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(From the *Ling Shu: Jing Jin Chapter*. This chapter originates from the same source as Chapter 4 of the Meridians category; their principles are interconnected and should be read in conjunction.)

When the sinews of the Foot-Taiyang channel are diseased, there is discomfort supporting the little toe, swelling and pain at the heel, and spasms. (The sinews originate from the little toe, converge above the calcaneus, follow the heel to converge at the popliteal fossa. 'Guo' sounds like 'guo'.) The spine may arch backward, the neck sinews become tense, the shoulder cannot be lifted, there is discomfort in the axilla, twisting pain in the supraclavicular fossa, and inability to turn the head left or right. (Its branch converges above the buttock, runs along the spine to the neck; its collateral converges at Jianyu (LI15), enters the axilla, and emerges superiorly at the supraclavicular fossa, hence these symptoms. 'Niu' sounds like 'niu', phonetic ni-jiu.) Treatment involves burning needle rapid puncture (Fanzhen Jiesi), using the improvement of condition as the criterion for stopping, and using the painful point as the acupoint. (Burning needle refers to a heated needle. Rapid puncture implies dispersing cold pathogens by leveraging the heat. The principle of burning needle acupuncture is detailed in Part 20 of this category earlier. Using improvement as the criterion means stopping when Qi arrives. Using the painful point as the acupoint means selecting the tender spot as the point. The following follows this rule. 'Fan' sounds like 'fan'.) This is called Zhongchun Bi (Mid-Spring Obstruction). (Zhongchun Bi corresponds to the Qi of the second lunar month associated with the Foot-Taiyang channel. This aligns with the principle in the *Yin Yang Xi Ri Yue* chapter, though that chapter distinguishes the twelve channels by left and right feet corresponding to the twelve months, whereas this chapter assigns them by hand and foot channels, likely to distinguish the meaning of Yin-Yang excess and deficiency. See Meridians Category 34. Also, the diagram of Hand and Foot Yin-Yang corresponding to twelve months is in Volume 4 of *Tu Yi*. The rest follows similarly.)

When the sinews of the Foot-Shaoyang channel are diseased, there is discomfort and spasms in the little toe and second toe, leading to spasms on the lateral side of the knee, with the knee unable to flex or extend, and tension in the popliteal region. (The sinews of Foot-Shaoyang originate from the little and second toes, ascend along the lateral aspect of the lower leg, and converge at the lateral aspect of the knee.) Anteriorly, they pull the thigh; posteriorly, they pull the sacrum. If they ascend to reach the costal margin, there is pain in the hypochondrium. (The branch ascends to the thigh; the anterior part converges at Futu (ST37), the posterior part at the sacrum; the straight portion ascends to the costal margin.) Superiorly, they pull the supraclavicular fossa, chest, breast, and neck, causing tension in the Weijin sinews. (The straight portion connects to the chest and breast, converges at the supraclavicular fossa, and ascends behind the ear. 'Wei' refers to tethering/holding. When pathology moves from left to right, the right eye fails to open; passing over the right frontal angle, it travels alongside the Qiao meridians, with the left collateral connecting to the right. (Left-to-right pathology causes right eye closure, indicating right-sided disease originating from the left. Thus, left eye closure indicates right-sided origin. 'Jiao' refers to the frontal angle. Traveling with Qiao meridians refers to the intersection of Yin-Qiao and Yang-Qiao; Yang enters Yin, Yin exits Yang, intersecting at the outer canthus, hence left connects to right.) Therefore, injury to the left frontal angle renders the right foot useless; this is called Weijin Xiangjiao (Crossed Connection of Tethering Sinews). (Injury to the sinews of the left frontal angle causes right foot dysfunction; conversely, right-to-left pathology behaves similarly, due to such crossed interconnection of sinew tethers.) Treatment involves burning needle rapid puncture, using improvement as the criterion, and the painful point as the acupoint. (Principle as before.) This is called Mengchun Bi (Early Spring Obstruction). (Foot-Shaoyang is the channel of generating Yang, thus corresponding to the first lunar month. Detailed principle as before.)

When the sinews of the Foot-Yangming channel are diseased, there is discomfort in the middle toe, spasms in the lower leg, jumping and hardness of the foot. (The sinews of this channel originate from the middle toe, converge on the dorsum of the foot; pathogenic factors ascend externally, add to the fibula, and converge at the lateral knee; the straight portion ascends along Futu, converging at the knee. 'Tiao' means jumping; 'Jian' means hard.) Spasms at Futu, swelling anterior to the thigh, hernia, and abdominal tendon tension. (The straight portion ascends along Futu to converge at the thigh, gathers at the genitalia, and distributes upward to the abdomen. (' ', ' ' are identical.) They pull the supraclavicular fossa and cheek, causing sudden facial deviation. In cases of tension, the eyes cannot close; in heat conditions, sinews relax and eyes cannot open. Cold in the cheek sinews causes tension, pulling the cheek and shifting the mouth; heat causes sinew relaxation and flaccidity, leading to inability to control and resulting in deviation. ('Pi' means deviation. The sinews go from the supraclavicular fossa up the neck and cheek, surrounding the mouth, and converge with the Taiyang channel. Taiyang is the upper net of the eye, Yangming is the lower net. Thus, any inability to close/open eyes, or tension/flaccidity/deviation of the mouth, are diseases of Foot-Yangming sinews: cold causes tension, heat causes relaxation.) Treatment uses horse fat (Magao) to apply to the tense side, and white wine mixed with Cinnamon Twig (Guizhi) applied to the flaccid side. Use a mulberry wood hook to correct the position, place raw mulberry charcoal in a pit, adjust height to match sitting posture, apply the ointment to warm the tense cheek, drink fine wine, eat roasted meat. Those who do not drink alcohol should force themselves to do so. Perform three massages. (Horse fat is soft and moist, nourishing sinews and treating Bi, hence used for the tense side. White wine and Cinnamon Twig are pungent and warm, unblocking meridians and promoting blood circulation, hence used for the flaccid side. Mulberry is neutral, benefiting joints and removing wind-cold-dampness Bi pain, hence the hook straightens the mouth. Raw mulberry charcoal in a pit provides warmth suitable for sitting. Applying the ointment warms the tense cheek. Drinking wine and eating meat aids blood and relaxes sinews. Even if one cannot drink, one should try. 'San fu yi er' means massaging the affected area repeatedly until the disease resolves. 'Dan' sounds like 'dan'. 'Fu' sounds like 'fu'.) Treatment also involves burning needle rapid puncture, using improvement as the criterion, and the painful point as the acupoint. This is called Jichun Bi (Late Spring Obstruction). (Foot-Yangming is the channel of abundant Qi, corresponding to the third lunar month. Rest as before.)

When the sinews of the Foot-Taiyin channel are diseased, there is discomfort in the big toe, pain at the medial malleolus, and painful spasms. (The sinews of Foot-Taiyin originate from the tip of the big toe and ascend to converge at the medial malleolus.) Pain at the medial condyle of the knee, pain radiating from the medial thigh to the hip, twisting pain in the genitalia, downward traction to the umbilicus and bilateral hypochondrium, and pain in the chest and inner spine. (The straight portion networks at the medial knee condyle, ascends the medial thigh, converges at the hip, gathers at the genitalia, ascends to the umbilical/abdominal/chest/hypochondriac regions, and the internal part attaches to the spine.) Treatment involves burning needle rapid puncture, using improvement as the criterion, and the painful point as the acupoint. This is called Mengqiu Bi (Early Autumn Obstruction). ('Mengqiu' should be 'Zhongqiu'; there is an error here and in the subsequent Foot-Shaoyin section, which should be swapped. Foot-Taiyin corresponds to the eighth lunar month.)

When the sinews of the Foot-Shaoyin channel are diseased, there are spasms in the sole of the foot, and pain with spasms at all points where the sinews pass and converge. (Foot-Shaoyin sinews originate below the little toe, hence spasms in the sole. The passing/converging points involve running obliquely below the medial malleolus with Foot-Taiyin sinews, converging at the heel, combining with Taiyang sinews, ascending to converge below the medial knee condyle, then running up the medial thigh with Taiyin sinews to converge at the genitalia, all capable of causing pain and spasms.) Diseases here primarily manifest as epilepsy, convulsions, and stiffness. (Epilepsy refers to Dianxian. 'Yuan' refers to pulling/tension. 'Jing' refers to severe rigidity and opisthotonos, worse than Yuan. Foot-Shaoyin is the channel of Heavenly Water; injury to True Yin causes these diseases. 'Yuan' sounds like 'chi'. 'Jing' sounds like 'jing'.) On the exterior, one cannot bend forward; on the interior, one cannot lean back. Thus, Yang disease patients exhibit opisthotonos and cannot bend; Yin disease patients cannot lean back. (Exterior combines with Taiyang sinews, hence cannot bend. Interior runs along the spine inside the paraspinal muscles to the neck, hence cannot lean back. Yang disease refers to exterior involvement. Yin disease refers to interior involvement. 'Fu' is synonymous with 'bend'.) Treatment involves burning needle rapid puncture, using improvement as the criterion, and the painful point as the acupoint. (Principle as before; this treats the exterior.) For interior involvement, use warming moxibustion/fomentation to guide Qi and administer herbs. If the sinews undergo severe twisting, and frequent/severe episodes occur, death is inevitable and untreatable. (Warming/guiding relaxes sinews; herbs nourish blood. 'Zhe Niu' refers to severe spasms. Frequent and worsening episodes indicate extreme Yin deficiency, hence fatal and untreatable.) This is called Zhongqiu Bi (Mid-Autumn Obstruction). ('Zhongqiu' is an error; it should be 'Mengqiu', as Foot-Shaoyin is the channel of generating Yin, corresponding to the seventh lunar month. Principle detailed under Taiyin/Taiyang sections earlier.)

When the sinews of the Foot-Jueyin channel are diseased, there is discomfort in the big toe, pain anterior to the medial malleolus, pain at the medial condyle, and pain with spasms in the medial thigh. (Foot-Jueyin sinews originate above the big toe, converge anterior to the medial malleolus, converge below the medial knee condyle, and ascend the medial thigh.) Genital dysfunction: injury internally leads to impotence; injury to cold causes retraction of the penis; injury to heat causes flaccidity and prolapse without retraction. (Genitalia refer to the external organs; Jueyin sinews converge here. Diseases of the genitalia present with these three variations.) Treatment focuses on circulating water and clearing Yin Qi. ('Qing' means regulate. This implies herbal treatment to promote water organ function and regulate Yin Qi, as Water is the mother of Liver.) If spasms occur, treatment involves burning needle rapid puncture, using improvement as the criterion, and the painful point as the acupoint. (For spasms, treatment should target the meridian.) This is called Jiqiu Bi (Late Autumn Obstruction). (Foot-Jueyin is the end of Yin, thus corresponding to the ninth lunar month.)

When the sinews of the Hand-Taiyang channel are diseased, there is discomfort in the little finger, pain behind the sharp bone of the medial elbow, pain entering the axilla along the back's interior, axillary pain, pain at the posterior axillary fold, pain wrapping around the scapula and pulling the neck, tinnitus/pain in the ear pulling to the mandible, and prolonged eye closure before vision returns. (Hand-Taiyang sinews originate from the little finger, converge at the wrist, behind the medial elbow sharp bone, at the axilla, shoulder, neck, behind the ear, mandible, and connect to the outer canthus. Hence pain pulls to ear/mandible, requiring prolonged eye closure to see. 'Han' sounds like 'han', phonetic he-gan.) Neck sinew tension leads to neck masses (Jing Lei), and neck cold-heat syndromes are treated with burning needle rapid puncture, using improvement as the criterion, and the painful point as the acupoint. (Neck masses refer to types of Scrofula. 'Lou' sounds like 'lou'.) If swelling persists, repeat puncture with a sharp needle. (If swelling does not recede after initial puncture, puncture again using a sharp needle, i.e., Feng Zhen.) The main branch ascends to Quya, follows the front of the ear, connects to the outer canthus, and converges at the frontal angle. Pain occurs with spasms at all passing points. (Main branch is the straight branch. 'Jiao' is the upper ear angle. All passing points can cause spasms and pain.) Treatment involves burning needle rapid puncture, using improvement as the criterion, and the painful point as the acupoint. (Principle as before.) This is called Zhongxia Bi (Mid-Summer Obstruction). (Hand-Taiyang corresponds to the fifth lunar month.)

When the sinews of the Hand-Shaoyang channel are diseased, spasms and pain occur at all passing points, and the tongue curls. (Hand-Shaoyang sinews originate from the tips of the little and second fingers, converge at the wrist, ascend the arm to converge at the elbow, wrap around the lateral elbow to the shoulder and neck. Their branch enters the jaw and ties to the root of the tongue. Hence, passing points cause spasms and pain.) Treatment involves burning needle rapid puncture, using improvement as the criterion, and the painful point as the acupoint. (Principle as before.) This is called Jixia Bi (Late Summer Obstruction). (Hand-Shaoyang corresponds to the sixth lunar month.)

When the sinews of the Hand-Yangming channel are diseased, support pain and spasms occur at all passing points, the shoulder cannot be lifted, and the neck cannot turn left or right. (Hand-Yangming sinews originate from the tips of the thumb and index finger, converge at the wrist, ascend to converge at the lateral elbow, and at the shoulder peak. Their branch wraps the scapula and clamps the spine; the straight portion goes from the shoulder to the neck. Another branch ascends to the cheek and converges at the zygoma; another straight portion goes to the left frontal angle, networks the head, and descends to the right mandible. Hence, passing points cause support pain and spasms.) Treatment involves burning needle rapid puncture, using improvement as the criterion, and the painful point as the acupoint. This is called Mengxia Bi (Early Summer Obstruction). (Hand-Yangming is the channel of combined Yang brightness, thus corresponding to the fourth lunar month.)

When the sinews of the Hand-Taiyin channel are diseased, support spasms and pain occur at all passing points; severely, this forms Xiben (Breathful Accumulation), with tight hypochondrium and hemoptysis. (Hand-Taiyin sinews originate from the thumb, ascend along the finger to converge behind the Thenar eminence, ascend the arm into the elbow, along the medial arm into the axilla, emerge at the supraclavicular fossa, converge at the anterior shoulder, ascend to the supraclavicular fossa, descend to converge in the chest interior, disperse through the diaphragm/cardiac region, merge below the diaphragm, reach the costal margin. Hence, passing points cause spasms/pain, and severe disease manifests as described.) Treatment involves burning needle rapid puncture, using improvement as the criterion, and the painful point as the acupoint. This is called Zhongdong Bi (Mid-Winter Obstruction). (Hand-Taiyin corresponds to the eleventh lunar month.)

When the sinews of the Hand-Zhongying (Pericardium) channel are diseased, support spasms occur at all passing points, extending anteriorly to chest pain and Xiben. (Hand-Jueyin sinews originate from the middle finger, converge at the medial elbow, ascend the medial arm, converge at the axilla, disperse anteriorly/posteriorly clamping the ribs. Their branch enters the axilla, disperses in the chest, converges at the diaphragm/cardiac region. Hence, passing points cause such diseases.) Treatment involves burning needle rapid puncture, using improvement as the criterion, and the painful point as the acupoint. This is called Mengdong Bi (Early Winter Obstruction). (Hand-Jueyin is the end of combined Yin, thus corresponding to the tenth lunar month.)

When the sinews of the Hand-Shaoyin channel are diseased, there is internal tension, Heart Fu Liang (substantial accumulation under the heart), and an elbow net-like tension below. Diseases at passing points include support spasms and sinew pain. ('Cheng' means supported below. 'Fu Liang' is a firm, hidden accumulation. 'Wang' is like a net's tension. Hand-Shaoyin sinews originate from the medial little finger, converge at the sharp bone, ascend to the medial elbow, enter the axilla, clamp the breast interior, converge in the chest, and descend to tie to the umbilicus. Hence, internally they cause internal tension and Fu Liang; externally they form the elbow net; at passing points they cause spasms/pain.) Treatment involves burning needle rapid puncture, using improvement as the criterion, and the painful point as the acupoint. (Principle as before.) If Fu Liang forms with expectoration of blood and pus, death is inevitable and untreatable. (Fu Liang exists above and below the umbilicus. If Fu Liang is established with bloody/purulent sputum, the disease is severe and visceral damage is critical, hence fatal and untreatable.) This is called Jidong Bi (Late Winter Obstruction). (Hand-Shaoyin corresponds to the twelfth lunar month. This section was previously misplaced after the non-burning needle section; it has been corrected here.)

Diseases of the Jing Jin (Sinew Channels): Cold causes reverse bending and sinew tension; heat causes sinew flaccidity and inability to retract, leading to impotence and dysfunction. Yang-side tension causes reverse bending; Yin-side tension causes inability to extend while bending. (The following summarizes sinew diseases. Yang/Yin tension refers to Foot-Taiyang and Foot-Taiyin, both affecting the back. Yang tension is exterior, causing opisthotonos; Yin tension is interior, causing inability to bend forward.) Burning needles treat cold-induced tension. Heat causes flaccidity; burning needles should not be used. (Most Bi diseases of sinews are cold-related, hence previous treatments specified burning needles. However, heat-induced cases require avoiding heat and not using burning needles; verification lies in whether sinews are tense or flaccid. Foot-Yangming and Hand-Taiyang sinew tension causes facial deviation and inability to see suddenly; treatment follows the methods above. ('Pi' is synonymous with 'deviation'.))