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(From *Ling Shu: Nine Needles and Twelve Sources*, *Cold-Heat Diseases*, *Heat Diseases*, *Jue Diseases*, *Miscellaneous Diseases*, *Zhong Shi*, and *Su Wen: Bone Empty Discussion*)

When needling to treat various heat syndromes, the technique should be swift and light, like a hand testing hot water; (*Ling Shu: Nine Needles and Twelve Sources*. The following sections all discuss methods of needling treatment for various diseases. "Like a hand testing hot water" refers to the application of light and dispersing techniques. Heat syndromes belong to Yang, and Yang governs the exterior, so treatment should be conducted in this manner.) When needling to treat cold syndromes or limbs feeling cold/clammy, retention of the needle should be prolonged, like a person unwilling to walk. (The phrase "like a person unwilling to walk" implies a sense of lingering and staying. Yin-cold stagnation makes obtaining Deqi difficult, so needle retention is appropriate as described.) For Yang pathologies located within the Yin aspect, select Sanli (Xialing); puncture straightly without fatigue/laxity, stop when the Qi descends, and if it does not descend, restart the procedure. (Yang pathology in the Yin aspect refers to heat in the Yin compartments. Xialing is another name for Sanli, an acupoint of the Foot-Yangming Stomach Meridian. Dai is synonymous with Dai (lax). Qi descending indicates the retreat of pathogenic factors. If they do not retreat, re-needling is required.) For high-positioned pathologies internal to the body, select Yinlingquan; for high-positioned pathologies external to the body, select Yanglingquan. ("High position" refers to the upper body, requiring distal selection from the lower body. However, high and internal pathologies belong to the Zang organs, so one should select Yinlingquan of the Foot-Taiyin Spleen Meridian. High and external pathologies belong to the Fu organs, so one should select Yanglingquan of the Foot-Shaoyang Gallbladder Meridian.)

If the body has suffered trauma with significant blood loss, or contracted Wind-Cold, or suffered a fall/crush injury resulting in flaccidity and inability to hold the four limbs, this is called Body Languor (Ti Duo). (From *Ling Shu: Cold-Heat Diseases*. Trauma with heavy bleeding combined with Wind-Cold contraction belongs to categories such as Tetanus. Alternatively, due to falls/crushing without necessarily bleeding, but presenting with limb flaccidity, all are termed Body Languor.) Treatment involves selecting the San Jie Jiao point below the umbilicus on the lower abdomen. San Jie Jiao refers to the intersection of the Foot-Yangming and Foot-Taiyin meridians, specifically Guanyuan, three cun below the umbilicus. (Guanyuan is an acupoint of the Ren Mai [Conception Vessel]; additionally, the meridians of Foot-Yangming and Foot-Taiyin both converge here, hence the name San Jie Jiao.)

For Unclogging (Long, urinary retention), select the Yin Qiao vessel and the area above the hair tuft (San Mao Shang, i.e., Dadun), and bleed the collateral vessels. (From *Ling Shu: Heat Diseases*. Urinary retention is called Long. One should select Zhaohai of the Foot-Shaoyin Kidney Meridian, which originates from the Yin Qiao vessel. "Above the hair tuft" refers to Dadun of the Foot-Jueyin Liver Meridian. Since the Kidney and Bladder are interior-exterior paired, and the Liver Meridian traverses the lower abdomen, these two meridians should be selected for treatment. If collateral vessels are involved, they should still be pricked to bleed. Long, pronounced Liangzhong qie. Qiao, pronounced Qiao.)

Men suffering as if from Gu poison (bloating/stuffiness), women suffering as if pregnant, with a sensation of the body and waist/spine being disjointed/loose, and lack of appetite, should first have Yongquan needled until bleeding appears; observe the dorsum of the foot for fullness, and bleed all such areas fully. (Gu refers to bloating/stuffiness resembling Gu poison toxicity. It should be interpreted as "fetus/pregnancy". Like Gu and like pregnancy means the form resembles these conditions without actually having them. Body/waist/knees feeling disjointed refers to fatigue, looseness, and inability to maintain posture. Yongquan is an acupoint of the Foot-Shaoyin Kidney Meridian. Fu Shang refers to the dorsum of the foot, speaking here of the Foot-Yangming Meridian; any areas that are full/excessive should be needled to release blood. , pronounced Jiangyu qie.)

For disease manifesting as profuse bloody diarrhea, select Ququan. (From *Ling Shu: Jue Diseases*. Profuse bloody diarrhea indicates the Liver's failure to store blood internally, thus one should select Ququan of the Foot-Jueyin Liver Meridian.)

For Malaria without thirst occurring every other day, select the Foot-Yangming Meridian; for Malaria with thirst occurring daily, select the Hand-Yangming Meridian. (From *Ling Shu: Miscellaneous Diseases*. *Ci Nue Lun* states: Malaria without thirst occurring every other day, needle the Foot-Taiyang Meridian; Malaria with thirst occurring every other day, needle the Foot-Shaoyang Meridian. See Disease Category 50 for details.)

For irritability, anorexia, and progressively quieter speech, needle the Foot-Taiyin Meridian; for irritability and excessive talking, needle the Foot-Shaoyang Meridian. (Irritability with anorexia and progressively quieter speech indicates damage to the Spleen, so one should needle the Foot-Taiyin Meridian and apply tonification. Irritability with excessive talking indicates excess pathogenic factors in the Liver and Gallbladder, so one should needle the Foot-Shaoyang Meridian and apply sedation.)

For Hiccups (Yue), stimulate the nose with grass to induce sneezing; once the patient sneezes, it resolves. Alternatively, hold the breath and rapidly guide the Qi downward, and it will resolve immediately. Alternatively, startle the patient greatly, and it may also resolve. (Yue refers to hiccups. Methods of treatment include stimulating the nose with grass to induce sneezing; the sneeze allows Qi to flow freely, resolving the hiccups—this is one method. Or, close the mouth and nose to hold the breath, then guide and disperse the Qi, preventing upward rebellion, which resolves it immediately—this is the second method. Or, startle him with other matters, which may also resolve it—this is the third method for treating Yue. My commentary: None of the chapters in *Nei Jing* explicitly list "hiccups" as a syndrome. Observing these three methods for treating Yue, all are used to treat hiccups; thus, ancient Yue undoubtedly refers to hiccups. As stated in *Kou Wen*: Food enters the stomach, Stomach Qi flows up to the Lung. Now, old cold qi and new grain qi return together into the stomach; new and old confuse each other, true and evil attack each other, Qi merges and rebels, emerging from the stomach, causing Yue. It also states: The Lung governs Yue. Zhang Zhongjing said: In Yangming disease, inability to eat, attacking the heat will inevitably cause Yue. This is because of deficiency-cold in the Stomach. Because the person is originally deficient, attacking heat causes Yue. It also says: If Stomach deficiency-cold prevents eating, drinking water will cause Yue. Cheng Wuji said: If there is Yue, there is a chattering sound. This Yue is hiccups, caused by deficiency-cold of Yangming and Taiyin, which is evident. Why did Li Dongyuan and later authors claim Yue belongs to Shaoyang, involving sound without matter, representing Qi pathology? Zhu Danxi said: Sound with matter expelled is vomiting; sound without matter expelled is Yue. All these equate dry heaves with Yue. Chen Wuyue further equated Yue with cough-reversal. Dry heaves belong to vomiting; cough-reversal belongs to coughing; what relevance do these have to Yue? Various theories differ, all lacking deep investigation. Yue, pronounced Yujue qie, also pronounced Hui.)

Collateral pain pulling from the hypochondrium to the lower abdomen causing distension and pain, needle the acupoint. (From *Su Wen: Bone Empty Discussion*. The soft area below the costal margin is called Zhong. is an acupoint of the Foot-Taiyang Bladder Meridian. pronounced Miao. pronounced Yi Xi.) When needling to treat various pain syndromes, the pulse must be Excess (Shi) (*Ling Shu: Zhong Shi*). This discusses painful conditions suitable for needling, where the pulse must be Excess. Therefore, it is evident that Deficient pulses are unsuitable for needling. Thus it is said: For diseases above the waist, the Hand-Taiyin and Hand-Yangming meridians govern; for diseases below the waist, the Foot-Taiyin and Foot-Yangming meridians govern. (This is the proximal selection method. Above the waist corresponds to Heaven Qi, so one should select the Lung and Large Intestine meridians, as the Lung Meridian travels from chest to hand, and the Large Intestine Meridian from hand to head. Below the waist corresponds to Earth Qi, so one should select the Spleen and Stomach meridians, as the Spleen Meridian enters the abdomen from the foot, and the Stomach Meridian descends from head to foot. Depending on whether the disease is in Yin or Yang, observe its governing meridian and needle accordingly.)

For diseases in the upper part, select points in the lower part; for diseases in the lower part, select points in the upper part; for diseases in the head, select points on the feet; for diseases in the waist, select the acupoint. (This is the distal selection method. If a disease is in the upper part but its pulse connects to the lower part, select from the lower part. If a disease is in the lower part but its pulse connects to the upper part, select from the upper part. Hence, for head diseases, select foot points; for waist diseases, select points. By clearing the source, the flow naturally unblocks; thus, all meridians have distinctions of Jing-River, Ying-Spring, Shu-Stream, Yuan-Source, Jing-River, and He-Sea points.) Diseases originating in the head cause heaviness in the head; those originating in the arms cause heaviness in the arms; those originating in the feet cause heaviness in the feet. To treat disease, first needle the site from which the disease originated. (First needle the origin, seeking the root cause.)

Painful conditions belong to Yin. (Same chapter. Generally, painful conditions arise from Cold pathogenic factors stagnating and rebelling in the meridians, or residing deeply between sinews and bones, condensing without dispersing; thus, painful conditions are Yin.) Pain that cannot be located by palpation belongs to Yin; needle deeply. (Inability to locate by palpation indicates the pathogen is hidden deep; this is Yin-Evil, so deep needling is appropriate. Conversely, superficial pain likely involves Yang-Evil, though most pains are Yin.) Diseases in the upper part belong to Yang; diseases in the lower part belong to Yin. Itching belongs to Yang; needle shallowly. (Yang governs ascending, so upper parts are Yang. Yin governs descending, so lower parts are Yin. Itching scatters and moves in the skin and interstices, thus belonging to Yang. All Yang diseases should be needled shallowly. Lower part diseases should naturally be needled deeply.) If a disease originates in the Yin first, treat the Yin before treating the Yang; if a disease originates in the Yang first, treat the Yang before treating the Yin. (This defines Yin and Yang based on meridian locations. Diseases in Yin or Yang have onset sequences. The first onset is the Root (Ben); the subsequent onset is the Branch (Biao). Treatment must address the Root first, consistent with the previous statement about first needling the origin of the disease.)