Library

Heaven One generates Water, Earth Six completes it. Earth Two generates Fire, Heaven Seven completes it. Heaven Three generates Wood, Earth Eight completes it. Earth Four generates Metal, Heaven Nine completes it. Heaven Five generates Earth, Earth Ten completes it.

Question: There are the Eight Extraordinary Vessels among the meridians.
The Nan Jing (Classic of Difficult Issues) states: "There are the Eight Extraordinary Vessels among the pulses, which are not restricted to the Twelve Regular Meridians." What does this mean? The answer is: There are the Yang Linking Vessel (Yangwei Mai), Yin Linking Vessel (Yinwei Mai), Yang Heel Vessel (Yangqiao Mai), Yin Heel Vessel (Yinqiao Mai), Chong Vessel (Chong Mai), Ren Vessel (Ren Mai), Du Vessel (Du Mai), and Dai Vessel (Dai Mai). These eight vessels are all unrestricted by the regular meridians, hence they are called the Eight Extraordinary Vessels. There are twelve regular meridians and fifteen collaterals, totaling twenty-seven, with Qi following each other up and down. Why are these specifically unrestricted by the regular meridians? The answer is: The sages planned and dug canals to facilitate water flow, preparing for unforeseen circumstances. When rain falls from heaven and the canals overflow, at that time, the waters flood wildly, and even the sages cannot redraw the plans. This is like the collaterals becoming full and overflowing; the various regular meridians can no longer restrain them.

Question: The method of Following and Opposing (Yingsui).
The Classic states: "Following and assisting is tonification; opposing and draining is sedation." When performing acupuncture, one should first warm the needle with a leather pad, then further warm it with the mouth. Using the left hand's fingernail, press upon the Ying-Spring or Shu-Stream acupoint to be needled, flick it to make it bulge, cut into it with the nail, then palpate and stroke along the meridian to unblock and obtain the point. Ask the patient to cough once, then insert the needle with the right hand. In spring and summer, perform twenty-four breaths (Xi), inserting deeply first and shallowly later (the reason for depth variation is noted in the commentary of Biao You Fu); in autumn and winter, perform thirty-six breaths, inserting shallowly first and deeply later. Insert slowly until the arrival of Deqi feels like a pulsating artery, with the needle feeling light and smooth under the skin. If Deqi has not arrived, it is like a fish that has not yet swallowed the hook; once the fish has swallowed and Deqi is obtained, apply tonification or sedation. For tonification, follow the direction of the meridian, push and press the needle inward, leave it stationary for a period, slightly longer. To withdraw, close the acupoint with the left hand, withdraw the needle slowly, and press quickly. For sedation, oppose the direction of the meridian, lift and extend the needle, leave it stationary for a while. To withdraw, open the acupoint with the left hand, withdraw the needle quickly, and press slowly. For tonification needles, rotate left and thrust the thumb outward; for sedation needles, rotate right and retract the thumb. Tonification follows exhalation then inhalation; sedation follows inhalation then exhalation. Pain indicates the need for sedation; itching and numbness indicate the need for tonification.

Question: The essential method for tonification needles.
The answer is: For the method of tonification needles, use the left hand to firmly press the cross-grain lines of the acupoint. Hold the needle with the right hand above the point. Ask the patient to cough once, and advance the needle with the cough. Take a long exhalation and insert the needle three fen into the skin. For needling hand meridians, emulate spring and summer by pausing for twenty-four breaths. For foot meridians, emulate autumn and winter by pausing for thirty-six breaths. When promoting Qi, if the needle feels heavy and tight, perform the number of Nine Yang: twist nine times and jerk nine times, termed "Heavenly Talent" (Tian Cai). Pause briefly, exhale twice, and slowly insert another three fen into the muscle. When the breath count is sufficient and the needle feels heavy and tight again, perform the generating numbers, termed "Human Talent" (Ren Cai). Pause briefly, exhale three times, and slowly insert another three fen between the sinew and bone. When the breath count is sufficient and the needle feels heavy and slippery again, perform the generating numbers, termed "Earthly Talent" (Di Cai). Advance the needle by the distance of a bean, called "Pressing" (An), which is intercepting and following. This is the extreme depth. Leave it still for a long time, then withdraw the needle to the Human level (Ren Bu). Wait until the Qi feels heavy and tight again, turn the needle head towards the disease site. When the patient feels heat under the needle, and the deficiency, emaciation, itching, and numbness dissipate, and the pathogenic trend recedes, after the needle feels slightly heavy under the skin, turn the needle head upward, advance it by a bean's distance, move and pause it, and remove it during inhalation. Withdraw slowly and insert slowly, and quickly cover the acupoint. Qibo said: "Insertion of the needle should be slow; too fast injures Blood. Withdrawal should be slow; too fast injures Qi." This precisely means that the needle does not injure Ying and Wei. Thus, advancing and retreating, flying through meridians and moving Qi, are all contained herein.

Question: The essential method for sedation needles.
For the method of sedation needles, use the left hand to firmly press the longitudinal grain lines three times. Hold the needle with the right hand above the point. Ask the patient to cough once, and advance the needle with the cough. Insert three fen, reaching the Heaven level (Tian Bu). Pause briefly and insert straight to the Earth level (Di Bu). Retract the needle by a bean's distance. When Deqi feels heavy and tight,搓 (rub) and twist without movement. When the breath count is complete, perform the number of Six Yin: twist six times and jerk six times. Inhale three times to draw back the needle, withdrawing to the Human level (Ren Bu), termed "Earthly Talent" (Di Cai). Wait again until Qi arrives and the needle feels heavy. When the breath count is sufficient, perform the completing numbers. Inhale twice to draw back the needle, withdrawing to the Heaven level (Tian Bu), termed "Human Talent" (Ren Cai). Wait again until Qi arrives and the needle feels heavy. When the breath count is sufficient, perform the completing numbers. Inhale to draw back the needle, withdrawing to the skin layer, termed "Heavenly Talent" (Tian Cai). Retract the needle by a bean's distance, called "Lifting" (Ti), which is supporting and opposing. This is the extreme depth. Leave it still for a long time, then advance to the Human level. Wait until the needle feels heavy and tight and Qi arrives. Turn the needle head towards the disease site. When the patient feels cold under the needle, and cold, heat, pain, and itching recede, and the needle feels slightly loose, lift the needle by a bean's distance, shake and pause it, and remove it during exhalation. Insert quickly and withdraw slowly, leaving the acupoint open.

Question: Meridians and Collaterals.
The answer is: There are twelve meridians and fifteen collaterals, distributed over the whole body, serving as the pathways for Qi and Blood. Their source roots internally in the Kidney, which is the root of life. The root is internal but spreads externally, just as a tree has roots; if the roots are injured, the branches and leaves will also suffer. If pathogenic factors invade from outside and injure the branches and leaves, they will also affect the roots. If the disease originates internally, the situation is inevitable. Therefore, it is said that the pathways of the Zang organs all emerge from the meridians and collaterals to circulate Qi and Blood. The Jing are the regular meridians, and the Luo are the branch collaterals. When Qi and Blood are disharmonious, myriad diseases arise. If the Essence and Qi of one meridian are insufficient, disharmony occurs. Thus, the Classic states: "When pathogenic factors strike the Yang, they flow into the meridians. From the face and neck, they descend to the Yangming; from the nape and back, they descend to the Taiyang; from the cheeks and flanks, they descend to the Shaoyang." When pathogenic factors strike the Yin, they flow into the Fu organs. Starting from the four extremities and arms, they enter the Three Yin. Since the Zang Qi is solid and cannot accommodate them, they return to the Fu organs. Fu organs refer to the Gallbladder, Stomach, Bladder, Large Intestine, and Small Intestine. Therefore, needling has its specific pathways. Observe the pathogenic and healthy states, excess and deficiency under the needle to apply tonification and sedation. Follow the Ying and Wei of the meridians to apply Following and Opposing methods; these paths do not deviate. All internal and external diseases begin in the skin and blood vessels, transmit through the meridians, connect internally to the Zang and Fu organs, causing blockage in the four limbs and nine orifices. Internal causes lead to Qi excess or deficiency, connecting externally to the meridians, causing shifts in Ying and Wei, and generating excess and deficiency in the upper, lower, left, and right. The Classic says: "Wind and Cold injure the Form; Worry, Fear, Anger, and Resentment injure Qi. Qi injury affects the Zang, resulting in Zang disease. Cold injury affects the Form, resulting in Form disease. Wind injury affects the Sinews, resulting in Sinew disease." Thus, both Form and Qi possess Yin and Yang internally and externally: Bones and Sinews are Yin, Skin and Flesh are Yang. Internally: Zang organs are Yin, Fu organs are Yang.

Question: Zi-Wu Tonification and Sedation.
The answer is: This is a method to promote the circulation of Ying and Wei. Turning left follows Zi (Rat), enabling the circulation of Yang in the exterior; turning right follows Wu (Horse), enabling the circulation of Yin in the interior. In the human body, Yang Qi is received in the four extremities, and Yin Qi is received in the Zang organs; thus, it is Yang on the outside and Yin on the inside. Turning left from the outside resembles Heaven; turning right from the inside resembles Earth; lifting from the middle resembles Man. One left, one right, one lift, allows the Qi of Yin-Yang and interior-exterior to enter, exit, and interact with the upper and lower, so that Ying and Wei circulate freely. Men are born in Yin (Tiger)—Yin is Yang, governed by Yang. Therefore, turning left follows Yang for tonification, and turning right opposes Yang for sedation. Women are born in Shen (Monkey)—Shen is Yin, governed by Yin. Therefore, turning right follows Yin for tonification, and turning left opposes Yin for sedation. This is the standard method. However, diseases differ in Yin-Yang and Heat/Cold, so turning the needle, selecting points, and entering/exiting must be appropriate. For example, in Heat diseases, needle the Yang meridians, using right rotation for sedation and left for tonification; in Cold diseases, needle the Yin meridians, using right for tonification and left for sedation. This is using Yin to harmonize Yang, and Yang to harmonize Yin, a method of adaptation. Generally, the principles of reversing and following in needle rotation must be understood here.
Zi (He-Sea) Point: If the Chi pulse is full, tonify, following its entry. Wu (Ying-Spring) Point: If the Cun pulse is full, sedate, following its exit.

Question: How about needle-head tonification and sedation?
The answer is: This is the standard method of tonification and sedation. It lies not in respiration but in the fingers. At the time of needling, first press and hold the Ying-Spring or Shu-Stream point with the left hand, flick it to make it bulge, cut with the nail. When the Qi arrives, resembling a pulsating artery, insert the needle smoothly. Upon obtaining Deqi, push the needle inward; this is tonification. Move and extend the needle; this is sedation. Excess involves Qi entering; deficiency involves Qi exiting. Because Yang is generated externally, it enters; because Yin is generated internally, it exits. This is due to the different nature of Qi entering and exiting from Yin-Yang and Water-Fire. Careful observation is required.
Additionally, there is a method of guiding Qi for tonification needles. "Palpating and stroking" means stroking up and down along the needled meridian segment to soothe Qi and Blood, facilitating their movement. "Cutting and dispersing" means using the thumbnail to cut左右 (left and right) around the acupoint to open the interstices before needling. "Pushing and pressing" means twisting and holding the needle with the right finger so that nearby Qi is not lost, allowing distant Qi to arrive. "Flicking to make bulge" means flicking the needle with the fingernail to fill the vessel Qi, allowing it to travel swiftly to the disease site. "Cutting down with the nail" means using the left hand's nail to fix the acupoint, dispersing Qi to needle Ying, and dispersing Blood to needle Wei, ensuring precise placement. "Unblocking to obtain" means advancing, retreating, rotating, or pausing the needle to allow Qi and Blood to circulate and connect near and far, so the disease can be treated. "Externally closing the gate to calm the Spirit" means using the left finger to close the needle hole before withdrawing, preventing the leakage of Meridian Qi. Hence it is said: "One who knows needling trusts the left hand."

Question: How is the method of waiting for Qi?
The answer is: In needling, waiting for Qi is paramount. Use the left hand to close the acupoint gate. Keep the mind free from distraction, awaiting the Qi like a noble guest, lying in wait like a crossbow, and striking like releasing the trigger. If Qi does not arrive, or arrives slowly, then rotate the needle to elicit it. The method of rotating the needle: ask the patient to inhale, then rotate the needle left. If it does not arrive, lift and pull left and right. If it still does not arrive, use the method of "Male Inside, Female Outside": for males, lightly press the acupoint and guard it strictly without inserting; for females, press heavily and firmly reject without withdrawing. The reason is that holding the needle inside is Yin, holding it outside is Yang, and depths differ. Pressing with the left hand clarifies this. Only aim for obtaining Deqi. If it still does not arrive despite this, it is untreatable. If Qi arrives under the needle, observe whether it is pathogenic or healthy, and distinguish excess and deficiency. The Classic says: "Pathogenic Qi arrives tight and rapid; Grain Qi arrives slow and harmonious. If soft and deficient, it is deficiency; if firm and solid, it is excess." This is the secret.

Question: The principle of respiration.
The answer is: This is the method of harmonizing Yin and Yang. The Classic says: "Exhalation is due to Yang exiting; inhalation follows Yin entering." Although respiration divides Yin and Yang, it is actually one Qi as the substance. This Qi traverses the five Zang organs internally, follows the San Jiao externally, distributes throughout the body, circulates through meridians, and flows into acupoints. Depending on the square/circular nature of Form and Qi, its application differs. Thus, the entry and exit of the five Zang correspond to the four seasons. The ascending and descending of the San Jiao constitute Ying and Wei. The circulation of meridians conforms to heavenly measures. Therefore, respiration and entry/exit are the hub of creation and the key of the human body, essential for acupuncturists. Yang meridians are shallow in the meridians; Yin meridians are deep in the Zang organs. Tonification and sedation both utilize respiration for needle insertion and withdrawal. Exhalation releases Qi; inhalation admits Qi. For tonification, when Qi exits, insert the needle; when Qi enters, withdraw the needle. For sedation, when Qi enters, insert the needle; when Qi exits, withdraw the needle. Exhalation should not exceed three breaths, following the Yang of the San Jiao externally. Inhalation should not exceed five breaths, welcoming the Yin of the five Zang internally. Exhaling first then inhaling is Yin within Yang; inhaling first then exhaling is Yang within Yin. Apply these according to the pathogenic Qi, Yin-Yang, and Cold-Heat of the disease. This is the flexible method and must not be misused.
Three Yin Meridians: Inhale first, then exhale. Three Yang Meridians: Exhale first, then inhale.

Question: What is the principle of Following and Opposing?
The answer is: This is the mechanism of giving and taking under the needle.
First, know the circulation of Ying and Wei. The Yang meridians run outside the vessels; the Yang collaterals run inside the vessels; the Yin meridians run inside the vessels; the Yin collaterals run outside the vessels. Each has its depth. Establish the needle at one fen for Ying and two fen for Wei. Alternate pausing to await Qi. When Qi is just arriving, quickly withdraw and pull the needle; this is Opposing (Ying). When Qi has passed, then advance the needle to chase it; this is Following (Sui). Thus, the Ci Fa (Needling Method) states: "Move back and rest, oppose and drain with right rotation for cooling; push in and rub, follow and assist with left rotation for warming."
Second, know the direction of the meridians. The Three Yang of the Foot go from Head to Foot; the Three Yin of the Foot go from Foot to Abdomen; the Three Yin of the Hand go from Chest to Hand; the Three Yang of the Hand go from Hand to Head. Upon obtaining Deqi, oppose the direction of the meridian's origin with the needle head, move and extend it; this is Opposing. Follow the direction of the meridian's destination with the needle head, push and insert it; this is Following. Thus, the Classic states: "For excess, stop and cut off; for deficiency, guide and raise."
For all needling methods, first use the left hand to palpate the acupoint and press with nails to open and soothe Qi and Blood, then insert the needle. If bleeding is desired, do not press with nails. Hold the needle with the right hand above the acupoint. Ask the patient to cough once, flick the needle, alternating left and right, penetrating into the interstices. This is the odd division of the Yang level. The Ci Yao states: "One fen is Ying." It also states: "At the time of needling, focus on the suspended Yang, then use respiration, slowly pushing to the muscle and beyond. These two are the even division of the Yin level." The Ci Yao further states: "Two fen is Wei. At the time of needling, focus on the suspended Yang and the two Weis. Do not let your spirit wander; know the survival or death of the disease." Then fix the acupoint with the left hand, immovable like Earth; hold the needle with the right hand, moving like Heaven. If Qi is obtained, the left hand pressing the acupoint can weigh five liang or more. Concentrate with the right hand to twist the needle and perform tonification/sedation. Only when blood vessels lie horizontally at the Shu point, appearing clear and feeling hard upon palpation, should one needle the vessel. Follow its direction, avoid bleeding, and if the needle is withdrawn, press quickly. For shallow or deep needling, fear of the needle stops the procedure. For performing tonification/sedation and Grain Qi...

Question: The principle of Slow and Fast.
The answer is: This is the method of holding and inserting/withdrawing the needle. The Classic states: "For needling excess and deficiency, slow insertion and fast withdrawal results in Repletion (Shi); fast insertion and slow withdrawal results in Emptiness (Xu)." However, this Classic has two interpretations: "Slow insertion and fast withdrawal" means either slow insertion and fast withdrawal, or slow withdrawal and fast pressing. "Fast insertion and slow withdrawal" means either fast insertion and slow withdrawal, or fast withdrawal and slow pressing (both interpretations are valid). The terms "Fast" and "Slow" can mean either urgency/slowness or duration/shortness. For cases that are neither excess nor deficiency, the method of inserting and withdrawing the needle should be neither fast nor slow, balanced in the middle.

Question: Appropriateness of Tonification and Sedation.
The answer is: Broadly, tonification and sedation do not exceed three methods.
First, diagnose the movement and stillness of the pulse. If the pulse is tense, insert deeply and retain for a long time; if loose, insert shallowly and withdraw quickly; if large, slightly release Qi; if slippery, withdraw quickly and insert shallowly; if choppy, ensure you have the pulse, follow its direction, retain for a long time, first press and stroke, after withdrawing press the acupoint quickly, do not bleed; if small, administer medicine.
Second, follow the Cold and Heat of the disease. For chills, first allow Yang Qi to enter the Yin portion, then rotate the needle back to the Yang portion. Ask the patient to inhale through the nose and exhale through the mouth. Strictly adhere to the generating/completing breath counts. When Yin Qi arrives abundantly, the needle feels cold, and the patient feels cool. For diseases far away, first guide Qi directly to the disease site. For Cold, advance the needle slightly; for Heat, withdraw the needle slightly, then treat using the generating/completing breath counts.
Third, follow the Excess and Deficiency diagnosed. Fat and thin bodies, pain, numbness, and itching, fluctuating severity of disease, firm and soft sensations under the acupoint—all are diagnoses of excess and deficiency. At the disease site, use other methods to obtain Qi: turning the needle up makes Qi rise; down makes Qi descend; left makes Qi go left; right makes Qi go right. Slowly pushing the needle makes Qi go forward; slightly pulling the needle makes Qi come. As stated, "Pushing advances, pulling stops, slowly going and slightly coming eliminates it." All these aim to attack pathogenic Qi.

Question: Selecting the Self Meridian.
The answer is: For needling deficiency and excess, use Following and Opposing, tonify the Mother, and sedate the Child. If neither deficient nor excess, select the Self Meridian, meaning the regular meridian itself has contracted the disease without invasion from other pathogens, hence selecting its own meridian. The method: Concentrate with the right hand holding the needle, use the left hand to await Qi in the acupoint. If Qi arrives like a pulsating artery, insert the needle, entering continuously and slowly bumping, entering Ying and reaching Wei. When Deqi feels like a tuna swallowing a hook, this is the Qi of the disease. Then, according to the amount of Qi and Blood in the original meridian, measure and select. Wait briefly, and when Qi is exhausted, withdraw the needle. If not exhausted, retain the needle at the gate, then withdraw.
The Classic says: "Enter when seen, exit when seen," this is what is meant.

Question: Tonification takes Qi from Wei, Sedation places Qi in Ying?
The answer is: The twelve meridians all take Ying as the root and Wei as the branches. To treat meridians, one must regulate Ying and Wei. To regulate Ying and Wei, one must rely on respiration. The Classic states: "Wei is Yang, Ying is Yin. Exhalation is Yang, Inhalation is Yin." Withdrawing the needle completely, leaving it still for a long time until Qi arrives, is taking Qi from Wei. Inserting the needle during inhalation until Deqi is obtained, is placing Qi in Ying.

Question: Diseases of Skin, Flesh, Sinew, Bone, and Vessel.
The answer is: The origins of all diseases begin in Ying and Wei, then spread to skin, flesh, sinew, and vessels. Thus, the Classic states: "Is Dong (Moving) refers to Qi. Suo Sheng Bing (Diseases Produced) refers to Blood. First comes Is Dong, then comes Suo Sheng Bing." From this, we know that diseases of skin, flesh, and vessels are also later-produced diseases. Therefore, in needling methods, only Ying and Wei are mentioned, implying that by understanding the reversal and following of Ying and Wei, the treatment of skin, flesh, bone, and sinew is included. Considering this, although parts have different depths, the妙 (wonder) lies in needling without excess or deficiency.
One is Skin, two is Muscle, three is Sinew and Bone.

Question: Duration and Speed of Needling.
The answer is: This is performed according to the severity of the disease. For mild cases, one tonification and one sedation suffice; for severe cases, repeat two or three times. If after tonifying and sedating the pathogenic Qi, the disease is not fully resolved, retain the needle, await Qi to arrive again, and perform tonification/sedation again. The Classic states: "Needling deficiency requires achieving Repletion; needling excess requires achieving Emptiness."

Question: Similarities and Differences in Needling Depths Among Various Schools.
The answer is: The Ling Shu states: "First needle shallowly to expel pathogenic Qi and attract Blood and Qi (meaning piercing the skin to expel Yang pathogenic factors). Then needle deeply to attract Yin pathogenic Qi (meaning few Yin pathogenic factors exit; pierce deeper through the skin, reaching the muscle but not entering the space between muscles). Finally, needle extremely deeply to bring out Grain Qi (meaning having entered the space between muscles, Grain Qi emerges)." This is its purport. I read the Nan Jing and often see the commentary by Acupuncturist Ding Deyong, who states that human muscles have varying thicknesses. Above the skin is the region of Heart and Lung, where Yang Qi travels; below the muscle is the region of Liver and Kidney, where Yin Qi travels. This explanation elaborates on the purport of the Ling Shu and is very detailed. As for Sun Simiao's Qian Jin Fang stating: "Needle insertion one..."