Library

Chills, shivering with the jaw trembling, inability to sweat, abdominal distension, and vexation. One should select points on the Hand-Taiyin Lung Meridian for acupuncture. For deficiency patterns, needle in the direction of the departing Qi (tonification); for excess patterns, needle against the direction of the arriving Qi (sedation).

The description of chills, shivering, and jaw trembling refers to the body feeling cold as if splashed with cold water, causing tremors. This occurs because cold pathogenic factors close the exterior, while internal Yang Qi is stagnant and vigorous, leading to an inability to sweat, abdominal distension, and mental vexation. In the absence of symptoms such as headache and fever, the pathogen is not in the Taiyang Meridian but in the Hand-Taiyin Lung Meridian. Therefore, when needling the Hand-Taiyin Meridian, one must distinguish between deficiency and excess. To treat deficiency, insert the needle following the direction of the departing Qi to tonify; to treat excess, insert the needle against the direction of the arriving Qi to sedate. Tonification replenishes the healthy Qi, while sedation expels the pathogenic Qi. This method relies on observing respiration to determine the timing of needle insertion and withdrawal, serving as a technique for tonification and sedation. Thus it is said: "Knowing Ying (welcoming) and Sui (following), one can anticipate the Qi."

In spring, select collateral vessels; in summer, select the intermuscular spaces and cutaneous pores; in autumn, select the Qi Kou (Cunkou pulse); in winter, select Jing-River and Shu-Stream points. These four seasonal methods each conform to the characteristics of their respective seasons. Collateral vessels treat diseases at the skin level; intermuscular spaces and cutaneous pores treat diseases at the muscle level; Qi Kou treats diseases at the meridian level; Jing-River and Shu-Stream points treat diseases at the bone marrow level.

Human Qi and Blood float and sink according to the ascending and descending Qi of the four seasons. When affected by pathogens, they advance or retreat according to the movement of Qi within the body. Therefore, acupuncture methods must vary in depth according to the season, and the principles of medication are the same. This describes general rules, which should not be rigidly adhered to. Since disease changes are endless, treatment must be applied flexibly according to circumstances. Thus, Zhang Zhongjing first differentiates pulse and symptom patterns to determine treatment methods, which is most appropriate.

The previous volume, *Chapter on Deficient Wind and Rogue Pathogens*, quotes from *Su Wen: Treatise on Four Seasons' Acupuncture Contradictions*: "Spring Qi is in the meridians, Summer Qi is in the sun-collaterals, Long Summer Qi is in the muscles, Autumn Qi is in the skin, Winter Qi is in the bone marrow." This refers to where the prosperous Qi of the body resides. The current text discusses using acupuncture to drain pathogens; the two texts mutually clarify their theoretical principles.

In *Ling Shu: Chapter on Cold and Heat*, the Yellow Emperor asked: "Cold-heat scrofula located in the neck and axilla, what Qi causes this?" Qibo replied: "These are all toxic vapors of mouse scrofula and cold-heat, lingering in the vessels without dispersing." The Yellow Emperor asked: "How to remove them?" Qibo said: "The root of mouse scrofula lies in the Zang organs, while its branches emerge above between the neck and axilla. Those floating in the vessels, not yet deeply attached to the muscles, or those externalized as pus and blood, are easy to remove. Please guide from the root to the branch, so that the pathogenic decline can be achieved and the cold-heat severed. Carefully examine its pathway and apply treatment; proceed slowly and withdraw slowly to eliminate the pathogen. If small like wheat grains, one insertion brings improvement, three insertions cure it."

Scrofula arises between the neck and axilla; severe cases connect into strings. This follows the pathways of the Foot-Shaoyang Gallbladder Meridian and Foot-Jueyin Liver Meridian. Initially caused by emotional stagnation, where Yang transforms into heat, and external pathogens take advantage, leading to cold-heat toxic pathogens lingering in the meridians and binding with Qi and Blood to form this disease. Due to internal injury combined with external pathogens, the root of the disease lies in the Zang organs. Before emerging in the neck and axilla, it floats in the vessels and has not yet deeply attached to the muscles. If externalized as pus and blood, the pathogen is still shallow and can be drained through pus and blood, making it easy to remove. "Guiding from the root to the branch" means first regulating Zang organ Qi, then unblocking the meridians to harmonize Ying and Wei (Defensive and Nutritive Qi), allowing the pathogen to decline and severing the cold-heat. Carefully examining the meridian pathways and using slow insertion and withdrawal are acupuncture techniques. Because the pathogen is within the meridian Qi and Blood, it cannot be removed abruptly; a gradual treatment method is required, which also applies to medication. If initially small like wheat grains, it is easy to treat, so three insertions suffice for a cure; if prolonged and deep-seated with large swelling, it is difficult to treat, as described in the following text.