Library

Huangdi asked Qibo: The qi of the four seasons has different forms. The onset of all diseases arises from specific causes. What is the fixed principle for moxibustion and acupuncture?

Qibo replied: The qi of the four seasons resides in specific locations. The principle of moxibustion and acupuncture is determined by obtaining Qi at the acupoints. Therefore, in spring, one selects the meridians between the blood vessels and the muscle intervals; for severe cases, deep insertion is used, while for mild cases, shallow insertion is applied. In summer, one selects the full meridians and the sun collateral vessels, targeting the spaces between muscles and piercing the skin. In autumn, one selects the Shu (Stream) points; if the pathogen is in the fu organs, the He (Sea) points are selected. In winter, one selects the Jing (Spring) and Ying (Well) points, requiring deep insertion and retention of the needle.

This chapter discusses how the qi of the four seasons enters and exits the skin and collaterals. The skin, flesh, sinews, and bones are the external correspondences of the six fu organs. Thus, the onset of diseases may originate from external pathogens affecting the skin, vessels, flesh, sinews, and bones, subsequently involving the internal six fu organs; or it may originate from dysfunction within the six fu organs, extending to their external corresponding structural layers. Both internal and external factors contribute to disease. Understanding the entry and exit of qi allows one to determine the treatment. Since the qi of the four seasons resides in specific locations, spring treatments target the meridians within the muscle intervals; summer treatments target the full meridians and sun collaterals, involving the muscle intervals and skin. This is because the qi of spring and summer moves from the interior to the exterior. Autumn treatments target the Shu points, and when the pathogen is in the fu organs, the He points are selected, reflecting the return of autumn qi from the exterior to the interior. Winter treatments target the Jing and Ying points with deep insertion and retention, indicating that winter qi stores within the interior. The movement of human qi follows the four seasons of heaven and earth; thus, the principle of moxibustion and acupuncture is fixed by obtaining Qi at the acupoints.

According to the *Ben Cang* chapter: The Lung combines with the Large Intestine, which corresponds to the skin and hair; the Heart combines with the Small Intestine, which corresponds to the vessels; the Liver combines with the Gallbladder, which corresponds to the sinews; the Spleen combines with the Stomach, which corresponds to the flesh; the Kidney combines with the San Jiao and Bladder, which correspond to the interstices and body hair. This illustrates the combination of zang and fu organs, and the correspondence of fu organs to structural layers. Consequently, some diseases, such as warm malaria and cutaneous edema, remain in the external structures, while others, such as intestinal obstruction and frequent abdominal borborygmi, reside in the fu organs.

For warm malaria with no sweating, use the fifty-nine acupoint needling method.

This refers to external pathogens affecting the bone marrow. The *Su Wen: Malaria Theory* states: Warm malaria results from wind-cold contracted in winter, hiding in the bone marrow. When yang qi expands greatly in spring, the pathogen cannot exit spontaneously. If exposed to intense summer heat, the brain marrow is scorched, muscles waste away, pores open, or physical exertion occurs, the pathogen exits with sweat. This disease roots in the Kidney, with its qi moving from the interior to the exterior. Therefore, if sweat does not occur, the pathogen cannot be expelled. One should use the fifty-nine acupoint method, employing the fourth type of needle (sharp needle) to puncture the bone and drain the pathogen.

For Feng Dan (wind-induced distension), use the fifty-seven acupoint needling method. Select all blood vessels in the skin and pierce them completely. (Dan refers to water disease).

This refers to external pathogens affecting the skin. Dan is a water disease caused by wind striking during sweating, causing wind-water pathogens to remain in the skin, leading to swelling. Use the fifty-seven acupoint method, selecting and piercing all blood vessels in the skin. Since the pathogen is in the skin, it should be dispersed from the surface. See the *Su Wen: Water-Heat Acupoint Theory* for details on the fifty-seven acupoints.

For Sundry diarrhea (undigested food in stool), tonify the intersection of the three yin meridians (Sanyinjiao SP6) and the He-Sea point of the Spleen (Yinlingquan SP9). Retain the needles for a long time until warm qi arrives, then remove them.

This is an internal pathology involving the Spleen, manifesting as sundry diarrhea. The Spleen belongs to damp earth and is the extreme yin within yin. Deficiency and cold of Spleen qi lead to sundry diarrhea. Therefore, one should tonify the intersection of the three yin meridians (Zusanli ST36 is often cited in other contexts, but here specifically Sanyinjiao SP6 is implied by "intersection of three yin") and Yinlingquan SP9 (the He-Sea point of the Spleen), retaining the needles until warm qi arrives.

Zhu Jigong asked: The classics only discuss diseases in the six fu organs; why is there mention of sundry diarrhea related to the Spleen organ? The answer is: The Yangming meridian does not follow the standard or root principles but transforms according to the Taiyin aspect seen within. The Spleen and Stomach are connected by membranes, combining yin and yang, serving as the source of qi and blood for the zang and fu organs. Hence, the lower chapters discuss diseases of the five zang organs while also mentioning the Stomach; this chapter discusses diseases of the six fu organs while including the Spleen.

For spasms in yang meridians, treat the yang meridians; for spasms in yin meridians, treat the yin meridians. Use sudden needling (cu ci).

Sinews have yin and yang aspects, corresponding to the twelve months of the four seasons. Therefore, spasms in yang meridians are treated via yang meridians, and those in yin meridians via yin meridians. Sudden needling involves using a red-hot needle to rapidly puncture, treating sinew bi syndrome.

For Tu (water accumulation), first select the area three cun below Huangu, puncture with a Bi needle, insert the needle, withdraw and re-insert repeatedly to drain all accumulated fluid. The tissue must become firm. If the sensation is slow, there will be irritability; if rapid, there will be calmness. Puncture once every other day until the fluid is exhausted. Then administer medicine to close the pathways. While needling, drink water. Do not eat immediately after drinking, and do not drink immediately after eating. Avoid other foods. Regulate for 135 days.

This is an internal pathology due to deficiency-cold of the Spleen and Stomach, causing water to overflow into the muscle texture. Tu implies abundance. Earth resides in the center and irrigates the four directions. When earth qi is deficient, water from the four directions overacts upon the earth, causing water disease. There are 365 intersections in the valleys. Large gatherings of muscle are called valleys, referring to the large muscles of the limbs. Huangu refers to selecting the muscle intervals of the limbs to drain water. Tong refers to a tube-like needle inserted and withdrawn to drain fluid. Edema in the muscles is soft; after drainage, the muscles become firm. Slow sensation causes irritability; rapid sensation brings calmness. Although water lies in the interstices, its origin is internal. "Drinking closing medicine" means that after water is drained, one should take herbs to strengthen the Spleen earth to prevent water recurrence. Drinking water during needling helps expel water externally. Since the Spleen governs the muscles, the root of water disease is the Spleen. Only after spleen water is drained can earth qi be replenished. Food enters the Stomach, transports to the Spleen and Lungs; food qi disperses to the Heart and Liver. With the aid of San Jiao qi, essence is steamed and refined, separating clear from turbid. Deficiency of middle jiao qi prevents separation of water and grain. Hence, do not eat after drinking, nor drink after eating. This indicates that deficiency of earth qi leads to water accumulation in the center due to deficiency of San Jiao yuan qi. The San Jiao circulates yuan qi through the interstices; deficiency leads to loose pores and internal water overflow. Eating only grains nourishes earth qi. The completion number of earth is ten, flourishing in the eight solar terms. Regulating for 135 days exceeds nine solar terms, allowing earth qi to recover.

For persistent Zhe Bi (heavy bi syndrome) with chronic cold, suddenly select Zusanli ST36.

This is pathogen retention in the joints causing bi syndrome. The *Su Wen: Bi Syndrome Theory* states: Excess dampness causes Zhe Bi. Dampness flows into the joints, causing chronic cold. One should suddenly select Zusanli ST36 to utilize the dry-heat qi of Yangming to overcome cold-dampness. Shen Liangchen notes: Valleys belong to bones. This continues the previous discussion on residual water in the interstices flowing into joints, becoming Zhe Bi. Thus, Zusanli of the Yangming meridian is selected to drain the zang via the fu.

Bone serves as the trunk.

Shen Liangchen states: This continues the discussion on bone diseases, located in the marrow nodes of the bone. Trunk implies hardness and strength like a tree trunk. Thus, warm malaria pathogens hide in the bone marrow; damp-bi qi flows into the joints. The bone acts as a trunk, resisting pathogenic injury. Mo Yun states: The *Wu Yun Da Lun* says: Kidney generates bone marrow; marrow generates Liver. The *Gu Kong Lun* discusses joint intersections where marrow emptiness exists to seep essence. Pathogens harm the orifices, but straight, hard bones resist injury. Pain in the bone relates to the marrow node and corresponds to the bone.

For intestinal obstruction, select Zusanli ST36. Drain excess, tonify deficiency.

Shen Liangchen states: This disease involves the San Jiao, causing intestinal obstruction. San Jiao qi steams and digests water and grain, separating clear from turbid. Water and grain reside in the Stomach, turning into feces and descending to the Large Intestine. Thus, intestinal obstruction results from San Jiao qi deficiency. The San Jiao is distributed in the upper, middle, and lower parts of the stomach region. Therefore, only Zusanli of the Foot-Yangming meridian is selected. Drain excess pathogen, tonify deficient healthy qi.

For Li Feng (leprosy), use Su needling on the swelling. After needling, use a sharp needle at the site, press to expel evil qi, stopping only when the swelling subsides. Eat regular meals; avoid exotic foods.

This is a pathogen in the vessels. The *Su Wen: Wind Theory* states: Wind-cold lodging in vessels without departing is called Li Feng. Swelling is due to nutritive heat in the vessels exiting into the dorsal flesh. Evil qi is the malignant pathogen remaining in place, causing collapse of the nasal bridge, discoloration, and skin ulcers. Thus, evil qi must be expelled until swelling resolves. Regular diet avoids exotic foods, implying bland dietary habits.

For frequent abdominal borborygmi, qi rushing to the chest, panting unable to stand long, the pathogen is in the Large Intestine. Puncture the Yuan source of Huang (Boning/Nebo), Juxu Shanglian, and Zusanli.

This is disease in the Large Intestine. The Large Intestine is the official of transmission; disease causes qi reversal, leading to borborygmi, qi rushing to the chest, and panting. Gaohuang refers to the mu-yuan of the zang-fu. Gao is above, Huang is below. The Yuan source of Huang is 1.5 cun below the umbilicus, named Bobo, belonging to the Large Intestine. Juxu Shanglian is 3 cun below Zusanli. Selecting these points is because the Large Intestine belongs to the Stomach.

For Small Intestine hernia, pulling the testis, connecting to the waist and spine, qi rushing to the heart. Pathogen in the Small Intestine connects to the testis, attaches to the spine, penetrates the Liver and Lung, and links to the Heart system. Excess qi causes reversal, rushing to the stomach and intestines, steaming the Liver, scattering to Huang, and knotting at the umbilicus. Select the Yuan source of Huang to disperse it. Puncture the Hand-Taiyin to support it. Select the Foot-Jueyin to descend it. Select Juxu Xialian to remove it. Adjust according to the meridians passed.

Shen Liangchen states: Hernia pulling the testis and qi rushing to the heart is Small Intestine hernia. Huang is the fat membrane outside the intestines; thus, the Yuan source of Huang is selected to disperse it. Puncture Hand-Taiyin to drain the pathogen. Select Foot-Jueyin to descend qi. Select Juxu Xialian to remove Small Intestine pathogen. Adjust qi according to the meridians traversed.

For frequent vomiting with bitter taste, frequent sighing, palpitations, fear of being caught, the pathogen is in the Gallbladder, with rebellion in the Stomach. Leakage of gall fluid causes bitter taste. Reversal of Stomach qi causes bitter vomiting. This is called "Gallbladder Vomiting." Select Zusanli to descend Stomach qi rebellion. If Stomach qi rebels, puncture the blood collaterals of the Shaoyang meridian to close Gallbladder rebellion. Balance deficiency and excess to eliminate the pathogen.

This is disease in the Gallbladder. Bitter vomiting indicates Gallbladder qi rebelling in the Stomach. Gallbladder qi desires to ascend, hence sighing to stretch. Disease causes Gallbladder qi deficiency, leading to palpitations and fear. Disease in the Gallbladder, rebellion in the Stomach, represents Wood overacting on Earth. Gallbladder fluid connects to Lianquan and Yuying; leakage causes bitter taste. Gallbladder pathogen in the Stomach causes Stomach qi rebellion and bitter vomiting. Select Zusanli to descend Stomach qi. Puncture Shaoyang blood collaterals to stop Gallbladder rebellion. Balance deficiency/excess to remove pathogen.

For inability to swallow food, chest blockage, pathogen in the Wei Wan (Stomach region). If in the Upper Wan, puncture to suppress and direct downward. If in the Lower Wan, disperse and remove.

This is disease in the Stomach region. Inability to swallow and chest blockage. If pathogen is in the Upper Wan, it cannot accept food/water; thus, suppress and direct downward. If in the Lower Wan, it cannot transform feces; thus, disperse and remove. Shen Liangchen states: Blockage is in the upper part. However, lower jiao obstruction affects the upper jiao. Food entering makes the Stomach full and Intestines empty; food descending makes the Intestines full and Stomach empty. If lower qi is blocked and food cannot enter, the Stomach becomes full and upper jiao blocks. Thus, the text generalizes the disease, but treatment distinguishes upper and lower. Scholars must appreciate this.

For lower abdominal pain and swelling, inability to urinate, pathogen in the San Jiao constraint. Select the Great Collateral of the Taiyang meridian. Observe collaterals connecting with the Jueyin small collaterals showing blood stasis. At the swelling and Wei Wan, select Zusanli.

This is disease in the Bladder. The lower shu of San Jiao emerges at Weiyang, joins the Taiyang main channel, enters the Bladder, and constrains the lower jiao. Excess causes retention; deficiency causes enuresis. Lower abdominal pain/swelling and urinary retention indicate San Jiao constraint. Select the Great Collateral of Foot-Taiyang. Small collaterals refer to Sun collaterals. Foot-Taiyang and Jueyin collaterals intersect at Fuyang. Remove blood stasis where knots exist. The Liver governs free flow; knots in Jueyin collaterals also cause urinary retention. If swelling extends to the Wei Wan, select Zusanli.

Observe complexion, investigate causes, know dispersion or recurrence. Observe eye color to know disease survival. Unify form, listen to movement. Hold Qi Kou and Ren Ying pulses to observe pulse quality. Hard, full, and slippery pulses indicate disease progression. Soft pulses indicate disease retreat. Full pulses in all meridians indicate recovery in three days. Qi Kou observes yin; Ren Ying observes yang.

Observing complexion distinguishes the five elements' colors. Green indicates internal disease in the Gallbladder and external disease in sinews. Red indicates internal disease in the Small Intestine and external disease in vessels. Investigating causes determines whether disease originates externally or internally, or transfers between them. Dispersion means pathogen disperses and disease ends. Recurrence means disease moves from external to internal or vice versa. Observing eye color examines blood color. External structures correspond internally to the six fu organs, which combine with the five zang organs. All diseases root in the five elements' colors, visible in the eyes. Thus, eye color reveals disease status. Unifying form means guarding spirit, uniting form and spirit. Listening to movement involves holding Qi Kou and Ren Ying to judge pulse qualities (hard, smooth, soft, quiet) and disease progression. Full pulses in meridians indicate pathogen in the meridians. Qi Kou and Ren Ying observe the qi of the three yin and three yang meridians. Shen Liangchen states: The five zang and six fu organs correspond to Heaven's Five Movements and Six Qi. Five Movements govern the interior; Six Qi govern the exterior. Five Movements govern the year; Six Qi govern the season. Zang organs combine internally with Fu organs; Fu organs correspond externally to Six Qi. Yin and Yang combine, facilitating internal-external communication. Thus, this chapter begins with the four seasons and ends with zang-fu yin-yang qi and blood, illustrating the great dao of human-heaven participation and yin-yang separation/combination.