《黃帝內經素問補註釋文》Vol. 37

Commentary on the Plain Questions of the Yellow Emperor's Inner Classic (Huangdi Neijing Suwen Buzhu Shiwen), Scroll 37 (Volume 2 in the present edition)

Commentary by Wang Bing (style name Qixuanzi), Director of the Imperial Stables during the Tang dynasty. Collated by Lin Yi and others, Minister of the Court of Imperial Entertainments and Editor in the Imperial Archives during the Song dynasty. Further revised to correct errors by Sun Zhao, Acting Secretary of the Tuntian Bureau of the Ministry of Works during the Song dynasty.

Miuci Lun (On Miuci Needling)

The Yellow Emperor asked: "I have heard of miuci (oblique needling), but I do not yet understand its meaning. What is miuci?"

Qi Bo replied: "When pathogenic qi invades the human body, it must first lodge in the skin and hair. If it does not leave there, it enters the minute collaterals (sun mai). If it still does not leave, it enters the collaterals (luo mai), and if it remains there, it enters the channels (jing mai). From the channels it moves inward to reach the five zang organs and spreads through the intestines and stomach. When both yin and yang are disturbed by the pathogenic qi, the five zang organs are injured. This is the process by which pathogenic qi enters from the skin and hair and progressively penetrates to the five zang organs. In such cases, the corresponding channels should be needled.

"Now there is a different situation. The pathogenic qi lodges in the skin and hair and, after entering the minute collaterals, stays there and blocks the flow of the vessels. Because it cannot enter the channels, it disperses into the major collaterals and produces unusual disorders. A disease that arises in the blood collaterals in this way is called 'strange pathogenic qi' (qi xie)." The commentary adds that, according to Quan Yuanqi, the "major collaterals" here refer to the fifteen collaterals.

"When pathogenic qi invades the major collaterals, it passes from the left side to the right and from the right side to the left. It crosses the channels above and below and on both sides, and spreads to the extremities of the four limbs. Its qi has no fixed location, and it does not enter the acupoints (shu xue) of the channels. This method of needling is called miuci." The term "extremities" (si mo) refers to the four limbs.

The Yellow Emperor asked: "Why, in miuci needling, do we treat the right side when the left is ill, and the left side when the right is ill? How does it differ from juci (direct needling)?"

Qi Bo replied: "When pathogenic qi invades the channels, if the qi of the channel on the left is in excess, illness will appear on the right. If the qi of the channel on the right is in excess, illness will appear on the left. There are also cases in which the site of the disease shifts." The collators note that the Jia Yi Jing (Canon of Acupuncture and Moxibustion) here reads "the disease changes and moves."

"If pain on the left has not ceased and the vessels on the right show pathological changes first, then juci must be used. One needles the channel where the disease is located, not the collaterals." The commentary explains that "illness first" (xian bing) means that the pain on one side has not yet stopped, and disorders on the other side have already begun to follow.

"Disorders of the collaterals are characterized by a separation between the location of the pain and the position of the channel, and for this reason are called miuci. The collaterals discussed here include the branches that split off from the main channels. They do not refer only to the connecting collaterals of the main channels, but also include collaterals such as the Gongsun and Feiyang." The collators cite Wang Bing's commentary to clarify that the collaterals discussed here are not the connecting collaterals of the main channels. They further point out that later in this chapter, the text describes pathogenic qi invading the collaterals of the foot Taiyin, causing lower back pain.

The commentary states that the luo (network) vessel joins the Foot Yangming channel at the root of the thigh, ascends to connect with the throat, and passes through the center of the tongue, which is also the course of the Foot Taiyin regular channel. Since it likewise runs as a concurrent main pathway, how can it be said that it is not a regular collateral (zhengjing bieluo)?

The Yellow Emperor asked: "I wish to understand how to perform miu ci (cross-needling, in which the illness is on one side of the body and the needle is inserted at the corresponding site on the other side). How should the points be selected?"

Qi Bo replied: "When pathogenic qi invades the luo vessel of the Foot Shaoyin channel, it causes sudden heart pain, abdominal distension, and a feeling of fullness and oppression in the chest and flanks. This luo vessel's branch runs alongside the regular channel, ascending from the kidney through the liver and diaphragm to reach the pericardium, so pathogenic qi that invades it produces these symptoms.

"If there is no accumulation, needle the Ran Gu point in front of the Ran bone to draw blood, and the pain will stop in about the time it takes to eat a meal. The point in front of the Ran bone is Rangu (Ran Valley), located in the depression below the large bone in front of the inner ankle. It is the ying (spring) point of the Foot Shaoyin channel. Insert the needle to a depth of about one-third of the patient's own cun (inch) and retain it for the duration of three breaths. If moxibustion is used, apply three cones. Needling here often draws a good deal of blood, after which the patient immediately feels hungry and wants to eat.

"If the pain persists, needle the right side when the pain is on the left, and the left side when the pain is on the right, and apply the same method in other cases.

"For a newly onset illness, five days of treatment will bring recovery. If the patient has had this condition before and it has only recently recurred, needle first, and recovery will follow in five days.

"When pathogenic qi invades the luo vessel of the Hand Shaoyang channel, it causes a sore throat, a curled tongue, dryness of the mouth, vexation in the heart, and pain along the outer side of the arm severe enough that the hand cannot reach the head. This channel runs along the back of the hand, passes along the outer arm to the shoulder, enters the Quepen (Basin of the Supraclavicular Fossa), and spreads to Danzhong (Central Chest), then branches to the pericardium. Its branch ascends from Danzhong through Quepen to the neck. Because the heart governs the tongue, these symptoms appear.

"Needle the tip of the middle finger and the index finger, just above the nail, at a point about the width of a leek leaf from the fingertip, one needle in each finger to draw blood. This is the Guanchong point, the jing (well) point of the Hand Shaoyang channel. Insert the needle to a depth of about one-tenth of the patient's own cun and retain it for the duration of three breaths. If moxibustion is used, apply three cones. Both hands are needled, which is why the text says 'each one needled.' The word wei refers to the wound left by the needle.

"Collators note that the Jia Yi Jing (Systematic Classic of Acupuncture and Moxibustion) places Guanchong at the tips of the little finger and the next finger (the ring finger), so the mention of the middle finger here may be an error.

"Young patients recover immediately after needling, and older patients recover a little later. When the pain is on the left, needle the right side, and when it is on the right, needle the left. This applies to newly onset cases of only a few days' duration.

"When pathogenic qi invades the luo vessel of the Foot Jueyin channel, it causes sudden hernial pain of great severity. This luo vessel departs from the main channel five cun above the inner ankle and runs to the Foot Shaoyang channel. One of its branches ascends the lower leg, passes the testicles, and gathers at the penis, which is why it suddenly..."

In sudden attacks of shanqi (a hernia-type qi disorder), with pain in the testicles and scrotum, needle the boundary between the nail and flesh at the edge of each big toe, one needle on each side.

This refers to Dadun (Great Mound, LR1), the well point of the Foot Jueyin Liver Channel, located at the tip of the big toe about one leek leaf's width from the corner of the nail. Insert the needle to a depth of three fen by tongshencun (body-inch measurement, taken from the patient's own proportions), and retain it for ten breaths. If moxibustion is used, apply three cones. Men usually respond immediately, while women respond after a short while. For pain on the left side, needle the point on the right, and for pain on the right side, needle the point on the left.

When evil qi invades the luo (collateral) vessels of the Foot Taiyang Channel, the head, nape, and shoulders hurt. This is because the Foot Taiyang Channel emerges from the brain, and a branch descends to the nape. Another branch separates from the inner shoulder and runs downward. Its luo vessel then ascends from the foot along the back to the head, which is why pain appears in the head, nape, and shoulders. The Newly Collated Annotation notes that the Jiayi Jing (Systematic Classic of Acupuncture and Moxibustion) records that its branch enters the vertex, connects to the brain, emerges, and descends to the nape. Wang Bing argues that the zheng ("main") in the phrase "the principal channel" should be read as zhi ("branch").

Needle the boundary between the nail and flesh at the edge of each little toe, one needle on each side, and relief usually comes immediately. This refers to Zhiyin (Reaching Yin, BL67), the well point of the Foot Taiyang Bladder Channel, located on the outer side of the little toe about one leek leaf's width from the corner of the nail. Insert the needle to a depth of one fen by tongshencun, and retain it for five breaths. If moxibustion is used, apply three cones. The Newly Collated Annotation notes that the Jiayi Jing records this point on the outer side of the little toe, about one leek leaf's width from the corner of the nail.

If there is still no relief, needle three points below the outer ankle. For pain on the left, needle the point on the right, and for pain on the right, needle the point on the left. Relief should come within about the time it takes to eat a meal. This refers to Jinmen (Metal Gate, BL63), the xi (cleft) point of the Foot Taiyang Bladder Channel, located below the outer ankle. Insert the needle to a depth of three fen by tongshencun. If moxibustion is used, apply three cones.

When evil qi invades the luo vessels of the Hand Yangming Channel, the chest becomes full of qi, breathing turns rapid, and the sides of the ribs and the chest feel hot. This is because the Hand Yangming Channel enters the shoulder end, and its branch runs straight up from the quepen (supraclavicular fossa, the hollow above the collarbone) to the neck. This is why these symptoms appear.

Needle the boundary between the nail and flesh at the edge of the second finger beside the thumb (the index finger), about one leek leaf's width from the fingertip, one needle on each side. For pain on the left, needle the point on the right, and for pain on the right, needle the point on the left. Relief should come within about the time it takes to eat a meal. This refers to Shangyang (Shang Yang, LI1), the well point of the Hand Yangming Large Intestine Channel. Insert the needle to a depth of one fen by tongshencun, and retain it for one breath. If moxibustion is used, apply one cone. The Newly Collated Annotation notes that the Jiayi Jing records Shangyang on the inner side of the index finger, about one leek leaf's width from the corner of the nail.

When evil qi invades between the arm and the palm, so that the arm cannot flex, needle behind the ankle...

The New Collation holds that, according to the Quan Yuanqi edition, this refers to the knuckle joints at the base of the fingers.

This refers to the area around the ankle bone.

First press with the fingers, and needle at the point where pain is felt. The number of needlings follows the waxing and waning of the moon. On the first day of the month, needle one point; on the second day, two points; the count rises day by day, reaching fifteen points on the fifteenth day, and on the sixteenth day falls to fourteen. Thereafter it decreases day by day. The period before the middle of the month is called sheng (birth), and the period after it is called si (death), distinguished by the moon's change from waning to full and from full to waning.

When pathogenic qi invades the foot Yangqiao (Yang Heel) vessel, the eyes ache, and the pain begins at the inner canthus. This vessel runs upward from the foot, reaches the head, and connects with the inner canthus, so when the disease occurs the eye pain begins there. The Eighty-One Difficulties states that the Yangqiao vessel rises from the middle of the heel, runs up along the outer ankle, and enters Fengchi (GB20). The Needle Classic states that the Yinqiao (Yin Heel) vessel enters the nasal cavity and connects with the inner canthus, and that after meeting the Taiyang channel and the Yangqiao vessel it ascends. From this it appears that the Yangqiao vessel also reaches the inner canthus.

Needle half a cun below the outer ankle, one point on each side. This refers to Shenmai (BL62), the origin point of the Yangqiao vessel, which lies in the depression below the outer ankle. The needle may be inserted three fen and retained for six breaths. If moxibustion is used, three moxa cones may be burned, that is, three ignitions of the moxa.

For illness on the left, needle the right side, and for illness on the right, needle the left side. Treatment may stop after about the time it takes to walk ten li.

When a person has fallen and been injured, and stagnant blood remains in the abdomen, causing abdominal distension and inability to pass stool or urine, first give a medicine to promote drainage, then needle the luo (network) vessel in front of Rangu (KI2), below the inner ankle, to let it bleed. This is a luo vessel of the Shaoyin channel. The New Collation holds that the character mai (vessel) in "bleeding from the vessel" may be a mistake for luo.

Next, needle the arterial pulsation on the dorsum of the foot, namely Chongyang (ST42), the source point of the Stomach channel. The needle may be inserted three fen and retained for ten breaths. If moxibustion is used, three cones may be applied. This point is used when the abdomen is swollen and the patient has no appetite, since the distension is the reason for choosing it.

If the symptoms still do not ease, needle the sanmao (three hairs) at the root of the nail of the big toe, one point on each side, until it bleeds. This usually brings immediate relief. Illness on the left is needled on the right, and illness on the right on the left. The point meant here is Dadun (LR1), the well point of the Jueyin channel.

Those who are easily saddened, startled, or low in spirits should also be treated with the methods described above.

When pathogenic Qi invades the collateral vessel of the Hand Yangming meridian, it causes deafness, with the person sometimes unable to hear sounds.

This is because a branch of the Hand Yangming meridian runs upward from the supraclavicular fossa to the neck and passes through the cheek; its collateral vessel also has a branch that enters the ear and meets the converging vessels (zongmai). Therefore, when disease occurs, there is deafness and sometimes an inability to hear.

Needle the index finger beside the thumb, at a point above the nail and about the width of a leek leaf from the fingertip, inserting one needle on each side. Hearing is restored immediately. This point is Shangyang (LI1), mentioned earlier.

If there is still no effect, needle the junction between the nail and flesh of the middle finger, and hearing is restored immediately. This refers to Zhongchong (PC9), the Jing-well point of the Hand Heart Governor meridian (that is, the Hand Jueyin Pericardium meridian). It is located at the tip of the middle finger, in a depression about the width of a leek leaf from the nail. Needle to a depth of one fen and retain the needle for the time of three breaths; for moxibustion, use three cones.

The ancient scriptural text has an omission, and no basis for it can be found in the course of the collateral vessels. Some suspect that here one should needle the junction between the nail and flesh of the little finger. Why say this? Because the text below says that the collateral vessel of the Hand Shaoyin meridian converges in the ear. If one selects the tip of the little finger, this is Shaochong (HT9), the Jing-well point of the Hand Shaoyin Heart meridian. Needle to a depth of one fen and retain the needle for the time of one breath; for moxibustion, use one cone.

The New Correction says: Wang Bing believed that this probably refers to Shaochong above the little fingernail. But on checking the Zhenjiu Jiayi Jing, the Heart Governor meridian runs upward along the throat and emerges below the Wangu (GB12) point of the Shaoyang meridian behind the ear. That being so, how could one fail to needle Zhongchong and instead suspect that Shaochong should be needled?

If the deafness is not intermittent but is a continuous inability to hear, then one must not needle. This is because the condition indicates that the Qi of the collateral vessel has already been cut off, and therefore it must not be needled.

When there is wind pathogen in the ear, needle by the same method: for disease on the left, needle the right; for disease on the right, needle the left.

In all cases of bi syndrome—blockage of Qi and blood in the meridians, with pain and numbness in the limbs—where the pain wanders and is located among the muscles, needling may be used. The number of needles should be determined according to the moon’s cycle from waning to waxing and from waxing to waning; the practitioner decides the number according to the flourishing or decline of Qi. If the number of needles exceeds the amount prescribed for that day, healthy Qi will be dispersed; if it falls short of the prescribed amount, pathogenic Qi will not be drained out. For disease on the left, needle the right; for disease on the right, needle the left. Stop when the disease stops; if it is not yet cured, needle again by this method.

Why should the number of needles be regulated by the moon’s waxing and waning? Because one must adjust according to the flourishing or decline of Qi.

On the first day of the lunar month, insert one needle; on the second day, two needles; thereafter increase daily; on the fifteenth day, insert fifteen needles. From the sixteenth day, decrease daily, inserting fourteen needles, and so on in decreasing order.

Needling in this way will neither exceed nor fall short of the prescribed number.

When pathogenic Qi invades the Foot Yangming meridian, it causes nasal congestion and runny nose, nosebleed, and coldness of the upper teeth.

This is because the Foot Yangming meridian begins at the nose, meets at the root of the nose, then descends along the lateral side of the nose and enters the upper teeth.

The passage continues from the preceding discussion of the hand Yangming channel (the Large Intestine channel, dàchángjīng). The channel emerges on both sides of the mouth, encircles the lips, and meets at Chengjiang (chéngjiāng, a Conception Vessel point in the depression below the lower lip). It then turns back and descends behind the chin, emerging at Daying (dàyíng, in front of the angle of the jaw), and ascends along Jiache (jiáchē, at the jaw angle) to the front of the ear. A disorder of this channel therefore causes nasal obstruction, nosebleeds, and a feeling of cold in the upper teeth. Because the channel crosses from one side of the face to the other, the text uses disorders of this channel to illustrate miù cì (cross-needling, in which an illness on one side is treated by needling the opposite side) and similar cases. The New Collation (xīn jiàozhèng) notes that in Quan Yuanqi's edition and in the Jiayi Jing (Jiǎyǐ Jīng), the phrase "channel of Yangming" is written as "collateral of Yangming."

The classic says to needle the junction of nail and flesh on the nail of the toe beside the middle toe of the foot, one needle on each side, treating a left-sided illness on the right foot and a right-sided illness on the left. The commentary holds that "middle" should be "big," the two characters having been confused in transmission. According to the acupoint diagrams in the Lingshu Jing (Língshū Jīng), the middle and second toes have no points on their nails, so the needling should be at the second toe beside the big toe. This is Lidui (lìduì), the well point (jǐng xué, the point where the channel begins) of the Yangming channel, and the words "second toe" should not appear at all. Lidui may be needled to a depth of one fēn (a body inch, tóngshēncùn) and retained for the length of one breath. If moxibustion is used, three cones may be applied, each cone being one burning of the moxa stick. The New Collation notes that the Jiayi Jing reads "needle the nail of the middle toe of the foot" without "second toe," probably taking the toe next to the big toe as the middle toe, which agrees with Wang Bing's commentary. The later phrase "the nail of the middle toe of the Yangming foot" refers to the same point. Lidui lies at the end of the second toe beside the big toe, at the spot about as wide as a leek leaf from the corner of the nail.

The classic further states that when evil qi invades the collateral of the foot Shaoyang (shàoyáng, Gallbladder) channel, it causes pain in the ribs and flanks, shortness of breath, cough, and sweating. The commentary explains the reason: a branch of the Gallbladder channel runs from the outer corner of the eye down to Daying, meets the hand Shaoyang channel beneath the cheekbone, continues down through Jiache to the neck, joins Quepen (quēpén, the supraclavicular fossa), descends into the chest, passes through the diaphragm, connects with the liver, belongs to the gallbladder, and runs along the ribs. For this reason it causes rib pain, coughing, and sweating. The rare character in the original is pronounced zhī liù qiè.

The treatment is to needle the junction of nail and flesh on the nail of the toe beside the little toe of the foot, one needle on each side. This refers to Qiaoyin (qiàoyīn), the well point of the Shaoyang channel. The needle may be inserted one body inch and retained for the length of one breath, and if moxibustion is used, three cones may be applied. The New Collation records that the Jiayi Jing places Qiaoyin at the end of the second toe beside the little toe, at the spot about as wide as a leek leaf from the corner of the nail.

The passage ends by stating that the shortness of breath will be relieved at once and the sweating will stop immediately. A person with cough should wear warm clothing and attend to their diet, and will recover within a day. Again, a left-sided illness is treated on the right side and a right-sided illness on the left. If the illness is cured immediately, no further treatment is needed; if it is not yet cured, the needling should be repeated as described above.

If pathogenic qi lingers in the collateral (luo) of the Foot Shaoyin, the Kidney channel of the foot, it causes throat pain and difficulty swallowing food. Without any obvious cause, the person also becomes easily angered, and qi surges upward to the diaphragm.

This is because a branch of the Foot Shaoyin channel emerges from the lungs, connects with the heart, and joins the chest. Its main channel rises from the kidneys, passes through the liver and diaphragm, enters the lungs, and runs along both sides of the throat to the root of the tongue. When pathogenic qi invades this channel, the throat becomes dry and painful, swallowing is impaired, and the person becomes angry for no reason as qi rushes upward to the diaphragm.

Bēn (the diaphragm) refers to the diaphragm. The New Collation (Xin Jiaozheng) holds that Wang Bing's reading of "bēn shang" as qi surging upward is not appropriate. The Nanjing (Classic of Difficulties) speaks of the cardiac orifice (bēnmén) of the stomach, and Yang Cao states that bēn is the diaphragm. Since the text says qi moves upward, bēn should not be read as "rushing upward" (bēn shàng).

For treatment, needle the collateral at the center of the sole, three needles on each side, six in total, and the illness will improve immediately. If the left side is affected, needle the right, and if the right side is affected, needle the left.

This refers to Yongquan (Gushing Spring, Kidney 1), the well point of the Foot Shaoyin. It lies in the depression of the sole and appears at the center of that hollow when the foot is flexed and the toes are curled. The needle may be inserted three fen (an ancient unit of depth) and retained for the duration of three breaths. If moxibustion is used, three zhuang (the number of moxa cones burned) may be applied.

If the throat is swollen and the person cannot swallow saliva, or saliva cannot be expectorated for a time, needle Ranggu (Kidney 2), the bone point in front of and below the inner ankle, to draw blood. The illness will then improve immediately. Again, if the left side is affected, needle the right, and if the right side is affected, needle the left.

Ranggu also belongs to the collateral of the Foot Shaoyin. The channel and collateral described here connect with the throat, so needling this point treats disorders of the throat. The twenty-nine characters above were originally misplaced before the passage on pathogenic qi invading the collaterals of the Hand and Foot Shaoyin, Taiyin, and Foot Yangming, and have been moved to this position. The New Collation points out that Wang Bing's commentary confused the courses of the channels and collaterals. According to the Zhenjiu Jiayi Jing (Systematic Classic of Acupuncture and Moxibustion), the collateral of the Foot Shaoyin runs alongside the channel and ascends to the pericardium, while the main Foot Shaoyin channel runs along the throat. The account in the Zhenjiu Jiayi Jing should be followed.

When pathogenic qi invades the collateral of the Foot Taiyin, the Spleen channel of the foot, the person suffers from lower back pain. The pain draws into the lower abdomen and the lower ribs, the person cannot straighten the body, and breathing is difficult to keep smooth.

The collateral of the Foot Taiyin joins the Foot Yangming at the thigh, ascends past the coccyx, and connects with the Foot Jueyin and Foot Shaoyang at Xialiao (Lower Liao). It then runs inward along the coccyx into the abdomen, rises to connect with the throat, and passes through the center of the tongue. Therefore, in lower back pain, the pain spreads to the lower abdomen and to the area beneath the ribs. The term for the soft hollow below the floating ribs is used here. When pathogenic qi enters, the collateral becomes tight, so the person cannot straighten the back and extend it backward, and breathing is affected.

There is no "xi" character in the middle. The New Collation (editorial note) says that, on a closer reading of Wang Bing's commentary, this is called a collateral of the Foot Taiyin channel. According to the Jiayi Jing (Systematic Classic of Acupuncture and Moxibustion), however, it should be a principal channel of the Foot Taiyin, not a collateral. Wang Bing's meaning here is unclear.

Needle the bone seams of the sacrum, where the lumbar region meets the buttocks, and the Yaoshu point (Waist Transport point) above the "pang," the muscular bulges on either side of the thigh. The number of needles should be determined by the waxing and waning of the moon. Once the needles are inserted, the effect should be immediate. For a left-sided illness, needle the right side, and for a right-sided illness, needle the left side.

The space between the lumbar and sacral bones is called "jie," and the Yaoshu point lies in its center. The needle may be inserted two cun deep, where cun refers to the patient's own body proportions (tongshencun, "same-body cun"). The New Collation notes that the commentary to the Qifu Lun gives "two fen," the commentary to the Cire Lun gives "two fen," the commentary to the Shuixue Pian gives "two fen," the commentary to the Rexue Pian gives "three cun," and the Jiayi Jing gives "two cun." The needle should be retained for seven exhalations, as the text states. The Zhong Gao Kongxue Jing says, "For the left side, take the right; for the right side, take the left," but since the Yaoshu point lies at the midline, the rule of crossing sides does not seem to apply. Below the waist, on either side of the buttocks, are four bony foramina, each of which treats lumbar pain. The commentary on the Xialiao points (sacral foramina below the sacrum) matches the text. This location is where the Foot Taiyin, Foot Jueyin, and Foot Shaoyang channels intersect. The needle may be inserted two cun and retained for ten exhalations. If moxibustion is used, three cones may be applied. Points should be selected along the muscles on either side of the thigh, at the Yaoshu point, and at the hip joint.

The New Collation further notes that this passage, concerning the invasion of the Foot Taiyin collateral by pathogenic qi and the method of needling, already appears in the chapter on "Needling for Lumbar Pain," where it is commented on in detail. This section adds only the words "Yaoshu." According to the Quan Yuanqi edition, these three characters were not originally present. Wang Bing probably knew that the Yaoshu point lies at the midline, so there is no question of selecting points on alternate sides, and for that reason he wrote a commentary on it. However, he did not know that the Quan Yuanqi edition originally lacked the words "Yaoshu."

When pathogenic qi invades the collateral of the Foot Taiyang, it causes the sinews and vessels to contract, the back to become tight, and pain to pull along the ribs.

This occurs because the Foot Taiyang channel branches off from the medial side of the scapula and descends through the muscles on both sides of the back, converging at the popliteal fossa (the hollow behind the knee). For this reason, when the illness arises, contraction, tightness of the back, and pain pulling along the ribs appear. The New Collation notes that, according to the Quan Yuanqi edition and the Jiayi Jing, the phrase "pain pulling along the ribs" should be followed by "pain pulling inward to the heart."

When needling, count the vertebrae beginning from the neck, pressing rapidly along both sides of the spine. If pressure produces pain, needle three times beside the painful spot, and the effect will appear.

"Counting the vertebrae from the neck" means starting at the Dazhui point (Great Hammer, below the seventh cervical vertebra) and counting down to the second vertebra. Press along the spine at a point one and a half cun from each side of the spinal column. If pressure produces pain, this indicates the location of the pathogenic qi. Next, one should respond according to the pain reaction...

The depth of needling should be determined by where the pathogenic qi lies. When the pathogenic qi invades along both sides of the spine, the text says to needle on both sides of the spine.

When pathogenic qi invades the luo (network) vessels of the Foot Shaoyang channel, it causes pain in the bishu (the area of the thigh root and hip joint) and makes it impossible to raise the leg. The Foot Shaoyang channel emerges from the qijie (Qi Thoroughfare, the vessel region near the groin), passes around the pubic hair, and then runs transversely into the biyan (the hip socket). This explains why the bishu hurts and the leg cannot be lifted. When needling the bishu, use hair needles (slender, fine needles). If the patient feels cold, the needle may be retained for a longer time, and the duration of retention should be set according to the waxing and waning of the moon. The effect can be seen immediately after needling.

Behind the bishu lies the Huantiao point. Huantiao is the point where the qi of the Foot Shaoyang channel emerges. It may be needled to a depth of one tongshencun (body inch, measured by the patient's own body proportions), and retained for two breaths (roughly the time of two breaths). If moxibustion is used, three zhuang (three cones of moxa wool) may be burned. The hair needle is the seventh of the needle types.

The Xinjiaozheng (New Collation) notes that, according to the Jiayi Jing (Classic of Categories), Huantiao lies within the bishu. The Qixue Lun (Discussion of Qi Points) places it at the boundary between the two biyan. This chapter says to needle within the bishu, but Wang Bing explained this as behind the bishu, which is an error.

In needling therapy, if the part of the body through which a channel passes shows no disease, one should apply miaoci (crossed or collateral needling), which treats the luo vessel corresponding to the site of the illness. The meaning of the original text is this: when the main channel is free of disease, the pathogenic qi lies in the luo vessels, and therefore miaoci is used. If the part through which a channel passes is diseased, then the channel itself is diseased, and miaoci should not be used.

For deafness, first needle the Hand Yangming channel. If there is no effect, then needle the part of the Hand Yangming channel that passes in front of the ear. The Hand Yangming channel referred to here is the point near the tip of the index finger, beside the thumb, namely Shangyang. According to the Zhonggao Kongxue Tujing, the Hand Yangming points Shangyang, Hegu, Yangxi, and Pianli can all treat deafness. However, this chapter refers to the Shangyang point mentioned earlier, not to Hegu or other points. The part of the Hand Yangming channel that passes in front of the ear lies roughly near the Tinghui point. It may be needled to a depth of four tongshencun, and if moxibustion is used, three zhuang may be burned.

For toothache from caries, first needle the Hand Yangming channel. If there is no effect, then needle the part where the channel enters the interior of the teeth, and the effect will be immediate. According to the Jiayi Jing and the Liuzhu Tujing (Illustrated Classic of Flowing Currents), the seven Hand Yangming points Shangyang, Erjian, Sanjian, Hegu, Yangxi, Pianli, and Wenliu can all treat toothache. The Hand Yangming channel runs through the cheeks and enters the lower teeth. The Foot Yangming channel runs along the outside of the nose and enters the upper teeth. (Qu, read as "qu," refers to dental caries.)

When pathogenic qi invades between the five zang organs, and the disease arises with the luo vessels pulling and causing pain, coming and going intermittently...

If the illness appears in only one place, apply miuci (crossed needling, a method that treats collateral-vessel disorders by puncturing on the opposite side of the body) at the edges of the nails on the hands and feet.

Puncture the jingxue (well points, located at the tips of the fingers or toes) of each channel. If the left side is affected, needle the right, and if the right side is affected, needle the left. Observe the luo (collateral) vessels and let out the blood from them, needling once every other day. If the illness is not stopped after one needling, needle five times in succession. Wherever a luo vessel shows stagnant blood, needle it the same number of times.

If the pathogen travels along the luo vessels and pulls at the upper teeth and lips so that they feel cold and painful, examine the luo vessels visible on the back of the hand, find the one containing blood, and let out that blood.

This means that if the pathogen spreads along the luo vessels and causes cold pain in the upper teeth and lips, one should needle the Yangming luo vessel on the back of the hand.

On the foot Yangming (stomach) channel, needle one point at the edge of the nail of the middle toe. Also needle one point each at the edge of the nail of the finger beside the thumb, which is the index finger. These usually take effect quickly. Needle the right side for left-side illness and the left side for right-side illness.

The commentary notes that the point for foot Yangming is Lidui (ST-45), on the second toe, and the point for hand Yangming is Shangyang (LI-1), at the edge of the index fingernail. The Needle Classic says that for toothache without fear of cold drinks, one should needle the foot Yangming channel, and for toothache with fear of cold drinks, one should needle the hand Yangming channel. The Newly Collated edition holds that the earlier phrase "middle finger and second finger nails" has an extra word, "second," and should read only "middle finger nail."

If the pathogen invades the luo vessels of the hand Shaoyin, foot Shaoyin, hand Taiyin, foot Taiyin, and foot Yangming channels, all five luo vessels converge in the ear and connect upward to the left side of the forehead.

The five luo vessels here are those of the hand Shaoyin (heart), foot Shaoyin (kidney), hand Taiyin (lung), foot Taiyin (spleen), and foot Yangming (stomach) channels. All of them connect with the interior of the ear and extend upward to link with the left forehead.

When the qi and blood of all five luo vessels are exhausted, the pulse continues to beat throughout the body, yet the body loses sensation and resembles a dead person. This condition is sometimes called shijue (corpse reversal).

That is, the patient suddenly faints and becomes stifled, like a corpse, yet the pulse continues beating as usual. When yin is excessive in the upper body, qi from below gathers upward and the pathogen rises with it. The rising pathogen disturbs yang qi, and disordered yang qi in turn blocks the five luo vessels, so the outward appearance is that of death. Because the illness arises from reversed flow (jue), it is sometimes called shijue.

For treatment, first needle the spot on the inner side of the big toe, beside the root of the nail, about one leek leaf's width from the nail tip. This is Yinbai (SP-1), the jingxue of the foot Taiyin spleen channel. Insert the needle to about one-tenth of the patient's cun (body inch) and retain it for the duration of three breaths. If moxa is used instead, apply three moxa cones.

Next, needle Yongquan (KI-1), the jingxue of the foot Shaoyin kidney channel, using the same method described above.

Finally, needle one point each at the edge of the nail of the middle toe of the foot.

The text next states that the second toe is the well point of the Foot Yangming (Stomach) channel. The needling method is the same as described earlier, and the point is Lidui. Next, the needle is inserted at the inner side of the thumb, about a leek leaf's width from the tip, at Shaoshang, the well point of the Hand Taiyin (Lung) channel. The depth is one fen (tongshencun, a unit measured by the patient's own body proportions), with the needle retained for three breaths. If moxibustion is used, three cones may be burned.

Then the well point of the Hand Pericardium (Shou Xinzhu), Zhongchong, is needled. The depth is again one fen, retained for three breaths, and one moxa cone may be burned. The New Corrections note that the Jiayi Jing (Classic of Acupuncture and Moxibustion) does not record needling the Hand Pericardium here. Looking closely at the five collaterals described in this passage, the Hand Pericardium is not among them, yet it is needled here, so six collaterals are actually involved. Wang Bing comments on the passage without clarifying this point.

At the tips of the prominent bones on the Shaoyin channel, one needle is inserted on each side, and the symptoms improve immediately. This refers to Shenmen, a depression at the tip of the prominent bone at the back of the palm and the shu-stream point of the Hand Shaoyin (Heart) channel. The depth is three fen, retained for seven breaths, and three moxa cones may be burned.

If there is still no improvement, a bamboo tube is placed in the ears and the patient is made to blow through it, so that qi (vital energy) enters the ears and assists the five collaterals in restoring the flow of qi. The tube should be inserted into the ear and held firmly with the hand to prevent the qi from escaping. The blowing should be forceful, until the qi is compressed and surges, at which point the collaterals will be open. The New Corrections cite Tao Yinju (Tao Hongjing) as saying that one should blow three times into the left ear and then three times into the right.

Alternatively, about one square inch of hair may be shaved from the left temple, burned to ash, and mixed into a cup of good wine to be drunk. For those who cannot drink alcohol, the medicinal liquid may be poured down the throat, and the illness will be relieved at once. The hair from the left temple is regarded as the residual essence of the blood in the five collaterals, which is why it is burned and taken. Wine helps the medicine circulate, and because its nature is ascending and it reaches the heart internally, and the heart governs the blood vessels, it is used to carry the medicine. (The character ti is read as yi and means to shave hair.)

In all needling, one must first examine the meridians, palpate carefully, and test along the channels, distinguish deficiency from excess, and then treat accordingly. If the meridians are out of balance, the meridian itself is needled. If there is pain in the body but the meridian itself shows no pathological change, miu ci (crossed needling, which needles the corresponding collateral on the opposite side of the body) is used. One must also observe the division of the skin, and wherever there is a visible blood vessel, the stagnant blood within it should be drawn out as completely as possible. This is the method of miu ci.

Treatise on the Reverse and Compliant Needling According to the Four Seasons

When the Jueyin (Liver) channel has excess qi, yin bi (yin impediment) occurs. Bi means pain; yin refers to cold; and "excess" means that the qi of the Jueyin is vigorous and congested.

Thus, when yin qi disperses to the surface of the body, cold obstruction (hanbi, a bi disorder caused by cold pathogens blocking the channels) results. The Xinjiaozheng (New Corrections) states: "On careful examination of Wang's explanation, which takes bi to mean pain, the meaning of the text still does not flow smoothly."

When yin qi is deficient, heat obstruction (rebi, a bi disorder caused by heat pathogens blocking the channels) arises. With yin qi deficient, yang qi is relatively excessive, so heat obstruction appears.

If the pulse is slippery, the patient may have wind-type fox hernia (feng hushan); if the pulse is choppy, there may be accumulation of qi in the lower abdomen (shao fu jiqi). The channel of the Jueyin runs up the inner thigh, enters the pubic hair region, encircles the genitals, and reaches the lower abdomen. Its collateral branch ascends the lower leg to the testicles and connects with the penis. Therefore, fox hernia and lower-abdominal qi accumulation appear. The Xinjiaozheng cites Yang Shangshan, who said: "The fox cannot urinate at night and only releases it at dawn; this human illness resembles the fox, and so it is called hushan (fox hernia)." Another view holds that the Sanjiao (Triple Burner) is the gufu (solitary palace), and therefore the hernia is called gu shan (solitary hernia).

When the Shaoyin channel qi is in excess, skin obstruction (pibi, a bi disorder in which pathogens invade the skin and block the channels) and yinzhen (hidden rash, a rash that erupts faintly) may occur; when it is deficient, lung obstruction (feibi) results. The water qi of the kidneys flows counter-ascendingly and connects upward to the lungs. The Foot Shaoyin channel passes upward from the kidneys, through the liver and the diaphragm (gemo), and enters the lungs. Thus, when Shaoyin is in excess, skin obstruction and hidden rash appear, and when it is deficient, lung obstruction appears.

If the pulse is slippery, the patient may have wind-type lung hernia (feng feishan); if the pulse is choppy, there may be accumulation (jiju) or blood in the urine. The Shaoyin channel enters the lungs, passes through the kidneys, and connects with the bladder. Therefore, lung hernia, accumulation, and blood in the urine appear.

When the Taiyin channel qi is in excess, flesh obstruction (roubi) and cold penetrating the interior (hanzhong) may occur; when it is deficient, spleen obstruction (pibi) results. The spleen governs the muscles, so these conditions appear.

If the pulse is slippery, the patient may have wind-type spleen hernia (feng pishan); if the pulse is choppy, there may be accumulation, with constant fullness in the chest and abdomen (xinfu changman). The Taiyin channel enters the abdomen, belongs to the spleen, and connects with the stomach. Its branch ascends from the stomach, passes through the diaphragm, and flows into the heart. Therefore, spleen hernia and constant fullness in the chest and abdomen appear.

When the Yangming channel qi is in excess, vessel obstruction (maibi, a bi disorder in which pathogens invade and block the vessels) occurs, and the body sometimes feels feverish; when it is deficient, heart obstruction (xinbi) results. When stomach qi is in excess, it rises to affect the heart; when it is deficient, it causes obstruction beneath the heart. Therefore, these conditions appear.

If the pulse is slippery, the patient may have wind-type heart hernia (feng xinshan); if the pulse is choppy, there may be accumulation, and the patient is often easily startled. The heart governs the vessels, which rise from the chest and emerge to belong to the Xinbao (Pericardium). Descending through the diaphragm, they connect with the Sanjiao. Therefore, heart hernia and frequent startling appear.

When the Taiyang channel qi is in excess, bone obstruction (gubi) occurs, with a heavy body; when it is deficient, kidney obstruction (shenbi) results. The Taiyang and Shaoyin channels are interiorly and exteriorly related, so whether qi is in excess or deficient, the disease may affect the kidneys.

If the pulse is slippery, the patient may have wind-type kidney hernia (feng shenshan); if the pulse is choppy, there may be accumulation, and at times there may be disorders of the crown of the head. The Taiyang channel meets at the crown of the head, enters the head to connect with the brain, and then descends along both sides of the spine to connect with the kidneys. Therefore, kidney wind hernia and disorders of the crown of the head appear.

The Shaoyang (Lesser Yang) channel's Qi, when in excess, causes the sinews and vessels to become obstructed and the ribs and flanks to feel full and distended. When the Shaoyang channel's Qi is deficient, it gives rise to ganbi (liver bi, an obstructive disorder of the liver region).

Shaoyang and Jueyin (Jueyin, the Terminal Yin) are mutually interior and exterior, so disorders of Shaoyang also affect the liver.

When the pulse is smooth and free-flowing, ganfeng shan (liver wind hernia, a hernia caused by wind in the liver channel) appears. When the pulse is rough and stagnant, jiju (accumulations) appear, and at times the sinews become tight and the eyes ache. The liver governs the sinews and vessels, so sinew tightness often occurs. The Jueyin channel's collateral ascends to the forehead and meets the Du mai (Governing Vessel) at the vertex. Its branch descends from the muxi (eye system, the vessels connecting to the eyes) and passes along the inner cheek, which is why the eyes ache.

Therefore, in spring the body's Qi resides mainly in the channels. In summer it resides in the sunluo (fine collateral branches of the channels). In late summer it resides in the muscles, in autumn in the skin, and in winter in the marrow of the bones.

The Yellow Emperor (Huangdi) said, "I wish to know the reasoning behind this." Qibo replied, "In spring, the heavens begin to unfold and the earth's Qi begins to disperse. Ice thaws, rivers flow, and the channels are clear, so the body's Qi lies within the vessels. In summer, the channel Qi is full and overflows into the sunluo. The sunluo, nourished by blood and Qi, make the skin full. In late summer, the channels and collaterals are both vigorous, and blood and Qi fill the muscles from within. In autumn, the heavens begin to contract, the couli (skin texture and sweat pores) close, and the skin is drawn tight. Here 'yin' means to pull and contract. In winter, the body stores and conceals itself. Blood and Qi remain within, attach to the marrow, and communicate with the five zang (organs)."

Thus, pathogenic Qi often invades the body in step with the seasonal changes of blood and Qi. Its changes are hard to predict, so it should be expelled according to the state of the channel Qi. When the pathogen is expelled, disordered Qi does not arise, and when the channel Qi is harmonized, the body does not fall into disorder.

The Yellow Emperor asked, "If acupuncture is performed against the seasons, how does this lead to disordered blood and Qi?" Qibo replied, "Needling the collaterals in spring causes blood and Qi to escape outward, leaving a person with too little Qi." Because blood and Qi spill outward, the body becomes deficient, and so Qi is lacking.

The Xin Jiaozheng (New Collation) commentary notes that the passage from "needling the collaterals in spring" through "causing the eyes to lose clarity" carries the same meaning as the Zhenyao Jingzhong Lun (Discourse on Essentials of Diagnosis and the End of the Seasons), differing only in wording. The commentary there is more detailed. That text discusses each of the four seasons separately, while this one discusses five periods. However, this passage includes "needling the muscles in late summer" but lacks an entry for "needling in autumn." It is suspected that the "needling the muscles" mentioned here corresponds to the "needling the skin in autumn" in the Zhenyao Jingzhong Lun.

Needling the muscles in spring causes blood and Qi to move in reverse disorder, so a person's Qi surges upward. When blood and Qi run backward, the Qi rushes upward, and this produces shangqi (upward-surging Qi).

Needling the sinews and bones in spring causes blood and Qi to stay trapped within the body and fail to disperse, so a person's abdomen becomes distended.

Needling the channels in summer causes blood and Qi to be depleted, so a person becomes weak, fatigued, and listless.

Meaning of Jiexie

When qi and blood are depleted and diminished, a person becomes drowsy, slack, and weak all over. This is called jiexie (a state of limb lassitude). The condition is neither clearly cold nor clearly hot, neither robust nor clearly weak, so it cannot be named precisely.

Consequences of Mistimed Needling by Season

Needling the muscles in summer causes the blood and qi to close inward (que, meaning "shut"). Yang qi cannot circulate freely, and the person becomes prone to fear. Needling the sinews and bones in summer drives blood and qi upward, corresponding to anger, so the person becomes prone to rage. The collators note that the classic omits the entry on needling at the summer-autumn boundary.

Needling the jing-luo (channels) in autumn drives blood and qi upward until they fill the lungs, so the person becomes prone to forgetfulness. Needling the luo (collateral vessels) in autumn prevents qi from moving outward. One variant reads "blood and qi do not move," while the Quan Yuanqi edition and the Taisu read "qi does not guard the exterior." The person becomes so extremely weak that they lie down and do not wish to move. The collators note that the classic omits the entry on needling at the late-summer division of autumn. Needling the sinews and bones in autumn causes blood and qi to dissipate inward, leaving the central qi weakened, and the person develops chills and shivering.

Needling the channels in winter causes the blood and qi to be fully discharged, so the eyes receive no nourishment and vision becomes unclear. Needling the collateral vessels in winter lets internal qi leak outward, and over time this develops into serious bi (painful obstruction) syndrome. Needling the muscles in winter exhausts yang qi, which is depleted further by spring, so the person becomes prone to forgetfulness. The collators note that the classic omits the entry on needling at the autumn-equinox division of winter.

Summary and Warning

All of these mistimed needling errors produce serious illnesses that violate the natural order, so the seasonal rhythms must not be disregarded. Violating them produces disordered qi, which seeps into the body (yin, meaning to soak in or spread gradually) and causes disease through successive transmission. Therefore, if a practitioner does not understand the channels and the causes of illness according to the seasons, and mistakes what is proper for what is improper, the upright qi will become disordered within the body and clash with the essential qi. One must carefully examine the jiuhou (nine indicators, the method of examining the pulses of the upper, middle, and lower body) so that the upright qi remains stable and the essential qi does not reverse.

Fatal Needling of the Five Zang Organs

The Yellow Emperor said, "Well said." He then described the fatal consequences of needling the five zang organs by mistake. Needling the heart causes death within a day, and the sign of this is yi (belching). The commentary notes that the chapter Zhenyao Jingzhong Lun (On Essentials of Diagnosis and the End of Illness) says that needling the heart causes death in a circular progression, about one week, while the chapter Ci Jin Lun (On Forbidden Needling) says death occurs within one day, with yi appearing as movement. Needling the liver causes death within five days, and the sign of this is excessive speech. The commentary observes that Zhenyao Jingzhong Lun leaves this matter unaddressed, whereas Ci Jin Lun records the fatal period for liver needling as five days.

Biao Ben Bing Chuan Lun (On the Transmission of Branch and Root Illnesses)

If a pathogenic influence invades a particular organ and produces corresponding abnormal signs, one can judge from them that the illness will prove fatal. The opening of the original passage is missing, but it continues: "Lung struck, death in three days." That is, when the pathogen harms the Lung, death follows in three days, and the sign is coughing.

The Zhenyao Jingzhong Lun (Essentials of Diagnosis and the Ends of Illness) says that a Lung strike leads to death in five days, while the Ci Jin Lun (Treatise on Forbidden Needling) gives three days. Both record coughing as the sign. The Xinjiaozheng (Newly Collated) editors note that the Jiayi Jing (Systematic Classic of Acupuncture and Moxibustion) records the sign as yawning instead. For the Kidney, the original reads, "Kidney struck, death in six days." The editors observe that the Jiayi Jing gives three days, with sneezing and yawning as the signs. The Zhenyao Jingzhong Lun says seven days and sneezing, and the Ci Jin Lun says six days and sneezing. The editors add that the Jiayi Jing contains no mention of yawning in this passage.

For the Spleen, the original reads, "Spleen struck, death in ten days." The editors note that the Jiayi Jing gives fifteen days, with swallowing as the sign. The Zhenyao Jingzhong Lun says the Spleen strike is fatal in five days, and the Ci Jin Lun says ten days, and both record swallowing. The author holds that all three texts attribute their statements to Qi Bo, yet the times of death and the signs differ among them, so the discrepancies were likely introduced in the course of copying.

When needling injures any of the five zang organs, it will inevitably bring about death. Once the corresponding signs of the injured organ appear, one can use them to predict that the patient will die. Bian (change) refers to a shift in the movement of Qi. The material from "Zhong Xin" (Strike the Heart) onward repeats the earlier discussion of counter-treatment and following-treatment signs.

Biao Ben Bing Chuan Lun

The editors note that, according to the Quan Yuanqi edition, this treatise came before the Pi Bu Lun (Treatise on the Skin Regions).

The Yellow Emperor asked: Diseases have branch and root, and needling has counter-treatment and following-treatment. How should one proceed?

Qi Bo replied: In needling, one must first distinguish yin from yang, so that the changes in the illness correspond from beginning to end. Only then can counter-treatment and following-treatment be applied properly. Branch and root transform into one another. Sometimes the illness lies in the branch and one treats the branch. Sometimes it lies in the root and one treats the root. Sometimes it lies in the root yet one treats the branch, and sometimes it lies in the branch yet one treats the root. Therefore treatment may succeed by taking the branch, or by taking the root, or by going against the momentum of the illness, or by following it. To understand the actual condition of the illness and grasp the essentials of treatment, both counter-treatment and following-treatment may be used. What matters is fitting the treatment to the condition.

One who understands counter-treatment and following-treatment and applies them correctly will not hesitate. One who understands branch and root will usually treat with confidence. When medical principles are clear and judgment is deep and precise, one need not ask others about every case, and the treatment will still be appropriate.

One who does not understand branch and root is called a blind practitioner. Here, shi (to know) means to recognize. Shallow insight and insufficient grasp of medical principle lead to errors in judgment, and treatment will therefore often go wrong.

The principles of yin and yang, counter and following, and branch and root may seem subtle, yet they extend to vast matters. Each has its own distinctions in explanation, but in the end they return to a single root…

True clarity means being able to distinguish Yin-Yang, to understand whether the course of an illness is favorable or adverse, to grasp the principles that correspond to it, and to recognize its subtle details. By observing the signs an illness displays, one can perceive even the slightest of them, and by investigating the direction a disease is taking, one can grasp it even when its scope is vast. In this way one comes to know the many from the few and the broad from the shallow. Thus it is said that by mastering one essential point, one comes to understand the harm of all hundred diseases.

To grasp many matters from the few and to infer broad contents from the shallow is what can be called grasping one essential point and understanding a hundred conditions. Penetrating many illnesses through a few principles, and inferring profound truths from what is near and shallow, depends on what? It depends on understanding the underlying patterns. If one is not a sage who follows the Dao, who could reach such a state? Therefore, those who study medicine can also come to know the hundred diseases by grasping one essential point.

To know the deep from the shallow and the distant from the near, the principles of biao (manifestation) and ben (root) may seem easy to explain, yet in practice they are not necessarily mastered. Here, biao and ben refer to distinguishing the principal source of a disease from its outward appearance. Although the pathology is extremely profound, one may enter through what is near and shallow and gradually penetrate the whole picture. Still, although the principle of biao and ben is easy to state, people's understanding often falls short of truly comprehending it.

Treatment that goes against the course of an illness is called ni (counter), and treatment that accords with the course of an illness is called cong (following). In treatment, one must distinguish what came first from what came later, and what is primary from what is secondary. If an illness appears first and a counter-flowing pattern arises afterward, one should treat the ben, the root of the disease. If a counter-flowing pattern arises first and illness follows, one should also treat the root. If a person catches cold and then falls ill, one should treat the root, and if illness comes first and cold follows, one should likewise treat the root. If fever comes first and illness follows, one should treat the root, but if fever comes first and then abdominal fullness (distension of the middle) appears, one should treat the biao, the manifestation. If illness comes first and diarrhea follows, one should treat the root, and if diarrhea comes first and another illness develops afterward, one should still treat the root. In such cases, these conditions must be regulated first, and only then should the other conditions be treated. If illness comes first and abdominal fullness follows, one should treat the biao, but if abdominal fullness comes first and then restlessness of the heart appears, one should treat the root.

The body also contains ke qi (external, transient qi that affects the body from outside) and tong qi (qi that is the same as or corresponds to the original pathogenic qi).

The Xinjiao (New Collation) notes that, when checking the Quan Yuanqi edition (Quan Yuanqi ben), the character yǒu in this passage is written as gù.

When the large and small excretions are blocked, one should first treat the biao. When they flow freely, one should first treat the ben.

When the root illness appears first and the biao illness arises later, one must examine the situation carefully. If the illness shows excess when it develops, one should treat the ben first and the biao afterward. If it shows deficiency when it develops, one should treat the biao first and the ben afterward.

What is meant by "benning biao" (treating the ben by way of the biao, or "root and then manifestation") is that an old illness comes first and a new illness arises later. Because the illness is in excess, one treats the root first and the manifestation afterward. What is meant by "biaoning ben" (treating the biao by way of the ben, or "manifestation and then root") is that a mild, slow condition appears first, and a severe, urgent condition arises later. Because the illness is in deficiency, one treats the biao first and the ben afterward.

One must also carefully observe whether an illness is urgent or slow, and treat it according to the actual circumstances. Jian (intermittent) refers to more numerous manifestations, and shen (severe) refers to fewer. More numerous manifestations means that the signs are many but the illness is comparatively light...

The diseases with few symptoms but deep, hard-to-treat courses should be carefully judged and weighed according to the specific situation before treatment is applied.

The saying "biao ben bu zu, you yu" (the root and manifestation may be deficient or excessive) does not mean that one may abandon therapeutic methods and treat the illness arbitrarily according to personal preference.

When the illness progresses slowly, several aspects may be treated together. When it is severe, treatment should concentrate on the main site of the disease. If stool and urine are not moving freely and other symptoms appear afterward, one should first treat the root (biao ben), meaning the fundamental cause of the disease.

"Bing xing" (parallel progression) refers to several channels being attacked by pathogenic qi at the same time, forming a combined disease (he bing). "Du xing" (solitary progression) refers to only one channel being affected, with no other pathogenic factors mixed in. When a combined disease is severe, the pathogens pass from one channel to another, and if this transmission is rapid, it can also cause death.

In general, when a disease transmits, if the heart is affected first, pain appears in the heart. This is because the Jing (essence) and Qi of the zang and fu organs all connect with the heart, so the heart is the first to hurt. After one day the disease reaches the lungs and a cough appears. This is heart fire overcoming lung metal, so the pathogen has moved into the lungs. The lung disorder shows as cough, which is why this symptom arises.

After three days the disease reaches the liver, producing distension and pain in the hypochondrium (the flanks). This is lung metal overcoming liver wood. The liver channel passes through the hypochondrium, which is why this occurs.

After five days the disease reaches the spleen, producing obstruction, pain throughout the body, and heaviness of the body. This is liver wood overcoming spleen earth. The spleen's nature is to be stable and to guard, and when the Qi of liver wood finds the spleen unguarded, it invades, producing these symptoms. If there is no improvement within three days, the patient will die.

This is the mutual attack of the overcoming qi among the Five Phases, and the weaker side can only yield. When four of the five zang organs have already been injured, how can the patient sustain life for long? This is why death comes so quickly.

The phrase "dong ye ban, xia ri zhong" (midnight in winter, midday in summer) refers to the zi hour, at midnight in winter, and the wu hour, at noon in summer. Commentators explain that this refers to the exact midpoints of day and night, not to a different timing for winter and summer.

The collators add that the Lingshu jing (Spiritual Pivot) records that after great Qi enters the zang organs, the disease first appears in the heart, passes to the lungs after one day, to the liver after three days, and to the spleen after five days, and that death follows if it is not cured within three days, at midnight in winter or midday in summer. The Jiayi jing (Systematic Classic of Acupuncture and Moxibustion) contains similar content: after heart pain, transmission to the lungs in one day causes cough; transmission to the liver in three days causes flank pain; and transmission to the spleen in five days causes obstruction, pain throughout the body, and heaviness, with death if not cured within three days. Broadly speaking, the Suwen (Plain Questions) emphasizes the condition of the disease, the Lingshu emphasizes the zang and fu organs, and the Jiayi jing records both the condition and the organs.

Lung disease produces panting and cough. Because the essence and Qi of the lungs are located high in the body and govern breathing, panting and cough arise.

After three days the disease reaches the liver, producing distension and pain in the hypochondrium. After one more day it reaches the spleen, producing heaviness and pain in the body. After five days abdominal distension appears, which is the pathogen passing spontaneously into the fu organs (the hollow organs paired with the zang). If there is no improvement after ten days, death follows, at sunset in winter or sunrise in summer.

In the middle of the first winter month (mengdong), sunset falls at the second quarter of the eighth ke of the shen hour. In the middle of the second winter month (zhongdong), sunset falls at the third quarter of the seventh ke of the shen hour. In the middle of the third winter month (jidong), the time of sunset is the same as in the first month. In the middle of the first summer month (mengxia), sunrise falls at the first quarter of the eighth ke of the yin hour. In the middle of the second summer month (zhongxia), sunrise falls at the third quarter of the seventh ke of the yin hour. In the middle of the third summer month (jixia), the time of sunrise is the same as in the first month.

When the liver is diseased, one suffers dizziness, blurred vision, and fullness in the ribs and flanks. This is because the true Qi of the liver disperses through the liver channel, which connects internally to the eyes and laterally to the ribs, so these symptoms appear. After three days, the body becomes heavy and aches all over, which means the liver disease has passed to the lungs. After five more days, the abdomen becomes distended, which means the pathogenic Qi has passed from the zang (solid organs) to the fu (hollow organs). After three more days, pain appears in the lower back, spine, and lower abdomen, and the calves ache. This means the stomach disease has passed to the kidneys. The kidney channel begins at the foot, ascends along the inner side of the calf, passes the inner side of the popliteal fossa and the posterior border of the inner thigh, runs through the spine, belongs to the kidneys, and connects with the bladder, which is why these symptoms occur. The lower back is where the kidneys reside, so back pain arises. If there is no improvement after three days, the patient will die. In winter, the time limit is sunset.

New Corrections note: According to the Jiayi Jing (Classic of Acupuncture and Moxibustion), this passage reads "midday" instead.

In summer, the time limit is the early meal. The timing of sunset is calculated using the winter method. "Early meal" refers to a time earlier than the usual meal, namely exactly the mao hour.

When the spleen is diseased, the body aches and feels heavy. This is because the true Qi of the spleen nourishes the body, and the spleen governs the muscles, so these symptoms appear. After one day, the abdomen becomes distended, which means the pathogenic Qi has passed from the zang to the fu. After two more days, pain appears in the lower abdomen, lower back, and spine, and the calves ache. This means the stomach disease has passed to the kidneys. After three more days, pain appears in the back and sinews, and urination is blocked. This means the pathogenic Qi has passed from the zang to the fu and has also affected the back. The character here read as "lü" is pronounced "lü." If there is no improvement after ten days, the patient will die. In winter, the time limit is the hour of rending (ending at the twenty-fifth ke after the shen hour). In summer, the time limit is the late meal, which is the twenty-fifth ke after the yin hour.

When the kidneys are diseased, pain appears in the lower abdomen, lower back, and spine, and the calves ache. This is because the true Qi of the kidneys descends, so these symptoms appear. After three days, pain appears in the back and sinews, and urination is blocked. This means the pathogenic Qi has passed from the zang to the fu. New Corrections note: According to the Lingshu Jing (Spiritual Pivot), this passage describes the disease passing to the back and bladder, that is, passing from the zang to the fu and affecting the back. After three more days, the abdomen becomes distended, which means the bladder disease has passed to the small intestine. New Corrections note: According to the Jiayi Jing, above the phrase "after three days" there are the two characters "to the heart," reading "heart distension." After three more days, fullness and pain appear in both flanks, which means the disease has passed from the fu to the zang. New Corrections note: According to the Lingshu Jing, this records that the disease passes to the small intestine in three days and to the heart in another three; the "pain in both flanks" described here is...

If the intestinal fu organs (liufu, the six fu organs) pass the illness to the heart, pain arises.

If it has not healed after three days, death follows: in winter at dachen (the time when the sky is bright, nine ke after the yin hour), and in summer at yanbu (nine ke after the shen hour, approaching dusk). Ke is a unit of the water clock, and the shichen hours (yin, shen, and the rest) are the two-hour periods of the Chinese day.

Stomach illness brings distension and fullness of the abdomen, because the stomach's channels run along the abdomen.

After five days, pain appears in the lower abdomen and lower back, and the calves ache. This is the stomach passing the illness to the kidney (shen).

After three more days, pain runs along the tendons of the back and urination is blocked. This is the illness moving from the kidney to its interior-exterior partner, the bladder (pangguang), and spreading to the back.

After five more days, the body feels heavy. The bladder, as a fu that stores fluids, passes the illness to the spleen (pi).

The Xinjiao Zheng (Newly Collated Edition) says that the Lingshu Jing (Spiritual Pivot) and the Jiayi Jing (Classic of the A and B) both record "after five days it rises to the heart," meaning the bladder passes the illness to the heart. This is transmission between organs that overcome each other, and it is why the body grows heavy. Wang Bing's statement that the illness passes to the spleen is an error.

If it has not healed after six days, death follows: in winter after midnight, and in summer at riDie. After midnight refers to eight ke after the zi hour, at the exact middle of the chou hour. riDie refers to eight ke after the wu hour, at the exact middle of the wei hour. The character for "Die" is read as "tu jie qie," which is pronounced dié.

Bladder illness brings urinary blockage, because the bladder is the fu that stores fluids.

After five days, the lower abdomen swells, the lower back aches, and the calves ache. This is the illness returning to a zang organ.

After one more day, the abdomen becomes full and distended. This is the kidney passing the illness to the small intestine.

After another day, the body aches. This is the small intestine passing the illness to the spleen.

The Xinjiao Zheng says that the Lingshu Jing records "after one day it rises to the heart," meaning the illness passes from fu to zang. The Jiayi Jing records "to the spleen," which matches Wang Bing's commentary.

If it has not healed after two days, death follows: in winter at jiming, and in summer at xiabu. Jiming refers to the early morning when the rooster crows, at the exact middle of the chou hour. Xiabu refers to five ke after the shen hour, when the sun leans toward the west.

Diseases that spread in this order each have a fixed limit before death, and needling cannot treat them.

The transmission of illness among the five zang organs generally follows this pattern. Some illnesses pass slowly and some quickly. Slow ones may cause death after one, two, or three years, and the next slowest after three or six months. Fast ones may cause death within one to four days, or five to six days. These are the cases this passage refers to.

Examining the regularity of this transmission, all of it is reckoned by the qi of the Five Phases. However, when the number of days of transmission is compared with the theory, the reasoning does not fit. If the Five Phases are taken as the guiding principle, and the illness passes by the count of "bu sheng" (not victorious) to the side that is "suo sheng" (what it defeats), then fire passing to metal should take one day, metal passing to wood should take two days, and wood passing to earth...

It should be said that "on the fourth day, Earth passes to Water," and that "on the third day, Water passes to Fire." The same applies to "the fifth day." If the days are counted by the qi each organ overcomes, and the change passes to the qi it cannot overcome, then Wood passes to Earth in three days, Earth passes to Water in five days, Water passes to Fire in one day, Fire passes to Metal in two days, and Metal passes to Wood in four days. The numbers of transmission days given in the scripture seem to follow the regularity of the qi of the Three Yin and Three Yang (sanyin sanyang).

The Treatise on the Jade Pivot and True Viscera (Yuji Zhenzang Lun) states: "The five viscera are interconnected, and the evil qi shifts in a fixed order. If it is not treated in time, it may pass on and cause death after three months, six months, or three or six days." The situation described here is the same. Even so, one should still observe carefully the number of days of transmission in each case, in order to judge whether it accords with these statements.

As for the phrase "skip one organ and stop" (jian yi zang zhi), the New Collation (xin jiaozheng) notes that the Classic of Acupuncture and Moxibustion (Jiayi Jing) lacks the character "stop" (zhi). The phrase means that in transmission the change skips one organ before passing on, and then stops. In other words, Wood passes to Earth, Earth to Water, Water to Fire, Fire to Metal, and Metal to Wood, each time skipping one organ. "Passing to the third or fourth organ" refers to reaching the third or fourth organ counting from the starting one.

Reaching the third organ means arriving at the qi that overcomes the qi of the starting organ. Reaching the fourth organ means arriving at the "parent qi" (the phase in the Five Phases (Wuxing) that generates the starting qi). The former can no longer inflict harm on the qi it generates. The latter stands in a mother-and-child relationship of generation with the starting qi, with no stage of mutual overcoming. Qi moves smoothly in its natural order, and so acupuncture treatment may be applied.