Library

*Ling Shu: Guan Zhen* (Spiritual Pivot: Official Needles) states: There are twelve categories of needling. *Ci Jie Zhen Xie* (Discourse on Needling Segments and True Evil) states: There are five categories of needling. "Chang" (Long/Extensive) means extensive or broad. "Chang Ci Jie" (Extensive Needling Categories) refers to determining the needling method based on the location of the disease. For example, headache, aversion to cold and fever, suppurative swelling, abdominal masses, bi-syndrome (painful obstruction), mania, epilepsy, and various wind diseases are all treated by selecting points based on the location of the disease. This serves to expand and enrich the application of the five and twelve needling categories, hence it is called "Chang Ci Jie".

Practitioners of needling may forgo pulse diagnosis and rely solely on the patient's self-reported symptoms.

Qi Bo, continuing the explanation of needling principles from the previous section, further elucidates the meaning of "Chang Ci Jie". The *Jiu Zhen Shi Er Yuan* (Nine Needles and Twelve Original Points) discourse states: "Whenever one intends to use needles, one must first diagnose the pulse." Now, stating that practitioners do not diagnose the pulse but only listen to the patient implies that needling methods can be guided either by pulse findings or by symptom presentation. This supplements the aspects of needling methods that were not fully detailed previously.

If the disease is in the head, manifesting as severe headache, employ deep needling (Cang Zhen). The needle should reach the bone; the disease will then resolve. However, the upper layers must not damage the muscle or skin above the bone. The skin is the pathway for the needle.

"Cang" retains its literal meaning. This describes the method for treating headache. "In the head" indicates the disease location is the head. "Severe headache" refers to sudden pain due to the disease being in the head. "Cang" here implies depth. "Cang Zhen" means deep needling. By employing deep needling, the needle must reach the bone for the disease to resolve. Although the needle reaches the bone, the tissue above (muscle outside the bone and skin) must not be damaged. The path of the needle from the skin to the bone constitutes the principle of needling. Hence, it is said: "The skin is the pathway." "Dao" (Pathway) means road or route.

Yang Ci (Yang Needling): Insert one needle centrally and four needles laterally. This treats aversion to cold and fever. If the cold-heat pattern is not in the Yang aspect but is deep and localized, needle the major Shu points of the Zang organs. To approach the Zang organs, needle the back Shu points. The back Shu points are located on the back. Needling these approaches the Zang organs because they are the convergence points of Zang Qi. Once the cold-heat in the abdomen is resolved, cease needling. Regardless of whether using Yang or Yin needling, the key point upon withdrawing the needle is to superficially induce bleeding to unblock the collaterals.

"Yang" was erroneously printed as "Yin" in old editions; corrected here. "Chu" is pronounced with the departing tone. This describes the method for treating cold-heat patterns. *Ling Shu: Guan Zhen* states: "The fifth is Yang Needling. Yang Needling involves inserting one needle centrally and four needles laterally." "Insert one centrally" corresponds to the central insertion; "four laterally" corresponds to the lateral insertions. This Yang Needling method treats cold-heat in the Yang aspect. If the cold-heat is not in the Yang aspect but is deep and specialized, it has entered the Yin aspect, so one needles the major Zang organs. Here, "major Zang organs" refers to approaching the Zang by needling the back. The Shu points of the five Zang organs are all on the back; these are the Back Shu points. It further explains that needling approaches the Zang because the Back Shu points are on the back and serve as the convergence of Zang Qi. One central and four lateral insertions constitute Yang Needling, treating cold-heat in the Yang aspect. Approaching the Zang by needling the back constitutes Yin Needling, treating cold-heat in the abdomen. Thus, once the cold-heat in the abdomen is gone, stop needling. "Stop needling" means to cease when the disease is addressed. Wherever "stop" appears below, it refers to ceasing needling. Whether Yang or Yin needling, generally, upon withdrawal, one should superficially induce bleeding to unblock the collaterals.

To treat suppurative swellings (Fu Zhong), needle the suppurating area. Observe the size of the abscess to determine the depth of needling. For large abscesses, which contain much pus and blood, needle superficially. For small abscesses, needle deeply. The needle must be inserted steadily, stopping when the desired effect is achieved.

"Na" (insert) is pronounced like "Na". This describes the method for treating suppurative swellings. Rotten flesh is "Fu"; elevated swelling is "Zhong". Treating Fu Zhong involves treating the internal rot and external swelling. When there is internal rot and external swelling, one should needle the surface of the rot. Then, observe the size of the abscess to decide the depth. Needling a large abscess involves superficial needling due to the abundance of pus and blood. A small abscess, if unruptured, contains toxic factors internally and requires deep needling. During deep needling, the needle must be inserted steadily, restoring normalcy, and stopping when the treatment goal is met.

For accumulations in the lower abdomen, needle from the skin downwards until reaching the lower abdomen. Needle the spaces between the fourth vertebrae on both sides of the spine. Needle the areas between the two iliac bones and the costal margin. This guides the Qi in the abdomen; when heat descends, the disease resolves.

"Tu" (protrude) is pronounced "Tu". "Qia" (iliac bone) is pronounced "Jia". "Liao" is pronounced "Liao", same as in other chapters. This describes the method for treating abdominal accumulations. "Liao" refers to thickening or protrusion. For accumulations in the lower abdomen, needle the protruding skin over the accumulation. Since there is an accumulation in the lower abdomen, the skin there protrudes; thus, needling from below to the lower abdomen targets this area. The space between the fourth vertebrae on both sides of the spine corresponds to the Shu points of the Pericardium and Jueyin meridians. For lower abdominal accumulations, needling the Jueyin Shu points is indicated. *Mai Yao Jing Wei Lun* states: "Disease named Xin Shan (Heart Hernia) presents with palpable form in the lower abdomen; therefore, needling is required." The lumbar bone is called Qia. The protrusions on both sides of the iliac bones correspond to the Juliao (Ju Liao) acupoint. The intercostal space at the costal margin corresponds to the Zhangmen (LR13) acupoint. The costal margin is the pathway of the Foot Jueyin Liver Meridian. The side of the iliac bone is the pathway of the Foot Shaoyang Gallbladder Meridian. For lower abdominal accumulations, combining needling of the Jueyin and Shaoyang meridians guides the Qi in the abdomen and warms the lower region, resolving the disease. "Lower" refers to the lower abdomen.

Disease in the lower abdomen, with abdominal pain and inability to urinate or defecate, is named Shan (Hernia). Caused by cold, needle the area between the lower abdomen and the thighs, and the area between the waist and the hip bone. Perform multiple needle insertions until local heat is felt, then the disease resolves.

This describes the method for treating Cold Shan. Disease in the lower abdomen, accompanied by pain and urinary/fecal retention, is named Shan. Caused by cold, one should needle the area between the lower abdomen and the thighs, which is the Chongmen (ST30) acupoint. Needle the area between the waist and the hip bone, which is the Mangmen (BL52) acupoint, located lateral to the spinous process of the 13th thoracic vertebra. Needling the area between the lower abdomen and the thighs treats the hernia. Needling the area between the waist and the hip bone dispels cold. Therefore, multiple insertions are used. "Jiong" means heat. Wait until full heat is perceived, and the disease will resolve.

Disease in the sinews, with sinew spasms and joint pain, preventing walking, is named Jin Bi (Sinew Bi). Needle the sinews as the target. Needle between the muscles, avoiding the bone. When the disease originates from heat in the sinews, cease needling once the disease resolves.

"Zhong" (hit/strike) is pronounced with the departing tone. This describes the method for treating Sinew Bi. Disease in the sinews causes spasms and joint pain. Spasms and joint pain prevent walking, hence the name Sinew Bi. One should needle the sinews to relieve spasms and restore normal function. The method for needling sinews is to needle between the muscles, avoiding the bone. Proper needling induces heat in the sinews. When heat arises in the sinews, the disease is resolving; once resolved, cease needling.

Disease in the skin and muscle, with widespread pain, is named Ji Bi (Muscle Bi), caused by injury from cold and dampness. Needle the major and minor divisions of the muscles. Use multiple needles and deep insertion. Local heat indicates efficacy. Do not injure the sinews or bones. Injury to sinews or bones may cause abscesses or complications. When all muscle divisions feel hot, the disease resolves, and cease needling.

This describes the method for treating Muscle Bi. Widespread pain in the skin and muscle is named Muscle Bi. Caused by cold and dampness, one should needle the major and minor muscle divisions. Major division refers to the convergence of large muscle groups; minor division refers to the convergence of small muscle groups. There are 365 meeting points between the muscles. Therefore, use multiple needles and deep insertion, considering the arrival of warm Qi as restoration of normalcy. Although deep needling is used, do not injure sinews or bones. Injury may lead to abscesses or changes in condition. Before such changes occur, proper needling should make all muscle divisions feel hot, resolving the disease, then cease needling.

Disease in the bones, with heavy bones that cannot be lifted, and soreness/pain in the marrow, with cold qi arriving, is named Gu Bi (Bone Bi). Deep needling should avoid injuring the vessels and muscles. Restore normalcy as the goal. The path follows the major and minor muscle divisions. When the bone feels hot, the disease resolves, and cease needling.

"Suan" (sore) is written as " ". This describes the method for treating Bone Bi. Disease in the bones causes heaviness and inability to lift them, accompanied by marrow soreness. Cold qi invading the bones is named Bone Bi. With Bi in the bones, one should needle the bones. In deep needling, avoid injuring vessels and muscles. Proper needling removes Bone Bi and restores normalcy. "Its Dao" refers to the bone pathway. Not injuring vessels and muscles means the Qi from the bone pathway also emerges through the major and minor muscle divisions. Needling the bone while waiting for Qi arrival, when the bone feels hot, the disease resolves, and cease needling.

Disease in the various Yang meridians, presenting with both aversion to cold and fever, and in all muscle divisions, also with both aversion to cold and fever, is named Kuang (Mania). Reduce the pulse (deplete excess). Observe the muscle divisions until they are all hot, then cease needling.

This describes the method for treating Mania. Disease in the Yang meridians with aversion to cold and fever indicates pathogenic factors attacking the meridians. Similar symptoms in the muscle divisions indicate pathogenic factors attacking the muscles. The interaction of pathogenic factors in the muscles and meridians results in Mania. Needling to reduce the pulse prevents pathogenic factors from attacking the meridians. Observing the muscle divisions becoming hot indicates the gathering of righteous Qi and heat. At this point, Mania resolves, and cease needling.

At the initial onset, the disease occurs once a year. If untreated, it occurs once a month. If still untreated, it occurs four or five times a month. This is named Dian Bing (Epilepsy/Melancholia). Needle the various muscle divisions and meridians. For cases without cold-heat alternation, regulate with needles. Cease needling when the disease resolves.

This describes the method for treating Dian Bing. Initial onset refers to the beginning of Dian Bing. If untreated at onset, it occurs annually. If annual attacks are untreated, it becomes monthly. If monthly attacks are untreated, it becomes frequent (4-5 times/month). All these manifestations are named Dian Bing. One should needle the various muscle divisions and meridians. "Various divisions" refers to muscle divisions; "various meridians" refers to the meridians. "Without cold" means absence of cold-heat alternation, differing from Mania. Mania belongs to Yang (excess); Dian Bing belongs to Yin (deficiency). Yang is associated with excess, Yin with deficiency. Therefore, one should tonify/regulate with needles, ceasing when the disease resolves.

Wind disease, presenting with aversion to cold and fever, and hot sweating occurring several times a day. First, needle the connective tissues and collateral vessels of the various muscle divisions. After sweating, if aversion to cold and fever persist, needle every three days. Cure within 100 days.

This describes the method for treating Wind Disease. Wind disease with aversion to cold, fever, and hot sweating occurring several times a day is due to Wind being a Yang pathogen with a stirring nature, causing alternating cold/heat and sweating. First, needle the connective tissues and extra-meridional collaterals of the muscle divisions before the attack occurs. Sweating is induced by needling. If sweating does not resolve the cold-heat pattern, needle every three days. After 100 days (ten cycles of the Heavenly Stems), the disease resolves.

Great Wind disease (Leprosy), with heavy joints and loss of eyebrows and beard, is named Da Feng (Great Wind). Needle the muscles as the target. Induce sweating for 100 days. Needle the bone marrow. Induce sweating for another 100 days. Total 200 days. Eyebrows and beard will regrow, then cease needling.

This describes the method for treating Li Feng (Leprosy/Great Wind). Great Wind is Leprosy. Wind pathogen lodging in the vessels and not leaving, causing skin ulcers, is named Li Feng. Thus, Great Wind disease presents internally with heavy joints and externally with loss of eyebrows and beard. One should needle the muscles to restore their normal state. Induce sweating for 100 days to expel the Wind pathogen. If the pathogen in the joints remains, needle the bone marrow and induce sweating for another 100 days. Total 200 days (twenty cycles of the Heavenly Stems). Eyebrows and beard will regrow, then cease needling.

This chapter lists needling methods for headache, suppurative swellings, abdominal masses, hernias, Bi-syndromes, mania, epilepsy, and various wind diseases, each having specific categories, hence titled "Chang Ci Jie" (Extensive Needling Categories).