《黃帝素問靈樞集註》Vol. 3

Qibo (a renowned physician of the Yellow Emperor's era) explains: Within the cosmic interplay of Yin and Yang, the two vital energies resonate with each other, manifesting as the cyclical alternation of cold and heat. In the dynamic movement of Yin-Yang, which prevails more - the Yin or Yang energy? Yin's nature is characterized by pairing (even), while Yang's nature stands alone (odd). During spring and summer, Yin diminishes while Yang flourishes. When this balance is disrupted, what should be supplemented and what purged? In autumn and winter, Yang wanes while Yin dominates, with flourishing Yin overwhelming weakened Yang - hence vegetation withers and rainwater seeps downward. How should one regulate during these transitional phases? The aberrant pathogenic Qi (unorthodox evils) and illnesses deviating from meridian pathways are beyond count.

Without understanding a meridian's origin (root) and terminus (knot), the functional disorders of the five zang and six fu organs resemble broken door hinges causing irregular opening/closing, with Yin-Yang imbalance reaching irreparable severity. The essential secret of the nine needle techniques lies in mastering meridians' beginnings and endings. Comprehending this principle, one can explain it in a single phrase; lacking this understanding, the Dao of acupuncture becomes ineffable.

Specifically: The Foot Taiyang meridian's root lies at the Zhiyin point (lateral side of little toe), terminating at the Mingmen (eyes). The Foot Yangming meridian originates at the Lidui point (tip of second toe), ending at Sangda (anterior to ear). The Foot Shaoyang meridian begins at the Qiaoyin point (tip of fourth toe), concluding at Chuanglong (within ear). The Taiyang governs "opening," Yangming governs "closing," while Shaoyang serves as the "pivot." If the opening function fails, muscles slacken and ulcerate with sudden acute disorders - treat via Taiyang points. Impaired closing prevents Qi from settling, causing atrophy - address Yangming points. Pivot dysfunction makes bones unstable - regulate Shaoyang points.

Similarly: The Foot Taiyin meridian's root is at the Yinbai point (medial side of big toe), ending at Taicang (Zhongwan point). The Foot Shaoyin originates at Yongquan, terminating at Lianquan. The Foot Jueyin begins at Dadun (tip of big toe), ending at Yuying (throat), connecting to Danzhong. Taiyin governs opening, Jueyin governs closing, Shaoyin serves as pivot. Opening dysfunction causes digestive disorders; closing failure severs Qi flow with melancholy; pivot impairment stagnates blood circulation. Treatment requires selecting appropriate meridian points according to deficiency/excess conditions.

(Note: "Root and knot" refer to meridians' starting/ending points; "opening-closing-pivot" summarizes the functional characteristics of the three Yin and three Yang meridians, analogizing to a door's hinge mechanism)

This scripture describes the pathways of the twelve primary meridians (three yin and three yang channels of the hands and feet), the essentials of acupuncture treatment, and methods for assessing the vitality of the five zang organs through pulse diagnosis.

The Qi of the Foot-Shaoyin Kidney Meridian originates from the Yongquan point (Zhijing) on the sole of the foot, flows through the Jinggu point, converges at the Kunlun point, and finally enters the Tianzhu and Feiyang points at the nape of the neck. The Qi of the Foot-Shaoyang Gallbladder Meridian begins at the Qiaoyin point, passes through the Qiuxu point, gathers at the Yangfu point, and enters the Tianrong and Guangming points. The Qi of the Foot-Yangming Stomach Meridian starts from the Lidui point, travels via the Chongyang point, converges at the Xialing point, and reaches the Renying and Fenglong points. The Qi of the Hand-Taiyang Small Intestine Meridian originates at the Shaoze point, flows through the Yanggu point, converges at the Shaohai point, and enters the Tianchuang and Zhizheng points. The Qi of the Hand-Shaoyang Sanjiao Meridian begins at the Guanchong point, passes through the Yangchi point, gathers at the Zhigou point, and enters the Tianyou and Waiguan points. The Qi of the Hand-Yangming Large Intestine Meridian starts from the Shangyang point, flows via the Hegu point, converges at the Yangxi point, and finally reaches the Futu and Pianli points. When these twelve meridians exhibit excessive Qi and blood stagnation, acupuncture treatment can be applied at the corresponding points.

Physicians assess the vitality of the five zang organs through pulse diagnosis: In healthy individuals, the pulse beats fifty times per day-night cycle (fifty ying), which represents the normal rhythm of the five zang organs' essence circulation. If the pulse beats fifty times without interruption, it indicates sufficient essence in all five zang organs. One missed beat in forty pulses suggests deficiency in one organ; one missed beat in thirty pulses indicates deficiency in two organs; one missed beat in twenty pulses reveals deficiency in three organs; one missed beat in ten pulses signifies deficiency in four organs. If interruptions occur before completing ten beats, it means the essence of all five zang organs is exhausted—a critical sign of impending death.

The Yellow Emperor asked Qibo: "Commoners and pampered nobles have different physical constitutions—the former with sturdy bones and firm muscles, the latter with delicate bodies and smooth Qi-blood circulation. Should the speed and depth of needle insertion be the same during acupuncture treatment?" Qibo replied: "Just as coarse and refined grains have different properties, for those with smooth Qi-blood flow, needles should be withdrawn quickly, while for those with sluggish circulation, withdrawal should be slower. For vigorous Qi-blood movement, use thin needles with shallow insertion; for sluggish movement, employ thick needles with deep insertion. Deep insertion requires longer needle retention, while shallow insertion permits quicker removal."

This passage primarily discusses how acupuncture treatment should be adjusted according to different individuals' constitutions and conditions.

For commoners (cloth-clad people), the needles may be inserted deeper and retained longer; whereas for nobility, the needling should be gentle and slow. This is because people's Qi and blood circulation states differ.

The Yellow Emperor asked Qibo about the relationship between physical constitution (Xingqi) and pathogenic factors (Bingqi). Qibo replied:

• If the constitution is weak but pathogenic factors are strong, draining techniques should be applied immediately;
• If the constitution is strong but pathogenic factors are weak, tonifying techniques should be applied immediately;
• If both constitution and pathogenic factors are deficient, indicating dual deficiency of Yin and Yang, acupuncture should not be used as it would worsen weakness, deplete Qi and blood, empty the five viscera, potentially causing death in elderly patients and making recovery difficult even for robust adults;
• If both constitution and pathogenic factors are excessive, indicating dual excess of Yin and Yang, pathogenic factors must be drained immediately to regulate excess and deficiency.

The essence of needling lies in harmonizing Yin-Yang. When properly balanced, Jing (essence) and Qi become abundant, form and energy unite, and Shen (spirit) remains internally anchored. Superior physicians balance Qi and blood, average ones may disrupt meridians, while poor practitioners exhaust primordial Qi and endanger life. Therefore, less skilled physicians must proceed cautiously, thoroughly diagnosing pathological changes in the five viscers, reactions of the five pulses, meridian excess/deficiency states, and skin pliability before needling.

Later, the Yellow Emperor asks Shaoshi about innate human endowments. Shaoshi explains there are layers of Yin within Yang and Yang within Yin—careful differentiation is required for proper needling. Diagnosis should consider the timing of disease onset, connecting internal changes in the five viscera and six bowels with external manifestations in sinews, bones, and skin, as both interior and exterior exhibit Yin-Yang divisions: the five viscers belong to Yin while the six bowels belong to Yang.

In the human body, the internal organs belong to Yang and are positioned externally, while the bones and tendons belong to Yin, and the skin belongs to Yang. Therefore, illnesses are categorized into different conditions:

When the disease resides in the "Yin within Yin" (the deeper Yin aspect), one should needle the Ying (Spring) and Shu (Stream) points of the Yin channels. When the disease is in the "Yang within Yang" (the superficial Yang aspect), one should needle the He (Sea) points of the Yang channels. If the disease is in the "Yin within Yang" (the deeper layers of the Yang channels), needle the Jing (River) points of the Yin channels. If the disease is in the "Yang within Yin" (the superficial layers of the Yin channels), needle the collateral vessels.

Disease manifestations also differ by Yin and Yang: illnesses in the Yang aspect are called "wind diseases," while those in the Yin aspect are called "bi (blockage) diseases." When both Yin and Yang are affected, it is called "wind-bi." If there are physical symptoms without pain, it belongs to Yang disease; if there are no physical symptoms but pain is present, it belongs to Yin disease.

If there is pain without physical manifestation, it indicates that the Yang Qi remains intact while the Yin Qi is injured—promptly treat the Yin aspect without attacking the Yang. If there is physical manifestation without pain, it means the Yin Qi is intact while the Yang Qi is injured—promptly treat the Yang aspect without attacking the Yin. If both Yin and Yang are disordered, with symptoms appearing intermittently and accompanied by restlessness, this is called "Yin overwhelming Yang," a condition that is neither purely external nor internal, and the illness is prone to worsening.

The Yellow Emperor asked Bogao: "How do the sequential and spatial relationships between physical and Qi disorders manifest?" Bogao replied: "Wind and cold harm the physical form, while grief, fear, anger, and rage harm the Qi. When Qi is injured, it affects the internal organs; when cold injures the physical form, it manifests externally; when wind injures, it damages the sinews and vessels. This illustrates the correspondence between form and Qi, internal and external."

Regarding acupuncture treatment: For an illness lasting nine days, three sessions of needling may cure it; for one month, ten sessions—adjust the treatment course proportionally. For chronic bi (blockage) syndromes that do not heal, observe the blood collaterals and drain the stagnant blood completely.

In terms of treatment difficulty: If the physical form is affected first without involving the organs, halve the usual treatment duration. If the organs are affected first and then manifest externally, double the treatment duration.

The Yellow Emperor further asked how to determine lifespan based on physical form. Bogao answered: "When the physical form and Qi are harmonious, life is long; when they are disharmonious, life is short. When the skin and muscles are well-proportioned, life is long; when they are disproportionate, life is short. When the blood, Qi, and channels are stronger than the physical form, life is long; otherwise, it is short. Those with a robust physique and relaxed skin enjoy longevity, while those with a robust physique but tight skin have a shorter lifespan."

This passage discusses methods for assessing lifespan based on physical characteristics and the application of different acupuncture treatments.

First, it explains the approach to determining longevity: If a person has a robust physique with strong and vigorous pulses, this indicates good health. However, if the body appears strong but the pulses are thin and weak, it suggests a decline in primordial Qi (yuanqi), which is a dangerous condition. Those with underdeveloped cheekbones have poor bone development and are prone to early death. Individuals with firm, well-textured muscles tend to live longer, while those with loose, textureless muscles are more likely to die young. These are all methods of evaluating life expectancy through physical observation.

The Yellow Emperor (Huangdi) asked Bogao how to determine lifespan, to which Bogao replied: People with low facial contours and short chins typically do not live past thirty, and if they also suffer from illness, they may die before the age of twenty. Healthy individuals with abundant primordial Qi will enjoy longevity, but sick people who appear emaciated yet display an abnormal excess of Qi will instead face death. Those whose bodies seem healthy but lack sufficient Qi are also in danger.

The text then discusses three different acupuncture therapies: The first is "piercing the nutrient aspect" (ying, treating blood-related disorders), which involves drawing a small amount of blood. The second is "piercing the defensive aspect" (wei, treating Qi-related disorders), which regulates the movement of Qi. The third treats "cold bi" (a condition of cold-damp obstruction in the meridians) using warming methods. Nutrient disorders manifest as chills, fever, shortness of breath, and impeded blood-Qi circulation. Defensive disorders present as Qi stagnation pain that comes and goes, along with intestinal rumbling and abdominal distension. Cold bi is characterized by persistent pain and skin numbness.

Finally, the warming therapy for cold bi is described in detail: For commoners, fire needle therapy is used, while nobles receive medicinal fomentation (yaoyun). The specific method for medicinal fomentation is as follows: Take twenty liters of strong wine and add one jin each of Sichuan pepper, dried ginger, and cinnamon bark. Finely chop the herbs and soak them in the wine, then add cotton wool and white cloth. Seal the mixture in horse dung to maintain warmth and allow fermentation for five days and nights. Afterward, remove and sun-dry the cloth, repeating the soaking process until the medicinal liquid is fully absorbed. When applying, use the soaked cloth and cotton to warm and press the affected area.

This passage describes specific operational methods in ancient Chinese acupuncture treatment, primarily consisting of two parts: heat compression therapy and the application of the nine needles.

Regarding heat compression therapy: A cloth strip six to seven chi long is made from coarse fabric and cotton wadding, heated over mulberry wood charcoal fire, then applied to areas experiencing pain due to cold-dampness. The heat must penetrate deep into the affected area. When the cloth cools, it should be reheated and reapplied, repeating this process thirty times. After inducing sweating, wipe the body with the cloth thirty times as well. Post-treatment, patients should rest indoors avoiding wind exposure. This heat application should follow each acupuncture session until recovery is achieved—a method called "internal heat therapy."

Concerning the key principles of using the nine needles: The essence of acupuncture lies in selecting appropriate needle types. Each of the nine needles serves distinct purposes, with specific lengths and sizes suited for different conditions. Improper needle selection leads to treatment failure: using deep-reaching needles for superficial ailments damages healthy tissue and causes skin ulcers; shallow needles for deep-seated conditions fail to expel pathogenic Qi (vital energy), resulting in suppuration; large needles for minor illnesses excessively drain Qi causing harm, while small needles for serious conditions inadequately eliminate pathogens.

Specific applications include: Wandering pain beneath the skin requires the chán needle (large-headed with sharp tip), avoiding areas with pale skin; muscular disorders use the round-tipped needle; chronic channel blockages employ the sharp-edged needle (triangular tip); weak pulse Qi requiring tonification calls for the dī needle (arrowhead-shaped), applied at specific points like well (jīng) and spring (yíng) acupoints; suppurative conditions need the sword-shaped needle; sudden bi (blockage) pain uses the slightly rounded sharp needle; persistent bi pain requires fine needles; deep-seated ailments demand long needles; edema and joint obstructions use large needles; chronic visceral diseases employ the sharp-edged needle, with seasonal variations guiding drainage at well and spring points.

The text concludes with nine needling techniques: transport needling (targeting spring points and back transport points), distant pathway needling (treating upper disorders through lower points), etc.—each corresponding to different pathological manifestations.

This passage details twelve ancient acupuncture needle techniques, each corresponding to specific conditions and treatment areas.

The first is called "paired needling" (ouci), used to treat heart obstruction (pain in the cardiac region). The practitioner presses both the anterior chest and corresponding back pain points, inserting needles obliquely at both locations simultaneously.

The second, "repetitive needling" (baoci), addresses migratory pain. After locating the pain point, insert the needle vertically without withdrawal, then press the painful area with the left hand before removing the needle - this may be repeated as needed.

Third is "relaxation needling" (huici) for tendon and vessel constriction. Insert one vertical needle at the affected area, then several oblique needles nearby while gently moving the affected limb to loosen the tendons.

"Uniform needling" (qici, also called "triple needling") treats deep-seated cold conditions. One vertical needle in the center flanked by two oblique needles forms a three-needle configuration.

"Elevated needling" (yangci) addresses widespread cold. One central needle surrounded by four shallow peripheral needles creates a five-point arrangement.

"Direct skin needling" (zhizhenci) treats superficial cold. Lift the skin before insertion, suitable for mild cold conditions.

"Transport needling" (shuci) targets heat syndromes. Insert and withdraw vertically with minimal rotation but deep penetration to drain heat.

"Short needling" (duanci) treats bone obstruction. Insert while gently shaking the needle downward until contacting bone, then rub along the bone surface.

"Floating needling" (fuci) addresses muscular constriction with cold. Insert obliquely but very superficially.

"Yin needling" (yinci) treats cold reversal (limb coldness). Needle symmetrically at the Shaoyin (Kidney) channel points behind both inner ankles.

"Adjacent needling" (bangzhenci) manages stubborn obstructions. One vertical needle at the center with an accompanying oblique needle nearby.

Finally, "supporting needling" (zanci) treats abscesses. Perform multiple rapid shallow insertions and withdrawals to induce bleeding and expel toxins.

The text concludes by noting that even when channel locations are too deep to visualize visually, practitioners should still select appropriate techniques according to circumstances. These twelve methods systematically correspond to the body's twelve primary channels, forming a complete therapeutic framework.

This passage explains the specific methods and principles of ancient acupuncture therapy. It begins by stating that needle insertion should be based on pulse depth: for superficial pulses, one shouldn't puncture directly but should first apply pressure to block the blood vessels before inserting the needle, thereby expelling pathogenic factors without harming vital Qi (the body's healthy energy).

The so-called "three-stage needling method" refers to inserting the needle progressively through three levels: the first insertion reaches the superficial skin layer to expel Yang pathogens; the second goes slightly deeper into the muscle layer to eliminate Yin pathogens; the third penetrates deepest into the intermuscular spaces to draw out "grain Qi" (referring to the body's vital energy). The sequence follows expelling pathogens superficially first, then drawing out Yin pathogens at mid-depth, and finally eliciting vital energy at the deepest level.

It emphasizes that acupuncturists must understand annual climatic changes, the waxing and waning of Qi and blood, as well as the causes of deficiency and excess patterns; otherwise, they cannot become qualified practitioners. The text then details five needling techniques corresponding to the five organs:

The first is called "half-needling"—a shallow, quick insertion and withdrawal resembling plucking hairs, only accessing the skin's Qi layer, corresponding to the lungs. The second, "leopard-spot needling," involves multiple shallow punctures around the acupoint to access meridian blood, corresponding to the heart. The third, "joint needling" (also called "abyss needling"), pierces directly into tendon attachments to treat tendon bi-syndrome (blockage pain), requiring care to avoid bleeding, corresponding to the liver. The fourth, "convergence needling," resembles a chicken's claw with divergent insertions into muscle interstices to treat muscle bi-syndrome, corresponding to the spleen. The fifth, "transport needling," employs straight deep insertion reaching the bone to treat bone bi-syndrome, corresponding to the kidneys.

Finally, two special techniques are mentioned: "burning needling" (referring to heated needles) and "expansive needling" (a method of broadening the puncture area). These methods all embody the Chinese medical principle of "tailoring treatment to the individual," selecting different needling techniques based on the disease's depth and the affected organ's characteristics.