《黃帝八十一難經纂圖句解》Vol. 7

This passage explains five distinct types of diarrhea symptoms and their underlying causes in traditional Chinese medicine. Diarrhea is classified into five categories, each with unique manifestations and etiological factors.

The first is stomach diarrhea (Wei Jing diarrhea), characterized by undigested food being expelled shortly after eating, with yellowish stool. This occurs when wind pathogens invade the intestines, disrupting the stomach’s digestive function.

The second is spleen diarrhea (Pi Jing diarrhea), marked by abdominal distension, persistent diarrhea, and vomiting immediately after eating. The spleen belongs to the Earth phase in the Five Phases (Wood, Fire, Earth, Metal, Water). Excessive dampness damages the spleen, impairing its ability to transform and transport food and fluids, leading to these symptoms.

The third is large intestine diarrhea (Dachang diarrhea), where the urge to defecate arises right after meals, with white-colored stool, gurgling sounds in the intestines, and severe pain. This results from qi deficiency in the large intestine, weakening its ability to regulate bowel movements.

The fourth is small intestine diarrhea (Xiaochang diarrhea), presenting with pus and blood in the urine, along with lower abdominal pain. The small intestine is connected to the heart, which governs blood, hence the presence of bloody discharge.

The fifth is severe dysentery-like diarrhea (Shen diarrhea), featuring abdominal pain, rectal tenesmus (a constant urge to defecate with little result), and difficulty passing stool. The term "dysentery-like" refers to the presence of abdominal masses. This type of diarrhea is linked to kidney qi deficiency, as the kidneys govern the two lower orifices (urinary and excretory passages).

Each type of diarrhea has specific causes and manifestations. Traditional Chinese medicine diagnoses the root of the condition by observing details such as stool color, accompanying symptoms, and pain location—all crucial diagnostic indicators.

This passage discusses five types of cold-induced disorders (shanghan) and their corresponding pulse manifestations. The five disorders are: wind-strike (zhongfeng), cold damage (shanghan), damp-warmth (shiwen), heat disease (rebing), and warm disease (wenbing), each with distinct symptoms and pulse characteristics.

Wind-strike (caused by pathogenic wind) presents with headache, body pain, and chills. The pulse shows a floating-slippery yang pulse (superficial level) and a soggy-weak yin pulse (deep level). Light pressure on the muscular layer reveals an overly prominent yang pulse, while deeper pressure shows weak yin pulse quality.

Cold damage (winter cold exposure) exhibits strong, tense, and obstructed pulses in both yin and yang positions, with particularly pronounced and tight-choppy pulses at both the inch (cun) and cubit (chi) positions.

Damp-warmth (dampness combined with wind-cold) manifests with cold legs, chest pain, excessive sweating, headache, and delirium. The pulse shows soggy-weak yang pulses (excessive dampness) and thin-rapid yin pulses (damp earth failing to restrain liver wood).

Heat disease (winter cold manifesting in spring) causes fever, chills, headache and body pain. The pulse displays floating qualities in both yin and yang positions - slippery upon light pressure (heart channel heat) and scattered-choppy upon heavy pressure (insufficient body fluids).

Warm disease (seasonal epidemics) typically occurs during unseasonal weather in spring-summer or autumn-winter, characterized by sudden fever and contagion where different age groups show similar symptoms. Ancient texts called this "great epidemics" (daxing) when occurring widely.

The passage also mentions a urinary difficulty symptom: painful urination with referred pain to the genital region, representing one manifestation of the "five drainages" (wuxie), a category of diarrhea-like disorders.

This passage primarily discusses the diagnosis and treatment of warm diseases, cold damage disorders, and cold-heat illnesses.

Regarding warm diseases, it explains they are caused by pathogenic ghostly influences spreading through the meridians. Since the specific affected meridian cannot be predicted beforehand, diagnosis must wait until symptoms manifest, after which treatment targets the afflicted meridian accordingly.

For cold damage disorders (Shanghan), it analyzes two distinct patterns in detail:

1) Cases of Yang Qi deficiency with excessive Yin Qi - these patients recover through diaphoretic (sweating) therapy, while purgative methods would prove fatal. Such patients experience chills due to both insufficient Yang and excessive Yin, with cold pathogens battling between the defensive and nutritive levels. Symptoms include fever with chills, floating and large pulse, absence of internal heat, and preference for warm food/drink.

2) Cases of excessive Yang Qi with Yin deficiency - these patients recover through purgative methods, while erroneous diaphoresis would be deadly. Here, excessive Yang causes heat while Yin deficiency also generates heat, as cold pathogens contend with Yang until Yin transforms into Yang. Symptoms manifest as persistent high fever without chills, potentially progressing to mental confusion.

The discussion of cold-heat illnesses outlines three scenarios:

1) Lung-Large Intestine system disorders - The lungs govern skin and hair, so lung pathology causes chills, while large intestine pathology causes fever. Symptoms include inability to lie flat, dry hair, and nasal dryness. Diaphoresis is contraindicated (potentially fatal), with purgation being appropriate.

2) Spleen-Stomach system disorders - The spleen governs muscles, so spleen pathology causes chills, while stomach pathology causes fever. Symptoms include painful skin and chapped lips.

These teachings embody the core TCM principle of pattern differentiation and treatment, emphasizing the need to determine disease mechanisms based on specific manifestations before applying corresponding therapeutic methods.

The essence (Jing) of the spleen manifests around the lips. When bodily fluids are excessively depleted, the lips become parched. This condition arises from an imbalance of dryness and dampness within the body and should not be treated with diaphoresis (sweating therapy), as this would lead to intestinal obstruction. Similarly, purgative methods would cause diarrhea. The proper treatment involves warming the middle burner and regulating Qi movement.

Regarding the symptoms of bone-chill fever: The kidneys govern the bones and are externally-internally related with the bladder. When the disease resides in the Yang aspect, the body experiences fever with heaviness and aversion to cold; when in the Yin aspect, there is coldness with general discomfort and restlessness. Persistent sweating occurs because the fluids produced by the kidneys enter the heart to transform into sweat—when this process becomes unregulated, sweating continues unabated.

Dry, painful teeth occur because teeth are extensions of the bones. The outward leakage of kidney fluids leads to desiccation and pain in the teeth due to lack of nourishment.

The 59th Difficulty discusses distinguishing manic disorder (kuang) from depressive disorder (dian). Mania belongs to excessive Yang patterns—during episodes, patients refuse to sleep, feel no hunger, hold inflated self-views of being virtuous and wise, display arrogant behavior, laugh without reason, enjoy singing, and act erratically beyond control, often engaging in unusual activities like climbing heights. Depressive disorder belongs to excessive Yin patterns—episodes feature low mood, fixed staring eyes, sudden collapse, and excessive pulse manifestations at all three positions (cunkou, guan, and chi).

The 60th Difficulty explains the classification of headaches and heart pains. Jue headache (cold-type headache) results from wind-cold pathogens stagnating in the three hand Yang meridians (Hand Yangming, Hand Taiyang, Hand Shaoyang), causing Qi congestion that surges upward to the head. Here "Jue" refers to coldness—headaches are thus divided into Jue headache and true headache, while heart pains are similarly classified as Jue heart pain and true heart pain.

When headache penetrates deep into the brain marrow, it is called "true headache" (zhen toutong). This occurs because the brain is where marrow fluids converge. When wind-cold pathogens invade the Mud Ball Palace (what Daoists call the Baihui point at the crown of the head) and enter the brain through the Fengfu point, it causes severe headache accompanied by cold extremities reaching the elbows and knees.

Pain caused by the mutual disruption of the five zang organs' Qi is termed "reversal heart pain" (jue xintong). Since all meridians connect to the heart, when any meridian becomes diseased and Qi-blood flows counterflow, it affects the heart causing pain. This type of heart pain stems from the reversed Qi movement of the five zang organs rather than being a primary heart condition. If the pain is excruciating with bluish extremities, it becomes "true heart pain" (zhen xintong), which may prove fatal within half a day if untreated.

Regarding diagnostic methods: Those exceptionally skilled in observation are called "divine" (shen) - they can diagnose by examining facial complexion, such as recognizing liver disease from a greenish hue, or detecting heart involvement when red appears. Those masterful in auscultation are called "sage" (sheng) - they discern conditions through the five sounds (gong, shang, jue, zhi, yu corresponding to the five zang organs), like diagnosing lung disease from frequent weeping or spleen disease from habitual singing. Those proficient in inquiry are called "artisan" (gong) - they diagnose through dietary preferences, such as recognizing lung disease from craving spicy flavors or liver disease from desiring sour tastes. Those adept in palpation are called "skillful" (qiao) - they assess organ conditions by examining the cunkou pulse, where a wiry tight pulse might indicate liver disease. These diagnostic approaches must be comprehensively applied to accurately determine the disease location.

This passage primarily discusses the pulse diagnosis theories of Chinese medicine and the meridian-organ systems. It begins by explaining diagnostic methods: when pressing firmly on the pulse reveals a wiry pulse (like a taut lute string) while listening to the patient's voice, one can determine illness in the five yin organs (zang); if a wiry pulse appears with light pressure, the disease resides in the six yang organs (fu).

There are three levels of diagnosis: judging by external symptoms is called "sage-level" diagnosis, such as observing facial complexion or taking pulses; perceiving through inner awareness is termed "divine-level" diagnosis, representing superior medical skill. The text emphasizes that true divine physicians can intuitively comprehend illnesses from within.

It then explains why the six yang organs have one more acupoint than the five yin organs: while each yin organ has five points (well, stream, brook, river, and sea points), the yang organs have an additional "source" (yuan) point. Since the six yang organs belong to yang (Chinese medicine classifies organs into yin-yang attributes) and the triple burner (the body's fluid circulation pathways) also pertains to yang—flowing among all yang meridians—the special "source" point was established. The "source" represents the root of primordial qi, as both the six yang organs and triple burner belong to the yang qi system.

Using seasonal metaphors, it clarifies why meridians begin at the "well" point: well points correspond to the east and springtime. Just as spring marks the genesis of all life (like the first month begins the year or jia days begin months), well points initiate the meridians. Spring's vital energy awakens insects and activates all life through its generative qi, hence treatment begins at the well point symbolizing this growth.

Finally, it addresses the Five Phase (Wood, Fire, Earth, Metal, Water) attributes of yin-yang well points: yin meridian well points belong to Wood (associating with spring), while yang meridian well points belong to Metal (associating with autumn). This reflects Chinese medicine's systematic correlation between acupoints and the Five Phases.

This scripture primarily explains the correspondence between specific acupuncture points—namely the Well (Jing), Spring (Ying), Stream (Shu), River (Jing), and Sea (He) points—and the principles of Yin-Yang and the Five Phases (Wood, Fire, Earth, Metal, Water) within the body's meridian system.

The text begins by using the metaphor of a mountain spring to describe meridian flow: The initial emergence of water is called the "Well point" (Jingxue), akin to a natural well in a valley. Well points are divided into Yin and Yang—those on Yang meridians correspond to Metal (Geng Metal), while those on Yin meridians correspond to Wood (Yi Wood). As the water flow grows slightly larger, forming small pools, these are termed "Spring points" (Yingxue). Yang meridian Spring points belong to Water (Ren Water), while Yin meridian Spring points belong to Fire (Ding Fire). When the water deepens further, creating channels suitable for irrigation, these are called "Stream points" (Shuxue). Yang meridian Stream points correspond to Wood (Jia Wood), while Yin meridian Stream points correspond to Earth (Ji Earth). As the water converges into larger channels, these are named "River points" (Jingxue). Yang meridian River points belong to Fire (Bing Fire), while Yin meridian River points belong to Metal (Xin Metal). Finally, where the waters merge completely, these are called "Sea points" (Hexue). Yang meridian Sea points correspond to Earth (Wu Earth), while Yin meridian Sea points correspond to Water (Gui Water).

These correspondences embody the Daoist principles of Yin-Yang harmony and the balance of firmness and softness. Like the relationship between husband and wife, Yin meridian points and Yang meridian points complement each other: Yi Wood (Yin Well) pairs with Geng Metal (Yang Well), Ding Fire (Yin Spring) with Ren Water (Yang Spring), Ji Earth (Yin Stream) with Jia Wood (Yang Stream), Xin Metal (Yin River) with Bing Fire (Yang River), and Gui Water (Yin Sea) with Wu Earth (Yang Sea). This pairing follows the Five Phases' restraining cycle (Metal restrains Wood, Water restrains Fire, etc.), yet through Yin-Yang harmonization, it forms a complete and dynamic cycle.

The five Yin organs (Liver, Heart, Spleen, Lung, Kidney) represent softness and receptivity, while the six Yang organs (Gallbladder, Small Intestine, Stomach, Large Intestine, Bladder, and Triple Burner) embody firmness and activity. Isolated Yin cannot generate life, nor can solitary Yang sustain growth—only through their union can vital functions persist, much like how the union of husband and wife enables procreation. This theory of Yin-Yang point pairing serves as a foundational principle in traditional Chinese acupuncture for selecting treatment points.

This passage explains the concepts of "well points" (jingxue) and "sea points" (hexue) in traditional Chinese meridian theory, along with the locations of source points for the five zang and six fu organs.

First, the explanation of "well points" and "sea points": The well points are like spring when all things begin to grow—they represent where qi and blood first start flowing in the meridians, when yang energy is just beginning to sprout, comparable to spring in the east. The sea points resemble winter when yang energy retreats inward—they are where meridian qi and blood gather and converge, analogous to winter in the north. Well points signify the beginning of qi and blood flow, while sea points represent their destination.

Next, the specific locations of source points for each organ:

The lung's source point is at Taiyuan (LU-9), located below the thenar eminence on the right palm—an important point on the Hand Taiyin Lung Meridian. The heart's source point is at Daling (PC-7), in the depression between the two tendons on the posterior side of the palm, belonging to the Pericardium Meridian. The liver's source point is at Taichong (LV-3), positioned two cun behind the big toe. The spleen's source point is at Taibai (SP-3), below the prominent bone on the inner foot. The kidney's source point is at Taixi (KI-3), located between the inner ankle and heel bone.

Special note: The source point of the Shaoyin Heart Meridian is at the duigu (Shenmen/HT-7, also called Zhongdu), found in the depression at the end of the bone on the posterior palm. Here it clarifies that the previous mention of "Daling as the heart's source" actually refers to the Pericardium Meridian—the true heart meridian cannot become directly diseased, hence it has no dedicated transport points. The heart meridian source point discussed here treats disorders of the surface meridian network, not the internal organ itself.

The gallbladder's source point is at Qiuxu (GB-40), located slightly anterior and below the outer ankle bone.

The Huangdi Bashiyi Nanjing (Yellow Emperor's Eighty-One Difficult Classics) provides detailed records on the locations and functions of the twelve primary source points (key acupoints where channel Qi and blood converge) in the human body. The source point of the Stomach Channel, Chongyang, is located on the dorsum of the foot, five cun above the bone where the artery pulsates. The source point of the Triple Burner (Sanjiao) Channel, Yangchi, lies in the depression on the ulnar side of the wrist joint. The source point of the Bladder Channel, Jinggu, is found below the large bone on the outer side of the foot, at the junction of red and white muscle tissue. The source point of the Large Intestine Channel, Hegu, is situated in the fleshy web between the thumb and index finger. The source point of the Small Intestine Channel, Wangu, is located on the ulnar side of the wrist joint, medial to the small finger.

Why do all twelve primary channels regard the "transport points" (acupoints that infuse Qi and blood) as their source points? This is because the transport points of the five solid organs (Zang) serve as crucial nodes for the movement and retention of Triple Burner (Sanjiao) Qi. The Triple Burner (a collective term for the upper, middle, and lower burners) circulates primordial Qi (Yuanqi) through these transport points and also temporarily resides there. The dynamic Qi between the kidneys below the navel (the primal life force) is the foundation of human vitality and the root of the twelve primary channels, hence it is called the "source" (Yuan). The Triple Burner and kidneys jointly govern the movement of primordial Qi, which is why the Triple Burner is referred to as the "special envoy of primordial Qi," responsible for circulating Qi through the upper, middle, and lower burners.

To elaborate: the upper burner resides between the heart and lungs, the middle burner in the region of the spleen and stomach, and the lower burner in the area of the liver and kidneys. The Qi of the Triple Burner circulates continuously through the five solid and six hollow organs (Zang-Fu). Since primordial Qi is the root of Triple Burner Qi and holds supreme importance, the term "source" (Yuan) becomes an honorific title for the Triple Burner, and the key acupoints where Qi gathers are all called source points. When treating diseases of the five solid and six hollow organs, the corresponding source points must be selected.

The sixty-seventh difficulty further explains: the alarm points (Mu points, where organ Qi gathers on the body surface) of the five solid organs are all located on the Yin-related abdomen. Specifically: the alarm point of the lungs, Zhongfu, is one cun below the clavicle, three intercostal spaces above the nipple; the alarm point of the heart, Juque, is one cun below the xiphoid process; the alarm point of the spleen, Zhangmen, is at the lower border of the ribs, level with the navel; the alarm point of the liver, Qimen, is beside the rib margin near the Burong point. These points are all crucial for treating diseases of their corresponding organs.

This passage primarily discusses the distribution and functional characteristics of acupuncture points related to the five zang organs (heart, liver, spleen, lung, kidney) and six fu organs (gallbladder, stomach, large intestine, small intestine, bladder, triple burner) in traditional Chinese medicine.

The text first explains the locations of the front-mu points (located on the chest and abdomen) and back-shu points (located on the back) for the five zang organs. For instance, the kidney's front-mu point "Jingmen" is positioned 1.5 cun lateral to the waist, while all five zang organs' back-shu points are located 1.5 cun lateral to the spine at specific vertebral levels: the lung shu at the third thoracic vertebra, heart shu at the fifth, liver shu at the ninth, spleen shu at the eleventh, and kidney shu at the fourteenth lumbar vertebra.

An important theoretical principle is presented here: yin diseases (internal organ disorders) manifest in yang areas (back-shu points), while yang diseases (superficial disorders) manifest in yin areas (chest and abdomen front-mu points). This explains why front-mu points are arranged on the yin regions of the chest and abdomen, while back-shu points are positioned on the yang region of the back.

The text then details the five major acupuncture points (well, spring, stream, river, and sea points) for each organ system. For example, the liver channel's points are: Dadun (well), Xingjian (spring), Taichong (stream), Zhongfeng (river), and Ququan (sea). Each of the other organs has corresponding sets of these five points.

Regarding the six fu organs, in addition to the five main points, there is an additional "source point" for each. For instance, the gallbladder channel's source point is Qiuxu, while the large intestine channel's source point is Hegu.

These acupuncture points form the fundamental theoretical system of Chinese medical acupuncture therapy, where stimulating specific points can regulate the corresponding organ functions.

This passage explains the functions and therapeutic applications of the five types of acupuncture points (well, spring, stream, river, and sea points) along the body's meridians, using the natural flow of water as a metaphor for the movement of Qi (vital energy) through these channels:

The well points (Jingxue) resemble mountain springs at their source, treating distension in the cardiac region. As wood-phase points corresponding to the liver, they address liver Qi stagnation that can disrupt spleen-earth function. Stimulating these points prevents wood overacting on earth.

Spring points (Yingxue) represent water just emerging before forming streams, indicated for feverish conditions. These fire-phase points correspond to the heart; excessive heart-fire can damage metal-phase lungs. Activating spring points checks fire's overaction on metal to reduce fever.

Stream points (Shuxue) are like deep pools where waters gather, treating bodily heaviness and joint pain. These earth-phase points regulate the spleen; spleen disorders affect water-phase kidneys (which govern bones). Stimulating stream points harmonizes spleen-earth.

River points (Jingxue) resemble formed waterways, addressing cough, asthma, chills and fever. These metal-phase points correspond to the lungs; lung imbalances can overact on wood-phase liver. Activating river points prevents metal's excessive restraint on wood, alleviating respiratory symptoms.

Sea points (Hexue) symbolize rivers merging with the ocean, treating rebellious Qi and diarrhea. These water-phase points govern the kidneys; kidney deficiency causes Qi rebellion, while insufficient kidney Qi leads to loose stools. Stimulating sea points prevents water's overaction on heart-fire, avoiding resultant liver Qi stagnation.

Through the theory of Five Phases (Wood, Fire, Earth, Metal, Water) mutual generation and restraint, this scripture elucidates how these five point categories regulate organ balance to treat corresponding disorders.

This scripture elucidates the fundamental principles of acupuncture treatment for disorders of the five zang and six fu organs, along with seasonal adjustment methods.

First, it explains the correspondence between specific acupoint categories (jing-well, ying-spring, shu-stream, jing-river, and he-sea points) and their associated disorders. Treatments must be adjusted according to seasonal variations, as each season's pathogenic Qi accumulates differently in ying-spring and shu-stream points.

Regarding supplementation and drainage techniques (supplementation strengthens function, drainage clears excess):

For deficiency patterns, apply supplementation when organ functions are weak; for excess patterns (hyperfunction or stagnation), use drainage to regulate; if neither deficiency nor excess exists, treat directly using the affected meridian's points.

Specific operational methods:

For deficiency patterns, supplement the "mother" organ (in the Five Phases generative cycle). For instance, if kidney pulse appears weak in spring—since kidneys (Water) fail to nourish liver (Wood)—one should supplement kidney Qi. For excess patterns, drain the "child" organ (the element it generates), such as draining heart fire when excessive heart pulse affects liver (Wood generating Fire). Always apply supplementation before drainage.

For balanced conditions without deficiency or excess—when only the meridian itself is affected—treat directly using the corresponding meridian points. For example, with abnormal liver pulse in spring but normal other organs, focus treatment on the Liver Meridian of Foot Jueyin and Gallbladder Meridian of Foot Shaoyang.

Regarding seasonal needling depth:

In spring and summer when Yang Qi resides at the body's surface and vital energy concentrates superficially, apply shallow needling at hairline and skin levels. During autumn and winter when Yang Qi withdraws inward and vital energy deepens, needle more profoundly, selecting jing-river and he-sea points located in muscular areas.

All methods must integrate the Five Phases (Wood, Fire, Earth, Metal, Water) attributes and adapt flexibly according to seasonal changes.

In autumn and winter, the body's Yang Qi (vital energy) and blood concentrate in deeper tissues, requiring deeper needle insertion during acupuncture treatment. During autumn, pathogenic Qi resides in the muscle layer, while in winter it settles deep within tendons and bones—thus needles must reach these deeper anatomical structures.

When nourishing Yang in spring and summer, one must preserve a measure of Yin Qi. These seasons belong to Yang dominance—the term "致" (zhi) here means "to attain." During periods of vigorous Yang energy, practitioners should deliberately guide a portion of Yin Qi to achieve harmony, preventing excessive Yang from becoming "solitary Yang" (an imbalanced state of Yang hyperactivity).

Conversely, when nourishing Yin in autumn and winter, a measure of Yang Qi should be retained. These Yin-dominant seasons require conscious guidance of Yang energy to prevent the formation of "solitary Yin" (an imbalanced state of Yin excess).

This principle stems from seasonal therapeutic particularities. In the warmth of spring and summer, pathogenic Qi predominantly affects Yang aspects, necessitating Yin guidance to balance Yang. Practically, this involves inserting needles to the depth corresponding with Liver and Kidney meridians (approximately five fen beneath the skin). After obtaining needle sensation (Deqi), specific manipulation techniques guide Yin energy to harmonize Yang. The human body's skin varies in thickness, with the subdermal layer housing the Qi circulation pathways of Liver and Kidney channels.

During cold autumn and winter months when pathogens concentrate in Yin aspects, Yang energy must be introduced for balance. The technique involves shallow insertion to the level of Heart and Lung meridians (about three fen deep). After obtaining Deqi, the needle is slightly advanced to guide Yang energy for Yin harmonization—the superficial skin layer being where Heart and Lung channel Qi circulates.

This explains the principle: "Spring and summer must guide one part Yin; autumn and winter must guide one part Yang."

The 71st Difficulty in the Classic states: "When needling the Rong blood (blood within vessels), do not injure Wei Qi (defensive energy at the body's surface); when needling Wei Qi, do not damage Rong blood—what does this mean?"

Wei Qi belongs to Yang. When needling Yang aspects, insert needles with the patient lying flat. Since Wei Qi circulates superficially (two fen beneath skin), treatment requires shallow insertion at a lowered angle to avoid penetrating too deeply and harming Rong blood.

For needling Yin aspects (Rong blood), first apply pressure and kneading with the left hand at the selected acupoint. After local Qi and blood disperse, insert the needle to the Rong blood depth (five fen beneath skin).

This passage explains the regulatory methods of "welcoming and following reinforcement and reduction" in traditional Chinese acupuncture therapy, along with the application principles of Jing-well and Ying-spring points.

Regarding the key points of needle insertion depth: One must wait for pathogenic Qi to disperse before inserting the needle, as inserting too deeply may damage the defensive Qi (the protective Yang energy at the body's surface). This embodies the principle of "piercing the nutritive level without harming the defensive level, piercing the defensive level without harming the nutritive level."

The 72nd Difficulty explains that understanding the Qi of "welcoming and following" enables regulation of Qi and blood circulation. "Welcoming" means obtaining Qi against its flow direction, while "following" means supplementing Qi along its flow. Defensive Qi moves counterflow while nutritive Qi moves with the flow—grasping this pattern allows regulation of Qi and blood. The key to regulating Qi and blood lies in discerning the deficiency and excess of Yin-Yang: when Yin is deficient and Yang is excessive, reinforce Yin and reduce Yang; when Yang is deficient and Yin is excessive, reinforce Yang and reduce Yin. Whether dealing with relative excess or dual deficiency/excess, one must adjust the Yin-Yang balance according to the disease location.

During diagnosis, one should determine the deficiency/excess relationship between interior/exterior by assessing the floating and sunken pulse qualities. Observing external manifestations reveals internal pathological mechanisms, while understanding internal conditions allows deduction of external symptoms. Treatment should be adjusted according to the specific manifestations of Yin and Yang pulses.

The 73rd Difficulty discusses the needling method for Jing-well points. Located at finger and toe tips where muscles are thin and Qi-blood circulation is minimal, these points are unsuitable for direct needling. Since Jing-well points belong to Wood and Ying-spring points belong to Fire (Wood generates Fire, making Fire the "child" of Wood), following the principle of "reducing the child in excess conditions," one should reduce Fire when Liver-Wood is excessive. Therefore, during spring treatments, selecting Ying-spring points for Fire reduction may be appropriate.

Note: The mentioned "Jing-well points" and "Ying-spring points" are specific acupoints located at the extremities of the twelve meridians, belonging to the five transport point system. Ancient physicians compared Qi-blood circulation to water flow, with five types of points arranged sequentially from extremities toward elbows/knees: Jing-well, Ying-spring, Shu-stream, Jing-river, and He-sea points.

This passage discusses the principles of "supplementing deficiency and draining excess" in acupuncture therapy, along with seasonal needling techniques.

Regarding supplementation and drainage: Excess conditions require draining techniques. For instance, excessive liver fire (an excess pathogen) calls for draining the fire point (Ying-spring point) of the liver channel. Deficiency conditions require supplementation—insufficient liver Qi (vital energy) necessitates tonifying the wood point of the liver channel. These methods must not be confused; one must never drain when supplementation is needed, nor supplement when drainage is required.

The seasonal needling methods follow the generative and controlling cycles of the Five Phases (Wood, Fire, Earth, Metal, Water):

• Spring calls for needling Jing-well points (Wood phase), as pathogenic Qi resides in the liver (Wood) during this season, preventing liver Wood from overacting on spleen Earth.
• Summer requires needling Ying-spring points (Fire phase), as summer pathogens concentrate in the heart (Fire), stopping heart Fire from overacting on lung Metal.
• Late summer (sixth month) employs Shu-stream points (Earth phase), when pathogenic Qi settles in the spleen (Earth), checking spleen Earth's overaction on kidney Water.
• Autumn demands needling Jing-river points (Metal phase), as autumn pathogens gather in the lungs (Metal), restraining lung Metal from overacting on liver Wood.
• Winter necessitates needing He-sea points (Water phase), when pathogenic Qi accumulates in the kidneys (Water), preventing kidney Water from overacting on heart Fire.

The five zang organs (liver, heart, spleen, lungs, kidneys) correspond with seasons, colors, odors, and flavors. Liver disorders, for example, manifest with bluish complexion, rancid body odor, craving for sour flavors, frequent sighing, and tearfulness. Though disease manifestations vary endlessly, their treatment timing can be grasped through seasonal rhythms.

The passage concludes with the therapeutic principle of "excess in the East (liver) causing deficiency in the West (lungs)": When liver excess induces lung deficiency, one should drain the South (heart) and supplement the North (kidneys). This applies the Five Phases' generative-control cycles to regulate Yin-Yang balance. The subtlety of acupuncture lies in mastering these intricate interconnections.

This passage explains the application of the Five Phase (Wuxing) mutual generation and restriction theory in Traditional Chinese Medicine's organ system regulation. The East corresponds to Wood (Mu) and governs the liver, while the West corresponds to Metal (Jin) and governs the lungs. When liver Qi (Wood excess) becomes hyperactive while lung Qi (Metal deficiency) is weak, balance can be restored by draining heart fire (South/Fire) and supplementing kidney water (North/Water).

The Five Phases maintain mutual restraining relationships: Metal restricts Wood, Wood restricts Earth, Earth restricts Water, Water restricts Fire, and Fire restricts Metal. Organ balance must be regulated according to these interactions. For instance, when liver Qi is excessive, lung Metal should normally restrain liver Wood, but if lung Qi is too weak to counterbalance, we must indirectly regulate by draining heart fire (Fire restricts Metal) and supplementing kidney water (Water generates Wood).

Specifically, heart fire is the "child" of liver Wood—excessive heart fire can deplete lung Metal, causing Metal-Wood conflict. Kidney water is the "mother" of liver Wood—supplementing kidney water can nourish liver Wood. Through the principle that "the child can make the mother substantial, while the mother can make the child empty," draining heart fire prevents excessive Metal restriction on Wood, while supplementing kidney water strengthens Wood's foundation.

Therapeutic methods involve acupuncture to drain heart fire while supplementing kidney water. Diagnosis first determines symptoms: draining heart fire regulates heart Qi and restores liver Qi balance, then supplementing kidney water ensures abundant kidney Qi, which nourishes the liver through the Water-generates-Wood relationship. This regulatory approach embodies the TCM treatment principle: "For deficiency, supplement the mother; for excess, drain the child."

This passage primarily discusses the principles of supplementation and drainage in traditional Chinese acupuncture therapy, along with the concept of "treating disease before it arises."

Regarding supplementation and drainage techniques: When reinforcement (boosting vital Qi) is needed, one should draw Qi from the defensive (Wei) level - the body's surface protective energy. The lungs govern the movement of the Five Qi, nourishing the five zang organs, six fu organs, and all meridians. During needling, the depth of insertion should correspond to the deficiency level of the meridian, drawing Qi from the Wei level before gently advancing the needle inward. For draining excess (expelling pathogenic factors), since pathogens often reside in the nutritive (Rong) level (the deeper blood network), one should draw Qi from this level, then guide the needle to release pathogens when the needle sensation propagates.

The specific operations involve four scenarios: If Yang Qi is deficient with excess Yin Qi, first supplement the Yang meridian then drain the Yin meridian; if Yin Qi is deficient with excess Yang Qi, first supplement the Yin meridian then drain the Yang meridian. For example, with gallbladder meridian deficiency and liver meridian excess, first reinforce the Foot Lesser Yang gallbladder meridian, then drain the Foot Jueyin liver meridian - the reverse situation requires reinforcing the liver meridian first then draining the gallbladder meridian. The essential principle lies in ensuring smooth circulation of nutritive and defensive Qi - this represents the key acupuncture technique.

Concerning "treating disease before it arises": Superior physicians (Shang Gong) can prevent disease before manifestation, while average physicians (Zhong Gong) only treat established conditions. For instance, recognizing liver disease, one understands it may transmit to the spleen, so first fortifies spleen Qi to block pathological transmission. Among the five zang organs, excess will attack deficiency - thus observing liver meridian disorder, one preemptively reinforces the spleen earth it might overcome.

This text embodies traditional Chinese medicine's preventive philosophy of "preventing disease progression after onset," along with the holistic approach of regulating Yin-Yang balance and promoting Qi-blood circulation in treatment.

The qi of the spleen must be protected from pathogenic influences originating in the liver. Thus, skilled physicians regulate the body before illness manifests—this is what we call "treating disease before it arises."

Average physicians, upon seeing liver disease, fail to understand the principle of disease transmission. They focus solely on treating the liver itself, unaware that liver disorders can transfer to the spleen through pathological mechanisms. Such practitioners concentrate exclusively on liver channel syndromes—this represents "treating disease after it has arisen," the method of ordinary healers.

The 78th Difficulty discusses the supplementation and drainage techniques in acupuncture. Supplementation involves withdrawing the needle during exhalation, while drainage entails inserting during inhalation. Yet these are merely surface manifestations—true supplementation and drainage don't depend entirely on coordinating breath with needle manipulation. The essence lies in whether one can guide the movement of channel qi.

True masters of needle technique emphasize the use of the left hand (traditionally considered the hand that governs qi). Before insertion, they press the acupoint location with the left hand, using plucking motions to make the channel qi flourish. Then they mark the precise insertion point with a fingernail. When channel qi is felt pulsating like a vessel's movement, the needle enters along the qi's direction. After obtaining qi (deqi), the needle is gradually advanced deeper—this constitutes supplementation. If after obtaining qi the needle is shaken and lifted outward, this represents drainage.

If qi cannot be obtained despite prolonged needle retention, first wait for qi in the superficial defensive (wei) level before proceeding deeper to the nutritive (ying) level. Should three attempts fail to elicit qi response, it indicates severe deficiency of both yin-yang and qi-blood, making further needling inadvisable. Since male yang qi resides externally and female yin qi internally, persistent failure to obtain qi often signals critical illness.

This passage explains the supplementation and drainage techniques in ancient acupuncture therapy along with key points for pulse diagnosis. When pressing on acupoints, if there's no Qi (vital energy) response for an extended period, or if the left-hand pulse shows no corresponding changes, such patients must absolutely not receive acupuncture—nine times out of ten it would prove fatal.

The 79th Difficulty (from the Classic of Difficulties) states: Inserting needles against the meridian's flow direction is called "confronting and seizing"—how could this not create deficiency? Here "confronting" means intercepting the meridian Qi, while "seizing" means draining pathogenic factors. This dual action of intercepting and draining naturally leads to depletion. Conversely, inserting needles along the meridian's flow direction is called "following and assisting"—how could this not create excess? "Following" means protecting upright Qi, while "assisting" means supplementing deficient meridians. Such manipulation naturally enriches Qi and blood.

The specific method is: Insert the needle as the Qi flow completes its cycle, then press the needle hole upon withdrawal—this is called "following and assisting." Judging deficiency and excess requires cautious discernment akin to having something yet seeming to lack it—when supplementing deficient meridians, it should feel both gained and not gained; when draining excess meridians, it should feel both eliminated and still present.

An example: For excess conditions, "drain the child" (based on Five Phase generation cycles—drain the organ it generates). For instance, with excessive heart fire, drain the Shu point of the pericardium meridian (belonging to Earth, since fire generates earth). For deficiency conditions, "supplement the mother"—with deficient heart fire, supplement the Jing-well point of the pericardium meridian (belonging to Wood, since wood generates fire).

The key to determining excess/deficiency lies in pulse qualities: A "firm" pulse (solid and forceful) indicates excess, while a "soft" pulse (weak and frail) indicates deficiency. If Qi arrival feels solid and forceful, it's "obtained"; if weak and frail, it's "lost"—hence the saying "as if obtained, as if lost." Before needling, one must first examine the five organ pulses and the selected acupoints—solid Qi can be drained, deficient Qi supplemented. If unable to accurately assess pulse conditions while holding the needle, one falls into the dilemma of "seeming right yet seeming wrong."

This scripture elucidates the essential principles of acupuncture treatment and the precautions regarding deficiency-excess tonification-drainage techniques.

Regarding needle manipulation techniques: The phrase "seeing before entering" refers to pressing the acupoint with the left hand before insertion to perceive the arrival of channel Qi (the circulating energy within the body). Only after sensing the Qi's arrival should the needle be inserted. The needle should remain until observing the complete circulation of channel Qi before withdrawal. This method differs from conventional reinforcing-reducing techniques based on Qi flow direction (note: techniques that determine needle direction according to blood and Qi circulation), emphasizing strict adherence to the natural patterns of Qi movement.

Concerning the therapeutic principles of deficiency-excess regulation: When liver Qi (belonging to the Wood phase) is excessive while lung Qi (belonging to the Metal phase) is deficient, the Five Phases mutual restraint principle dictates using Metal to balance Wood. However, if a practitioner observes strong lung Qi with subtle, deficient liver Qi yet tonifies the lungs instead of reinforcing the liver, this constitutes the error of "tonifying excess and draining deficiency" (note: making excess conditions more excessive and deficient conditions more deficient). Such mistaken treatment damages insufficient vital Qi while promoting excessive pathogenic Qi, representing a common fault among unskilled physicians.

The text particularly emphasizes that acupuncture must accurately assess organ deficiency-excess relationships and regulate according to the Five Phases generation-restraint cycles. Otherwise, it may produce opposite effects. This embodies the fundamental therapeutic principle in Chinese medicine: "tonify deficiency and drain excess."