《孫真人備急千金要方》Vol. 88

Sun Zhenren’s Essential Prescriptions Worth a Thousand Gold for Emergencies, Volume Eighty-Eight, Hidden Section Six

Prescriptions for Acupuncture and Moxibustion

Third: Rules on Acupuncture and Moxibustion Prohibitions

Prohibitions on acupuncture

Do not perform acupuncture in extremely cold weather. (The Plain Questions says, “Do not perform acupuncture when the weather is cold; when the weather is warm, there is no concern.”) Do not use draining methods when the moon is waxing; do not use tonifying methods when the moon is full; and do not treat when the moon is waning.

Do not perform acupuncture just after sexual intercourse. After acupuncture, do not have sexual intercourse.

Do not perform acupuncture when very angry, and do not become angry after acupuncture. Also do not perform acupuncture when exhausted, drunk, overly full, hungry, or thirsty; avoid these conditions after acupuncture as well.

Those who arrive by carriage should lie down and rest first, then receive acupuncture after roughly the time it takes to eat a meal. Those who arrive on foot should sit and rest first, then receive acupuncture after roughly the time it takes to walk ten li.

For someone who has been greatly startled or frightened, wait until their breathing has settled before performing acupuncture.

If acupuncture mistakenly injures the heart, the patient will die after one day and will hiccup when the condition manifests. If it injures the lungs, the patient will die after three days and will cough when it manifests. If it injures the liver, the patient will die after five days and will speak abnormally when it manifests. If it injures the spleen, the patient will die after fifteen days and will have difficulty swallowing when it manifests. If it injures the kidneys, the patient will die after three days and will sneeze when it manifests. (Different chapters give differing accounts of the time to death and symptoms following injury to the five viscera: the “Acupuncture Prohibitions” chapter, the “Essentials of Diagnosis and the End of the Channels” chapter, and the “Following and Reversing the Four Seasons in Acupuncture” chapter of the Plain Questions each record different versions. Wang Bing’s commentary says that although all these accounts come from Qibo, their differences may be due to errors in transmission.)

If acupuncture mistakenly injures the gallbladder, the patient will die after one and a half days and will vomit when the condition manifests.

If acupuncture mistakenly injures the diaphragm, it will cause internal injury, and the patient will inevitably die within a year at most.

If acupuncture pierces a large blood vessel on the top of the foot and the bleeding does not stop, it will lead to death. The same is true if acupuncture pierces a large blood vessel on the inner thigh and the bleeding does not stop.

Inserting a needle into the channels that run across the face may cause blindness if they are accidentally injured.

When needling the Master’s Guest point, located beside the eye, inserting the needle too deeply and injuring a channel may cause internal leakage and deafness.

When needling the Naohu point at the back of the head, penetrating into the brain will cause immediate death.

Needling the kneecap may cause lameness if joint fluid is drawn out.

When needling the channels beneath the tongue, inserting the needle too deeply may cause uncontrolled bleeding and loss of voice.

Excessive bleeding from needling the Taiyin channel of the arm will cause immediate death.

If a channel in the network of vessels on the sole is injured, bleeding may continue without stopping.

If the Shaoyin channel of the foot is injured and the body is further weakened, blood loss may make it difficult to speak.

Needling a large vessel at the Xi region, such as behind the knee, may cause a person to collapse and their complexion to become abnormal.

If needling the hollow at the front of the chest injures the lungs, breathing may become rapid, leaving the person able to breathe only with their head tilted back.

If a channel at the Qichong region is injured and blood flow is obstructed, the area may swell, possibly forming a lump near the groin.

If Qi becomes stagnant after needling the hollow of the elbow, the arm may be unable to bend or straighten.

Injuring the spinal cord while needling between the vertebrae may cause a person to stoop and become hunched.

Needling three inches below the inner thigh too deeply may cause involuntary urination.

Injuring the breast by needling above the nipple may cause swelling and ulceration.

Needling the hollow between the ribs beneath the armpit may cause coughing.

If needling the Quepen hollow above the collarbone too deeply allows Qi to escape, it may cause shortness of breath, coughing, and rebellious Qi.

If needling the lower abdomen injures the bladder and urine escapes, the lower abdomen may become distended.

Needling the thenar eminence of the palm, the raised area at the base of the thumb, too deeply may cause swelling.

Needling the calf too deeply may cause swelling.

If needling the hollow above the eye socket injures a channel in the bone, it may cause tearing and blindness.

If a needle enters a joint and joint fluid escapes, the limb may become unable to bend or straighten.

The following points are forbidden to needle or should not be needled deeply:

Needling the Shenting point is forbidden. The Shangguan and Quepen points must not be needled deeply. Excessive bleeding should be avoided at the Qixi point. Needling the center of the navel is forbidden. The Zuojiao point should not be needled for a prolonged time.

The Yunmen point must not be needled deeply. This is what the classic says; today, needling it is prohibited altogether. Students should study this carefully.

Needling the Wuli and Futu points is forbidden. However, according to the Jia Yi Jing (Classic of Acupuncture and Moxibustion), the Futu point on the Foot Yangming channel may be needled to a depth of five fen, so it should not be regarded as absolutely forbidden.

Needling the Sanyangluo point is forbidden. Excessive bleeding should be avoided at the Fuliu point. Needling the Chengjin point is forbidden. Excessive bleeding should be avoided at the Rangu point. Needling the Ruzhong and Jiuwei points is forbidden.

Moxibustion contraindications:

Moxibustion is forbidden at the Touwei, Chengguang, Naohu, Fengfu, Yimen, and Yinshi points.

Moxibustion must not be applied at Xiaguan (an acupoint in front of the ear, near the jaw joint) when there is dryness or discomfort in the ear, or reduced hearing.

Moxibustion must not be applied at Ermen (an acupoint in front of the ear) when there is pus in the ear or reduced hearing.

Moxibustion is forbidden at Renying (an acupoint near the pulse of the carotid artery in the neck). It is also forbidden at Yangguan.

If adverse effects occur after moxibustion at Sizhukong (an acupoint outside the end of the eyebrow), the eyes may become smaller or even go blind.

Moxibustion is forbidden at Chengqi (an acupoint below the eye), Jizhong (at the midline of the spine on the back), Ruzhong (at the nipple), and Chimai (near the back of the ear). It is also forbidden at Shimen (an acupoint in the lower abdomen) for women, and at Baihuanshu (an acupoint in the lumbosacral region).

If adverse effects occur after moxibustion at Qichong (an acupoint near the groin), the person may be unable to breathe. If adverse effects occur after moxibustion at Quanye, pus-filled sores may develop and cause ulceration.

Moxibustion is forbidden at Tianfu, Jingqu, Futu, Diwuhui, and Jiuwei.

Fourth: A mnemonic for cross-referencing changes in the Five Zang and Six Fu

The changes in the Five Zang and Six Fu are endless, and their descriptions are scattered among the entries for the various meridians. Related information is often difficult to discern and hard to master in full. The material is now gathered and arranged together as a mnemonic for cross-reference. Learners who give it some attention and study it carefully should quickly recognize the connections it contains.

The Five Zang

The kidneys belong to Water and are ranked first; the heart belongs to Fire and is ranked second; the liver belongs to Wood and is ranked third; the lungs belong to Metal and are ranked fourth; the spleen belongs to Earth and is ranked fifth.

The Six Fu

The bladder, small intestine, gallbladder, large intestine, stomach, and Triple Burner.

Meridians of the Five Zang

Foot Shaoyin, Hand Shaoyin, Foot Jueyin, Hand Taiyin, and Foot Taiyin.

Meridians of the Six Fu

Foot Taiyang, Hand Taiyang, Foot Shaoyang, Hand Yangming, Foot Yangming, and Hand Shaoyang.

Pulse qualities of the Five Zang

The kidney pulse is deep and soft; the heart pulse is surging and vigorous; the liver pulse is taut and long; the lung pulse is floating and short; the spleen pulse is moderate and large.

Weights of the Five Zang

The kidneys weigh one jin and two liang, though another account gives one jin and one liang; the heart weighs twelve liang; the liver weighs four jin and four liang, with three lobes on the left and four on the right; the lungs weigh three jin and three liang, with six lobes and two appendages; the spleen weighs two jin and three liang.

Weights of the Six Fu

In the order given in the original text, they weigh nine liang and two zhu, two jin and fourteen liang, three liang and three zhu, two jin and twelve liang, and two jin and fourteen liang. The zhu is an ancient unit of weight.

Lengths of the Six Fu

The original text records that one item measures seven cun in both length and breadth, though another account gives nine cun; another item is two zhang and four chi long and two cun and four fen wide.

This section sets out the correspondences among the five Zang organs, six Fu organs, body parts, official titles used as metaphors, and meridian points. The source records variant accounts, which are retained here.

Three cun and three fen; one zhang and two chi (another account gives a width of six chi); one chi and five cun.

What the six Fu organs receive

Nine sheng and two he (another account gives nine sheng and nine he); two dou and four sheng; one he (the Nanjing records three he); one dou and two sheng; three dou and five sheng.

Official titles of the five Zang organs

Ladies of the inner palace; the emperor; the senior general (another account says a court officer); the grand secretary (another account says the senior general); the remonstrance adviser.

Official titles of the six Fu organs

Water bureau clerk; granary inspector; general’s adjudication clerk; granary supervisor; inner provisions officer.

Transport points of the five Zang organs

The 14th vertebra, the 5th vertebra, the 9th vertebra, the 3rd vertebra, and the 11th vertebra.

Transport points of the six Fu organs

The 19th vertebra, the 18th vertebra, the 10th vertebra, the 16th vertebra, the 12th vertebra, and the 13th vertebra.

Here, “vertebra” refers to the bones of the spine. Transport points are places where meridian Qi is conveyed and gathered; they are commonly used as reference points for acupuncture.

Front-Mu points of the five Zang organs

Jingmen, Juque, Qimen, Zhongfu, and Zhangmen.

Front-Mu points of the six Fu organs

Zhongji, Guanyuan, Riyue, Tianshu, Zhongwan, and Shimen.

Front-Mu points are points on the chest and abdomen where the Qi of the Zang and Fu organs gathers.

The exit, flow, arrival, passage, movement, and entry points of the five Zang meridians

Exit: Yongquan, Zhongchong, Dadun, Shaoshang, and Yinbai (corresponding here to the Heart). A side note says that the Pericardium and Heart meridians each exit at Shaochong.

Flow (written as “stay” in the Jiayijing): Rangu, Laogong (corresponding to Shaofu on the Heart meridian), Xingjian, Yuji, and Dadu.

Arrival: Taixi, Daling (corresponding to Shenmen on the Heart meridian), Taichong, Taiyuan, and Taibai.

Passage: Shuiquan, Neiguan (corresponding to Tongli on the Heart meridian), Zhongfeng, Lieque, and Gongsun.

Movement: Fuliu, Jianshi (corresponding to Lingdao on the Heart meridian), Zhongxi, Jingqu, and Shangqiu.

Entry: Yingu, Quze (corresponding to Shaohai on the Heart meridian), Ququan, Chize, and Yinlingquan.

“Exit,” “flow,” “arrival,” “passage,” “movement,” and “entry” classify stages in the movement of meridian Qi. The points listed after each term are the corresponding acupuncture points; the notes in parentheses give the Heart meridian points that correspond in some categories.

Exit points of the six Fu meridians

Zhiyin, Shaoze, Zuqiaoyin, Shangyang, Lidui, and Guanchong. Guanchong is the exit point of the Sanjiao meridian; the source lists it twice.

Flow points of the six Fu meridians

Tonggu, Qiangu, Xiaxi, Erjian, Neiting, and Yemen.

Arrival points of the six Fu meridians

Shugu, Houxi, Linqi, Sanjian, Xiangu, and Zhongzhu.

Passing through: Jinggu, Wangu, Qiuxu, Hegu, Chongyang, Yangchi.

Following the course: Kunlun, Yanggu, Yangfu, Yangxi, Jiexi, Zhigou.

Entering: Weizhong, Xiaohai, Yanglingquan, Quchi, Sanli, Tianjing.

Tianjing.

The five sensory openings (the body’s five sense organs): ears (another version reads “yin”), tongue (another version reads “mouth”), eyes, nose, lips.

The five forms of nourishment (nourishing relationships corresponding to the five viscera): bones (Jing), blood (vessels), sinews, skin and hair, flesh.

The five bodily fluids: saliva, sweat, tears, nasal discharge, and spittle.

The five sounds: groaning (another version reads “sighing”), speech, shouting, weeping, and singing.

The six Qi sounds: si, chui, hu, he, xu, and xi. These characters are also used to name vocalized breathing techniques in traditional health cultivation.

The five spirits (concepts associated with bodily and mental activity): Zhi (Jing), Shen (nature; another version reads “spirit of the vessels”), blood (Hun), Qi (Po), and intention (wisdom; another version reads “nourishing intention”).

The five conditions of excess (symptoms arising from excess in five respects): distension and fullness; uncontrollable laughter; anger; labored breathing with the head raised; and difficulty passing urine and stool.

The five conditions of deficiency (symptoms arising from deficiency in five respects): cold, numb hands and feet; sorrow (another version reads “kindness”) and fear; short, shallow breathing with little Qi; and inability to move the limbs.

The six emotions: aversion and sorrow; alarm and fear, worry (another version reads “favor and affection”); fondness and delight (another version reads “straightforward joy”); dignity and anger; pleasure and foolishness; greed, integrity, deviousness, generosity, impartiality, and wickedness.

The eight dispositions: desire and restraint; friendship; kindness (another version reads “favor” or “sorrow”); Qi (another version reads “uprightness”); public-mindedness and self-interest (another version reads “resentment”).

The five constant virtues: wisdom (planning), propriety (discernment), benevolence (solemnity), righteousness (governance), and trustworthiness (sagacity).

The five faculties: hearing (acuity), sight (clarity), bearing (respectfulness), speech (compliance), and thought (wisdom).

The five faults (five kinds of transgression): impatience, ease and idleness, arrogance, overstepping one’s place, and foolishness.

The five kinds of vocalization: chanting, shouting aloud, reciting, intoning, and singing.

The five tones (the five musical notes and their string counts): Yu (48 silk threads), Zhi (54 threads), Jue (64 threads), Shang (72 threads), and Gong (81 threads).

The five colors: black, red, blue-green, white, and yellow.

The five flavors: salty, bitter, sour, pungent, and sweet.

The correspondences among the five odors are as follows:

The five odors are putrid, scorched, rank (also called foul), fishy, and fragrant. “Favorable” among the five flavors refers to the ways the flavors generate and support one another—that is, “the child comes to assist the mother”: sour, sweet, bitter, salty, and pungent. “Harmful” among the five flavors refers to flavors that restrain one another or are incompatible. Their order is sweet, salty, pungent, bitter, and sour. There are also five climatic influences that are unfavorable: dryness, heat, wind, cold, and dampness.

The five numbers are one (six), two (seven), three (eight), four (nine), and five (ten). The Five Phases are Water, Fire, Wood, Metal, and Earth; the five seasons are winter, summer, spring, autumn, and late summer (the last month of summer).

The five forms are curved, hollow, straight, bent, and round. The Waitai Miyao says that these forms correspond to the outward forms of the Five Phases and also take their models from the shapes of the five internal organs.

The five domestic animals are the pig, sheep, chicken, dog, and ox. The five grains are soybeans, wheat, hemp, rice, and millet; another version gives “yellow millet” in place of rice. The five fruits are chestnut, apricot, plum, peach, and jujube. The five vegetables are bean leaves, Chinese chives (a vegetable similar to Chinese scallion), garlic chives, scallions, and winter mallow.

The treatise says: Suppose the kidneys, heart, liver, lungs, and spleen are taken as the five internal organs. Then the bladder, small intestine, gallbladder, large intestine, and stomach are their corresponding six bowels. The Foot Shaoyin channel is called the Kidney channel, and the Foot Taiyang channel is called the Bladder channel. By extension, the five internal organs, five fruits, five vegetables, and the other categories are all arranged according to the principle of corresponding items of the same kind. The remaining material can be understood in the same way. The Waitai Miyao later added twenty-three entries, but these were not part of the original text of the Qianjin Yaofang, so they are not included here.