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(This section discusses the pathogenic factors affecting the five Zang organs.)

When pathogenic factors invade the Lung, symptoms include pain in the skin, aversion to cold with fever (han re), panting and upward rushing of Qi, sweating, and coughing that pulls on the shoulders and arms (or back). Treatment should involve needling the Shu points in the anterior chest, such as Yunmen (Cloud Gate) and Zhongfu (Central Treasury). On the back, beside the third vertebral segment (Feishu BL-13; some texts add "fifth segment" after "third"), press quickly with the hand. The spot where the patient feels a sense of relief or comfort is the acupoint; then needle it. Alternatively, take Qimen (Dipper), an acupoint of the Foot-Yangming Stomach Meridian, to disperse the pathogen.

When pathogenic factors invade the Liver, symptoms include pain in both hypochondriac regions, internal cold, retention of evil blood within, frequent pulling sensations in the joints during movement, and occasional swelling of the feet. Treatment should involve taking Xingjian (Moving Between) LR-2 to guide Qi from the hypochondrium, tonifying Zusanli ST-36 to warm the middle Jiao (stomach/spleen), and pricking the blood vessels to dissipate evil blood (prick visible collateral vessels of the Liver meridian). Take the blue veins between the ears to remove the pulling sensation.

When pathogenic factors invade the Spleen and Stomach, symptoms include muscle pain. If Yang Qi is excessive and Yin Qi is deficient, there is heat in the middle Jiao and frequent hunger. If Yang Qi is deficient and Yin Qi is excessive, there is cold in the middle Jiao, borborygmus (intestinal rumbling), and abdominal pain. If both Yin and Yang are excessive (both Spleen-Stomach pathogens are strong), or if both are deficient (both Spleen-Stomach righteous Qi are weak), there will be both cold and heat syndromes. All these conditions should be regulated via Zusanli ST-36.

When pathogenic factors invade the Kidney, symptoms include bone pain and Yin Bi (obstruction). Yin Bi is characterized by the inability to find tenderness upon pressing, abdominal distension, lower back pain, difficulty in defecation, pain in the shoulders, back, neck, and nape, and occasional vertigo. Treatment should involve taking Yongquan KI-1 and Kunlun BL-60. Observe for blood stasis; if present, bleed all visible vessels.

When pathogenic factors invade the Heart, symptoms include heart pain, a tendency toward sadness, and occasional vertigo leading to fainting. Assess excess or deficiency and regulate the Shu points accordingly (tonification or reduction should target Taoling PC-4 of the Pericardium meridian and Shenmen HT-7 of the Heart meridian).

(This section primarily discusses external contraction of cold and heat.)

For Pi Han Re (Skin Cold-Heat syndrome), the patient cannot lie close to the mat (because the pathogen is exterior, they fear proximity to the mat). Hair becomes scorched, the nose dries and shrivels, and there is no sweat. Treatment involves taking the Luo-connecting point of the Taiyang meridian, Feiyang BL-58, and tonifying the Hand-Taiyin Lung meridian's Taiyuan LU-9.

For Ji Han Re (Muscle Cold-Heat syndrome), there is muscle pain, scorched hair, dried and shriveled lips, and no sweat. Treatment involves taking points on the lower part of the three Yang meridians to remove blood stasis (all are Luo-connecting points needing bleeding) and tonifying the Foot-Taiyin Spleen meridian's Dadu SP-2 and Taibai SP-3 to induce sweating.

For Gu Han Re (Bone Cold-Heat syndrome), the patient has nowhere to rest comfortably, and sweat pours down incessantly. If the teeth have not yet become dry/shriveled, take the Luo-connecting point of the Shaoyin meridian, Dazhong KI-4. If the teeth are already shriveled, it is a death case and untreatable. Gu Jue (Bone Jue) is similar (Jue due to bone cold).

If the body has suffered injury with excessive blood loss, or contracted wind-cold, or suffered a fall/drop injury, resulting in flaccidity and weakness of the four limbs unable to hold themselves, this condition is called Ti Duo (Body Languor). Treatment involves taking the San Jie Jiao (Three Intersections) located three cun below the umbilicus. The San Jie Jiao refers to the intersection of the Yangming and Taiyin meridians, which is Guanyuan CV-4.

Headache caused by rebellious Yang Qi, accompanied by chest fullness and dyspnea, should be treated by taking Renying ST-9 (Renying means 'rebellious'; when Yang pathogen rebels in the Yang meridians causing headache and chest fullness, needle the Foot-Yangming Renying point). Sudden aphonia with Qi obstruction should be treated by taking Futu LI-18 and bleeding the base of the tongue. Sudden deafness with Qi stagnation/misting, causing unclear hearing and vision, should be treated by taking Tianyou TE-16. Sudden spasms, epilepsy, vertigo, and inability of the feet to support the body should be treated by taking Tianzhu BL-10. Sudden severe heat toxicity reversing internally, with Liver and Lung Qi clashing causing blood effusion from nose and mouth, should be treated by taking Tianfu LU-6. These five points are collectively known as the "Five Regions of Tianyou" (Summarizing the previous five points; "Five Regions of Tianyou" uses one point to represent the upper, lower, front, and back).

The Hand-Yangming Large Intestine meridian has a branch entering the teeth, named Daying. For lower tooth decay/pain, treat using arm points (Shangyang LI-1, Erjian LI-2, and Sanjian LI-3 all treat toothache). Use tonification for aversion to cold, and reduction for absence of aversion to cold. The Foot-Taiyang Bladder meridian has a branch entering the teeth, named Jiaosun. For upper tooth decay/pain, take points between the nose and the cheekbone. At the onset of illness, if the pulse is full/excessive, use reduction; if deficient, use tonification. Another method suggests taking points outside the nose, such as Dicang ST-4 and Juliao SI-18. The Foot-Yangming Stomach meridian has branches flanking the nose entering the face, named Xuanlu, belonging to the mouth area, connecting inwardly to the root of the eye. Needle where pathology is observed. Reduce excess and tonify deficiency; reversing this principle will worsen the condition.

The Foot-Taiyang Bladder meridian has a pathway through the neck into the brain, directly connecting to the root of the eye, named Yanxi (Eye System). For severe headache and eye pain, take Wangzhen BL-59 located between the two tendons in the neck. Upon entering the brain, it separates into the Yin Qiao and Yang Qiao vessels. The Yin and Yang Qiao vessels intersect; Yang enters Yin, Yin exits Yang, intersecting at the outer canthus of the eye. When Yang Qi is excessive, the eyes open; when Yin Qi is excessive, the eyes close.

For Re Jue (Heat Jue syndrome: Yang pathogen excess, Yin Qi deficiency), take the Foot-Taiyin Spleen meridian (tonify) and Foot-Shaoyang Gallbladder meridian (reduce). Retain the needles. For Han Jue (Cold Jue syndrome: Yin pathogen excess, Yang Qi deficiency), take the Foot-Yangming Stomach meridian (tonify) and Foot-Shaoyin Kidney meridian (reduce). Retain the needles. (This explains tonifying the Spleen and Stomach meridians to fill the four limbs, and reducing the Water and Fire meridians to drain pathogenic factors.)

For Tong Zong (Languid tongue) with drooling and irritability, take the Foot-Shaoyin Kidney meridian. For chills, shivering, jaw quivering, inability to sweat, abdominal distension, and irritability, take the Hand-Taiyin Lung meridian. (These two sections discuss both Cold and Heat Jue syndromes together.)

When needling deficiency patterns, needle along the direction of departing Qi (follow the Qi as it leaves, like inserting the needle during exhalation). When needling excess patterns, needle against the direction of arriving Qi (meet the Qi as it arrives, like inserting the needle during inhalation).

The Five Zang organs correspond to five important regions on the body (indicating that the internal Zang organs connect to five critical external areas). One is Futu ST-32; two is the calf (Pi); three is the back. If disease begins in the head and face, first needle the Taiyang points in the neck to induce sweating. If disease begins in the lower legs, first needle the Foot-Yangming points to induce sweating (these three sections should be cross-referenced with the Ci Re Pian chapter). Hand-Taiyin can induce sweating (take Yuji LU-10 and Taiyuan LU-9). Foot-Yangming can induce sweating (take Neiting ST-44 and Xianggu BL-65). Therefore, if inducing sweating via Yin meridians causes excessive sweating, stop at Yang meridian points; if inducing sweating via Yang meridians causes excessive sweating, stop at Yin meridian points. (When Yin and Yang are balanced, sweating stops naturally; refer to the Re Bing Pian chapter regarding "heat disease about to sweat".)

The harm of needling: If the needle hits the target but is not withdrawn promptly, Jing (Essence) will leak (once the needle hits the disease site, it should be removed). If the needle does not hit the target but is withdrawn, it leads to Qi stagnation/pathogen accumulation (if the needle misses the disease site and is removed, pathogenic Qi remains). Essence leakage causes the disease to worsen and the body to emaciate. Pathogen accumulation leads to the formation of carbuncles and sores.