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Lei Gong asked: Regarding the teachings on prohibited pulse points, the principle of acupuncture generally begins with the meridians. I wish to hear the rationale behind this? The Yellow Emperor replied: The meridians are essential for determining life and death, managing all diseases, and regulating deficiency and excess; they must not be left ununderstood.

The Lung Meridian of Hand-Taiyin originates in the middle jiao (middle burner), descends to connect with the Large Intestine, returns along the upper opening of the stomach, passes through the diaphragm, and enters into the Lung. From the lung system (trachea and larynx), it emerges horizontally at the axilla, descends along the medial aspect of the upper arm, running anterior to the Heart Meridian of Hand-Shaoyin and Pericardium Meridian of Hand-Jueyin, reaches the elbow crease, follows the medial border of the forearm to the cun kou (radial artery pulse point), ascends to the thenar eminence, follows the radial border of the thenar, and exits at the tip of the thumb. Its branch arises from the wrist, goes straight to the medial side of the index finger, and exits at its tip. When this meridian is disturbed, disease occurs: lung distension, bloating with wheezing and coughing, pain in the supraclavicular fossa, and in severe cases, crossing both hands over the chest with visual confusion, known as Arm Jue syndrome. This meridian governs diseases generated by the Lung: cough, qi rebellion, wheezing with sound, vexation, chest fullness, pain along the anterior medial border of the arm, cold limbs, and heat in the palm. If lung qi is excessive, there is shoulder and back pain, sweating upon wind-stroke, frequent urination with small volume. If lung qi is deficient, there is cold shoulder and back pain, shortness of breath insufficient for respiration, and change in urine color (or sudden incontinence). For these diseases of the twelve meridians, excess is treated by draining, deficiency by tonifying, heat by rapid needling, cold by retaining the needle, sinking qi by moxibustion, and neither excess nor deficiency by treating the affected meridian directly. In excess, the cun kou pulse is three times larger than the ren ying pulse; in deficiency, the cun kou pulse is smaller than the ren ying pulse.

The Large Intestine Meridian of Hand-Yangming originates at the lateral tip of the index finger, follows the radial border of the finger, emerges between the two bones at He Gu, ascends between the two tendons, follows the radial border of the forearm, enters the lateral aspect of the elbow, ascends along the lateral border of the upper arm to the shoulder, emerges anterior to the acromion, ascends to the meeting point of the vertebral column, descends into the supraclavicular fossa, connects with the Lung, passes through the diaphragm, and enters into the Large Intestine. Its branch rises from the supraclavicular fossa to the neck, penetrates the cheek, enters the lower teeth, returns to encircle the lips, crosses at Ren Zhong, going left to right and right to left, ascending to flank the nostrils. When disturbed, disease occurs: toothache, cheek swelling. This meridian governs diseases generated by fluids: yellow eyes, dry mouth, nasal congestion or epistaxis, throat obstruction, pain in the anterior shoulder, and pain with dysfunction of the index finger. If qi is excessive, heat and swelling occur along the meridian pathway; if deficient, chills that do not resolve. In excess, the ren ying pulse is three times larger than the cun kou pulse; in deficiency, the ren ying pulse is smaller than the cun kou pulse.

The Stomach Meridian of Foot-Yangming originates at the side of the nose, crossing at the root of the nose, adjacent to the Large Intestine meridian, descends along the lateral nose, enters the upper teeth, returns to encircle the lips, crosses below the chin at Cheng Jiang, follows the posterior mandible down to Da Ying, along Jia Che, ascends anterior to the ear, passes through Ke Zhu Ren, follows the hairline to the forehead. Its branch descends from anterior to Da Ying to Ren Ying, follows the throat into the supraclavicular fossa, passes through the diaphragm, enters the Stomach, and connects with the Spleen. Its main vessel descends from the supraclavicular fossa along the medial mammary line, descends flanking the umbilicus, and enters the Qi Chong region. Its branch originates from the stomach outlet, descends along the abdominal interior to meet the main vessel at Qi Chong, then descends to Bi Guan, reaches Fu Tu, enters the knee patella, follows the lateral tibial border, descends to the dorsum of the foot, and enters the space between the middle toes. Another branch diverges three cun below the knee, entering the lateral space of the middle toe. Another branch diverges from the dorsum, enters the big toe, and exits at its tip. When disturbed, disease occurs: aversion to cold, desire to stretch, frequent yawning, dark complexion. Upon onset, aversion to people and fire, startle at wooden sounds, palpitations, preferring to stay alone behind closed doors; in severe cases, climbing high to sing, discarding clothes and running, abdominal rumbling and distension, known as Gai Jue syndrome. This meridian governs diseases generated by blood: mania, warm pathogen heat with sweating, nasal congestion or epistaxis, tight lips, neck swelling and throat obstruction, abdominal edema, knee pain, pain along the chest, breast, Qi Chong, thigh, Fu Tu, lateral calf, and dorsum of the foot, with dysfunction of the middle toe. If qi is excessive, the anterior body is hot; if stomach qi is excessive, digestion is rapid with hunger and yellow urine. If qi is deficient, the anterior body is cold and shivering; stomach cold causes distension. In excess, the ren ying pulse is three times larger than the cun kou pulse; in deficiency, the ren ying pulse is smaller than the cun kou pulse.

The Spleen Meridian of Foot-Taiyin originates at the tip of the big toe, follows the medial white flesh margin, passes posterior to the nuclear bone, ascends anterior to the medial malleolus, ascends the medial calf, follows the posterior tibia, crosses anterior to the Liver Meridian of Foot-Jueyin, ascends along the anterior medial knee and thigh, enters the abdomen, enters the Spleen, and connects with the Stomach. It ascends through the diaphragm, flanks the pharynx, connects to the root of the tongue, and scatters under the tongue. Its branch diverges from the stomach, ascends through the diaphragm, and pours into the Heart. When disturbed, disease occurs: stiff tongue root, vomiting after eating, epigastric pain, abdominal distension with belching, relief after defecation or passing gas, heavy body. This meridian governs diseases generated by the Spleen: tongue root pain, immobility, inability to eat, vexation, urgency in the heart region, cold malaria, loose stools, mass diarrhea, urinary retention, jaundice, anorexia, blue lips, swelling and pain in the inner thigh and knee when standing forcibly, cold limbs, and dysfunction of the big toe. In excess, the cun kou pulse is three times larger than the ren ying pulse; in deficiency, the cun kou pulse is smaller than the ren ying pulse.

The Heart Meridian of Hand-Shaoyin originates in the Heart, emerges to belong to the Heart System, descends through the diaphragm, and connects with the Small Intestine. Its branch rises from the Heart System, flanks the pharynx, and connects to the Eye System. Its main vessel returns from the Heart System to ascend to the Lung, emerges at the axilla, descends along the posterior medial aspect of the upper arm, runs posterior to the Lung and Pericardium meridians, reaches the medial elbow, follows the posterior medial forearm, reaches the end of the ulnar styloid process, enters the posterior medial palm, and exits at the tip of the little finger. When disturbed, disease occurs: dry throat, heart pain, thirst with desire to drink, known as Arm Jue syndrome. This meridian governs diseases generated by the Heart: yellow eyes, flank fullness and pain, pain along the posterior medial arm, cold limbs, and heat and pain in the palm. In excess, the cun kou pulse is twice as large as the ren ying pulse; in deficiency, the cun kou pulse is smaller than the ren ying pulse.

The Small Intestine Meridian of Hand-Taiyang originates at the tip of the little finger, follows the lateral hand up to the wrist, emerges at the ankle, goes straight up along the lateral border of the forearm bone, emerges between the two bones at the medial elbow, ascends along the posterior lateral border of the upper arm, emerges at the shoulder joint, winds around the scapula, crosses the shoulders, enters the supraclavicular fossa, heads to the axilla, connects with the Heart, follows the pharynx down through the diaphragm to the Stomach, and enters the Small Intestine. Its branch rises from the supraclavicular fossa along the neck to the cheek, to the outer canthus, and enters the ear. Another branch diverges from the cheek, ascends to the cheekbone, reaches the nose, to the inner canthus, and obliquely connects to the zygoma. When disturbed, disease occurs: sore throat, submandibular swelling, inability to look back, shoulder feeling like being pulled, elbow feeling like being broken. This meridian governs diseases generated by the axilla: deafness, yellow eyes, cheek swelling, pain in the neck, jaw, shoulder, elbow, and posterior lateral arm. In excess, the ren ying pulse is twice as large as the cun kou pulse; in deficiency, the ren ying pulse is smaller than the cun kou pulse.

The Bladder Meridian of Foot-Taiyang originates at the inner canthus, ascends to the forehead, and crosses at the vertex. Its branch goes from the vertex to the upper angle of the ear. Its main vessel enters from the vertex to connect with the brain, returns to descend separately along the nape, follows the medial shoulder blade, flanks the spine to the waist, enters the paraspinal muscles, connects with the Kidney, and enters the Bladder. Its branch descends from the waist to meet at the posterior orifice, penetrates the buttocks into the popliteal fossa. Another branch diverges from the medial shoulder blade, descends flanking the spine, passes the hip pivot, follows the posterior lateral thigh, merges into the popliteal fossa, descends through the gastrocnemius, emerges posterior to the lateral malleolus, follows Jing Gu, to the lateral tip of the little toe. When disturbed, disease occurs: headache striking upward, eyes feeling like popping out, neck feeling like being pulled, spine and waist feeling like broken unable to bend, popliteal fossa feeling knotted, calf feeling torn, known as Ankle Jue syndrome. This meridian governs diseases generated by sinews: hemorrhoids, malaria, mania, epilepsy, pain in the head, fontanelle, neck, yellow eyes with tearing, nasal congestion or epistaxis, pain in the neck, back, waist, sacrum, and feet, with dysfunction of the little toe. In excess, the ren ying pulse is twice as large as the cun kou pulse; in deficiency, the ren ying pulse is smaller than the cun kou pulse.

The Kidney Meridian of Foot-Shaoyin originates below the little toe,斜趣slopes toward the sole, emerges below Ran Gu, follows posterior to the medial malleolus, branches into the heel, ascends the medial calf, emerges at the medial popliteal border, ascends the posterior medial thigh, penetrates the spine, enters the Kidney, and connects with the Bladder. Its main vessel ascends from the Kidney, penetrates the Liver and diaphragm, enters the Lung, follows the throat, flanks the tongue root. Its branch emerges from the Lung, connects with the Heart, and pours into the chest. When disturbed, disease occurs: hunger without desire to eat, face black as charcoal, hemoptysis, wheezing with throat sounds, desire to rise from sitting, blurred vision, heart hanging with hunger sensation, known as Bone Jue syndrome. This meridian governs diseases generated by the Kidney: oral heat, dry tongue, throat swelling and qi rebellion, dry and painful throat, vexation, heart pain, jaundice, dysentery, pain in the posterior medial spine and thigh, weakness and cold limbs, lethargy, heat and pain in the soles. With moxibustion, encourage eating to generate flesh, loosen belt, wear heavy shoes, and walk with a staff. In excess, the cun kou pulse is twice as large as the ren ying pulse; in deficiency, the cun kou pulse is smaller than the ren ying pulse.

The Pericardium Meridian of Hand-Jueyin originates in the chest, emerges to belong to the Pericardium Collateral, descends through the diaphragm, and sequentially connects with the Triple Energizer. Its branch follows the chest, emerges at the hypochondrium, descends three cun below the axilla, ascends to the axilla, runs along the medial upper arm between the Taiyin and Shaoyin meridians, enters the elbow, descends along the forearm between two tendons, follows the center of the palm, and exits at the tip of the middle finger. Its branch diverges from the palm, follows the ring finger, and exits at its tip. When disturbed, disease occurs: heat in the palm, spasm and stiffness of the arm and elbow, axillary swelling, chest and flank fullness, violent palpitations, red face, yellow eyes, uncontrollable laughter. This meridian governs diseases generated by the vessels (or Pericardium): vexation, heart pain, heat in the palm. In excess, the cun kou pulse is one time larger than the ren ying pulse; in deficiency, the cun kou pulse is smaller than the ren ying pulse.

The Triple Energizer Meridian of Hand-Shaoyang originates at the tip of the ring finger, ascends between the two fingers, follows the dorsal wrist, emerges between the two forearm bones, ascends through the elbow, follows the lateral upper arm to the shoulder, crosses posterior to the Foot-Shaoyang, enters the supraclavicular fossa, distributes in the Tan Zhong, scatters and connects with the Pericardium, descends through the diaphragm, and belongs to the Triple Energizer. Its branch rises from Tan Zhong, emerges at the supraclavicular fossa, ascends the neck, flanks the ear, goes straight up to the upper ear angle, curves down to the mandible/cheek, to the infraorbital region. Its branch enters the ear from behind, exits anterior to the ear, passes anterior to Ke Zhu Ren, crosses the cheek, to the outer canthus. When disturbed, disease occurs: deafness, roaring tinnitus, throat swelling and obstruction. This meridian governs diseases generated by qi: sweating, pain in the outer canthus, pain in the cheek, ear, shoulder, elbow, and lateral arm, with dysfunction of the ring finger. In excess, the ren ying pulse is one time larger than the cun kou pulse; in deficiency, the ren ying pulse is smaller than the cun kou pulse.

The Gallbladder Meridian of Foot-Shaoyang originates at the outer canthus, ascends to the head corner, descends behind the ear, follows the neck anterior to the Hand-Shaoyang, to the shoulder, crosses posterior to the Hand-Shaoyang, enters the supraclavicular fossa. Its branch enters the ear from behind, exits anterior to the ear, to the posterior outer canthus. Its branch diverges from the outer canthus, descends to Da Ying, meets the Hand-Shaoyang at the orbital floor, adds to Jia Che, descends the neck, meets the supraclavicular fossa, descends to the chest, penetrates the diaphragm, connects with the Liver, enters the Gallbladder, follows the interior of the costal arch, emerges at Qi Chong, surrounds the pubic hair, transversely enters the hip groove. Its main vessel descends from the supraclavicular fossa to the axilla, follows the chest, passes the hypochondrium, meets the hip groove, descends along the lateral thigh, emerges at the lateral knee, descends anterior to the fibula, reaches the end of Jue Gu, emerges anterior to the lateral malleolus, follows the dorsum of the foot, enters the tip of the fourth toe. Its branch diverges from the dorsum, enters between the big toe, follows the interosseous space, exits at the tip, returns through the nail bed, exits at the hair tuft. When disturbed, disease occurs: bitter taste, frequent sighing, heart and flank pain preventing turning, dust-like complexion, lack of luster, heat on the lateral foot, known as Yang Jue syndrome. This meridian governs diseases generated by bones: head, face, jaw pain, outer canthus pain, supraclavicular swelling, axillary swelling, scrofula, sweating with chills, malaria, pain in the chest, flank, thigh, knee, lateral leg, lateral malleolus, and joints, with dysfunction of the fourth toe. In excess, the ren ying pulse is one time larger than the cun kou pulse; in deficiency, the ren ying pulse is smaller than the cun kou pulse.

The Liver Meridian of Foot-Jueyin originates at the hair tuft of the big toe, ascends along the lateral dorsum of the foot, one cun from the medial malleolus, eight cun from the lateral malleolus, crosses posterior to the Taiyin, ascends the medial calf, follows the medial thigh into the pubic region, circles the genitalia, reaches the lower abdomen, flanks the Stomach, enters the Liver, and connects with the Gallbladder. It ascends through the diaphragm, distributes in the hypochondrium, follows the posterior throat, enters the nasopharynx, connects to the eye system, ascends to the forehead, and meets the Du Meridian at the vertex. Its branch descends from the eye system to the cheek interior, circles the lips internally. Its branch diverges from the liver, ascends to the forehead, meets the Du Meridian at the vertex. When disturbed, disease occurs: dust-like complexion, loss of color. This meridian governs diseases generated by the Liver: chest fullness, vomiting and rebellion, profuse diarrhea, fox hernia, spermatorrhea, and stranguria. In excess, the cun kou pulse is one time larger than the ren ying pulse; in deficiency, the cun kou pulse is smaller than the ren ying pulse.

When the Qi of the Foot-Shaoyin meridian perishes, the bones become withered. Shaoyin is the winter pulse, hidden and nourishing the marrow. Thus, if bones are not nourished, flesh cannot adhere. If flesh and bone are not intimate, flesh shrinks and recedes. Receding flesh makes teeth appear long and dirty, and hair loses luster. Loss of luster indicates bone death first. Disease worsens on Wu days and dies on Ji days, as Earth overcomes Water.

When the Qi of the Hand-Shaoyin meridian perishes, the vessels become blocked. Blocked vessels mean blood does not flow. Unflowing blood means hair loses luster. Thus, a face like dark charcoal indicates blood death first. Disease worsens on Ren days and dies on Gui days, as Water overcomes Fire. The Ling Shu states: At the end of Shaoyin, the face is black, teeth are long and dirty, abdomen is distended and closed, upper and lower passages are blocked, and death ensues.

When the Qi of the Foot-Taiyin meridian perishes, the vessels fail to nourish the lips. Lips are the root of muscle. Without nourishment, muscle becomes flaccid. Flaccid muscle leads to fullness in the philtrum (or tongue atrophy). Fullness in the philtrum causes lip retraction. Retraction indicates muscle death first. Disease worsens on Jia days and dies on Yi days, as Wood overcomes Earth.

When the Qi of the Hand-Taiyin meridian perishes, skin and hair become scorched. Taiyin circulates qi to warm the skin and hair. Without qi, skin and hair scorch. Scorched skin and hair lose fluids. Lost fluids cause skin joints to adhere to bone. Adhesion causes nails to wither and hair to break. Breaking hair indicates hair death first. Disease worsens on Bing days and dies on Ding days, as Fire overcomes Metal. The Jiu Juan states: Abdominal distension and closure, inability to breathe, frequent belching and vomiting, vomiting leads to rebellion, rebellion leads to red face. If no rebellion, upper and lower passages are blocked. Blocked passages lead to black face, scorched skin and hair, and death.

When the Qi of the Foot-Jueyin meridian perishes, sinews become flaccid. Jueyin is the Liver meridian; the Liver is the convergence of sinews. Sinews gather at the genitalia and connect to the tongue root. Without nourishment, sinews contract and tighten. Tightening pulls the testicles and tongue. Blue lips, curled tongue, and retracted testicles indicate sinew death first. Disease worsens on Geng days and dies on Xin days, as Metal overcomes Wood. The Jiu Juan states: Internal heat, dry throat, frequent urination, vexation, severe cases have curled tongue and retracted testicles, leading to death.

When the Yin of the five Zang organs perishes, the eye system twists. Twisting causes dizziness. Dizziness indicates Zhi (will) death first. Thus, if Zhi dies first, death occurs in one and a half days.

When the Taiyang meridian perishes, it is the end. Signs include staring upward, opisthotonos, convulsions, pale face, and absolute sweat, leading to death.

When the Shaoyang meridian perishes, it is the end. Signs include deafness, relaxation of all joints, and severance of the eye system. Severance leads to death in one and a half days; death occurs when the whites of the eyes turn white (or cyan-white).

When the Yangming meridian perishes, it is the end. Signs include facial twitching, fright, delirium, yellow face, and excessive but non-flowing upper and lower meridians (or insensitivity), leading to death.

When the six Yang meridians perish, Yin and Yang separate. Separation causes pores to open, absolute sweat flows out in beads like strings, rolling out without flowing back, indicating Qi death first. Thus, morning prediction means evening death, evening prediction means morning death. This is the failure of the twelve meridians.