《黃帝素問靈樞集註》Vol. 2

The Yellow Emperor inquired of Qibo: "The essence of all acupuncture treatment lies in mastering the twelve primary channels' pathways and terminal points, the locations of collateral branches, the distribution of the Five Shu Points (well, spring, stream, river, and sea points), the coordination between the six bowels and the channels, seasonal influences on Qi and blood circulation, the acupoints where the five organs' essence converges, as well as the principles of needle depth and point selection. I hope you can explain these in detail."

Qibo replied: "Allow me to systematically elucidate. The Qi of the Lung Channel originates at Shaoshang point (on the medial side of the thumb tip), classified as a Well point (Wood phase in the Five Phases); flows to Yuji point (thenar eminence area), a Spring point; transmits to Taiyuan point (depression one cun behind Yuji), a Stream point; moves through Jingqu point (at the radial pulse location), called a River point due to its constant pulsation; and finally converges at Chize point (cubital fossa arterial region), a Sea point. This describes the pathway of the Hand Taiyin Lung Channel.

The Heart Channel's Qi emanates from Zhongchong point (middle fingertip), a Well-Wood point; flows to Laogong point (center of palm), a Spring point; infuses into Daling point (depression between two bones at wrist crease), a Stream point; travels through Jianshi point (three cun between forearm tendons), where abnormal Qi flow manifests while normal flow remains imperceptible, marking it as a River point; ultimately returning to Quze point (medial cubital depression, accessible when elbow is flexed), a Sea point. This traces the Hand Shaoyin Heart Channel's route.

The Liver Channel begins at Dadun point (lateral side of big toe near hair cluster), a Well-Wood point; passes through Xingjian point (between first and second toes), a Spring point; enters Taichong point (depression two cun above Xingjian), a Stream point; proceeds to Zhongfeng point (depression one and a half cun anterior to medial malleolus, where reverse pressure causes obstruction while proper pressure facilitates flow, perceptible when foot is rocked), a River point; finally merging at Ququan point (above large tendon below medial knee prominence, accessible with knee flexion), a Sea point. This outlines the Foot Jueyin Liver Channel's distribution.

The Spleen Channel originates at Yinbai point (medial tip of big toe), a Well-Wood point; flows to Dadu point (depression behind big toe's major joint), a Spring point; transmits to Taibai point (below tarsal bone on foot dorsum), a Stream point; with Qi moving to Shangqiu point... (Subsequent channels follow identical principles, systematically detailing each channel's Qi-blood transmission pattern through the five-point sequence of well, spring, stream, river, and sea points)"

This passage explains the distribution of acupoints and location methods for several important meridians (yin and yang channels) in the human foot. It primarily describes the pathways of the Spleen Meridian of Foot-Taiyin, Kidney Meridian of Foot-Shaoyin, Bladder Meridian of Foot-Taiyang, Gallbladder Meridian of Foot-Shaoyang, and Stomach Meridian of Foot-Yangming as they traverse the foot region.

Taking the Kidney Meridian of Foot-Shaoyin as an example: The channel Qi begins at Yongquan (KID-1, located in the depression at the center of the sole), which serves as the "Well" point (the first of the Five Shu Points). It then flows to Rangu (KID-2, found in the depression below the bony prominence on the inner foot), the "Spring" point. Next, it pours into Taixi (KID-3, in the depression between the medial malleolus and Achilles tendon), the "Stream" point. The energy then ascends to Fuliu (KID-7, approximately two cun above the medial malleolus where the pulse can be felt), the "River" point. Finally, it enters Yingu (KID-10, situated between the large and small tendons on the medial knee, palpable only when the knee is flexed), the "Sea" point.

Other meridians follow similar descriptive patterns, each meticulously detailing the positional characteristics and location methods for every acupoint. For instance, the Bladder Meridian's Zhiyin (BL-67) lies at the lateral tip of the little toe, Tonggu (BL-66) in the depression on the outer foot, and Weizhong (BL-40) at the exact center behind the knee. The terms "Well, Spring, Stream, River, Sea" represent the Five Shu Point system unique to Chinese acupuncture, symbolizing the flow of channel Qi from small to large and from superficial to deep.

Special attention must be paid to body positioning during point location—Yingu (KID-10) requires knee flexion, Yanglingquan (GB-34) needs leg extension, while Chongyang (ST-42) demands foot rotation for precise identification. Such details prove crucial in clinical acupuncture practice.

This passage details the pathways of several key meridians in the human channel system and their major acupoints.

Regarding the Stomach Meridian of Foot Yangming: The Jiexi (ST41) point is located in the depression one and a half cun above the Chongyang (ST42) point on the instep. Descending further, we reach the Xialing point (commonly known as Zusanli ST36), situated three cun below the knee on the outer side of the shinbone. Another three cun downward is the Juxu Shanglian (ST37) point, followed by Juxu Xialian (ST39) another three cun below. Both the Large Intestine and Small Intestine meridians connect with the Stomach meridian, collectively belonging to the Foot Yangming system.

For the Triple Burner (Sanjiao) Meridian: This channel pairs with the Hand Shaoyang meridian, originating at Guanchong (SJ1), the well point (Jing point) of metal nature at the tip of the ring finger. It then flows through Yemen (SJ2) between the little and ring fingers, Zhongzhu (SJ3) in the depression behind the knuckle, Yangchi (SJ4) at the wrist hollow, Zhigou (SJ6) three cun above the wrist between two bones, and Tianjing (SJ10) in the depression above the large bone on the outer elbow. A descending branch separates before the big toe, behind the Shaoyang meridian, passing through Weiyang (BL39) at the outer knee hollow (the connecting point of the Taiyang meridian).

The Triple Burner meridian connects with the Foot Shaoyang and Taiyang meridians, diverging five cun above the outer ankle to pierce the calf and link with the Bladder meridian. Dysfunction of the Triple Burner manifests in urinary disorders: excess patterns show as urinary retention while deficiency patterns as enuresis, treated respectively with draining and tonifying methods.

The Small Intestine Meridian of Hand Taiyang originates at Shaoze (SI1) on the little finger tip, flowing through Qiangu (SI2) in the depression before the knuckle on the hand's outer side, Houxi (SI3) behind the knuckle, Wangu (SI4) on the wrist's outer side, Yanggu (SI5) below the wrist's sharp bone hollow, and Xiaohai (SI8) half a cun from the inner elbow's large bone edge.

The Large Intestine meridian pairs with the Hand Yangming channel, beginning at Shangyang (LI1) (this section remains incomplete). These descriptions meticulously record each meridian's pathway and the positional relationships between significant acupoints.

This passage primarily discusses the locations and functions of meridians and acupoints in the human body. It begins by describing five key points along the Hand Yangming Large Intestine Meridian: starting from the well point (Shangyang) at the tip of the index finger, progressing through the spring point (Erjian), the stream point (Sanjian), the source point (Hegu), then the river point (Yangxi), and finally reaching the sea point (Quchi) on the outer elbow. This constitutes the five transport point system of the Hand Yangming Meridian.

The text then explains that the human body contains five zang organs and six fu organs. Each zang organ has five transport points (totaling 25), while each fu organ has six transport points (totaling 36). The meridians of all six fu organs originate from the three yang meridians of the foot, ascending to connect with the hand meridians.

A detailed listing follows of seven major cervical arteries and their locations: the central Ren Meridian's Tiantu point, flanked sequentially by the Foot Yangming Meridian's Renying, the Hand Yangming Meridian's Futu, the Hand Taiyang Meridian's Tianchuang, the Foot Shaoyang Meridian's Tianrong, the Hand Shaoyang Meridian's Tianyou, and the Foot Taiyang Meridian's Tianzhu. The exact center of the neck houses the Du Meridian's Fengfu point, while the inner armpit contains the Hand Taiyin Meridian's Tianfu point, and three inches below the armpit lies the Hand Jueyin Meridian's Tianchi point.

Subsequent instructions cover needling techniques for specific points: when needling Shangguan (upper gate), the mouth should remain open and not closed; when needling Xiaguan (lower gate), the mouth should stay closed and not open. For Dubi point, the knee must be bent rather than extended, while for Liangguan points, the limbs should be straightened rather than flexed.

The conclusion outlines correspondences between the six fu organs and five zang organs: the lung pairs with the large intestine (the conveyance fu), the heart with the small intestine (the reception fu), the liver with the gallbladder (the essence-storing fu), the spleen with the stomach (the grain-processing fu), and the kidney with the bladder (the fluid-regulating fu). Notably, the Shaoyin Meridian belongs to the kidney, which also connects upward to the lung, thus governing both organs. The triple burner (san jiao) serves as the waterway-regulating fu, linking to the bladder, and stands unique among the six fu organs as the only one without direct pairing—the solitary fu.

This scripture primarily discusses how acupuncture treatment should adapt to seasonal variations and disease characteristics when selecting different needling techniques, as well as the key principles to observe during treatment.

For spring acupuncture, one should select points along the collateral vessels, Ying-Spring points (one of the Five Shu points), and the spaces between major meridians and muscles—deep insertion for severe conditions and shallow insertion for mild cases. Summer acupuncture should focus on Shu-Stream points (another of the Five Shu points), minute collaterals, and the superficial layers of muscles and skin. Autumn acupuncture employs He-Sea points (another of the Five Shu points), with other methods similar to spring techniques. Winter acupuncture targets Jing-Well points (another of the Five Shu points) and Shu-Stream locations, requiring deep insertion with needle retention. These methods align with the seasonal climatic characteristics, the location of pathogenic factors, and the nature of the internal organs.

For patients with muscle spasms (转筋), have them stand during treatment for immediate effect. Those with flaccidity and cold limbs (痿厥) should extend their limbs before needling to achieve rapid results.

Regarding the essentials of acupuncture: "Easy to state" (易陈) refers to the simplicity of explaining the principles, while "difficult to master" (难入) denotes the challenge of practical application. Ordinary physicians focus only on needling techniques, whereas skilled physicians prioritize regulating the rise and decline of Qi (气) and blood for supplementation or drainage. Within the body, vital Qi (正气) and pathogenic Qi (邪气) contend—the former representing normal physiological functions, the latter disease-causing factors. Before needling, one must first identify the affected meridian and understand the fluctuations of Qi and blood. The crux of acupuncture lies in controlling the speed of needle insertion. Ordinary practitioners concentrate solely on limb acupoints without comprehending Qi-blood circulation, while accomplished physicians discern the dynamics of Qi movement.

During treatment, focus intently on sensing the Qi response beneath the needle. When pathogenic Qi is excessive, avoid supplementation; when vital Qi is deficient, refrain from drainage. The optimal treatment moment is fleeting—failure to grasp supplementation and drainage principles will deplete Qi and blood, diminishing efficacy. One must master the patterns of Qi-blood circulation regarding favorable/adverse conditions and excess/deficiency to seize the perfect therapeutic opportunity. Ordinary physicians cannot perceive the subtleties of Qi movement—only accomplished practitioners fully comprehend acupuncture's essence. Deficient Qi-blood manifests as "adverse" (逆), while abundant Qi-blood appears as "favorable" (顺).

This passage discusses the principles of balancing "form and Qi" (physical structure and vital energy) in traditional Chinese acupuncture, particularly regarding supplementation and drainage techniques. The explanation unfolds in several key aspects:

Regarding supplementation and drainage techniques: When the pulse is weak, apply supplementation techniques—like pursuing and replenishing energy. When the pulse is excessive, use drainage methods—as if confronting and reducing pathogenic factors. For stagnant blood, promote circulation; for excessive pathogenic Qi, drain it away. Slow needle insertion with quick withdrawal constitutes supplementation, while quick insertion with slow withdrawal represents drainage. Patients typically feel fullness with supplementation and emptiness with drainage methods.

Locations of pathogenic factors differ: Pathogenic Qi in the upper body (referring to invasion of the upper regions), turbid Qi in the middle (from improper diet affecting stomach/intestines), and clear Qi in the lower (cold-dampness invading through the feet). Needle depth must correspond to the pathogen's location—too shallow fails to expel it, while too deep drives it inward.

Meridian systems have distinct domains: Skin, flesh, sinews and vessels each correspond to specific channels. Over-draining the five Yin meridians (organ channels) can be fatal, while excessive drainage of the three Yang meridians (bowel channels) causes debilitation. Excessive drainage of Yin essence leads to death; excessive drainage of Yang Qi induces mania.

Diagnostic essentials: Observe changes in facial complexion and eye expression to discern Qi's dispersion or accumulation. Treatment must sequence supplementation/drainage according to Qi's repletion or depletion, while considering whether upright Qi remains. Supplementation should feel like gaining something, drainage like losing something—only then can balance be achieved.

This scripture primarily explains how skilled physicians diagnose illnesses by observation and discern the patterns of pathogenic Qi's invasion into the human body.

A master physician observes the shifting five colors in a patient's eyes and measures the pulse's characteristics—its magnitude, speed, smoothness or roughness—to determine the condition. They distinguish between "virtual pathogens" (internal imbalances) and "proper pathogens" (external invasions). The technique of "right hand inserting needles while the left assists" refers to acupuncture manipulation. When the channel Qi arrives, treatment ceases—meaning needles are withdrawn once tonifying or draining techniques have harmonized the Qi and blood. The key to regulating Qi and blood lies in maintaining unwavering focus throughout.

The human body contains 365 acupoints, all locations where collateral channel Qi and blood infuse the joints. If the Qi of the five viscera internally collapses, the pulse will show severed internal Qi movement. Mistakenly treating external symptoms or stimulating Yang channel points in such cases—retaining needles to draw out Yang Qi—will further deplete the viscera, causing death marked by quiet expiration due to exhausted primordial Qi. Conversely, if the five viscera's Qi externally collapses, erroneously stimulating limb points to draw out Yin Qi will cause Yang Qi to collapse inward, creating fatal counterflow marked by agitated death due to Yin Qi excess.

Eye observation is emphasized because the five viscera's essence (Jing) manifests in ocular hues. Normal coloration indicates strong voice; abnormalities produce uncharacteristic sounds. The text describes states like "biran" (fullness) and "huangran" (derangement).

The Yellow Emperor asked Qibo about pathogenic Qi's invasion patterns. Qibo replied: The upper body easily suffers wind pathogens, while the lower body tends to accumulate dampness. Pathogens invade without fixed rules—sometimes entering Yin channels to reach the bowels, or penetrating Yang channels to linger in the meridians. Though Yin and Yang have different names, their natures interconnect; channels and collaterals link seamlessly like an endless ring. Pathogens unpredictably invade Yin or Yang, upper or lower, because all Yang channels converge at the head and face where Qi and blood abound. Exposure to cold causes stiffness and pain here, which massage and warmth can alleviate.

This dialogue between the Yellow Emperor (Huangdi) and Qibo primarily discusses the pathways and effects of pathogenic Qi invading the human body. When the body is weakened, immediately after exertion, or during perspiration after eating, the couli (skin pores) open, making it easier for pathogenic Qi to invade. When evil Qi enters the face, it affects the Yangming channels; when it enters the neck, it affects the Taiyang channels; when it enters the cheeks, it affects the Shaoyang channels; and when it enters the chest, back, or both flanks, it similarly affects the corresponding channels.

The Yellow Emperor inquires about pathogenic Qi invading the Yin channels. Qibo explains that Yin channel pathogens typically begin their invasion through the inner aspects of the arms and legs, as these areas have thinner skin and softer muscles, making them vulnerable to wind pathogens that can damage the Yin channels. However, pathogenic Qi invading the Yin channels doesn't necessarily directly harm the five zang organs (heart, liver, spleen, lungs, kidneys). If the organs' Jing (essence) is abundant, the pathogens cannot take hold and will instead transfer to the six fu organs. Thus, when Yang channels are affected, the meridian system suffers, while Yin channel afflictions impact the fu organs.

The discussion then turns to how emotions and external factors damage the five zang organs: worry and fear injure the heart; exposure to cold and consumption of chilled beverages harm the lungs (when internal and external cold pathogens combine, causing rebellious Qi to rise); falls leading to blood stasis or extreme anger causing Qi stagnation damage the liver; sexual intercourse while intoxicated followed by exposure to wind during perspiration harms the spleen; and excessive heavy lifting or bathing after sexual activity while sweating injures the kidneys.

When the Yellow Emperor asks why the face isn't affected by cold, Qibo explains: The Qi and blood from all twelve primary channels and 365 collaterals flow upward to nourish the face. The purest Jing rises to the eyes to create vision, branch Qi flows to the ears for hearing, ancestral Qi (zongqi) reaches the nose for smell, and turbid Qi from the stomach arrives at the lips and tongue for taste. The face's abundant Qi and blood, thick skin, and strong muscles enable it to withstand severe cold.

Finally, when the Emperor inquires about manifestations of pathogenic Qi causing disease, Qibo emphasizes that illness only manifests through the combined interaction of both Yin and Yang factors. This dialogue systematically presents traditional Chinese medical theories regarding external pathogen invasion pathways, emotional causation of disease, and the face's unique physiological characteristics.

Huangdi inquired of Qibo about medical arts, saying: When external pathogenic factors (xieqi) invade the body, they cause chills and shivering; while internally generated pathogens produce milder symptoms. Initially, the pathogenic qi first manifests in facial complexion before physical symptoms appear—the condition seems to hover between existence and non-existence, subtle and elusive.

After expressing admiration, Huangdi continued his inquiry: I've heard that diagnosing illness by observing facial complexion is called "illumination" (ming), diagnosing through pulse examination is called "divine perception" (shen), and determining disease location through questioning is called "skill" (gong). How should these three diagnostic methods be integrated?

Qibo replied: The changes in complexion, pulse, and the skin of the forearm (chi skin) resonate like drumsticks and drum, or shadow and substance. They resemble the relationship between a tree's roots and leaves—when the roots die, the foliage withers. Diagnosis requires comprehensive observation of complexion, pulse, and physical changes: mastering one method makes an ordinary physician (gong), mastering two makes a skilled physician (shen), and mastering all three makes a divine physician (ming).

He then elaborated specifically: Those with a greenish complexion should exhibit wiry-tight pulses; red complexion corresponds to flooding pulses; yellow to intermittent pulses; white to floating pulses; black to deep pulses. When complexion and pulse show a restraining relationship (e.g., green complexion with flooding pulse), the condition is dangerous; when they show a generating relationship (e.g., green complexion with deep pulse), recovery is likely.

Huangdi further asked how to diagnose disorders of the five zang organs. Qibo explained that one must first determine the correspondence between facial complexion and the five pulse qualities. By examining pulse speed, strength, smoothness or roughness, combined with palpation of the chi skin (tight skin corresponding to rapid pulse, loose skin to slow pulse, etc.), one can assess disease severity. Truly superior physicians (shanggong) who integrate all three methods achieve 90% cure rates; average physicians (zhonggong) using two methods achieve 70%; ordinary physicians (xiagong) relying on one method achieve 60%.

The Yellow Emperor inquired of Qibo: When the pulse manifests as slow, rapid, small, large, slippery, or rough, what diseases do these pulse conditions correspond to? Qibo explained in detail the pulse manifestations associated with pathological changes in the five zang organs:

Heart-related disorders:

• Extremely rapid pulse: Will present with convulsions of limbs
• Slightly rapid: Heart pain radiating to the back, with loss of appetite
• Extremely slow: Prone to uncontrollable manic laughter
• Slightly slow: Mass formation below the heart (Fu Liang syndrome), vomiting blood upon movement
• Extremely large: Sensation of throat obstruction
• Slightly large: Heart Bi syndrome radiating to back, prone to tearing
• Extremely small: Frequent hiccups
• Slightly small: Development of wasting-thirst disorder (similar to diabetes)
• Extremely slippery: Prone to thirst
• Slightly slippery: Heart Shan syndrome involving the navel with abdominal gurgling
• Extremely rough: May lose voice
• Slightly rough: Hematemesis with cold extremities, tinnitus and dizziness

Lung-related disorders:

• Extremely rapid: May develop manic-depressive disorder
• Slightly rapid: Lung cold with fever, fatigue, bloody cough, pain radiating to waist/back/chest, nasal polyps
• Extremely slow: Profuse sweating
• Slightly slow: Wei syndrome (muscle atrophy), hemiplegia, persistent head/neck sweating
• Extremely large: Lower leg edema
• Slightly large: Lung Bi syndrome with chest/back pain, photophobia
• Extremely small: Diarrhea
• Slightly small: Wasting-thirst disorder
• Extremely slippery: Shortness of breath with wheezing
• Slightly slippery: Bleeding from upper and lower orifices
• Extremely rough: Hematemesis
• Slightly rough: Scrofula (lymphatic tuberculosis) in neck/armpits, lower limb weakness

(Note: Subsequent sections on liver, spleen and kidney pulse-pathology patterns follow the same analytical framework of "extreme/slight + pulse quality + corresponding symptoms," detailing each organ's pathological manifestations with specific bodily reactions. The original text's diagnostic methodology consistently links pulse variations to comprehensive clinical presentations.)

This passage discusses diagnosing illnesses through pulse variations and their corresponding acupuncture treatments.

When the pulse is profoundly slow (deep and retarded), severe cases manifest as spinal curvature, while mild cases lead to indigestion with regurgitation. A flooding pulse in extreme cases causes impotence, and in milder forms results in stony edema (a type of swelling) extending from the navel to the lower abdomen—when it reaches the stomach region, it becomes incurable. A faint pulse in severe cases produces unceasing diarrhea, while mild cases lead to wasting-thirst disorder (similar to diabetes).

A slippery pulse in extreme conditions causes urinary retention and hernia, while mild cases result in bone wilting (osseous weakness) where one cannot rise from sitting, and experiences dizziness upon standing. A choppy pulse in severe cases manifests as major abscesses, while mild cases lead to amenorrhea or hemorrhoids.

The Yellow Emperor inquired about acupuncture techniques for these six pulse variations. Qibo responded:

• Tense pulses typically indicate cold syndromes, requiring deep needling with prolonged needle retention
• Slow pulses generally signify heat syndromes, needing shallow insertion with swift withdrawal to dissipate heat
• Flooding pulses indicate abundant Qi but deficient blood, requiring gentle Qi drainage without bloodletting
• Slippery pulses show excessive Yang Qi with heat, demanding rapid withdrawal and shallow needling to drain Yang
• Choppy pulses suggest abundant blood but deficient Qi with cold, necessitating precise meridian puncture followed by needle retention according to Qi flow direction, with immediate pressure on the puncture point after withdrawal
• Faint pulses reveal deficiency in both Yin-Yang and Qi-blood, making them unsuitable for acupuncture—sweet-flavored herbs should be used for regulation

The Emperor then asked about the pathways through which the Qi of the five zang and six fu organs enter their corresponding He-sea points (specific acupoints). Qibo explained these are the internal branches of Yang meridians connecting to the organs, clarifying:

• Spring and stream points treat external meridian disorders
• He-sea points treat internal organ disorders

Finally, the text enumerates He-sea points for various organs and their location methods:

• Zusanli (ST36) for the stomach channel—located with the foot dorsiflexed
• Shangjuxu (ST37) for the large intestine channel—located with the foot elevated
• Xiajuxu (ST39) for the small intestine channel
• Weiyang (BL39) for the triple burner channel—located by flexing and extending the leg
• Weizhong (BL40) for the bladder channel—located with the knee bent
• Yanglingquan (GB34) for the gallbladder channel

These location techniques emphasize adjusting body posture according to each point's anatomical position for precise identification.

This passage recounts the dialogue between the Yellow Emperor (Huangdi) and Qibo on diagnosing and treating disorders of the six bowels (stomach, large intestine, small intestine, triple burner, bladder, and gallbladder) by observing external symptoms, along with the essentials of acupuncture treatment.

When the stomach channel is affected, symptoms include facial heat and hardened, sunken blood vessels on the dorsum of the foot. Disorders of the large intestine manifest as severe intestinal pain, gurgling sounds, winter-cold-induced diarrhea, pain around the navel, and difficulty standing for long. Treatment involves needling points on the stomach channel above the upper part of Juxu (a point on the lower leg's anterolateral side). Stomach disorders present with abdominal distension, epigastric pain, fullness in the ribs, difficulty swallowing, and loss of appetite—these can be treated by needling Zusanli (ST-36).

Small intestine disorders cause lower abdominal pain, referred pain from the spine to the testicles, frequent urge to defecate, heat or cold sensations in front of the ears, intense heat in the shoulders, and heat or sunken blood vessels between the little and ring fingers. Treatment targets the lower part of Juxu. Triple burner disorders lead to abdominal distension, hardening of the lower abdomen, difficulty urinating, and fluid retention—these can be treated at Weiyang (BL-39), located between the Taiyang (Bladder) and Shaoyang (Gallbladder) channels.

Bladder disorders present as swelling and pain in the lower abdomen, an urge to urinate upon pressure but inability to pass urine, heat in the shoulders, and heat on the outer side of the little toe and behind the ankle. Treatment involves needling Weizhong (BL-40). Gallbladder disorders cause frequent sighing, bitter taste in the mouth, vomiting of bitter fluids, palpitations, fear, and a sensation of a foreign object in the throat. Sunken blood vessels along the foot-Shaoyang (Gallbladder) channel can be treated with moxibustion, while alternating chills and fever require needling Yanglingquan (GB-34).

The Yellow Emperor asked whether acupuncture requires any special techniques. Qibo replied: "The needle must precisely strike the acupoint and avoid muscle nodules. When the point is accurately needled, the sensation will propagate; if the muscle is needled, the skin will hurt. Incorrect tonification or drainage techniques will worsen the condition, while needling tendons will relax them. If pathogenic qi is not expelled, it will contend with upright qi, complicating the illness. Careless needling may turn a mild condition into a severe one—this must be avoided."

(Note: The mentioned acupoints are crucial in ancient acupuncture therapy, each corresponding to specific organs and channels. The ancients diagnosed internal diseases by observing external bodily reactions, reflecting the TCM diagnostic principle of "inferring the interior from the exterior.")

This passage primarily explains certain medical terminology and concepts related to meridians. It first mentions that when pathogenic factors invade the chest and back (some versions write "shoulders and back"), they affect the corresponding meridians. The character "胻" refers to the lower leg region.

The term "淖泽" consists of two parts: "淖" indicates turbid fluids, while "泽" refers to thin, clear bodily fluids (as elaborated in the Jia-Yi Jing). When these abnormal fluids invade the body, it becomes incapable of containing them, leading to "瘛瘲" (convulsions and spasms).

The passage then lists a series of symptoms with their pronunciations and explanations:

• "吤" is pronounced "jiè" and refers to rebellious qi (reverse flow of energy).
• "哕" is pronounced "yǐ liè qiē" and denotes hiccups.
• In "息贲," "贲" is pronounced "bēn," indicating rapid breathing.
• "痠" is pronounced "suān," meaning soreness or aching.
• "瘕" is pronounced "jiǎ," referring to abdominal masses.
• "㿉" is pronounced "tú huí qiē," describing swelling.
• "仆" is pronounced "fù," meaning fainting or collapse.

It also explains two types of parasites:

• In "蛕蝎," "蛕" refers to intestinal worms, while "蝎" indicates wood-boring insects.
• "腄" is pronounced "zhú chuí qiē," referring to the buttocks.
• "清" is pronounced "róng měi qiē," meaning clear or pure.
• "揄" is pronounced "chōng mù qiē."
• "睾" is pronounced "gāo," denoting the scrotum.

Finally, it explains that within the human meridian system, there are the Yang Linking Vessel and Yin Linking Vessel, which can lead to "维厥" (disordered qi and blood flow in the meridians). These annotations and phonetic explanations are derived from Volume Two of the Huangdi Neijing Lingshu Jizhu (Collected Commentaries on the Spiritual Pivot of the Yellow Emperor's Inner Canon), primarily serving as clarifications for medical terms and their pronunciations.