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For many years, I have treated hundreds of thousands of patients in clinical practice, many of whom suffered from difficult and complicated diseases. By using the yin-yang positive-negative mechanism of the Twelve Meridians (Twelve Main Channels) as a general guideline for flexible modification and treatment, good results were mostly achieved. Clinical practice has proven that utilizing the positive-negative mechanism of the Twelve Meridians to regulate diseases yields unparalleled efficacy.

The *Ling Shu: Wei Qi Chapter* states: "Those who can distinguish the yin and yang of the Twelve Meridians know the origin of diseases; those who can observe the location of deficiency and excess know the upper and lower levels of the disease; those who understand the Qi passages of the Six Fu Organs can untie knots and connect breaks at the gates; those who know the hardness and softness of deficiency and excess conditions know where to apply tonification and sedation methods. Therefore, I strictly follow the will of the ancient sages in diagnosing and treating diseases clinically. Thus, the principles of the operation of the Twelve Meridians are extremely important for symptoms, diagnosis, and treatment."

Based on my long-term exploratory experience, I do not advocate rigidly adhering to fixed acupoint prescriptions when using acupuncture to treat diseases. Instead, one should formulate flexible, adaptive acupoint selection plans based on the differences in the "yin-yang movement phenomena" of the Twelve Meridians. It is believed that only by observing the changes in the "Twelve Meridians" and varying the methods accordingly can one align with the true rules of diagnosis and treatment. In short, coordinating with the yin-yang operating functions within the human body leads to good efficacy.

21. Treatment and Understanding of Reversal and Smooth Regulation in Tuina Massage Cases

(I) Case 1

Luo XX, Female, 72 years old, residing at Wudang Mountain. Consulted on November 23, 1995.

Symptoms: The patient experienced vomiting and diarrhea accompanied by abdominal pain due to eating inappropriate food. Although cured by Western medicine, she frequently suffered from severe abdominal pain within the following three months. She could not straighten her waist, groaning in pain while bending forward and pressing on her abdomen. During attacks of abdominal pain, she could not eat and frequently visited the toilet, regardless of whether there was stool or not. Medication could only temporarily relieve the pain, but the abdominal pain would recur after a few days, with identical symptom manifestations each time.

Pulse Diagnosis: The Cun (inch) positions of both Mai Kou (Radial Artery Pulse Points) showed surplus, while the Chi (cubit) positions showed insufficiency. The Cun positions of both Ren Ying (Carotid Artery Pulse Points) were floating, rapid, and surging, while the Chi positions showed insufficiency. The width of the Yin and Yang pulse waves was equal. Based on the pulse manifestation, it was proven that the Zheng Yun (Positive/Normal Operation) had surplus, while the Fan Yun (Reverse Operation) was insufficient.

Treatment adopted a reversal method of massage to adjust the Qi mechanisms of Yin and Yang. First, the Foot Three Yin Meridians (Foot Taiyin Spleen, Foot Shaoyin Kidney, Foot Jueyin Liver) on the left and right inner sides of the lower limbs were selected. From the knee to the medial malleolus of the foot, pushing and rubbing techniques were used, focusing on pressing the Sanyinjiao (SP6) acupoint. Subsequently, holding the patient's big toe, rocking and pulling methods were used to guide the flow of Jing Qi (Meridian Qi) (this method was applied first to the right side, then the left). Next, the Hand Three Yang Meridians (Hand Taiyang Small Intestine, Hand Yangming Large Intestine, Hand Shaoyang Sanjiao) on the left and right outer sides of the upper limbs were selected. From the elbow joint to the wrist joint, massage techniques were applied from top to bottom, and Hegu (LI4), Houxi (SI3), and Waiguan (TE5) acupoints were pressed (first right, then left).

After applying these massage techniques for 25 minutes repeatedly three times, the patient's abdominal pain decreased significantly. Upon re-examination of the "Mai Kou" and "Ren Ying" arteries, the differences in surplus and insufficiency among Yin, Yang, Cun, and Chi had become balanced. The next day, the Yin and Yang pulse images regressed slightly. After three consecutive treatments using the above-mentioned reversal regulation massage technique, the patient's pulse and symptoms were completely cured. Follow-up for three months showed no recurrence of abdominal pain.

The *Ling Shu: Xiao Zhen Jie Chapter* says: "Knowing the coming and going allows one to know the smoothness, reverseness, excess, and deficiency of Qi." This case involved abdominal pain formed by the excessive Zheng Yun and insufficient Fan Yun of both Yin and Yang. Through the use of massage and Tuina employing reversal regulation techniques, excellent results were achieved. This proves that the treatment legislation of reversal and smoothness based on the positive-negative mechanism of the "Twelve Meridians" is very correct.

The *Xiao Zhen Jie Chapter* further states: "Clearly knowing the smooth and reverse normal operations without hesitation," which teaches future physicians that if, during pulse diagnosis, the "reverseness and smoothness deviation" of the yin-yang movement of the "Twelve Meridians" is identified, one should correctly and unquestioningly execute either reversal or smooth treatment methods. Hence, the classic text says: "Whenever using needles, one must first diagnose the pulse." This is because the internal positive-negative, excess-decline functions of the "Twelve Meridians" cannot be seen on the surface. Only by observing the positive-negative pulse waves of the "Mai Kou" and "Ren Ying" to diagnose their excess and decline phenomena can one aim precisely ("shoot the arrow at the target") to implement the rules of smooth and reversal regulation.

Observing some previous physicians' statements regarding medical principles such as smoothness, reverseness, meeting, and following, they were mostly established based on the principle of "normal operation": "Hand Three Yin move from chest to hand; Hand Three Yang move from hand to head; Foot Three Yang move from head to foot; Foot Three Yin move from foot to abdomen." If they knew that the "Twelve Meridians" also possess reverse operation functions, they certainly would not make such ungrounded arguments. According to the discussion on smooth and reverse diagnostic principles in the *Ling Shu: Xiao Zhen Jie Chapter*: it refers to observing the "smoothness and reverseness" phenomenon of Yin and Yang arteries. One must first understand the deficiency, excess, smoothness, and reverseness of Yin and Yang pulse images before deciding on the acupoint prescription based on reversal and smooth principles. The diagnostic and therapeutic principles of massage/Tuina are the same as those of acupuncture. Therefore, performing massage/Tuina treatment without pulse diagnosis inevitably leads to improprieties.

(II) Case 2

Li XX, Female, 42 years old, residing at Wudang Mountain. Consulted on September 5, 1996.

Symptoms: The patient reported feeling uneasy in the chest cavity for the past half-month, with a sensation of Qi gathering in the chest. Dizziness and vertigo, unable to look upward; looking upward causes dizziness and nausea. Prefers stillness and dislikes movement; symptoms alleviate when lying quietly in bed, but arise immediately upon standing up, causing dizziness, vertigo, nausea, and desire to vomit.

Pulse Diagnosis: The pulse waves at the left and right Mai Kou: Both Cun positions showed a "Choppy (Se) image with weak pulse," while the Guan (bar) and Chi positions were obvious. Synthesizing the pulse waves of the Cun, Guan, and Chi positions at both Mai Kou points, a pattern of wider below and narrower above appeared. The pulse waves at the left and right Ren Ying: Both Chi positions showed a "Choppy (Se) image with weak pulse," while the Cun and Guan positions were obvious. Synthesizing the pulse waves of the Cun, Guan, and Chi positions at both Ren Ying points, a pattern of wider above and narrower below appeared. Because the width and strength of the Yin and Yang pulse waves were equal, it proved that neither Yin nor Yang had excess or deficiency. According to the "Choppy pulse at the Cun position" of both Mai Kou points, it was proven that Yin Meridian Qi was blocked internally and could not operate normally outward, thus gathering in the chest. According to the "Choppy pulse at the Chi position" of both Ren Ying points, it was proven that Yang Meridian Qi was obstructed externally and could not operate normally downward, causing dizziness and vertigo rising upward. A massage and Tuina treatment method was adopted to adjust the Jing Qi of Yin and Yang.

Treatment Method: 1. On the right Hand Three Yin Meridians, from elbow to hand, rubbing and pushing methods were used, and Yuji (LU10), Neiguan (PC6), and Laogong (PC8) acupoints were pressed. 2. The regulation of the left Hand Three Yin Meridians was the same as the right. 3. On the right Foot Three Yang Meridians, from knee to foot, rubbing and pushing methods were used, along with lifting and grasping at the Jiaoxi (ST41) acupoint, and Yanglingquan (GB34), Zusanli (ST36), and Neiting (ST44) acupoints were pressed. 4. The regulation of the left Foot Three Yang Meridians was the same as the right.

After regulating repeatedly for 40 minutes three times using the above method, the patient felt relief from various symptoms. Immediately re-examining the pulse, the Choppy image in the "Cun position" of both Mai Kou and the "Chi position" of both Ren Ying transformed, and the pulse waves slightly increased. Following this treatment method once daily via massage and Tuina, after five treatments, all symptoms disappeared and the patient was completely cured.

Regarding massage and Tuina therapy, it can also be combined with dry acupuncture therapy, playing a role in coordinating Yin and Yang meridians. It is particularly suitable for the elderly, children, patients with weak constitutions, and those afraid of needles and pain. It is also very effective for cases where Left/Right or Yin/Yang Jing Qi is not deficient but ascending/descending is uneven, or where Yin/Yang has partial excess or deficiency.

22. Pulse Diagnosis Understanding for Medicinal Treatment

The *Huang Di Nei Jing Su Wen* discusses three pulse diagnosis methods.

1. Diagnosing the Three Regions and Nine Positions (San Bu Jiu Hou): Divided into Upper, Middle, and Lower regions, each having Heaven, Earth, and Human positions, totaling nine positions, to confirm which region (Upper, Middle, or Lower) the disease resides in.

2. Diagnosing the Mai Kou and Ren Ying to observe the excess and decline phenomena of the Hand and Foot Three Yin and Three Yang Meridians. This mainly serves as the basis for diagnosing and treating the "Twelve Meridians" using acupuncture and massage. I believe this diagnostic method can also serve as the basis for diagnosing and treating the differentiation of Zang-Fu organ Yin-Yang deficiency and excess using medicinal therapy.

3. Diagnosing the Cun, Guan, and Chi pulse images of the two Mai Kou points. This mainly serves as the basis for treating diseases with medicines, allowing regulation of diseases according to the Yin-Yang deficiency and excess pulse images of the Cun, Guan, and Chi positions. The later generations' diagnostic method of solely diagnosing the two Mai Kou points for treatment originates from this.

The *Su Wen: Mai Yao Jing Wei Lun* states: "Inside the Chi area on both sides are the costal margins; outside the Chi area observes the Kidneys; inside the Chi area observes the middle abdomen. Above this, outside the left observes the Liver; inside observes the diaphragm; outside the right observes the Stomach; inside observes the Spleen. Above that, outside the right observes the Lungs; inside observes the chest center; outside the left observes the Heart; inside observes the Dan Zhong. Anterior observes anterior, posterior observes posterior. The end reaching upwards concerns the chest and throat; the end reaching downwards concerns the lower abdomen, waist, thighs, knees, shins, and feet." This explains that the ancient sages could diagnose the pulse images of the Five Zang Organs (Liver, Heart, Spleen, Lungs, Kidneys) and the Stomach Fu Organ through the "Cun Kou position" of the Left and Right Hand Taiyin Meridians, distributing the diagnosis of the Five Zang Organs and Stomach to the Left and Right Cun, Guan, and Chi positions. This proves that the ancient sages' ability to diagnose the deficiency and excess of the Five Zang Organs using the "Two Mai Kou Points" is also a "Holistic Theory" diagnostic method.

Both Chi positions belong to the Kidneys: The Left Kidney belongs to True Water; the Right Kidney belongs to True Fire. The True Water of the Left Chi position generates the Liver Wood of the Left Guan position; the Liver Wood of the Left Guan position generates the Heart Fire of the Left Cun position. The True Fire of the Right Chi position generates the Spleen Earth of the Right Guan position; the Spleen Earth of the Right Guan position generates the Lung Metal of the Right Cun position.

Since the *Mai Yao Jing Wei Lun* discussed above only mentioned the "Stomach Fu Organ" in its diagnosis of the Six Fu Organs, assigning its diagnosis to the Guan position of the Right Mai Kou, and did not mention the Large Intestine, Small Intestine, Sanjiao, Gallbladder, and Bladder, later generations' pulseology works assigned the Six Fu Organs to the Cun, Guan, and Chi positions of the Left and Right Mai Kou points. This is the argument of later pulseologists.

I believe that arranging Zang and Fu organs in a single position for diagnosis easily causes confusion. Physicians with extensive clinical experience all have their own pulse diagnosis experiences. The classic text says: "Those skilled in adjusting the Chi do not rely on the Cun; those skilled in pulse diagnosis do not rely on complexion." Therefore, experienced doctors are not confused by pulse images. Doctors with insufficient experience find it difficult to distinguish clearly.

I believe: Since pulse diagnosis for the "Six Fu Organs" in acupuncture can utilize the "Ren Ying Artery," medicinal treatment can also utilize the "Ren Ying Artery." This allows distinguishing the boundary between Yin and Yang according to external Yang and internal Yin, conforming to the physiological law of Yin-Yang opposition in the human body. Only then can Yin-Yang opposition differentiation be used to distinguish the deficiency, excess, severity, and slightness of Yin and Yang meridians to make correct diagnoses and achieve good therapeutic effects.

Based on my years of clinical practical experience: Some patients have "disease pulse phenomena" different from others. Even by examining the four arterial sites of "Mai Kou" and "Ren Ying," the phenomena of Yin-Yang excess and decline cannot be observed. When encountering such difficult-to-diagnose situations, one should utilize the "Three Diagnostic Methods" formulated by the ancient sages, using them together to assist pulse diagnosis.

I encountered a patient suffering from right-sided migraine. Through diagnosing "Mai Kou" and "Ren Ying," no abnormal phenomena of Ming/Yang, deficiency, or excess were observed. Later, using the diagnosis of Heaven, Earth, and Human three regions on the patient's head, the artery at the "side of the forehead" hairline on the right side was found to show a uniquely vigorous pulse wave. Needling the Touwei (ST8) and Shangguan (GB7) acupoints on the right side using the sedation needle method cured the condition. I also encountered a patient with stomach fullness. After examining "Mai Kou" and "Ren Ying," no abnormal pulse images of Yin/Yang excess or decline were observed. Later, examining the "Diyang Acupoint" artery on the foot revealed that the left and right "Diyang Arteries" showed full and bounding pulse waves. Needling the bilateral "Zusanli (ST36)" acupoints using the sedation needle method cured the condition. Therefore, this proves that the "Three Pulse Diagnosis Methods" of the ancient sages, when pulse diagnosis is difficult to confirm, should be "fully" adopted to assist diagnosis.

Regarding pulse diagnosis, the sages of past dynasties had much experience, which I will not repeat here. I谨 record my personal点滴 experiences in pulse diagnosis for readers to verify in clinical experiments. The rhyme is as follows:

Close your eyes and concentrate your spirit, do not forget; observe the pulse carefully with your spirit.
Mai Kou and Ren Ying, Yin and Yang harmonious, neither fast nor slow indicates health.
Spring wiry, Summer flooding, corresponds to growth; Autumn floating, Winter stone-like, returns to storage.
Pulses responding to the Four Seasons, Heaven and Man united; Pulses reversing the Four Seasons, the body suffers disaster.
Complexion and Pulse matching, treatment is easy to cure; Complexion and Pulse clashing, healing is hard to rectify.
Left pulse too excessive overcomes the Right; Right pulse too flourishing controls the Left.
Left pulse insufficient may assist the Right; Right pulse insufficient reversely follows the Left.
Yin pulse upper flourishing, Yang easily sinks; Yang pulse upper flourishing, Yin easily hides.
Yin and Yang extreme deficiency, heavy sinking downward; Left belongs to Blood deficiency, Right to Qi deficiency.
Yin and Yang phenomena all floating upward, Lower deficiency, Fire rises, inflammation diagnosed upward.
Floating, Deep, Slow, Rapid must be distinguished; Tight, Relaxed, Large, Small, Slippery waves participated.
Cold, Heat, Deficiency, Excess each have images; Yin, Yang, Interior, Exterior are the general outline.

Since the Stomach Meridian is the Sea of the Five Zang and Six Fu Organs, and the left and right "Ren Ying Acupoint areas" are the Stomach Meridian pulse sites, they can diagnose the pulse images of the Six Fu Organs. The Lung Meridian is the place where all meridians converge, so the two Mai Kou positions can diagnose the pulse images of the Five Zang Organs. Observing the left and right Mai Kou diagnoses the root of the Five Zang Organs; observing the left and right Ren Ying diagnoses the branch of the Six Fu Organs. With root as primary and branch as secondary, obtaining the hierarchy of root and branch naturally establishes the treatment principles for balancing Yin and Yang. For example, Zhang Zhongjing, the Medical Sage of the Han Dynasty, was skilled in treating diseases with medicines and also paid great attention to diagnosing the pulses of both Yin and Yang. The original preface of the *Shang Han Lun* states: "...Ren Ying and Diyang, the three parts are not consulted separately." This shows he also diagnosed the Ren Ying pulse. Sage Zhang Zhongjing not only diagnosed the Ren Ying pulse but also attached great importance to diagnosing the arteries of "Cunkou and Diyang." Because diagnosing the "Diyang Artery" also belongs to the site where Stomach Meridian Qi descends, the diagnosis of "Ren Ying and Diyang Arteries" are both related to the Foot Yangming Stomach Meridian. The above are my views and practical experiences on pulse diagnosis, awaiting future scientific research to verify their merits and demerits.

23. Case Studies of Diagnosis and Medicinal Treatment Using the Mechanism of the Twelve Meridians

(I) Case 1

Geng XX, Male, 15 years old. Initial consultation on July 30, 1995: The patient had suffered from an exogenous disease for more than 30 days. After more than a month of treatment with Western medicine and intravenous infusion, the condition had not healed, fluctuating in severity. Due to the prolonged illness, he came to the Wudang Taoist Clinic for treatment.

Symptoms: Mild headache, alternating chills and fever, body temperature reached 38.5°C during fever, restlessness and irritability, vomiting bitter water, soreness and weakness of the four limbs, little appetite. Symptoms were lighter in the morning and heavier in the afternoon. Urine was yellow, tongue red with white coating mixed with green.

Pulse Diagnosis: The arteries at both Cun Kou were wiry and small, showing a pulse wave width twice as wide. It was perceived that the Guan and Chi positions of the left and right Mai Kou had pulses, while the Cun positions had weak pulses. When the pulse wave operated positively, it could not reach the Cun pulse position. The arteries at the left and right Ren Ying were slightly stronger than those at the two Cun Kou, both showing Cun stronger than Chi. Based on the wiry, small, and weak pulse waves, it was proven that the pathogenic factor was not too severe, but the Healthy Qi (Zheng Qi) was also deficient. Since Healthy Qi was deficient, it lacked the ability to resist pathogens, causing the pathogen to linger for a long time without healing. Based on the symptoms of alternating chills and fever and vomiting bitter water, as well as the wiry and small arteries, it was proven that the pathogen was located in the Foot Shaoyang Gallbladder Meridian. "Xiao Chai Hu Tang" (Minor Bupleurum Decoction) plus Chuanxiong was adopted for treatment. Prescription: Hong Chai Hu 18g, Dang Shen 24g, Huang Qin 13g, Zhi Ban Xia 10g, Gan Cao 7g, Sheng Jiang 13g, Chuan Xiong 6g, Da Zao 9 pieces, Xian Che Qian Cao 30g.

Second consultation on August 3, 1995. After taking two doses of the above prescription, the frequency of vomiting bitter water decreased, and body temperature reduced to 38°C. Other symptoms remained the same, Yin and Yang pulse images were unchanged. However, the pulse wave force at the two Cun Kou slightly increased. Continued with two more doses of the above prescription.

Third consultation on August 6, 1995. After taking four doses of the previous prescription, symptoms of headache, chills/fever, and vomiting subsided, body temperature 37.5°C, green-white tongue coating eliminated, but the tongue was found to be dry and lacking fluids. The patient reported: Appetite increased, but still felt somewhat restless and thirsty, desiring to drink. Examination showed pulse waves at both Mai Kou had reached the Cun position, but during positive operation, the pulse waves still appeared weak and powerless. Examination of the left and right Ren Ying arteries showed a reduced disparity between Cun superiority and Chi weakness, but imbalance remained. Pathogens had been expelled, but spirit was listless and body fluids were deficient. Following the previous prescription, Huang Qin, Ban Xia, and Chuan Xiong were removed, and herbs nourishing Yin and generating fluids were added for regulation.

Prescription: Sha Shen 20g, Chai Hu 9g, Mai Dong 20g, Yi Yi Ren 18g, Gan Cao 7g, one slice of Sheng Jiang, five pieces of Da Zao.

Fourth consultation on August 9, 1995. After taking three doses of the above prescription, thirst and restlessness were eliminated, body temperature: 36.8°C. Examination of Mai Kou and Ren Ying arteries tended towards peace, but the patient still felt weakness in the four limbs. Later, patent medicine "Bu Zhong Yi Qi Wan" (Tonify the Middle and Augment the Qi Pill) was used for regulation to cultivate Middle Qi. After five days of服用, all symptoms disappeared and the patient was completely cured.

Reflection: Xiao Chai Hu Tang is composed of Chai Hu, Ren Shen, Huang Qin, Gan Cao, Ban Xia, Sheng Jiang, and Da Zao, mainly treating Shaoyang syndrome where pathogens are located. Because the patient had symptoms of headache and yellow urine, Chuan Xiong and Che Qian Cao were added.

My experience using Chai Hu is: If the Left Cun Kou pulse is wiry, showing a pulse wave width doubled, and during reverse operation the Guan and Chi pulse waves are very clear; but during positive operation, the pulse waves cannot reach the Cun position, it is considered that Liver Qi is difficult to extend, and Chai Hu is commonly used to soothe it. Predecessors used "Xiao Yao San" (Free and Easy Wanderer Powder) to treat women whose Liver was injured by depression and anger, which is also a variation of Xiao Chai Hu Tang.