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Jue heartache (Heartache due to Jue syndrome) with mutual traction pain in the back, patients often feel as if someone is touching their heart from behind. Those who curl up and bend over have Kidney Heartache (Ren Xin Tong), first needle Jinggu (BL64) and Kunlun (BL60); if symptoms persist after withdrawal, then acquire Ran Gu (KI2). Jue heartache accompanied by abdominal distension and chest fullness, with severe heart pain, is Stomach Heartache (Wei Xin Tong), acquire Da Du (SP2) and Tai Bai (SP3). Jue heartache where pain feels like a needle piercing the heart, with very severe heart pain, is Spleen Heartache (Pi Xin Tong), acquire Ran Gu (KI2) and Tai Xi (KI3). Jue heartache with a cyan complexion resembling death, unable to sigh deeply all day, is Liver Heartache (Gan Xin Tong), acquire Xing Jian (LR2) and Tai Chong (LR3). Jue heartache where pain alleviates when lying down or staying indoors, but worsens with movement, with unchanged complexion, is Lung Heartache (Fei Xin Tong), acquire Yu Ji (LU10) and Tai Yuan (LU9). True Heartache (Zhen Xin Tong) presents with cold extremities reaching the joints, severe heart pain; onset in the morning leads to death in the evening, onset in the evening leads to death in the morning. If heartache is caused by accumulation of excess pathogens within the heart, it cannot be needled, and Shu points should not be acquired. Heartache radiating to the lower back and spine with desire to vomit, acquire Foot-Taiyin points; heartache with abdominal distension, aversion to cold, and difficult defecation, acquire Foot-Shaoyin points; heartache radiating to the back with dyspnea, needle Foot-Shaoyin points, if ineffective acquire Hand-Shaoyang points; heartache radiating to the lower abdomen with wandering pain location and difficulty in urination and defecation, needle Foot-Jueyin points; heartache presenting only with shortness of breath and insufficient respiration, needle Hand-Taiyin points. For heartache, needle at the ninth vertebral segment; pressing while needling can immediately relieve pain; seek above and below for the tender point, and needling upon finding it will immediately relieve pain. Mutual traction pain between the back and heart is treated at Tiantu (CV22), the point beside the tenth vertebra, and Shangji (Zhongwan CV12); Xiaji refers to Guanyuan (CV4). The situation of evil qi invading the yin and yang on left and right sides of the back and chest is generally as described.

The Yellow Emperor asked: How does the pulse at Cun Kou reflect distension? Qibo answered: A pulse that is large, firm, and choppy indicates distension. The Yellow Emperor asked: How to know about Zang-Fu distension? Qibo answered: Yin pulses correspond to Zang organs, Yang pulses correspond to Fu organs. The Yellow Emperor asked: Is the qi causing distension located within the blood vessels, or inside the Zang-Fu organs? Qibo answered: It exists in both, but neither is the residence of distension. The Yellow Emperor said: I wish to hear about the residence of distension. Qibo answered: Distension occurs outside the Zang-Fu organs, pushing against them, expanding the chest and hypochondrium, and swelling the skin, hence named distension. The Yellow Emperor said: The Zang-Fu are located within the chest, hypochondrium, and abdomen, like forbidden objects in boxes and cabinets, each having its own position and name, sharing the same region but differing in nature; I wish to understand the reason. Qibo said: You do not understand my meaning, please ask again. The Yellow Emperor said: The chest and abdomen are the outer boundaries of the Zang-Fu; Dan Zhong (CV17) is the palace city of the Heart Master; the Stomach is the Great Granary; the pharynx and Small Intestine are for transmission; the five orifices of the Stomach are the gates of the neighborhoods; Lian Quan (CV23) and Yu Ying are the pathways for fluids. Therefore, the Five Zang and Six Fu organs have their respective boundaries, and their diseases have different manifestations. Ying Qi circulates within the vessels; Wei Qi rebellion causes Mai Distension (Distension of Vessels); Wei Qi merging with the vessels and circulating along the muscle intervals causes Fu Distension (Distension of Skin). Needling San Li (ST36) with draining method: for recent cases, drain once; for distant cases, drain three times, regardless of deficiency or excess, the key lies in rapid draining. The Yellow Emperor said: I wish to hear the forms of various distensions. Qibo answered: Heart Distension manifests as vexation, shortness of breath, and restless sleep; Lung Distension manifests as empty fullness, wheezing, and coughing; Liver Distension manifests as fullness and pain under the hypochondrium radiating to the lower abdomen; Spleen Distension manifests as frequent hiccups, heaviness and discomfort in the four limbs, body weight so heavy one cannot bear clothes, and restless sleep; Kidney Distension manifests as abdominal fullness radiating to the back, soreness and pain in the waist and thighs; among the Six Fu Distensions, Stomach Distension manifests as abdominal fullness and epigastric pain, smelling burnt odors in the nose, food intolerance, and difficult defecation; Large Intestine Distension manifests as borborygmus and gurgling pain, and if exposed to cold in winter, results in undigested diarrhea; Small Intestine Distension manifests as lower abdominal distension radiating to the lower back with pain; Bladder Distension manifests as lower abdominal fullness and urinary retention; San Jiao Distension manifests as qi filling the skin, feeling soft but not firm; Gallbladder Distension manifests as pain and distension under the hypochondrium, bitter taste in the mouth, and frequent sighing. All these distensions share one principle: clearly understanding reversal and smoothness, and accurate needle count. Draining deficiency and tonifying excess, if Shen (Spirit) leaves, evil enters and righteousness is lost, true Qi cannot be stabilized; this failure by crude practitioners is called premature death. Tonifying deficiency and draining excess, returning Shen to its chamber, and filling emptiness for a long time, is called a skilled practitioner. The Yellow Emperor asked: How is distension generated, and what is its cause? Qibo answered: Wei Qi in the body usually runs parallel to the vessels and along the muscle intervals. Its movement has reversal and smoothness, Yin and Yang follow each other, achieving Heavenly Harmony, allowing the Five Zang organs to restart, following the four seasons' sequence, and digesting grains. Then, Jue Qi stays below, Ying Qi stagnates, Cold Qi rebels upward, True Qi and Evil Qi attack each other, two Qi clash, resulting in distension. The Yellow Emperor said: Excellent! How to resolve doubts? Qibo answered: Combine with True Qi, integrate three aspects to understand. The Yellow Emperor said: Excellent! The Treatise on Distension states that regardless of deficiency or excess, the key is rapid draining. Recent cases drain once, distant cases drain three times. Now some patients do not improve after three drainages, where is the fault? Qibo answered: This is because the needle sank into the muscular adipose tissue (Huang) without hitting the Qi Acupoint. If the Qi Acupoint is not hit, Qi closes internally; if the needle does not sink into Huang, Qi cannot move upward and outward; if only muscle is pierced, Wei Qi becomes chaotic, Yin and Yang chase each other, leading to distension. When draining is indicated but not performed, Qi fails to descend, hence three drainages fail. One must change the approach; stop when Qi descends. If it doesn't descend, start again, ensuring safety, how could there be danger? For dry distension, carefully examine the pulse; drain if indicated, tonify if indicated, effective like a drumstick striking a drum, how could it not descend? The Yellow Emperor asked: Can Skin Distension and Drum Distension be needled? Qibo answered: First drain the collateral vessels of the distended area, then regulate the meridians, removing the blood collaterals. Sudden abdominal fullness that does not depress on pressure, acquire the Foot-Taiyang meridian collaterals, which is the Front-Mu point of the Stomach. The Foot-Shaoyin Shu point is located 3 cun lateral to the spine, 5 cun further out; use a round-sharp needle. Wei Qi rebellion causes Mai Distension; Wei Qi merging with vessels causes Fu Distension. Drain San Li (ST36). Recent cases drain once, distant cases drain three times, regardless of deficiency or excess, rapidly drain San Li.