Library

(The full texts of *Suwen: Discourse on the Essentials of Needling* and *Discourse on the Levels of Needling*)

The Yellow Emperor asked, "I wish to hear about the essentials of needling."

Qibo replied, "Diseases manifest at different depths, superficial or deep; accordingly, needling must be performed at corresponding shallow or deep levels. Each treatment must reach its proper depth without exceeding the prescribed limits. (Failing to needle shallowly when required, or deeply when required, constitutes an excess beyond the limit.) If needling is too deep, it causes internal injury; if too shallow, it leads to external stagnation. Stagnation allows pathogenic factors to invade. (Needling too deeply damages the interior Qi, while needling too superficially causes Qi to stagnate externally, resulting in swelling and allowing pathogens to follow.) Improper depth becomes a great harm, disturbing the Five Zang organs and subsequently giving rise to severe diseases. ('Zei' means harm. 'Dong' means disturbance or injury. 'Subsequently giving rise to severe diseases' is detailed below.) Therefore, disease may reside in the hair follicles and interstices, in the skin, in the muscles, in the vessels, in the sinews, in the bones, or in the marrow. (This elaborates on the varying depths of internal and external lesions, indicating that practitioners must select appropriate needling depths based on the condition.)

Thus, when needling the hair follicles and interstices, do not injure the skin. Injury to the skin disturbs the Lung internally; disturbance of the Lung leads to warm malaria in autumn, characterized by shivering and chills. (Needling the hair follicles and interstices is the most superficial level. The skin is slightly deeper. The skin corresponds to the Lung; injury to the skin disturbs the Lung internally. The Lung corresponds to autumn, hence warm malaria occurs in autumn with shivering chills. 'Su' is pronounced 'su'.) When needling the skin, do not injure the flesh. Injury to the flesh disturbs the Spleen internally; disturbance of the Spleen leads to abdominal distension, irritability, and loss of appetite during the eighteen days at the end of each of the four seasons, totaling seventy-two days. (Skin is exterior, flesh is interior. Flesh corresponds to the Spleen; injury to the flesh disturbs the Spleen internally. Earth of the Spleen reigns for eighteen days at the end of each season, totaling seventy-two days. Once Spleen Qi is injured and cannot transform and transport, symptoms of distension, irritability, and aversion to food occur during the Chen, Xu, Chou, and Wei months.) When needling the flesh, do not injure the vessels. Injury to the vessels disturbs the Heart internally; disturbance of the Heart leads to heart pain in summer. (Vessels lie within the flesh and correspond to the Heart; injury to the vessels disturbs the Heart internally. The Heart reigns in summer; external qi injury leads to heart pain in summer.) When needling the vessels, do not injure the sinews. Injury to the sinews disturbs the Liver internally; disturbance of the Liver leads to heat syndromes and flaccid sinews in spring. (Vessels are not sinews. Sinews correspond to the Liver and reign in spring. Injury to sinews disturbs Liver Qi, leading to heat syndromes during the spring yang rising phase. Heat causes sinew relaxation, termed flaccidity. 'Chi' has the same meaning.) When needling the sinews, do not injure the bones. Injury to the bones disturbs the Kidney internally; disturbance of the Kidney leads to abdominal distension and lower back pain in winter. (Sinews are exterior, bones are interior. Bones correspond to the Kidney and reign in winter. Injury to bones disturbs the Kidney internally, leading to distension and lower back pain in winter, as the root Yuan Qi is injured and the waist is the mansion of the Kidney.) When needling the bones, do not injure the marrow. Injury to the marrow leads to emaciation, wasting, soreness, and a sense of bodily slackness and weakness, making movement difficult. (Marrows fill the bones and belong to the essence category, being the deepest level. Injury to essence and marrow leads to dryness, wasting, and soreness. 'Xie Xie' describes a state of slackness and weakness, indicative of Yin deficiency. Yin deficiency leads to Qi deficiency; Qi deficiency prevents movement, which is termed 'bu qu'. Note: As stated in *Hai Lun*, insufficiency of the Sea of Marrow presents with similar symptoms; see Meridian and Collateral Category 32. 'Shuo' is pronounced 'shi zhuo qie'. 'Xie' is pronounced 'hang'. 'Xie' is pronounced 'ji'.)

The Yellow Emperor asked, "I wish to hear about the specific distinctions in needling depth."

(The full text of *Suwen: Discourse on the Levels of Needling*.) Qibo replied, "When needling the bones, do not injure the sinews; when needling the sinews, do not injure the flesh; when needling the flesh, do not injure the vessels; when needling the vessels, do not injure the skin; when needling the skin, do not injure the flesh; when needling the flesh, do not injure the sinews; when needling the sinews, do not injure the bones. (The first four sentences advise against shallow needling when deep needling is indicated; the last three advise against deep needling when shallow needling is indicated. The meaning follows below.)"

The Emperor said, "I do not understand what you mean; I wish to hear your explanation."

Qibo said, "'Needling the bones without injuring the sinews' means the needle reaches the sinew layer and stops, failing to reach the bone. (For disease in the bone, one should needle directly into the bone without injuring the sinews; if the needle only reaches the sinew layer to extract Qi and then withdraws without reaching the bone, the disease is not in the Liver, and the attack is misplaced, thus injuring the sinews.)

"'Needling the sinews without injuring the flesh' means the needle reaches the flesh layer and stops, failing to reach the sinew. (For disease in the sinew, one should needle directly into the sinew; if the needle only reaches the flesh layer and withdraws without reaching the sinew, the disease is not in the Spleen, thus injuring the flesh.)

"'Needling the flesh without injuring the vessels' means the needle reaches the vessel layer and stops, failing to reach the flesh. (For disease in the flesh, one should needle directly into the flesh; if the needle only reaches the vessel layer and withdraws without reaching the flesh, the disease is not in the Heart, thus injuring the vessels.)

"'Needling the vessels without injuring the skin' means the needle reaches the skin layer and stops, failing to reach the vessel. (For disease in the vessel, one should needle directly into the vessel; if the needle only reaches the skin layer and withdraws without reaching the vessel, the disease is not in the Lung, thus injuring the skin. The above four sections describe the harm of failing to needle deeply when required.)

"'Needling the skin without injuring the flesh' refers to disease located in the skin; the needle enters the skin without injuring the flesh. (Needling the skin too deeply and hitting the flesh injures Spleen Qi.)

"'Needling the flesh without injuring the sinews' refers to over-penetrating the flesh to hit the sinew. (Needling the flesh too deeply and hitting the sinew attacks Liver Qi.)

"'Needling the sinews without injuring the bones' refers to over-penetrating the sinew to hit the bone. This is called 'reversal'. (Needling the sinew too deeply and hitting the bone injures Kidney Qi. The above three sections describe the harm of needling too deeply when not indicated, all of which are termed 'reversal'.)"