has been exhausted. Body fluids are water; “fill” means to be full, and “enclosure” refers to the skin. Yin water accumulates inside, and the swelling water Qi surges upward into the lungs, leaving Lung Qi in danger. Po is the spirit of the lungs. When the Kidneys are harmed by water pathogenic influence, the lungs, as the mother organ, receive no nourishment from the Kidneys. This is why it is said, “its Po dwells alone.”

When Yin essence is damaged within and Yang Qi is depleted outside, the Triple Burner, the body’s passageway for the movement of Qi and water, becomes obstructed, and the water passages are blocked. Body fluids fill the skin, causing the body to become obstructed and swollen. Hence it is said that the swelling is so great that the body no longer fits its clothes.

This kind of illness makes the pulses at the extremities of the limbs rapid, and the pulse Qi throbs inward in the lungs. “Movement in the lungs” means rapid breathing and coughing. Water Qi is obstructed within the abdominal membranes, while edema spreads over the body’s surface. If one tries to determine the visible signs and the root of the illness, these symptoms alone are not enough to decide.

“Four extremities” refers to the ends of the limbs. The Zuo Tradition says, “When wind pathogens are excessive, they cause illness at the ends of the four limbs.” The Ling Shu Jing says, “Yang Qi is received from the ends of the limbs.”

The New Corrected Edition notes that the character shi in the phrase “the body manifests outwardly” may be an error.

Qibo said: “When examining the pulse, distinguish between floating and sunken; eliminate water-dampness that has accumulated over a long time.”

The New Corrected Edition notes that the Tai Su has the character jing where another version has cuo.

Therefore, gently move the ends of the four limbs, wear warm clothing, and regulate the condition with miao needling, inserting needles at the collateral vessels corresponding to the affected area, so that the body may recover. Open the Ghost Gate, the sweat pores that release sweat and unblock the body’s exterior, and cleanse the Pure Residence, the passages that allow water to be discharged. Nourish Jing and Qi at their proper times, so that the Yang Qi of the Five Zang organs can spread and the organs can be unblocked. Then Jing and Qi will arise naturally, the body will grow strong on its own, bone and flesh will be in harmony, and abundant upright Qi will return to balance.

“To balance and regulate the measures” means to examine whether the pulse is floating or sunken: a floating pulse indicates illness at the exterior, while a sunken pulse indicates illness within. Illness within is treated by promoting discharge; illness at the exterior is treated by inducing sweating. That is why the text below says, “Open the Ghost Gate and cleanse the Pure Residence.” “Remove what is stagnant, old, and accumulated” means to clear away water that has been stored for a long time and things that have become lodged, just as grass stems should not remain in the body for long. The complete edition reads “grass stems.”

“Gently move the four extremities” means to move the limbs gently so that Yang Qi gradually circulates and spreads. That is why the scripture says to wear warm clothing. When the channels are full, the collateral vessels overflow. When the collaterals overflow, regulate them with miao needling, so that…

Although its appearance remains as before, there is no swelling; this is why it is called “cross-needling” (miao ci), in which needling is applied to the relevant area to treat a disorder of the meridians. Needling the affected site is intended to restore its appearance to its original state.

“Opening the Ghost Gate” means opening the mysterious portals—the sweat pores—so that pathogenic Qi can be expelled with the sweat. “The five Yangs” refers to the Yang Qi of the five zang organs. “Purifying the Palace” means draining fluid from the bladder. When the pulse is harmonious, the essence Qi of the five zang organs returns to the Kidneys at the proper time. Then the Yang Qi of the five zang organs gradually spreads outward, clearing away the turbid Qi beyond the organs. In this way, essence and marrow form naturally, and the muscles become full naturally. Once the zang-fu organs are harmonized, the Qi of bone and flesh supports and coordinates with one another, and the Qi of the main meridians returns to balance.

The Yellow Emperor said, “Well said.”

“Essentials of the Jade Tablet” Chapter

The Yellow Emperor asked, “I have heard that ‘measurement’ and ‘the extraordinary and constant’ refer to different things. How should they be applied?”

Qibo replied, “‘Measurement’ means assessing how deep or superficial an illness is; ‘the extraordinary and constant’ refers to unusual and special disorders. Allow me to explain the essentials of diagnosis: in changes of the five colors and the pulse, and in judging by measurement and the extraordinary and constant, everything hinges on grasping one principle.”

That principle is understanding the correspondence between complexion and pulse. Once this correspondence is understood, one can assess how deep or superficial an illness is and distinguish unusual disorders.

“The spirit turns without reversing; if it reverses, it no longer turns, and its vital mechanism is lost.”

Here, “spirit” refers to the activity of life as expressed through the movement of blood and Qi. The “Treatise on the Spirit of the Eight Seasonal Nodes” says, “Blood and Qi are a person’s spirit and Qi; they must be carefully nourished.” Blood and Qi respond to the four seasons, waxing and waning in succession with the seasons and circulating in the order of the Five Phases without competing or falling into disorder. This is what is meant by “the spirit turns without reversing.” “Reversing” means moving against the proper course. Blood and Qi follow the Qi of the season; they do not move against it. If they do, they violate the natural order. When that order is violated, blood and Qi become disordered and lose the vitality of their normal circulation.

How should this be understood? When Wood Qi declines, Fire Qi should flourish; when Fire Qi declines, Earth Qi should flourish; when Earth Qi declines, Metal Qi should flourish; when Metal Qi declines, Water Qi should flourish; and when Water Qi declines, Wood Qi should flourish. This cycle repeats without end and is called “the spirit turns without reversing.” If the order is reversed—Water flourishing as Wood declines, Metal as Water declines, Earth as Metal declines, Fire as Earth declines, and Wood as Fire declines—this is called “reversing without turning.” Since this goes against the natural course, how could life be sustained?

“The essential measure lies close at hand, yet is subtle.”

The key to changes in the five colors and the five pulses lies close to the natural order, yet is exceedingly subtle.

These essentials were inscribed on a jade tablet and given the title “The Jade Pivot in Harmony.”

“Jade Pivot” is the title of the chapter. It means that the key points about these cyclical changes are recorded in the chapter called “Jade Pivot.” The version here is the same as the main text of the “Treatise on the Jade Pivot.” The New Collation says: “Examine the passage beginning ‘the utmost number of the Dao’ carefully. From that point on, it repeats the main text of the ‘Treatise on the True Organs of the Jade Pivot,’ though the commentaries differ considerably.”

When facial colors appear above, below, to the left, or to the right, one must examine the corresponding vital area.

The “complexion” referred to here means a color that differs from the person’s normal organ color—that is, a color expressed by the Qi of another organ. For example, if red, yellow, white, or black appears in the area corresponding to the liver, each is called “Qi from another organ.” The same applies to the other organs. To inspect the color, one examines the areas above, below, to the left, and to the right of the Mingtang, the diagnostic area around the nose. Thus, wherever a color appears, the corresponding vital area must be examined. The New Collation says: According to the edition by Quan Yuanqi, “complexion” is written as “guest.” Methods of complexion inspection are described in detail in the Jia Yi Jing.

If the color seen on the face is faint, treat the condition with a decoction, and the illness will be cured in ten days. A faint color indicates a mild illness, so recovery takes only ten days.

If the color seen on the face is more pronounced, medicine must be taken until a full course is complete; recovery will take twenty-one days. A pronounced color indicates a severe illness, so the entire course must be completed before recovery.

If the color seen on the face is extremely pronounced, treat the condition with fermented wine, and recovery will take one hundred days. The illness is grave, so it takes many days to resolve.

If the complexion is withered and dull, and the facial flesh has wasted away, the condition cannot be treated. When the color is extremely pronounced and withered, and the facial flesh has wasted away, the condition is incurable; the illness will run its course in one hundred days. The New Collation says: Although a withered complexion and wasted flesh cannot be treated, the illness will still run its course in one hundred days.

If the pulse is short and the breath ceases, the person will die. A short pulse already indicates Qi deficiency; if it gradually ceases as well, the true Qi is nearly exhausted, so death is certain.

A person who contracts a warm disease while their upright Qi is extremely deficient will die. When upright Qi is extremely deficient and a warm disease develops, the warm Qi will consume the Jing and blood, leading to death.

When facial colors appear above, below, to the left, or to the right, their location must be considered: appearance in the lower part indicates a favorable pattern; appearance in the upper part indicates an unfavorable pattern. A color in the lower part shows that the Qi causing the illness remains below, so the pattern is favorable. A color in the upper part is a sign that the Shen Qi has been harmed, so the pattern is unfavorable.

An abnormal color on a woman’s right side indicates an unfavorable pattern, while one on her left indicates a favorable pattern. For a man, an abnormal color on the left indicates an unfavorable pattern, while one on the right indicates a favorable pattern. The left belongs to Yang, so for a man the right side is favorable and the left unfavorable. The right belongs to Yin, so for a woman the right side is unfavorable and the left favorable.

When Yin or Yang becomes excessively strong, either can lead to death. A color that appears contrary to the usual pattern on a woman’s left side, or on a man’s right side, indicates that the positions of Yin and Yang have been reversed. This color on a man’s left side is called “double Yang”; on a woman’s right side, it is called “double Yin.” When Yin or Yang Qi reaches its extreme, it turns into its opposite, and either condition may therefore lead to death.

“Yin and Yang Oppose One Another”

The New Corrected Edition says: According to the “Treatise on the Correspondence of Yin and Yang,” the text reads “Yin and Yang act in opposition.”

Treatment must be guided by weighing the waxing and waning of Yin and Yang. This is a matter of exceptional patterns and of careful assessment. “Weighing and balancing one against the other” refers to the loss of a suitable balance between the two Qi, with neither remaining appropriately higher or lower. When a condition departs from the norm, one must assess and measure changes in Qi, then treat according to the specific circumstances.

A forceful pulse accompanied by obstruction, numbness or paralysis, and alternating cold and heat all result from the intermingling of cold and hot Qi; they are not caused by an excess or deficiency of pathogenic Qi.

A pulse that stands alone without support indicates that Qi has been depleted. When Qi is deficient and leaking away, the blood is damaged.

A pulse that shows only the exterior and not the interior, or only the interior and not the exterior, is called “isolated” and indicates that Qi has declined and perished. If both the exterior and interior are present but Qi is insufficient, this is called “deficiency and decline.”

An isolated pulse is an adverse pattern, while deficiency is a favorable one. The isolated pulse has no support, so it is called “adverse.” Qi in deficiency and decline may recover, so it is called “favorable.”

In applying the method for exceptional patterns, begin with Taiyin. To assess exceptional patterns, first use the Taiyin pulse at the Qi gate (the pulse point at the wrist) to establish the normal Qi of the four seasons, then measure Qi that has departed from the norm.

A pulse showing that one’s own Five Phases Qi is being overcome is called “adverse,” and an adverse pattern leads to death. When Wood Qi encounters a Metal pulse, Metal Qi a Fire pulse, Fire Qi a Water pulse, Water Qi an Earth pulse, or Earth Qi a Wood pulse, each encounters a phase that it cannot overcome; these are therefore called “adverse.” If this overcoming continues without end, the adverse pattern leads to death.

A pulse showing a state that one’s own Five Phases can overcome is called “compliant,” and a compliant pattern allows one to survive. When Wood Qi encounters Water, Fire, or Earth pulses; Fire Qi encounters Metal, Wood, or Earth pulses; Earth Qi encounters Metal, Water, or Fire pulses; Metal Qi encounters Earth, Wood, or Water pulses; or Water Qi encounters Metal, Fire, or Wood pulses, these pulses all fall within the range of what each phase can overcome, and are therefore called “compliant.” A compliant pattern does not bring unceasing overcoming, damage, and decline, so one can survive.

The winds from the eight directions and the Qi of the four seasons restrain one another in a cycle that repeats without end. Since change never goes beyond the scope of the Five Phases, even when the phases overcome one another, the cycle continues.

If adverse movement extends across all five kinds of Qi, it can no longer be discussed phase by phase as though it were balanced Qi. With this, the relevant points have been covered.

“Treatise on the Essentials of Diagnosis and the End of the Channels”

The Yellow Emperor asked: What are the essentials of diagnosis?

Qibo replied: In the first and second months of the year, the Qi of Heaven begins to unfold and the Qi of Earth begins to stir into life. The human body’s Qi corresponds to the Liver.

“Fang” means “upright.” Here it refers to the harmonious blending of Heaven and Earth’s Qi, which allows all things to grow. Wood Qi governs for seventy-two days, roughly corresponding to the final twelve days of the three seasonal periods after the Beginning of Spring. By month, this is the first and second months, when the body’s Qi resides in the liver.

In the third and fourth months, the weather is balanced and expansive, while Earth Qi settles and stirs into activity. The body’s Qi resides in the spleen. Yang Qi is bright and abundant, and all things flower and begin to bear fruit. As the season draws to a close, Earth Qi takes up residence and grows strong. Earth also gives rise to Bing Fire, so the body’s Qi resides in the spleen.

In the fifth and sixth months, the weather is vigorous and Earth Qi rises; the body’s Qi resides in the head. Heaven’s Yang is blazing, and Earth Qi ascends. Since Fire by nature rises, the body’s Qi is said to reside in the head.

In the seventh and eighth months, Yin Qi begins to bring decline and killing; the body’s Qi resides in the lungs. In the seventh month, the three Yin lines begin to form; in the eighth, Yin Qi begins to bring decline and killing. This force corresponds to Metal, as does the nature of Lung Qi, so the body’s Qi resides in the lungs.

In the ninth and tenth months, Yin Qi begins to condense into ice and Earth Qi begins to close and store; the body’s Qi resides in the heart. Yin Qi starts to gather, and Earth Qi begins to close and store, entering storage along with Yang Qi. Thus the body’s Qi resides in the heart.

In the eleventh and twelfth months, ice and snow form again, Earth Qi closes, and the body’s Qi resides in the kidneys. Yang Qi lies deeply hidden, so the body’s Qi resides in the kidneys.

Qi changes in this way: in spring it comes forth through Wood Qi; in summer it grows and flourishes through Earth; it rises to its fullness and belongs to Fire; it brings decline and gathers inward through Metal; and it withdraws from the cold and lies hidden through Water. All these changes follow the rising, descending, floating, and sinking of Yin-Yang Qi. The “Treatise on the Generation of the Five Zang Organs” says that the forms of the five Zang organs can be understood through their correspondences with things of the same kind. This means that kinds of Qi respond to one another.

Therefore, in spring, acupuncture should be applied to the scattered Shu points (acupoints distributed across the body) and the Fenli (the dividing lines and textures between muscles). Stop once bleeding occurs.

“When the illness is severe, Qi passes on; when it is mild, Qi circulates.” This distinguishes the severity of pathogenic Qi. “Passing on” means transmission between things: Qi passes to what overcomes it. “Circulating” means moving in a cycle, flowing among the Qi of the Five Phases. A note by the New Textual Collation states that the Taishu reads “circulates and returns” here.

In summer, prick the collateral vessels and acupoints, stopping as soon as blood appears. “Exhausting the Qi” means using bleeding to drain all the pathogenic Qi that has accumulated in the collateral vessel reached by the needle. Once the pathogenic Qi has been expelled, the acupoint closes firmly, allowing the channel Qi to flow along its course; pathogenic factors such as pain then subside downward. This needling method is used because Yang Qi is vigorous in summer.

The New Collation says: According to the “Treatise on Needling in Accord with and Against the Qi of the Four Seasons,” summer Qi resides in the minute collaterals. Here, “collateral acupoints” means the acupoints on the minute collaterals. The “Treatise on Acupoints for Water and Heat” also says that in summer one selects the flourishing channels and the spaces between the flesh and its grain.

In autumn, needle the skin, directing the insertions up and down along the grain of the flesh, using the same method; stop when the pulse Qi changes. “Following the grain” means following the texture of the flesh. “Up” refers to the channels of the hands, and “down” to those of the feet. “A change in the spirit” means that the pulse Qi has changed from its condition before needling. Since the pulse shows the activity of the spirit Qi, this is why it is described in this way.

The New Collation says: According to the “Treatise on Needling in Accord with and Against the Qi of the Four Seasons,” autumn Qi resides in the skin, which agrees with the meaning here. The “Treatise on Acupoints for Water and Heat” also says to select acupoints to drain Yin pathogenic factors and He-Sea points to disperse Yang pathogenic factors by reducing them. Huangfu Shian says this is the responsive treatment method for early autumn.

In winter, needle the acupoints and orifices, inserting the needle along the grain of the flesh. For severe conditions, needle straight downward; for milder conditions, needle downward at dispersed points. “Straight downward” means inserting the needle directly downward; “dispersed downward” means inserting it downward at scattered points.

The New Collation says: According to the “Treatise on Needling in Accord with and Against the Qi of the Four Seasons,” winter Qi resides in the bones and marrow. Here, “acupoints and orifices” means acupoints and openings associated with the bones and marrow. The “Treatise on Acupoints for Water and Heat” also says that in winter one selects Jing-Well and Ying-Spring points. Huangfu Shian says this is the responsive treatment method for late winter.

Spring, summer, autumn, and winter each have their corresponding methods of needling. If, in spring, one instead needles the areas and uses the methods appropriate to summer, the pulse Qi will become disordered and weak, and pathogenic factors will invade the bone marrow. The illness will be difficult to cure, and the person will lose their appetite and strength.

The heart governs the pulse, so the pulse Qi becomes disordered and weak. The kidneys govern the bones, so pathogenic factors penetrate deep into the bone marrow. When heart Fire is weakened, Stomach Earth also becomes deficient; the person then loses the desire to eat and lacks strength.

The New Collation says: According to the “Treatise on Needling in Accord with and Against the Qi of the Four Seasons,” needling the collateral vessels in spring causes Qi and blood to spill outward, weakening the person.

If, in spring, one instead needles the areas and uses the methods appropriate to autumn, the sinews and vessels will contract, and the movement of Qi will run counter to its proper course. When rebellious Qi circles back, it can bring on coughing. The illness will be difficult to cure, and the person will often be startled, or even weep. The liver governs the sinews, so needling areas corresponding to autumn causes the sinews and vessels to contract. When the movement of Qi runs counter to its proper course and circles back, coughing results. The liver is associated with fright and fear, so the person will often be startled; the lungs…

Qi governs the movement of Qi dynamics. When those dynamics surge upward, the person also weeps. The Corrected Edition says: According to “On Following and Reversing the Four Seasons in Acupuncture,” needling the muscles in spring disrupts the movement of Qi and Blood, causing Qi to surge upward.

If, in spring, one needles the parts associated with winter, pathogenic Qi remains lodged in the zang-fu organs. The person develops abdominal distension, the illness becomes difficult to cure, and there is also a desire to speak. In winter, Yang Qi lies hidden, so pathogenic Qi can easily become lodged in the zang-fu organs. When Kidney Qi becomes congested and excessive, the abdomen distends; therefore, needling the parts associated with winter in spring causes abdominal distension. Fire receives Qi in winter, and the Heart governs speech, so the person wants to speak. The Corrected Edition says: “On Following and Reversing the Four Seasons in Acupuncture” records that needling the sinews and bones in spring causes Qi and Blood to stagnate within the body, producing abdominal pain.

If, in summer, one needles the parts associated with spring, the illness does not resolve and the person becomes drowsy and weak. The Liver nourishes the sinews; when Liver Qi is insufficient, the sinews become slack and weak. The Corrected Edition says: “On Following and Reversing the Four Seasons in Acupuncture” records that needling the channels in summer depletes Qi and Blood, leaving the person fatigued and weak.

If, in summer, one needles the parts associated with autumn, the illness does not resolve. The person loses the desire to speak, feels alarmed and unsettled, and imagines that someone is coming to seize them. The Liver belongs to Wood and is related to speech. Needling the parts associated with autumn weakens Liver Wood, causing fear: the person neither wants to speak nor can shake the feeling of dread. The Corrected Edition says: “On Following and Reversing the Four Seasons in Acupuncture” records that needling the muscles in summer causes Qi and Blood to withdraw inward, making the person prone to fear. The Jia Yi Jing gives “distress” instead of “fear.”

If, in summer, one needles the parts associated with winter, the illness does not resolve. The person has little Qi and sometimes feels like becoming angry. In summer, Kidney Qi is damaged, while Liver and Lung Qi become mutually excessive; the inner capacity for emotional response is then insufficient, leaving the person with little Qi and sometimes a desire to become angry. The Corrected Edition says: “On Following and Reversing the Four Seasons in Acupuncture” records that needling the sinews and bones in summer causes Qi and Blood to surge upward, making the person prone to anger.

If, in autumn, one needles the parts associated with spring, the illness does not resolve. The person becomes absent-minded and intends to do something, but after getting up forgets what it was. This is caused by weakness of Liver Qi and results from improper needling. The Corrected Edition says: “On Following and Reversing the Four Seasons in Acupuncture” records that needling the channels in autumn causes Qi and Blood to surge upward, making the person prone to forgetfulness.

If, in autumn, one needles the parts associated with summer, the illness does not resolve. The person becomes more prone to sleeping and also dreams easily. When Heart Qi is low, Spleen Qi appears isolated and weak, making the person prone to sleep. The Heart governs dreams, which are governed by the spirit, so the person dreams easily. The Corrected Edition says: “On Following and Reversing the Four Seasons in Acupuncture” records that needling the network vessels in autumn prevents Qi from reaching the body’s surface, making the person reluctant to move when lying down.

If, in autumn, one needles the parts associated with winter, the illness does not resolve. The person often feels cold and shivers.

Cold evil Qi attacks upward, so people may feel cold from time to time. “Sasa” describes the sensation of waves of cold repeatedly striking.

The Newly Collated Corrections says: According to the “Treatise on Needling in Accord with or Contrary to the Four Seasons,” needling the sinews and bones incorrectly in autumn causes Blood and Qi to dissipate inward, leaving the person cold and shivering.

If needling is performed incorrectly in winter and the patient has still not recovered by the spring equinox, they may feel sleepy but be unable to sleep. After falling asleep, they may seem to see things.

This happens because Liver Qi is deficient, making the person sleepy but unable to fall asleep. The Liver is associated with the eyes, so after falling asleep the person may seem to see the shapes of objects. The Newly Collated Corrections says: According to the “Treatise on Needling in Accord with or Contrary to the Four Seasons,” needling the channels incorrectly in winter causes Blood and Qi to be depleted, making a person’s vision unclear.

If needling is performed incorrectly in winter and the patient has still not recovered by the summer solstice, Qi activity surges upward, and various forms of impediment disease may arise. This is because the Qi in the vessels has been damaged. The Newly Collated Corrections says: According to the “Treatise on Needling in Accord with or Contrary to the Four Seasons,” needling the collaterals incorrectly in winter causes Blood and Qi to leak outward; when this stagnates for a long time, it develops into severe impediment disease.

If needling is performed incorrectly in winter and the patient has still not recovered by the autumn equinox, they become especially prone to thirst.

This thirst is caused by Lung Qi deficiency. The Newly Collated Corrections says: According to the “Treatise on Needling in Accord with or Contrary to the Four Seasons,” needling the flesh incorrectly in winter exhausts Yang Qi, making a person prone to forgetfulness.

Whenever needling the chest or abdomen, the Five Zang organs must be avoided.

The Heart and Lungs lie above the diaphragm, while the Kidneys and Liver lie below it. The Spleen belongs to Earth and occupies the center. Therefore, when needling the chest or abdomen, the Five Zang organs must be avoided. The Five Zang store and nourish the spirit, ethereal and corporeal souls, thought, and will. If they are injured, these faculties of consciousness disperse, endangering life; needling must therefore be done with great care.

If the Heart is struck by a needle, the person will die after one full cycle of the breath. “One cycle” here means the complete circulation of Qi through the twelve double hours.

The Newly Collated Corrections says: The “Treatise on Needling Prohibitions” records that if the Heart is struck, death follows after one day, and hiccups occur when the illness begins; the “Treatise on Needling in Accord with or Contrary to the Four Seasons” records the same. The present classic omits the time to death for striking the Liver. The “Treatise on Needling Prohibitions” says that if the Liver is struck, death follows after five days, and delirious speech occurs when the illness begins; the “Treatise on Needling in Accord with or Contrary to the Four Seasons” records the same.

If the Spleen is struck, death follows after five days. Five is the number of Earth, so it is used here to indicate the time to death after the Spleen is injured.

The Newly Collated Corrections says: The “Treatise on Needling Prohibitions” records that if the Spleen is struck, death follows after ten days, and swallowing motions occur when the illness begins; the “Treatise on Needling in Accord with or Contrary to the Four Seasons” records the same.

If the Kidneys are struck, death follows after seven days. The completed number of Water is six; once the count of Water has run its course, death follows on the seventh day. Another interpretation holds that “seven days” is a corruption of “ten days.”

The Newly Collated Corrections says: The “Treatise on Needling Prohibitions” records that if the Kidneys are struck, death follows after six days, and sneezing occurs when the illness begins. The “Treatise on Needling in Accord with or Contrary to the Four Seasons” also says that death follows after six days, with sneezing and yawning when the illness begins.

If the Lungs are struck, death follows after five days.

In the Five Phases’ generating sequence, Metal corresponds to four. Once Metal’s number is exhausted, death should occur on the fifth day. Some say “death on the third day,” but this is a scribal error in the character for “five.”

The New Collation says: The “Discourse on Needling Contraindications” records that injury to the lungs by needling leads to death after three days, with coughing as the symptom; the “Discourse on Needling in Accord with and Against the Four Seasons” contains the same account. In his commentary on the latter, Wang Bing says that all three discussions were spoken by Qibo, but their records differ, so there must have been errors in transmission.

Anyone who sustains a needling injury to the diaphragm will also suffer damage to the internal organs. Even if the condition improves, the person will not live beyond a year and will inevitably die. The Qi of the Five Zang organs governs the year together; when the diaphragm is injured, the Qi of the Five Zang organs restrains and harms one another, which is why the person cannot live beyond a year.

The key to avoiding the Five Zang organs when needling is to know how to guide the needle in accordance with the position of the organs. “In accordance with” means knowing the locations of the diaphragm, spleen, and kidneys. If these locations are unknown, needling will go wrong.

The kidneys are attached to the spine, the spleen lies at the center of the body, and the diaphragm connects to both sides of the ribs. Needling is appropriate only when these locations are understood; without that knowledge, the organs may instead be injured.

When needling the chest or abdomen, always cover the skin with a piece of cloth, then insert the needle through a single layer of cloth. This helps fix the needling site and prevents accidentally puncturing the Five Zang organs. The New Collation says: In another edition, the character “jiao” is written as “yao” or “qiao.” (“Jiao” is pronounced “yao,” and “zhu” is pronounced “lüe.”)

If needling has not brought recovery, it may be repeated; the key is to wait until Qi arrives at the needle. The Needle Classic says: During needling, if Qi has not yet arrived, one may continue needling as many times as necessary. Once Qi arrives, withdraw the needle and do not needle further. This is the principle being described.

Needling must always be done in silence. Here, “silence” means a quiet and serious manner, allowing the practitioner to observe whether the channel Qi has arrived or become depleted.

When needling a swollen area, the needle may be moved to help drain a large amount of pus and blood.

When needling a channel, do not move the needle, because channel Qi should not be allowed to disperse.

These are the essentials of needling. The Yellow Emperor said, “I would like to know the signs that appear when the Qi of each of the twelve channels is exhausted.”

“End” means that the Qi is depleted. Qibo said, “When the Qi of the Foot Taiyang channel is exhausted, the eyes turn upward, the body arches backward, the limbs convulse, the face turns pale, and terminal sweat breaks out. Once the sweat appears, the person dies.”

“Eyes turned upward” means that the eyes cannot move and can only gaze upward. The Foot Taiyang channel begins at the inner corner of the eye, ascends to the forehead, and meets at the crown. From the crown it enters and connects with the brain, then emerges and descends along the back of the neck, passing inside the shoulder blades and along both sides of the spine before reaching the lower back. One branch descends along the foot to the outer side of the little toe. The Hand Taiyang channel begins at the tip of the little finger, ascends along the arm to the shoulder, and enters the supraclavicular fossa. One branch ascends across the cheek to the inner corner of the eye, where it joins the Foot Taiyang channel. The New Collation says: According to the Jia Yi Classic...

The scripture says that a branch of the Foot Taiyang channel runs diagonally and connects with the cheekbone. Another branch rises from the supraclavicular hollow, runs up the neck, passes across the cheek, and reaches the outer corner of the eye. The New Corrected Edition says that, according to the Jia Yi Jing, the word “outer” here should read “dui.”

Thus, when the Qi of the Foot Taiyang channel is about to be exhausted, the eyes roll upward, the body arches backward, and convulsions occur. The face turns pale, and sweat suddenly breaks out. “Exhaustion sweat” means that beads of sweat appear suddenly but do not run down; they soon dry up. When the Qi of the Foot Taiyang channel is utterly depleted, sweating occurs. Once this kind of sweat appears, the person will die.

When the Qi of the Shaoyang channels is about to be exhausted, deafness, laxity in the joints of the limbs, a fixed stare, and severed vessels around the eyes occur. Death follows about a day and a half after these symptoms appear. Just before death, the face first turns bluish white, and then the person dies.

The network vessels of the Foot Shaoyang channel, the Gallbladder channel, begin at the outer corner of the eye, rise to the corner of the head, and then descend behind the ear. One branch enters the ear from behind, then emerges and passes in front of it. A branch of the Hand Shaoyang channel, the Triple Burner channel, also enters the ear from behind and emerges in front. For this reason, when the Qi of the Shaoyang channels is about to be exhausted, deafness, a fixed stare, and severed vessels around the eyes occur. Shaoyang governs the bones; when its Qi is depleted, the joints become loose and weak. A bluish-white complexion indicates Metal Qi overcoming Wood Qi, and so is regarded as a sign of impending death. “Qiong” describes staring straight ahead, as if startled; it is pronounced like “qiong.”

When the Qi of the Yangming channels is about to be exhausted, the mouth and eyes twitch; the person is easily startled, speaks incoherently, and the face turns yellow. If the pulse Qi in both the upper and lower parts of the Yangming channels is excessive, yet the person is numb and unresponsive, death will follow.

The network vessels of the Foot Yangming channel, the Stomach channel, begin beside the nose, meet at the middle of the bridge, descend along the sides of the nose, and enter the gaps between the upper teeth. They emerge, circle the lips, and meet at the Chengjiang point below the lower lip. From there, they descend along the back edge of the jaw to the Daying point, pass through Jiache, rise to the Guest Host point in front of the ear, and follow the hairline to the forehead. A branch descends from a point in front of Daying to the Renying point, follows the throat into the supraclavicular hollow, and then descends through the diaphragm.

The Hand Yangming channel, the Large Intestine channel, begins in the hand and runs up the arm to the shoulder. After passing behind the junction of the clavicles, it enters the supraclavicular hollow above and below, connecting with the lungs. A branch rises from the hollow to the neck, passes through the cheek, descends into the teeth, then emerges and circles the lips, meeting at the philtrum. The channel on the left connects to the right, and the one on the right connects to the left; they then rise alongside the nose to the nostrils. Regarding the phrase “reaches the Foot Yangming” in the original, the New Corrected Edition notes, citing the Jia Yi Jing, that “qiu” should read “kong,” and that the four characters meaning “reaches the Foot Yangming” are absent.

Therefore, when the Qi of the Yangming channels is about to be exhausted, the mouth and eyes twitch. This twitching means that the eyes blink incessantly and the jaw jerks. When the Stomach is ill, the person dislikes people and bright fires. The sound of wooden objects can make them suddenly frightened; they may also curse people without regard to closeness or kinship. Hence they are easily startled and speak incoherently. A yellow complexion indicates that…

“Upper color” refers to the pulse at the hands, and “lower color” refers to the pulse at the feet. “The channels are exuberant” means that the pulses on the face, around the eyes, at the neck and jaw, on the tops of the feet, at the wrists, and along the calves are all agitated and forceful. “Insensate” means that sensation has grown dull and one can no longer distinguish good from bad. These signs all indicate that Qi is about to be exhausted, and death will ultimately follow. (“Shan” is pronounced like “shan” in flash.)

When the Qi of the Lesser Yin channel is about to be cut off, the complexion turns black, the teeth appear long and coated with grime, and the abdomen becomes distended and blocked, with no passage between the upper and lower body. Death ultimately follows.

When the Qi of the Hand Lesser Yin Heart channel is cut off, the blood can no longer circulate. When the Qi of the Foot Lesser Yin Kidney channel is cut off, the bones lose their nourishment and become rigid. As the bones stiffen, the gums recede upward, making the teeth appear longer and grime-coated. When the blood deteriorates, the skin loses its vitality, so the complexion becomes black as lacquer and loses its rosy color. The Foot Lesser Yin Kidney channel rises from the kidneys, passes through the liver and diaphragm, and enters the lungs. The Hand Lesser Yin Heart channel begins in the heart, connects with the heart system, descends through the diaphragm, and links to the lower abdomen. That is why, when the Qi of the Lesser Yin channels is about to be cut off, the abdomen becomes distended and blocked, with no passage between the upper and lower body.

The New Collation says: A close reading of Wang Bing’s commentary shows that the phrase “the bones do not soften; the bones are rigid” should be corrected. In the Classic of Difficulties and the Jia Yi Jing of Acupuncture and Moxibustion, the text reads, “When the bones are not moistened, the flesh cannot adhere,” so it should be changed to “the bones are not moistened.” The phrase “the Hand Lesser Yin channel connects to the lower abdomen” appears as “connects to the small intestine” in the Jia Yi Jing of Acupuncture and Moxibustion.

When the Qi of the Greater Yin channel is about to be cut off, the abdomen becomes distended and blocked, breathing is difficult, and belching and vomiting occur frequently.

The Foot Greater Yin Spleen channel ascends along the front of the inner thigh, enters the abdomen, connects to the spleen, and links with the stomach. The Hand Greater Yin Lung channel begins in the middle burner—the area between the chest and abdomen—descends to connect with the large intestine, then returns upward along the opening of the stomach, passes through the diaphragm, and connects to the lungs. That is why these symptoms appear when the Qi of the Greater Yin channels is about to be cut off. The Ling Shu Jing says, “When the Foot Greater Yin channel moves abnormally, symptoms include vomiting after eating, abdominal distension, and frequent belching.”

Vomiting causes Qi to rise counter to its proper flow, and this upward surge makes the face red.

The New Collation says: In the Ling Shu Jing, this passage should read, “There is frequent belching; belching leads to vomiting, and vomiting leads to counterflow.”

If Qi does not surge upward, the upper and lower parts of the body cannot communicate. When they cannot communicate, the complexion turns black, and the skin and hair become dry and scorched; death ultimately follows.

During vomiting, Qi can still pass upward, so the only result is a red face. Without vomiting, the lower part is already blocked and the upper part is also obstructed. The Qi of the heart then scorches the skin and hair outwardly, ultimately causing death. Why does this happen? One branch of the Foot Greater Yin Spleen channel leaves the stomach, passes upward through the diaphragm, and flows into the heart. This shows that the skin and hair become dry and scorched because the Qi of the heart scorches them from within.

When the Qi of the Jueyin channel is about to be cut off, the interior becomes hot, the throat dries out, and urination occurs frequently. As agitation in the heart worsens, the tongue curls up and the scrotum contracts; death ultimately follows.

A collateral vessel of the Foot Jueyin Liver channel ascends along the lower leg and connects to the penis; its main channel enters the hair…

The channel passes through the lower part of the body and the genital region, then ascends to the lower abdomen. It runs up along both sides of the stomach to the throat, and then enters the nasopharynx. The Hand Jueyin channel—the Hand Jueyin Pericardium Channel—begins in the chest; after emerging, it connects with the pericardium.

Thus, when the Qi in the channels is about to be exhausted, symptoms may include internal heat, a dry throat, frequent urination, and distress in the heart. The Ling Shu Jing says: “The liver corresponds to the sinews; the sinews converge at the genital region, and the channels extend to the root of the tongue.” Therefore, when the illness becomes severe, the tongue may curl up and the testicles may retract. This too is because the Jueyin channel passes through the genital region.

New Collation Note: According to the Jia Yi Jing, “gao” should be written “gao” (testicle), and “pass through” should be read as “encircle.”

These are the ways in which the Qi of the twelve channels becomes depleted and fails. The Hand Three Yin, Hand Three Yang, Foot Three Yin, and Foot Three Yang together are called the twelve channels. “Fail” means that the Qi of the channels has been exhausted and is tending toward collapse. New Collation Note: For a detailed account, see the Ling Shu Jing’s discussion of the exhaustion of Qi in the twelve channels, which also contains passages that match the Su Wen.