Ling Shu 1 of 3

Nguyen Van Nghi Tran Viet Dzung Christine Recours Nguyen

huangdi

黃

neijing LINGSHU

帝 內 經

Volume I

靈

Books I - III

樞 N.V.N. Edition Translated from the French by Edward S. Garbacz, MD With Additional Commentary by Sean Christiaan Marshall, D. Ac. © Jung Tao School of Classical Chinese Medicine - 2002 7.

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To my fellow Vietnamese countrymen

For many long years, our medicine has been stifled. Today, we are liberated and independent. Cadre must help their fellow countrymen and the government to promote a medicine responsive to the needs of our people supported by the foundations of Science, Nation, popular Support. Once, our grandparents had invaluable experience treating diseases thanks to Vietnamese medicine. In order to enlarge the medical horizon, their descendants will have to engage in the research and coexistence of Oriental and Western medicines. Ho Chi Minh (Letter to the Minister of health, hanoi, February 27, 1955).

no 8/9.

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We insist on thanking

_ Doctor Nguyen Van Huong, former Minister of health of the Democratic republic of Vietnam, _ Mister Vo Van Sung, former Delegate General of the Democratic republic of Vietnam, France, _ Doctor Tran Quang Hy, former member of the Institute of research of Oriental Medicine, hanoi thanks to whom we have been able to have access to research texts of Oriental Medicine during the long resistance (1926-1974) of the Vietnamese people.

Nguyen Van Nghi, MD Marseille, October, 1972

no 10/11.

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INTRODUCTION

Regrettably, the Confucian literature of our era reports: “Since the publication of the translation of the Lingshu into popular and Western language, the practice of acupuncture and moxabustion is lost...”. It is not about a literal loss, but a loss in quality due to translators ignorant of all medical material, distorting the thinking and extremely subtle facts of Oriental energetic medicine without which acupuncture no longer makes sense.

Shu

樞

signifies “hinge” - that which fastens the strap hinge to a door to

facilitate its opening and closing.

Ling

靈 (1) implies the qualities “of genius”, “inspired” and “marvelous”

regarding the work. The term Lingshu has been rediscovered in the writings of Zhang Jing Yue (1563-1640 AD): “The essential dwelling of the mind (shen) bears the name Lingshu.” It can be otherwise said that the human brain is the “door” of intelligence and that all works of “genius” depend on it. Wang Tao (702-772 AD), native of Mei county in Shangxi province and distinguished doctor of the Tang Dynasty (618-906 AD), more precisely states regarding this: ““Shu” designates “Tian Shu” (“Celestial Hinge”). The celestial movements take place in the space where the hinge and machinery (driving force) are constantly active. “”Lingshu” comprises the sense of using needles and abandoning medicines. This is why the celestial machinery is traced out in space so that each of us has the ability to perceive it. The space is Ling and the driving force shu. The Lingshu also includes the notions of the jingmai, ying and wei becoming evident in our shen ling (mind, brain). Nothing is more marvelous than this.”

1. According to the Zhongwen Dictionary, the etymology of this character describes two sourcerers sitting around a campfire invoking a rainstorm (SCM).

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According to these assertions, we may then define the word “Ling” in the sense of “rapidity”, “agility”, that is to say, to constantly have in mind the logic of following the spontaneous celestial (seasonal) movements . The word “shu” is envisioned in the sense of “motor”, the driving force, thanks to which the human organism is able to respond with rapidity to modifications in the “5 movements” and “6 energies”. Ling and shu then are the indispensable movements of our energetic system allowing us to be able to confront all pathological problems. For this reason, the Lingshu has been the object of passionate discussion and research for over two thousand years, and it is again at the end of the 20th century. According to Ma yuan Tai of the Tang Dynasty (618-906 AD), author of commentaries and explanations of the Lingshu that we possess: “The Lingshu has also been called “Zhen Jing” (“Classic of Acupuncture”) for the first time by Huang Fumi, alias Shi An, of the jin Dynasty (265-420 AD)” In reality, this designation had already been utilized by Huangdi himself in Paragraph 1 of Chapter 1 of the Lingshu: Huangdi questions Qi Bo: “I govern 10,000 people. I feed a hundred families and collect the taxes. I pity myself when they are no longer provided for and moreso when they fall ill. I therefore desire that they be protected from using toxic medicines and that they no longer use stone-puncture, but only use the fine needles: _to activate and aerate the jingmai _to balance the blood and energy _and in analyzing the “favorable/contrary” movements and the “arriving/exiting” movements of the energy. This therapeutic method is destined for posterity. We must therefore formulate the rules to perpetuate them and render them easy to apply and difficult to forget, and organize them carefully in chapters in which the notions of interior and exterior, Beginning and Ending must be presented in a didactic and complete manner. For this, we must consider everything and omit nothing in the writing of the “Classic of Needles” (Zhen Jing). What do you think ?”

*

*

*

We have published the Suwen before the Lingshu because: 1- The Suwen speaks on the mechanism of the triggering of illnesses. Once the illness reveals itself, caution cannot safeguard against a future complication. For this reason, in this classic work, it is advised to delve deeply into: _ the origin of yin and yang, cold and heat _ the preservation of yin, dietary hygiene and the behavior of the individual _ the phenomena of stimulation and inhibition, of victory and response of the “5 movements” _ the favorable and unfavorable phenomena of the “6 energies” which are the necessary conditions for the prevention of the illness, one of our greatest everyday preoccupations.

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2- The Lingshu is centered totally on therapy because pathophysiology alone cannot ensure the longevity of illnesses. It is the first work which teaches us: 13. _ about the circulation of ying (or rong : nutritive energy) and wei (defensive energy), qi (energy), xue (blood) and about the activities of the jing (channels) and mai (vessels), zang (organs) and fu (bowels); _ about the annual and seasonal movements of the natural world which man must be subjected to and about the necessity of neutralizing wind; _ about needle use, thanks to which one can open the “way”(Dao) so as to master all aspects of the problem of the jiao-ben (summit and root) of the illness and its treatment. The Suwen and Lingshu are, therefore, two critical works in service to humanity from antiquity to our times. It is written: “Man unites with heaven and earth and responds to the solar and lunar movements. It is in this way that the Dao of the Santai (“The Ultimate Three”: heaven-Man-earth) is completed”. Above, the energy of man follows the movements of the sun (traveling through the 28 constellations) and moon (Lunar phases: full moon, waning moon), and below, the energy of man answers to the ebb and flow of the ocean. This comparative study of man and the cosmos is also found in the analogous study of the 12 jingmai of the human being and the 12 rivers of earth.

_

The Suwen constitutes the penultimate reference book of medical practice which addresses all those who practice general medicine (phytotherapy, physical therapies, massage therapy, etc.), while the Lingshu is a specialty work of acupuncture and moxabustion (Zhen Jiu). Both the Suwen and Lingshu are each composed of 81 chapters because, according to the ancient masters: “The number 81 is the multiple of 9 (=9 x 9); 9 results from multiples of 3 (=3 x 3) and the number 3 is the number of Santai (“The Ultimate Three”: heaven-Man-earth). The multiple of numbers spreads out to infinity and the transmission of the Dao is eternal. All this thanks to two works, Lingshu and Suwen.” We will publish the Lingshu in 3 volumes of approximately 1500 pages. The original work and commentaries belong to Ma yuan Tai and his collaborator Zhang An Yin (2), physicians of the Tang Dynasty (618-906 AD). Our translation is complete which allows our readers to savor the subtlety of Oriental energetic medicine. Our commentaries are developed under the symbol “N.V.N.” (Nguyen Van Nghi). Volume 1 consists of 3 books: 1- Book 1 concerns numerous studies: _ the study of the use of “9 Needles” according to different techniques _ the study of the Wu shu (5 shu-antique) points according to the principle “Judge the origin in order to study the causes”. _ examination of the pulses and complexions of the body (3) _ the functions of “Opening-Hinge-Closing” of the 3 yin and 3 yang and their clinical applications _ the concordance and discordance of xing (bodily form) and qi (energy), jing (principal channels) and luo (secondary vessels) _ the different needling techniques. 2. Designated in the text under “Commentaries” by the abridged names Ma Shi and Zhang Shi. 3. Here, complexions refers not just to the face, but the “complexions” of the xing (form); for example, the “complexions” of the skin, eyes, voice quality, nails, acupucture points, channel trajectories, etc. (SCM).

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2- Book 2 concerns the following studies: _ the “mental activities” in the maintenance of the health of the living being _ the different pathophysiologic, diagnostic and therapeutic aspects at the time of the manifestation and disappearance of the illness. _ the jingmai and luobie : energetic points, emptiness/fullness, treatment. 3- Book 3 contains the following notions: _ the jingbie (distinct channels) and their system of union. _ the depth of needling and the duration of time to leave the needle in place. _ the jinjing (tendinomuscular channels) and their analgesic effect. _ the method of measurement of the length of the jingmai and the method of determination of the topography of the points. _ the production and distribution of ying (nutritive) and wei (defensive) energy as a function of the sanjiao (SJ). _ the rules of needling and choice of points following the rules of the “Four Seasons”; the attack on the 5 organs by perverse energy and its treatment. _ the classification and treatment of illness caused by cold and heat. The use of points called “windows of heaven.”

The Neijing comes before all medical texts, and we have constantly used our knowledge and long experience in Classical Chinese Medicine to offer a translation that is as faithful as possible. It is evident that such work cannot pretend to attain perfection. Also, critiques and corrections will be welcomed. Finally, we thank our readers, colleagues and friends who have understood the necessity of having a thorough knowledge of traditional foundations and whose loyalty is for us the most precious of encouragements and needed support for our perseverance.

Marseilles, February 1994

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15.

Book 1 Book 1 consists of 7 chapters :

Chapter 1: “9 Needles” and “12 yuan” (Jiu Zhen Shi Er yuan) Chapter 2: Origin of the shu-antique points (Ban Shu) Chapter 3: Explanation of the “Little Needles” (Xiao Zhen Jie) Chapter 4: Pathologic Forms of Attack on the Organs and Bowels by Perverse energy (Xieqi Zang Fu Bing Xing) Chapter 5: Origin and Gathering (Gen Jie) Chapter 6: Long and Short - Hard and Soft (Tu Yao Gong Ru) Chapter 7: Use of the Needles (Guan Zhen)

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no 16/17.

CHAPTER I “9 Needles” and “12 yuan” (Jiu Zhen Shi Er yuan)

“9 Needles” (Zhen) represent the collection of different types of acupuncture needles used before, during and after the era of Huangdi. “12 yuan” (sources) are the places of external gathering of the source energy originating from the 5 organs and 6 bowels located in the interior. These source points are specific in the treatment of the organs and bowels. Chapter 1 of the Lingshu contains 17 paragraphs devoted to: 1 - the study of the “9 Needles”, their names, forms and different lengths, used according to various techniques: - rapid and slow needling - needling “in opposition” and “in pursuit”, “in opening” and “in closing” - needling for tonifying and dispersing effects - needling to balance the shen - needling and waiting for the energy - needling and the examination of the pulses which, at a practical level, are of prime importance. 2 - the study of deleterious illnesses caused by erroneous treatments or by poor manipulation of the needle which emphasizes the importance of the evaluation of the state of emptiness and fullness and the seriousness or benignness of the illness. 3 - presentation of the 12 yuan (source) points which are not only situated between the elbows and hands and between the knees and feet, but also in the thoraco-abdominal region. These points must be used systematically in all cases of energetic problems of the 5 organs and 6 bowels. The study of these yuan points leads to that of the Wu shu points (the 5 shu antique points): jing, ying, shu, jing and he and their relationships to the organs and bowels. All these problems are presented in the chapter aptly entitled: “9 Needles” and “12 Yuan” (Jiu Zhen Shi Er Yuan).

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PARAGRAPH 1

18.

Huangdi questions Qi Bo: “I govern 10,000 people. I feed a hundred families, and I collect the taxes from them. I pity myself when they are not provided for and especially when they fall ill. I therefore desire that they be protected from toxic medicines and that they no longer use lithopuncture, but only use the fine needles: - to activate and aerate the jingmai - balance the blood and energy - and analyze the “favorable/contrary” movements and the “entering and exiting” movements of the energy. This therapeutic method is destined for posterity. We must therefore formulate the rules to perpetuate them and render them easy to apply and difficult to forget, and organize them together carefully in chapters in which the notions of interior and exterior, Beginning and Ending must be presented in a didactic and complete manner. For that, we must consider all and omit nothing in the drafting of the “Classic of Acupuncture” (Zhen Jing). What do you think about this?”

EXPLANATION AND COMMENTARIES I - Ma yuan Tai (Ma Shi) explains: “It is written in “The Annals” (Ban Qi) that the emperor had divided the earth into “jing” and had invented the system of measure “Bo” (“foot” = measure of length) to divide up the jing into “Mu” where he cultivated the 5 grains (5 types of rice) to feed the people and be paid taxes. This notation explains the phrase: “I govern 10,000 people. I feed a hundred families and I collect the taxes.” In this paragraph, Huangdi seeks to define the foundation of acupuncture, and Qi Bo contemplates over it to compose the texts.” II - Zhang An Yin (Zhang Shi) comments : “ ... If the peasant falls ill, he can neither work the earth nor provide for his needs. Therefore, the emperor created the methods of “9 Needles” and “Fine Needles” which he wished to perpetuate. All medicines, whatever their origin, are toxic; lithopuncture was used to evacuate perverse energy. These two methods are “resolvents” and “dispersants’. 19. “Favorable and contrary movements” are transmitted by the blood and energy, and the “movements of “exiting and entering”” are the sites of reunion by which the energy is secreted to the exterior and regains the interior (internal and external trajectories). Man lives thanks to the energy of heaven and earth. The yin and yang of man, obeying the reason of heaven and earth, circulate in perpetual fashion because everything stopping is a sign of disease. Based on the Dao of heaven and earth, Huangdi invented the method of the “9 Needles” so that the yin and yang, blood and energy of man follow the cosmic rhythm. Knowing this principle well, one cannot forget the “channels” and “rules”, that is to say, the “routes” and “directions”, the “knots” and “framework”.

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Figure 1 Plan of rice fields in the era of ancient China (land divided into 9 plots).

In this chapter of the “9 Needles”, Huangdi mentions the “Fine Needles” and Qi Bo indicates the “Little Needles”. Does there exist then, other than the “9 Needles”, a category of “Little Needles”? The sage utilizes “9 Needles” based on the numbers of heaven and earth which begin with the number 1 and end with the number 9. The multiple of 9 (9 X 9 = 81) conforms to the number of Huang Zhong. The use of the “9 Needles” associated with the “Little Needles” permits the reuniting of the number 5 of yin and the 5 flavors with the numbers of Xia Du (I Jing: “Book of Changes”) in order to carry on the work of Fu Xi and Shen Nong. As a result, the development of the technique of needling based on the study of Liang Yi and Si Shang and the even and odd numbers of the Xia Du (I Jing) precedes the method called “mastery of self” and the method of government of the country and of pacification because the people are the basis of the state. 20.

III. N.V.N. In ancient China, each rice paddy had the shape of an ideogram (not “jing”) divided into 9 parcels (see Figure 1). Each parcel was divided into 100 “Mu” (1 Mu = 3600 m2). The central parcel belonged to the state and the other 8 peripheral parcels belonged to the 8 rice-cultivating families. These 8 families used not only their land, but also that of the state. At the time of the rice harvest, the state received its share of 1/9th of the crop in the form of taxes known as “jing taxes”.

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PARAGRAPH 2 Qi Bo:

“That His Majesty permits me to show him with order all that I know, beginning with the number 1 and ending with the number 9. In effect: _ The “knot and ankle” (1) of the “little needles” resides in the difficulty of putting into practice simple words. The inferior doctor deals only with the form (xing); the good doctor keeps watch over the jing shen (essence-mental) of the illness in marvelous fashion. At the moment when the guest is still at the door, there is no illness; how then can one know the etiology? The skill of needling resides in the speed or slowness of the needle. _ The inferior doctor only attends to “guan” (joints, barriers). _ The good doctor becomes attached to “go” (movement, driving force). These movements do not become detached from the “xue” (2, 3) (points); they are delicate and sublime. At the moment of the arrival of the energy, he does not deviate by the minutest amount, and when he ignores this, he attains no result. It is then necessary to know the movements of arrival and departure of the energy well in order to intervene in time. The inferior doctor ignores this rule; the good doctor respects it. _ Needling performed at the moment of departure of the energy is “contrary”, and needling at the moment of arrival is “favorable”. To know the contrary and favorable and bring ones knowledge to the determination of the regulation is to attain the height of the acupuncture technique.”

EXPLANATIONS AND COMMENTARIES:

21.

I- Ma Shi comments:

In Chapter 74 (“Great Study on the True Basic Notions”) of the Suwen, we have also noted the phrase: “To know “contrary” and “favorable” well is to intervene in time without error”. But the spirit of this phrase concerns the “summit” and “root” and not the needling technique per se. The meaning varies, therefore, within this context. The previous paragraph explicitly demonstrates the “knot and ankle” of the “little needles” and the reasoning of the method of acupuncture. It is easy to speak of the “knot” and ”ankle” of the little needles, but difficult to put into practice. The inferior doctor, like a little worker, holds obstinately to the prestige and principle of the technique. The good doctor instead closely follows the jing-shen of the individual because, 1. Term used symbolically to convey what is essential, most important or the key element of a concept (ESG). 2. Literally, “holes”; acupuncture points (see Chapter 60 (“Dissertation on the Bone Holes”), Suwen, Volume III, NVN Ed.). 3. Dr. Vannghi likened the xue to “chiney pots” or ventilation conduits. Thus, acupuncrtue points serve as a means of energetic “aeration” between the cosmos and the internal milieu (ESG).

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within the emptiness and fullness of the energy and blood, a good tonification or dispersion depends not only on the needling technique, but also on the state of the shen which is nothing but the essential energy of man. The phrase “... in marvelous fashion” implies that the essential energy must always be safeguarded. Infiltration of perverse energy into the organism is short-lived, like a guest passing through; this is why one gives it the name of “guest energy”. The phrase “... The guest is again at the door” means to say that the perverse energy tends to penetrate into the “doors” (energetic points). If one does not succeed in determining it or the channels affected, how can one dare to study etiologies to therapeutic goals? Once the cause of the illness is known, one can carry out the method of needling, but the skill resides in the rapid or slow implantation of the needle. “The inferior doctor only attends to the 6 “guan” (joints of the 4 limbs)” because he ignores the entering and exiting movements of the essential energy and perverse energy. “The good doctor only attends to the “go” (movement, mobility, driving force)”, that is to say, to the movements of departure and arrival of the energy. These movements do not leave the xue (“holes”). The energy of man can be found in a state of emptiness or fullness; the needling can be rapid or slow. After placing the needle in permanently, one obtains deqi (arrival of the energy); one must conserve it and not lose it. 22. At the time of fullness of the energy, one must not tonify; this is why “at the moment of arrival of the energy, one must not go to meet it”. At the time of emptiness of the energy, one must not disperse; this is why “at the moment of departure of the energy, one must not go to pursue it.” If one knows “go” (movements, driving forces), one must penetrate (needle) them without the slighest deviation (that is to say, needle exactly in its center); If one does not know them, no result is obtained; that is to say, one ignores the emptiness and fullness and the application of tonification and dispersion in the case of exhaustion of the blood and energy, responsible for the stagnation of perverse energy. This is why it is necessary to clearly determine the contrary and favorable movements, the emptiness and fullness, to apply the needle at the opportune moment. The inferior doctor becomes confused and fails to appreciate the marvels of the energy; only the good doctor is capable of delving deeply into the method of the use of the needles”. II - Zhang Shi explains: _ “The inferior doctor only deals with the form” means that he only needles the skin, flesh, muscles, vessels and bones. _ “The good doctor keeps watch over the jing shen” means to say that he knows how to determine the emptiness and fullness of the blood and energy in order to apply the methods of tonification or dispersion. _ “ ... in marvelous fashion”: praise addressed to good doctors who know how to keep watch over and direct the jing shen. _ “The door” designates the place of entry and exiting of the essential energy, and “the guest is again at the door” denotes that the perverse energy is again found at the place where the essential energy enters and exits. _ “Etiology”, the word which implies that one must determine the location of the illness before applying acupuncture. _ “Slow and rapid”, words designating slow and rapid needling _ “The inferior doctor keeps watch over the guan”. Guan are the generic names for the joints of the 4 limbs. _ “The good doctor becomes attached to the movements of “go” (driving force)”; in other words, he knows perfectly the precise spot where the energetic points occur. Then the needling is as rapid as an arrow flying from a crossbow. _ “These movements do not become detached from the “holes” (points)”. This means that the good doctor recognizes in precise fashion the points to needle.

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_ The perverse energy and essential energy are sometimes in fullness, sometimes in emptiness. One must clearly know their “arrival” and “departure” at the level of the points. Needling must be exact without deviating even the slightest from its center. _ The moment of arrival of the energy is the moment of fullness of the perverse energy and emptiness of the essential energy. Therefore, one must not hurry to go to meet it to tonify it. In other words, one must not tonify when the perverse energy is in a period of virulence. _ When the perverse energy is moving away, this is the period of weakening of the essential energy. Therefore, one must not hurry to pursue it to disperse it at the risk of injuring the essential energy. It is necessary then to wait for just the right moment when “the energy is underway, arriving or leaving” to intervene as rapidly as an arrow drawn in a crossbow. 23.

In Chapter 27 (“Separation and reunion of Pure energy and Perverse energy”) of the Suwen, it is said : “If one does not discern the perverse energy in a clear-sighted manner and if one uses acupuncture to disperse it after its departure, the essential energy escapes without returning and the perverse energy comes back to worsen the illness”. For this reason, it is mentioned: “When the perverse energy has left, one must not pursue it, and, when the perverse energy has arrived, one must not hurry to go to meet it.” This assertion means that one must aim for just the right moment of arrival or departure of the perverse energy to disperse or tonify because needling performed too early or too late causes defeat. This is why the inferior doctor who ignores this principle is an insignificant doctor. An erroneous application of tonification or dispersion injures the blood and energy and does not eliminate the perverse energy. Knowledge of the moment of departure and arrival of the perverse energy therefore permits determining the emptiness and fullness of the essential energy in order to needle in time. This fact is also ignored by the inferior doctor; it is that which is the difference between him and the good doctor. At the moment of departure of the energy, the perverse energy and essential energy are simultaneously empty or in a weak state. A tonification or dispersion performed on the field is a favorable action.” This is why “to know the contrary is to know how to act without error”; this means knowing the opportune moment to needle. “To go against it and eliminate it”, is dispersion, that which brings about emptiness. “To go in pursuit of it and aid it” is tonification, that which brings about fullness. In this way, to know the reasoning behind “against” and “pursuit” is to widely possess the techniques of acupuncture.” III - N.V.N. : All oriental methods and reasoning, in a general manner, follow a logical progression comprised of its own appropriate laws. The drafting of a book, even a medical one, must also conform to these same laws, with its chapters, table of contents, orderly diagrams of “numbers 1 to 9 “. These numbers are not just a simple numerical order, but possess a qualitative and progressive value. The “knot and ankle” of the “little needles” is easy to speak of but difficult to practice. The inferior doctor sees only the form (xing), while the good doctor studies the jing shen of the person to determine the excessive and insufficient states of the blood and energy. In other words, he masters a very effective technique which consists of “observing the illness” in order to appreciate the emptiness and fullness of the shen qi (mental energy); he understands the reason for the fixation of perverse energy within the organism and knows in precise fashion its sites of infiltration. These facts are vital because, without them, it is impossible to define pathologic characteristics. The efficacy of the needling technique depends essentially on the slow or rapid

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manipulation of the needle. In this regard: _ the inferior doctor knows only the energetic points located near joints; _ the good doctor bases his judgment on the constitution, diet and the psycho-affective state of the patient to determine the mechanism of emptiness or fullness, the processes of excess and insufficiency of the perverse energy, because the alteration of the organism is intimately linked to that of the points of acupuncture, sites of appearance of the very subtle reactions of emptiness and fullness, excess and insufficiency. 24.

When the perverse energy is in fullness, it is advised against to use the method of tonification which would reinforce it. When it has left, the method of dispersion to expel it is contra-indicated. The physician must know the reason for the evolutive mechanism of the illness to analyze the phenomena of “coming and going”, “entering and exiting” of the perverse energy in order to use the method of tonification in time and without error. One who does not know this reasoning of these pathological processes cannot perform in time the desired needling during tonification and dispersion, like an arrow on a tense bowstring which does not slacken at the opportune moment. The one who uses acupuncture must know the movements of coming and going (of arrival and departing) of the energy, that this movement can be “contrary” or “favorable”, excessive or insufficient. By that, one must know the duration of the needle in situ. The inferior physician ignores this fact; only the good physician clearly comprehends it and uses it in marvelous fashion. Concerning “favorable” (shung) and “contrary” (ni) movements, when the pulse of the energy is empty and small, it is contrary; and when the pulse of the energy that has already arrived is harmonious and balanced, it is favorable. Understanding the systems of movements of arrival and departure and of the favorable and contrary movements, therefore, permit performing the needling at the moment desired with certainty. One must base his judgment on the direction of orientation of the departure and arrival of the jingmai in order to carry out the needling. If the movement of arrival is contrary, one must disperse to eliminate the fullness; then the perverse energy passes from fullness into emptiness. In the opposite case, when the movements are favorable, one must follow the path of the circulation in order to perform the needling, and the method of dispersion (to go against in order to eliminate) and the method of tonification (pursue to augment) are intended to effectively harmonize the emptiness and fullness. In this manner, to grasp this “bolt and hinge” is to clearly understand the essential reasons for needling.

PARAGRAPH 3 “ In a general way, in the event of [therapeutic] victory, the principles of use of the needles consist of rendering full the empty, excreting the too full, removing blood stasis and weakening the perverse energy. According to the Dao Yao (4): “To transmit to the needle first slow then rapid movements is to render full, and to transmit to the needle first rapid then slow movements is to render empty. To speak of emptiness and fullness is like “to not have” and “to have”. To judge before and after is like “to survive” and “to die”; this is emptiness and this is fullness; it is like “gain” and “loss”.

4. Classic??.... (ESG).

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EXPLANATIONS AND COMMENTARIES

25.

I- Zhang Shi explains : “Render full the empty” means to say that, in the event of emptiness of the radial pulse, one must tonify. “Excrete the too full”: In the event of fullness of the radial pulse, one must disperse. “Remove stagnated blood”: Eliminate contaminated blood accumulated within the vessels. “...Weaken the perverse energy ...in event of [therapeutic] victory”: In event of fullness of the perverse energy at the level of the channels, one must disperse to evacuate it. “First slow then rapid movements”: Slow implantation of the needle and rapid removal. “First rapid then slow movements”: Rapid implantation of the needle and slow removal. “To speak of emptiness and fullness”: Fullness implies the sense of the presence of the essential energy, and emptiness, the absence of the perverse energy. “To judge before and after”: To examine the state of emptiness and fullness in order to apply tonification and dispersion. “This is emptiness, this is fullness”: During tonification, it is necessary to tense the body as in a moment of receiving something, and during dispersion, it is necessary to relax it as in a moment when one loses something. Such are the words on the technique of the “Little Needles”.

II - N.V.N. : This important paragraph merits a more precise interpretation. The principles of use of the needles consist of applying the method of tonification in syndromes of emptiness to reinforce the potential of the essential energy and the method of dispersion in syndromes of fullness to excrete the perverse energy. In chronic syndromes of compression/accumulation of the blood, it is also necessary to use the process of dispersion to combat the stasis of perverse energy. In the evolutive period of the illness, the perverse energy triumphs over the essential energy; one must also use the method of dispersion to evacuate the perverse energy which, in fullness, then becomes empty. The Dao Yao states: “Slow insertion and rapid withdrawal of the needle retains the essential energy which is not evacuated to the exterior; this is the method of tonification. Rapid insertion and slow withdrawal of the needle exteriorizes the perverse energy by the route of insertion; this is the method of dispersion.” To speak of emptiness and fullness also implies to speak of the sensation of the arrival of the energy (deqi). The departure and arrival of the energy are at once slow and rapid as if it was alternately present or absent. Therefore, the examination of these phenomena must be meticulous.

III. S.C.M.: While bearing in mind that this “emptiness and fullness” may refer to the states of either the perverse energy or essential energy, clinically, one would always disperse the perverse energy and tonify the essential energy.

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PARAGRAPH 4

26.

“Knowledge of the “knot and ankle” of the emptiness and fullness is an excellent standard by which to comprehend the chapter on “9 Needles”; thus, tonification and dispersion are based solely on the manipulation of the needle. In order to disperse, first hold the needle and push it in rapidly, then withdraw it slowly. Moving the yang energy away by advancing the needle, the perverse energy will be secreted. In order to tonify, press on the point with the finger before performing a slow needling. This technique bears the name “make the heat enter”, to allow ofr the prevention of dispersal of the blood and secretion of the energy. Tonification implies the sense of “submission” (obedience) whose ideogram expresses the image of a light step, of a light support (of the finger), like the poise of a mosquito. Setting the needle in place is slow, and the withdrawal of the needle is as rapid as the shooting an arrow from a crossbow. The left hand is associated with the right in order to stop the energy. The “door” being closed, the energy is in fullness in the interior, preventing the formation of blood stasis. In the event of stasis, one must eliminate it rapidly.” EXPLANATIONS AND COMMENTARIES I - Ma Shi emphasizes : “This paragraph is presented in Chapter 3 (“Explanation of the Little Needles”) of this same work, but in a slightly different fashion.” II - Zhang Shi explains : “This paragraph completes the previous one and explains the “knot and ankle” of needling based on emptiness and fullness. In practice, if the radial pulse is in emptiness, it is necessary to tonify; this is why it is said: “render full the empty”. If it is full, it is necessary to disperse; this is why it is said: “Excrete the too full”. The radial pulse is the site of gathering of the “hundred vessels” and site of examination of emptiness and fullness. Chapter 7 (“Special Study on Yin and Yang”) of the Suwen also states: “Qi Kou (radial pulse) becomes the “inch” (thumb) pulse in order to determine life and death; in the event of blood stasis, one must eliminate it... . “ If the perverse energy at the level of the channels is in fullness, one must disperse. This is why it is said : “render empty in the event of victory of the perverse energy”. In the Dao Yao, it is also stated : “In order to tonify, implantation of the needle is slow and withdrawal rapid; and in order to disperse, the insertion of the needle is rapid and the withdrawal slow.” It is also stated differently: “Slowly then rapidly, this is fullness; rapidly then slowly, this is emptiness.” 27. Fullness and emptiness owe their name only to the presence or absence of the energy. The energy makes up part of the group “without form”; it seems “to exist” and “to not exist”. Examining before and after the needling, the fullness seems to disappear then appear, and the emptiness to appear then disappear because: _ for the energy to be in fullness, it is necessary that it be in emptiness before becoming full. _ for the energy be in emptiness, it is necessary that it be in fullness before becoming empty. In summary, the phenomena of emptiness and fullness are those of the same energy which

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appears always to exist. Emptiness and fullness are like “gain” and “loss”. At the moment of dispersion to render empty, the patient experiences a sensation of quivering as if he had lost something; and at the moment of tonification to render full, the subject experiences a sensation of tension as if he had received something. The patient feels these sensations because emptiness and fullness come from the same energy and are like a “gain” or a “loss”. Emptiness and fullness are the genuine “knot” and genuine “ankle” of the acupuncture technique and the true marvelous expression of “9 Needles”. One must know the emptiness in order to tonify and the fullness in order to disperse at the opportune moment. The technique is therefore simple since it is based on the manipulation of a single needle. In order to disperse, one must firmly hold the needle, implant it rapidly and withdraw it slowly. If one can dissipate the yang energy during the manipulation to advance the needle, the perverse energy will be eliminated. In order to tonify, press firmly on the point with the finger before needling. This technique is called “Entry of the heat”; it prevents the dispersal of the blood and secretion of the energy. Tonification implies the sense of “pursuit” with contemplation as if, desiring to leave, one constructed a plan; as if already at the door, one considered what one was going to do, or else, as if one held out his hand toward an uncertain support... . It is like the movement of a fly which is poised. But to withdraw the needle, it evokes the image of the break in the arc of a bowstring. All this has the same meaning as the phrase: “ First slowly then rapidly”. The right hand withdraws the needle and the left closes the point of impact of the puncture; it is what one calls the technique of “2 hands” (left and right). At that instant, the essential energy stops in the interior and the door is closed at the exterior; the “central” energy (Zhongqi) is in fullness and the blood does not stagnate. In the event of stagnation, one must quickly eliminate it. In principle, this technique of tonification never provokes blood stasis.”

III - N.V.N. : The essential point of the method of regulation of the emptiness and fullness is using the 9 types of needles according to the different methods of tonification and dispersion. Each of these methods has its specificity, and the needles are employed as a function of the opening and closing of the energy. 28. • In the process called dispersion, the insertion of the needle is rapid and withdrawal slow; the point of impact of the needle is left free because, in fact, it involves an action at the level of the external region responding to the yang. In this way, the needle has created a path of exit to facilitate the evacuation of the perverse energy. If, in some illnesses where dispersion is obligatory, the method of heated needles is used in its place, a compression of blood and energy forms in the interior to trigger the illness called Nei Wen (mild internal heat). This Nei Wen therefore comes from blood stasis whose end result is the non-excretion of the perverse energy. • In the process called tonification , the essential point depends on the orientation of the energy of the pulse at the moment of its departure in order to transmit to the needle movements of rotation, advancing and retreating. As a result, needling performed after the departure of the energy is absolutely in vain. Needling to direct the energy and pressure on the point must be delicately and skillfully performed like a mosquito poised on the skin and subtly taking off, leaving the impression of still being there. The removal of the needle must evoke the image of the precise and lightning-quick departure of an arrow. The right hand performs the process of withdrawal of the needle, the left hand compresses and blocks the point of impact of the needle to prevent the “central energy” (Zhongqi: energy of the spleen) from becoming evacuated to the exterior, like a closing a door, so

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that the Zhongqi becomes full in the interior. Such is the therapeutic method of tonification of the essential energy and of the evaluation of the perverse energy without provoking blood stasis. If, in spite of all, blood stasis forms at the level of the luomai (secondary luo vessels) after the needling, it is necessary to evacuate it by techniques of local bleeding.

PARAGRAPH 5 “Concerning technique, firmness and confidence are invaluable. Needle vertically without angling to the right or left; focus attention on the “specks of dust of autumn” (5, 6) and on the patient. Knowledge of the points allows needling without danger. At the moment of implantation of the needle, to stimulate with attention to the yang energy and the “2 wei” without diverting the jingshen allows determining the persistence or disappearance of the illness. Also examine the little vessels across the shu points which are hard and solid to the touch.

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph is devoted to the technique of the manipulation of the needle. The physician must be sure of himself in order to determine in precise fashion the points of the channel affected. The essential feature of the method is to firmly hold the needle; this is why “firmness” is called “invaluable”. While the needle is firmly maintained in this manner, implant it vertically with dexterity without angling to the right or left; concentrate the jing shen on the needle without apprehension; the skill is extreme. “The jing shen becomes fixed on the specks of dust of autumn” implies the sense of the concentration of the mind of the physician on the patient in order to determine the emptiness and fullness of the channel. Needling will be, in this way, without danger. This effort of concentration mobilizes the yang energy of the physician. In this manner, the “2 wei” (wei of the physician and wei of the patient) is in communion of effort and lucidity. At this moment, the mental state of the physician becomes concentrated on the patient to help him recognize if the illness persist or not. One determines the exact location of the point when, upon pressure of the finger, a hard and firm point is felt. 29. The essential feature for the physician is to look after his serenity in order to discern the points of the channel to attain. Such is the “knot and ankle” of the art of acupuncture. II - N.V.N.: The essential points of this paragraph are: _ The art of holding the needle is extremely invaluable in the practice of acupuncture. _ During needling, one uses three fingers of the right hand (thumb, index, middle) to 5. Literally, the skill of needling resides in the spaces of “specks of dust of autumn”, an expression showing how subtle the way of dexterity is. 6. In autumn, the metal movement and quality is respponsible for the drying of leaves into dust particles...????. The Chinese character for it is sean (SCM)

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firmly maintain the needle and stick it vertically into the skin without angling right or left. _ The mind of the physician must be concentrated on the body of the needle and tips of his fingers. _ The observation must be meticulous. Attention must be focused on the mental state of the patient. Therefore, before needling, one must : _ become preoccupied with the mental spirit of the patient, _ examine the emptiness and fullness of yin and yang and of the “2 wei” (7), the inviolable residence of the shen, _ determine the state of the mental energy and energy of the organs and bowels to control the seriousness of the illness _ and search for the existence of the little vessels (blood vessels) that cross the shu points (transporting points) to perform movements of pressure/friction in order to have a sensation of hardness that gives evidence of the formation of the accumulation of the perverse energy.

III. S.C.M: Regarding the “inviolability” of the residence of the Shen and the “2 wei” (exterior and interior) which house the shen, one must “keep watch over” the mental state of the patient during treatment. If the patient becomes emotionally disturbed by or during a treatment, that treatment is to be terminated.

PARAGRAPH

6

30.

“Each of the “9 Needles” are totally different: 1. 2. 3. 4. 5. 6. 7. 8. 9.

Chai Zhen or needle with an arrow point, 1.6 cun long. yuan Zhen or needle with an oval point, 1.6 cun long. Di Zhen or needle with a blunt point, 3.5 cun long. Feng Zhen or needle with a triangular point, 1.6 cun long. Pi Zhen or needle with a sword point, 4 cun long, 1.6 cun wide. yuan Li Zhen or needle with a fine, rounded point, 1.6 cun long. Hao Zhen or needle with a filiform point, 3.6 cun long Chang Zhen or needle with an elongated point, 7 c. long Da Zhen or needle with a wide point, 4 cun long.

7. Regarding the “2 wei”, Zhang Jing Yue’s explanation is slightly different from Ma Shi’s. According to him, “The “wei” located at the yang is the wei of the exterior. The energy of the spleen, located in the interior, is the “wei” of the organs and bowels. These two places (yang and yin, exterior and interior) are the sites where the mental energy (shen qi) gathers that must not be disturbed. During use of the needles, one must keep watch there”. Zhang Jing Yue’s explanation appears to be clearer and more plausible than that of Ma Shi.

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Chai Zhen, with a wide shaft and head pointed like an arrow, is intended to disperse yang energy. yuan Zhen is egg-shaped and allows massage of the point before incising the skin without affecting the flesh to disperse the energetic part. Di Zhen, with blunted point calling to mind a barb of a grain of rice, is intended for superficial puncture of the channels to draw the energy. Feng Zhen, with 3 facets, is intended to “hollow out” (enlarge) points in individuals affected by chronic disease. Pi Zhen, needle with a sword-like point, is intended to drain pyogenic formations. yuan Li Zhen, small and rounded, calling to mind the neck hair of a fox, is intended to treat the “Bao qi” syndromes (generic name given to chronic painful paresthesias). Hao Zhen, fine, calling to mind the stinger of the mosquito, is intended for needling in a lively manner. This needle is left in place a long time to combat painful paresthesias. Chang Zhen, long with pointed head and fine thin shaft, is intended to treat painful syndromes of deep parts. Da Zhen, calling to mind the shape of a stick with a rounded tip, is intended to drain serous fluid at the level of the guan (joint = hydrarthrosis). Such are the general features of the “9 Needles.” 31.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains : “This paragraph is devoted to the description of the “9 Needles” and their uses. The “Little Needles” are developed at length in Chapter 3 (“Explanations of the “Little Needles””). Knowledge of the “knot and ankle” of the emptiness and fullness is the essential basis in the practice of the “9 Needles.” That is to say that each needle type must be used wisely. Tonification and dispersion are based on the manipulation of the needle. In other words, the “opening” and “closing” of points must be in accordance with the state of the essential energy and perverse energy. “Push the yang energy away so that the needle advances.” here, yang energy means the essential energy. When the yang energy is pushed away, the perverse energy is driven back to the exterior. “Make the heat enter”. When heat manifests at the point of the needle, the perverse energy is evacuated and the essential energy is not secreted to the exterior. This expression represents the action of needling during tonification and dispersion. In the classics, it is said : “The blood is with Ying Qi, and energy is with Wei Qi.” Wei energy circulates at the same time in the yin and in the yang; this is why one uses this yin and this yang energy between “2 wei” (8)”. In Chapter 76 (“Circulation of Wei energy”) we read: “It is imperative to wait for the energy to know where it occurs in order to apply a suitable needling; this is what one calls “timely needling”. When the illness is found within the three yang channels, one must wait for the arrival of the energy in the yin part in order to needle.” 8. See also commentary in the Zhen Jiu Da Cheng in “Art and Practice of Acupuncture and Moxabustion” Volume II, Wording 75, page 12 (N.V.N. Edition) and “Footnote 5” above.

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In Chapter 75 (“Effects of Needling on the Source energy and Perverse energy”) it is also stated: “The harmony of the 6 channels (3 yin and 3 yang) is synonymous with health. If the area above the channel is in fullness, the area below is surely in emptiness and the blood does not circulate. In this case, perverse energy is certainly present in the yuan luo (secondary vessels) and is found in a state of fullness and accumulation causing a compression/obstruction of the great channels (principal channels). One must needle to disperse; this is the technique called “freeing the accumulation”. This is why, in the presence of little vessels located across the shu points of the channel (jing shu: energetic point and not the 3rd shu-antique point), they are not only visible, but indeed they give an impression of fluctuance (slightly painful) upon pressing with the finger. (see Figure 2) 33... “9 Needles” is the generic names given to the 9 different types of needles. Each type is used according to precise indications. II - Ma Shi explains : “This paragraph deals with the forms and usage of the “9 Needles”. Figures are inserted in this paragraph.” III - N.V.N : The explanation of Zhang Shi concerns instead the previous paragraph. That of this paragraph is presented only in a few words. 32.

Figure 2 State of emptiness of the principal channel and state of fullness of the secondary vessels. In the 1st case: tonification. In the 2nd case: dispersion.

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Figure 3 The “ 9 Needles “

PARAGRAPH 7

33.

Perverse energy is at the top, impure energy is at the center and pure, clarified energy is down below. Needling the Xianmai (vessels of the “fossa”: vessels located at the level of the nucha ( 9 ) ) excetes the perverse energy, and needling the Zhongmai (center vessels) excretes the impure energy. the

Needling too deeply submerges the perverse energy and worsens illness.

This is why it is said: “The skin, flesh, muscles and vessels have their different locations, their different illnesses and their different treatments. In the event of fullness, do not augment the fullness; in the event of emptiness, do not augment the emptiness. Worsen neither the insufficient nor the excessive because to act in this manner is to worsen the illness. To needle the “5 Mai” (“5 Vessels”) is to provoke death; to needle the “3 Mai” (“3 Vessels”) is to also provoke death; to eliminate yin is to provoke inanition; to eliminate yang is to provoke “Kuang” (agitation, violent madness).”

9. Pertains to the nape (neck) (ESG).

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EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This chapter develops the methods of utilization of the “Little Needles” in the treatment of illnesses brought about by perverse energy and their disadvantages. The energy of “wind, rain, cold, heat” attacks the upper part of the body. This is why it is said : “Perverse energy is at the top.” The cereal energy (diet: drinks, food) penetrates into the stomach and becomes transformed into “jing” (“pure energy”: essence) which flows towards the lungs via the intermediary of the spleen; this cereal energy also becomes transformed into “zhuoqi” (“impure energy”) which gathers at the level of the intestines. This transformation can occur in the course of a climatic disturbance (unbalanced cold or heat) or in the course of a diet disturbance to trigger intestinal illnesses. This is why it is said: “The impure energy is at the center”. 34.

The aggression of the clear and damp energy (humidity) of earth always begins at the feet. This is why, it is said: “The pure energy is down below.” “Xianmai” (xian = fossa ; mai = channel-vessel) is a point of the channel located at the level of the nucha which is easily spotted. Needling this point excretes the perverse energy. “Zhongmai” (zhong = center) designates Sanli (St 36), he point of the Foot Yangming. “Needling too deeply submerges the perverse energy” means that it is not necessary to needle Sanli (St 36) too deeply when the illness is superficial at the risk of conducting the perverse energy more toward the interior. “Skin, flesh, muscles and vessels have their different places... .” means that the jingluo (principal and secondary channels) have a specific location and a specific function. This is why deep or superficial illnesses manifest at different levels (either at the skin, flesh ...). It is at these levels that one must needle according to the principle “Do not render full what is already full; do not render empty what is already empty... .” On the other hand, if one weakens the body in an insufficient state and if one reinforces the perverse energy in a state of fullness, one worsens the illness. “5 Mai” designates the 3 yang channels (taiyang, yangming and shaoyang). Too intense a dispersion of the yang energy is responsible for “inanition”. This term encompasses the sense of fright, collapse and weakness. “To eliminate yin is to provoke death” means to say that needling the point Wuli (LI 13) can carry with it serious accidents. In Chapter 60 (“Inscriptions Engraved on Jade”) of the Lingshu, it is stated: “After having performed 5 times the reducing method of the energy at the level of Wuli and after having awaited the arrival of the energy (deqi), if withdrawal of the needle is done after the departure of the energy, the energy of the organ will become exhausted”. “To eliminate the yang provokes kuang (violent madness)” means to say that needling the point Wuli can carry with it a loss of the yang energy of the patient. This phrase explains the dangers of an erroneous needling.” II - Ma Shi specifies : “This paragraph defines three types of perverse energy (xieqi: cosmic energy), impure energy (zhuoqi) and clear energy (qingqi) and emphasizes the disadvantages of needling too deeply thereby avoiding errors. Perverse energy attacks the top part of the body. This is why it is said: “Perverse energy is at the top”. This attack takes place at the points Fengmen (Bl 12) and Fengfu (GV 16). The cereals (foods) penetrate the stomach and are transformed into energy which gathers at the lung. But during the course of unfavorable climatic changes (unbalanced cold or heat), this energy accumulates at the level of the intestines and has the name Zhuoqi (impure energy). This is why, the text states: “Impure energy is at the center”. 35. Clear, cool and damp energy (energy of earth), infiltrates into the organism via the feet.

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This is why it is said: “Clear and humid energy is below”. Needling Xianmai (Bl 12, GV 16) located at the top eliminates the perverse energy and that of Zhongmai (center vessel represented by Sanli St 36) evacuates the impure energy. Needling must not be too deep because the illness is found in the superficial zone of the body. Deep needling worsens the illness. This is why it is stated: “Skin, flesh, muscles, jing and luo have their different locations.” Wuli (LI 13), belonging to the Hand Yangming, is a prohibited point. As a consequence, during dispersion, if one removes the needle in the full act of needling, and if one repeats the process 5 times, the energy of the organ will be wiped out. The term “organ” designates the Hand Taiyin (Lu) whose energy commands the “100 energetic currents”. This is why it is stated : “To eliminate yin is death” and “To eliminate yang is madness” (kuang). III - N.V.N : Perverse energy infiltrates into the jingluo to provoke illness. Cosmic perverse energy (wind-cold) generally penetrates into the cephalic region at the level of Fengfu (GV 16) and Fengmen (Bl 12). One then says: “Perverse energy is at the top.” A dietary disturbance is caused by the production of impure energy (Zhouqi). This energy accumulates within the stomach and intestines. One then says: “Impure energy is at the center.” Cold-damp of the earth infiltrates into the organism at the level of the feet. One says then: “Clear and damp energy is at the bottom”. This is why needling points on the head can evacuate perverse energy, and needling points belonging to earth can eliminate impure energy accumulated within the stomach and intestines. In superficial illnesses, one must avoid needling too deeply because the perverse energy can follow the path of the needles to penetrate more deeply into the organism and aggravate the illness. This is why one says: “Skin, flesh, muscles and vessels (jingluo) are each in a wellestablished layer. Each illness is treated by therapeutic methods that are appropriate to it. The variety of the types of the “9 Needles” answers to that of the illnesses”. One does not apply the tonification method in syndromes of fullness and the dispersion method in syndromes of emptiness. As a result, if, in the case of insufficiency of the essential energy, one uses dispersion and, in the case of excess, tonification, one worsens the illness. On the other hand, in serious cases, dispersion of the energy of the yin channels of the 5 organs causes fatal accidents, and dispersion of the energy of the yang channels of the 6 bowels is responsible for a weakening that is difficult to restore. In other words, erroneous application of dispersion of the yin channels causes annihilation of the energy of the 5 organs, resulting in death; and an erroneous application of dispersion of the yang channels is the origin of violent madness (kuang). 36.

PARAGRAPH 8 During needling, if the energy does not arrive, the number of needlings is not of importance. Needles are used for different purposes according to their type. The “knot and ankle” of needling consists of obtaining the arrival of the energy (deqi) which is the mark of effectiveness. This effectiveness is like that of the wind sweeping the clouds away revealing the blue sky. This needling method is entirely sufficient.”

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EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph defines the efficacy of needling, taking deqi as “knot and ankle”. The preceding paragraph emphasized the importance of the following axiom according to which “different illnesses are treated by different needles.” “... like the wind sweeping the clouds away and revealing the blue sky” is an expressive image representing the dissemination of the essential energy after needling. II - Ma Shi states: “This paragraph defines the “knot and ankle” of needling, taking the “arrival” and “nonarrival” of the energy as the basis of explanation. During needling, if the energy has not yet arrived, one must know how to wait and stay close by the patient to repeat the needling as many times as is necessary. The attitude of the physician is like that of a man who awaits a distinguished guest. If the energy has arrived, one should stop needling. In the preceding paragraph, it is stated: “The skin, flesh, muscles and vessels have different locations; illnesses also have different locations and must be treated differently.” This assertion shows that needling must be done with great prudence as a function of the location of the illness. “When the energy arrives, one must stop needling” justifies that one attaches much importance to the deqi of the needling itself. 37. III - N.V.N. : During needling, one does not obtain deqi when one manipulates the needle carelessly. It is necessary to begin the procedure again until it has arrived. removal of the needle cannot be done until after obtaining the energy. The “9 Needles” are each used with a specific indication and each presents a particular form. It is advised to only use them in order to treat “the place where they will be victorious”. One attaches importance to the deqi because the arrival of the energy is a sign of the effectiveness of needling. As stated in this paragraph, this effectiveness is comparable to that of the “wind sweeping the clouds away”.

PARAGRAPH 9 Huangdi: “ T e l l me about the site of exit of the energy of the 5 organs and 6 bowels.” Qi Bo:

“The 5 organs each have 5 shu-antique points, that is, a total of 5 X 5 = 25 shu points. The 6 bowels each have 6 shu points, that is, a total of 6 X 6 = 36 shu points. The jingmai are 12 in number, and the luomai, 15 in number, making a total of 27 energies that ascend and descend. The place of exteriorization of the energy bears the name jing; the place of flowing out, ying; the place of flowing down, shu; the place of passage, jing and the place of gathering, he. For this reason, the 27 energies of the 27 jingluo all circulate at the level of the 5 shu-antique points.”

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EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains : “During needle use, perfect knowledge of the places of birth and beginning, of entry and exit, of the energy is indispensable. Ying and wei, blood and energy are produced via the cereals (food) at the level of the stomach bowel. Ying circulates within the channels and wei outside the channels. But the blood and energy circulating within the channels saturate the exterior and flow down into the interior via the luomai. In the interior, the 5 organs unite with the “5 movements” which is why they each have 5 shu antique points. Among the “6 energies” coming from from the “5 movements”, one distinguishes 2 types of fire (Ministerial fire and Imperial fire). 38... The jingmai are 12 in number because they belong to the 6 organs and 6 bowels. The luomai are 15 in number because they belong to the 12 jingmai, to 2 curious vessels (renmai and Dumai) and to the spleen (Dabao, Sp 21, “great luo”). The 27 energies of these 12 jingmai and 15 luomai (27 jingluo) enter and exit at the level of the 4 limbs, between the knees and toes and the elbows and fingers. The site of departure of the energy is the jing point, the place of flowing out in a trickle, the ying point, place of flowing down, the shu point, place of flowing out strongly√√, the jing point, place of passage, and the he point, place of gathering. The circulation of the 27 energies also passes by these points. The energy and blood circulating outside the channels at the level of the skin and flesh, originating from the great luo (dai luo: longitudinal luo and tendinomuscular channels) of the 5 organs, flows down to the ying and shu points to unite with the blood and energy circulating within the channels at the level of the elbow and knee, that is to say, at the he points. Such is the circulatory process of the energy and blood of the organs/bowels and of the jingmai at the level of the shu-antique points. (Figure 4).

II - Ma Shi comments : “The jing, ying, shu, jing and he points are the sites of passage of the energy of the organs/bowels and of the jingluo (principal and secondary channels). The 5 organs are heart, lung, spleen, liver and kidney. They each have their shu-antique points: jing, ying, shu, jing and he, that is, 5 X 5 = 25 shu-antique. To the 5 organs and 6 bowels, one adds the xin bao luo (XB), totaling 12 principal channels (jing). Each channel has its own luo, making 12 points, to which one adds Changqiang (GV 1) of the Dumai, Jiuwei (CV 15) of the renmai and Dabao (Sp 21) of the spleen, totaling 15 luo points. 39. The study of these luo is found in Chapter 10 (“Channels-Vessels”) of this classic. But the Nanjing does not consider Changqiang (GV 1), Jiuwei (CV 15) and Dabao (Sp 21) to be luo and speaks of yangqiao and yinqiao, which are not adapted to the text of the Lingshu. According to Chapter 18 (“Energetic Aspects of the Pulses of Man in Good Health”) of the Suwen, the stomach has 2 luo points, Fenglong (St 40) and Xie Li (internal luo vessel of the stomach), and the spleen also has 2 luo points, Gongsun (Sp 4) and Dabao (Sp 21, external vessel), thereby showing the importance of the generatory system (spleen-stomach) of blood and energy. But if one only considers the external circulation of the luomai, there are 15. 38... The energy of the 12 channels and that of the the 15 luo circulating in the external part of the body form one circulatory system of 27 energies. The place where the energy begins its circulation is called the jing point, implying the sense of a source (from a mountain), such as the point Shaoshang (Lu 11) of the lung channel.

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From there, the energy flows out in a trickle; this is the ying point, like the point Yuji (Lu 10). From there, the energy flows out strongly; this is the shu point, implying the sense of movement, like the point Taiyuan (Lu 9). From there, the energy passes to the jing point (route of passage), like Jingqu (Lu 8). From there, the energy gathers at a specific place; this is the he point, like Chize (Lu 5). These 27 energies carry out their movements at the level of these shu-antique points.

Figure 4 Circulatory system of the blood and energy in the channels and outside the channels.

III - N.V.N.: This paragraph does not mention the yuan points because the yuan points of the yin channels unite with the shu points and because the shu points and yuan points of the yang channels possess the same action. IV - S.C.M.: Dabao (Sp 21) as the “upper belt” channel.....

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PARAGRAPH

10

“The places of secretory exchanges correspond to the 365 reunions (“articulations”, shu or energetic points). When one knows the “knot and ankle”, a single phrase can explain all. When one ignores them, there is total confusion. The places of secretory exchanges are the sites of entry and exit of the shen qi (mental energy) and involve neither the skin, nor the flesh, nor the muscles, nor the bones.”

EXPLANATIONS AND COMMENTARIES

40.

I - Zhang Shi explains : “During needling, it is necessary to clearly differentiate the sites of entry and exiting of the shen qi which is none other than the source energy. It comes from heaven (celestial or innate energy) and unites with the cereal energy in order to maintain the entire organism. This is why it is said : “When one knows the “knot and ankle”, a single phrase can explain all. When one ignores them, there is total confusion.” The luomai (secondary vessels) infiltrate into these sites of exchange and not into the skin, nor into the flesh, nor into the muscles, nor into the bones.” II - Ma Shi states : “The sites of secretory exchanges are the places of entry and of exiting of the shen (mental). These are places called “knot and ankle” which one must clearly know. These sites of exchanges are the 365 reunions which represent the zones of permeation of the jingluo (principal and secondary channels). The four sentences of this paragraph are mentioned in Chapter 74 (“Great Study on the True Basic Notions”) of the Suwen, but they concern the “inch” pulse and “foot” pulse, the left and right, responding or not responding to the laws of “Sitian-Taiguan” (10). On the other hand, the term “secretory exchanges” implies the sense of conduction, of entering and exiting of the blood and energy designated under the name of shen and does not involve the skin, flesh, muscles or bones. For this reason, during use of the needle, one must pay attention to the shen qi, and to do that it is necessary to know the secretory sites. In this way, those who are learning acupuncture must realize the importance of the 365 reunions.” III - N.V.N. : This paragraph defines, in fact, the points of acupuncture. IV - S.C.M.: This paragraph highlights the critical fact that the channels and points of acupuncture are unique energetic structures not of neuro-musculo-vascular origin.....more

10. See Suwen, Volume III, NVN Edition. unclear

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PARAGRAPH 11 “• Examination of the color of the eyes allows appreciation of the state of loss or the state of recuperation of the energy. • Examination of the body and the movements of the pulses allows distinguishing the essential energy and perverse energy. The right hand directs the needle, and the left hand transmits a pressure against the point to be needled. At the perception of the arrival of the energy, one must withdraw the needle.” EXPLANATIONS AND COMMENTARIES

41.

I - Zhang Shi explains: “The good physician examines the color of the eyes to determine the loss or recuperation of the energy at the level of the eyes which enables the appreciation of the seriousness or benignness of the illness. To distinguish the essential energy and perverse energy is to evaluate the emptiness of the essential energy and fullness of the perverse energy. “When the energy arrives, one removes the needle” indicates the withdrawal of the needle after tonification or dispersion, that is to say, after the regularization of the energy.” II - Ma Shi specifies: “This paragraph demonstrates the technique of using the needle. First, one must examine the body and colors before inserting the needle. In man, the 5 colors manifest in the eyes. This is why examination of the eyes determines the state of the essential energy. Furthermore, it is necessary to examine the body and tune into the movements of the pulses. A small, large, late, rapid, slippery or rough pulse allows one to determine disease caused by perverse energy or by the essential energy. Once this examination is completed, one performs the needling. The right hand inserts the needle, and the left hand maintains the area surrounding the needle. This is the technique used during tonification and dispersion. Wait for the arrival of the energy to remove the needle.”

PARAGRAPH 12 “Before needling, one must examine the pulses to evaluate the benignness or seriousness of the illness. • If, when the energy of the 5 organs is exhausted in the interior, one performs the needling in order to provoke fullness at the exterior, one creates a phenomenon called Zhongjie (“juxtaposition of exhaustion” or “double exhaustion”); it provokes death preceded by a period of calm. • If, when the energy of the 5 organs is exhausted at the exterior, one performs the needling in order to provoke fullness in the interior, one creates a phenomenon called Nijue (“contrary afflux” or flow in the wrong way); it also provokes death, preceded by a period of agitation, the consequence of a fatal error in the use of points of the 4 limbs.”

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EXPLANATIONS AND COMMENTARIES

42.

I - Zhang Shi explains: “This paragraph underscores the importance of examining the pulses in determining the degree of virulence of the perverse energy to a therapeutic goal. “The energy of the 5 organs is exhausted in the interior” means that if, when the energy of the radial pulse is exhausted in the interior and is no longer perceived by the finger, one performs the needling at the exterior, at the level of the he point where the energy of the luo yang reunite, and one leaves the needle in place to attract the energy, it is the yang energy which arrives and one therefore creates the phenomenon called zhongjie in the interior. This phenomenon is fatal. In the interior, the absence of the energy and the absence of movement are total; this is why it is said “...death preceded by a period of calm.” This phrase demonstrates that the yin energy of the 5 organs comes from the yang energy located at zhongjiao (middle jiao). When one needles to attract the yang energy, it leaves the interior; one then has the phenomenon of “double exhaustion”: exhaustion existing within the 5 organs and exhaustion provoked at the level of the source of production of yin energy, hence zhongjie. “The energy of the 5 organs is exhausted at the exterior” says that if, when the energy of the radial pulse is exhausted at the exterior, one performs the needling of the shu points of the 4 limbs and one leaves the needle in place to attract the yin energy, one provokes, in fact, the arrival of the yang energy because the yin energy is exhausted within the interior and, in this manner, one creates a circulation in the wrong way known as jueni (“contrary afflux”). In other words, this phrase indicates that the yin energy must be within the interior and the yang energy at the exterior; if one attracts the yang energy towards the interior, the phenomenon is “contrary” (ni) and is grave.” II - Ma Shi states: “The “knot and ankle” of the needling method consists first of examining the pulses. In the event of error, the consequences are disastrous. The examination of the pulses is essential before needling because it allows evaluating the seriousness of the disease in order to apply an adequate therapy. “When the energy of the 5 organs is exhausted in the interior”, the energy of the radial pulse is also exhausted and does not reach the finger. It is then recommended to tonify and “fill” the interior. But the bad physician needles the site of the illness located at the exterior, at the level of the he point of the yang channels, and leaves the needle in permanently to make the yang energy flow. When the yang energy arrives, the exhaustion in the interior is double (zhongjie, “juxtaposition of exhaustion”). The zhongjie phenomenon is fatal. The absence of movements is linked to the total exhaustion of the energy which is why “death [is] preceded by a period of calm.” “ ... Provoking fullness at the exterior” means to say making the energy return by sticking the points located in the axilla and thorax which are the disseminating points of the organs located at the exterior. 43. “When the energy of the 5 organs is exhausted at the exterior”, the energy of the radial pulse is also exhausted at the exterior and does not arrive at the finger. In this case, one must render “full” and tonify the exterior. But the bad physician creates the rendering full within the interior by sticking the points of the 4 limbs, that is to say, the jing, ying, shu, jing and he points which are the origin points of the organs belonging to the interior; and he, furthermore, leaves the needle in place to call forth the yin energy which benefits the yang energy in penetrating into the interior. This results in the formation of jueni (“contrary afflux”) which is a fatal phenomenon.”

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III - N.V.N. : Radial pulse examination allows evaluation of the degree of seriousness of the illness. 1 - When the energy of the 5 organs is in a state of emptiness and annihilation, the illness belongs to the emptiness of yin (interior) . If the physician tonifies the yang channels, he aggravates this emptiness of yin. One is then in the presence of a deleterious illness called zhongjie. The annihilation of yin is fatal and explains why “death preceded by a period of calm.” The cause of this disaster is a fatal therapeutic error because it is contrary to the principle according to which “all cases of emptiness of the energy of the organs must be reinforced by the method of tonification, and the points located in the region under the axilla and thorax, which are the sites of exiting of the energy of the organs, are strictly prohibited”. 2 - Similarly, when the energy of the 5 organs manifests at the exterior by signs of exhaustion-annihilation, the illness is associated with the emptiness of yang. If the physician tonifies the yin channels responding to yin in order to help the yin, he provokes a “double exhaustion” of yang, responsible for the separation of yin and yang. The deleterious illness created in this manner has the name “Nijue” (“contrary afflux”: flow in the wrong way) which is also fatal. It is provoked by an excess of yin energy, explaining that “death preceded by a period of agitation”. This illness is therefore created by a therapeutic error because the physician opposes the fundamental principle according to which “in all cases of emptiness of yang energy, it is necessary to tonify yang and the points located at the extremities of the fingers and toes are strictly prohibited”. 3 - This paragraph emphasizes the following facts: a. When the energy of the radial pulses does not arrive at the finger following an “internal exhaustion”, this energy is yin. In this case, one must tonify yin, that is to say, the organ. b. Similarly, when the energy of the radial pulse does not arrive at the finger following an “external exhaustion”, this energy is yang. In that case, one must tonify yang, that is to say, the bowel. c. The Nanjing considers the energy of the heart and lung at the level of the “inch” (thumb) pulses as the external energy, that is to say, yang energy, and the energy of the kidney and liver at the level the “foot” and “barrier” pulses as internal energy, that is to say, yin energy. This reasoning does not conform to the spirit of the Lingshu, and it appears then that it is a question of conceptual reasoning according to which the heart and lung are located within the thorax which is yang in relation to the abdomen which is yin.

PARAGRAPH

13

“Needling

presents

44.

two

risks:

1. To not remove the needle when it has already reached the zone of the illness because this risks provoking an excretion of the jing (essence). 2. To remove the needle as soon as it reaches the zone of the illness because this risks making the perverse energy return. The excretion of jing worsens the illness with weakness, and the return of perverse energy is the origin of abscesses and ulcerations.”

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EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph emphasizes the disadvantages of abundantly or insufficiently attratcting the energy during needling. In effect, the energy originates from jing (essence). This is why when the needle “touches” the ill zone, as long as the needle is not removed immediately, it seriously injures the jing energy and excretes the source energy, hence, the worsening of the illness with weakness; or else, when the needle comes to touch the zone of illness, immediate removal of the needle is the origin of the return of the perverse energy with stasis, responsible for the formation of abscess and ulceration. According to Chapter 81 (“Abscesses and Tumors”) of this same work: “The jingmai circulate without interruption following the celestial “degrees” and the terrestrial “laws”. If the stars make a mistake of a single degree, it produces interference in solar and lunar phenomena... . If the surface of the earth does not have a dam and and water accumulates, it overflows everywhere and causes a flood... . blood and vessels, ying and wei circulate without stopping. Their obstruction is at the origin of inflammations and edema. It is because the ying and wei circulate continuously throughout the entire organism, within the interior as well as at the exterior, above as well as below, that there is no illness.” “This is why Chapters 1 (“9 Needles and 12 yuan”) and 81 of the Lingshu, the first and last, are devoted to explaining the phenomena of the production and beginning, the entering and exiting of the jing energy. If yin and yang are in disequilibrium, stagnation of blood and energy is set up, resulting in abscesses and ulcerations” II - Ma Shi comments: “This paragraph, like the previous one, emphasizes the errors of acupuncture practice. When one needles to disperse fullness, it is necessary to remove the needle as soon as it makes contact with the ill zone because the needle left in place favors excretion of the jing energy which worsens the illness with weakness. When one needles to tonify emptiness, one must leave the needle in place as soon as it makes contact with the ill area because, if one removes it immediately, the perverse energy returns and provokes abscesses and ulcerations. 45. In Chapter 21 (“Diseases of Cold and Heat”) of the Lingshu, it is stated: “The risk of the needling touching the effected zone with the needle left in place is excretion of jing (essence). The risk of the needling not touching the effected zone with removal of the needle is the return of the perverse energy.” With respect to this paragraph, the difference lies in the negative form. Note, however, that this paragraph is centered on the principles of tonification and dispersion, while Chapter 21 exclusively studies the method of dispersion of fullness.” III - N.V.N. : In practice, during dispersion, _ when the needling touches the zone of the perverse energy, one must remove the needle because leaving it in place can injure the jing energy; _ when the needling reaches the zone of the perverse energy, one must at once apply the method of rotating the needle before removing it in order to avoid stagnation of the energy responsible for the phenomena of compression/obstruction; _ late removal of the needle can equally diminish the potential of the jing thereby aggravating the illness and weakening the patient; _ the immediate removal of an implanted the needle can also bring about a stagnation of the perverse energy responsible for inflammation and abscesses.

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PARAGRAPH 14 “ The 5 organs are with the 6 bowels; the 6 bowels have 12 yuan (sources); the 12 yuan have their origins at the “si guan” (“4 barriers”: elbow, axilla, knee and hip). The si guan are specific in the treatment of the 5 organs. During disturbances of the 5 organs, one must needle the 12 yuan.

The 12 yuan are the source-sites of the 5 organs; the energetic activities of the 365 articulations (reunions, points) come from there. When the 5 organs are ill, the reaction manifests itself at the 12 yuan. The 12 yuan are therefore the sites of the beginning of all organic manifestations. To know the yuan well is to observe the reactions of the exterior to determine which of the 5 organs is disturbed. taiyin in yang is the lung. Its yuan manifests at Taiyuan (Lu 9). Taiyuan is bilateral. taiyang in yang is the heart. Its yuan manifests at Daling (XB 7). Daling is bilateral. shaoyang in yin is the liver. Its yuan manifests at Taichong (Li 3). Taichong is bilateral. Taibai

Zhiyin in yin is the spleen. Its yuan manifests at Taibai (Sp 3). is bilateral.

46.

The yuan of Huang manifests at Boyang (Xiahuang, Qihai CV 6). Boyang is on the midline (unilateral). The yuan of Gao manifests at Jiuwei (CV 15). Jiuwei is also on the midline (unilateral). All 12 yuan are specific points to treat the 5 organs and 6 bowels.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph is devoted to the study of the organic liquids (xinye) originating from the pure energy (literally, extremely pure, rarefied energy; essence). From Gao (serous membranes) and from Huang (peritoneum), the organic liquids (xinye) reach the exterior, permeate the skin and luomai (where they turn red (blood)) and moisten the channels at the level of the shu (energetic) points by which they penetrate into the organs and bowels. In this manner, exterior and interior, exit and entry establish reciprocal exchanges. Under the action of zhongjiao (middle jiao), the energy of the cereals (geqi) becomes transformed into organic liquid, extremely pure substance, which floods the interstitial milieu, exteriorizes at the level of the sweat glands, infiltrates into the bones, maintains the marrow and brain and makes the skin glow. Such is the circulatory system passing by 365 secretory sites (“articulations”, “reunions”: acupuncture points) in order to permeate the skin, pores and interstitial milieu. When the organic liquids spread to the exterior, the skin and flesh weaken;

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when they are in excess within the interior, the Gao and Huang swell. “Gao” are the serous membranes which cover the organs and bowels, and “Huang”,the peritoneum. Organic liquids originating from the pure energy leave the Gao and Huang to permeate the exterior. This is why, in fat people, the flesh is flabby, the skin fragile and the belly hanging down. Such is the phenomena of “reciprocal response” of the interior and exterior. In Chapter 81 (“Abscesses and Tumors”), it is stated: “The zhongjiao (middle jiao) secretes an energy similar to the drops of a rose which appear within Xi and Gu (small valleys and big valleys) and saturate the sunluo (system of energetic capillaries). The organic liquid, formed in this way, changes color (red) and transforms into blood (xue). When the blood is harmonious, it fills first the luomai (system of secondary channels) and jingmai (system of principal channels). When yin and yang are complete, they circulate without stopping under the action of the respiration, according to well-determined rules and their circulatory cycle is in accordance with the Celestial Dao... .” Xi and gu make up part of the flesh and skin. They constitute the yuan of the channels by which the organic liquids infiltrate to reach the sunluo where they transform into blood, the latter gathering at the level of the organs and bowels. This is why it is said: The 12 yuan are the source-sites of the 5 organs and the sites of passage of the energy of the 365 “articulations” (“reunions”: acupuncture points).” 47. The “si guan” designate the 2 elbows, 2 axilla, 2 knees and 2 hips, These are the sites of the articulations (joints) where blood and energy passes. The 12 yuan manifest at the si guan. The si guan treat the illnesses of the 5 organs because the 5 organs are linked to the 6 bowels and each possesses its yuan. Such is the system of reunion and internal and external relationships of the organs and bowels, of yin and yang. This is why it is said: “To know the yuan well is to observe the reactions of the exterior to determine which of the 5 organs is disturbed.” The liver, heart, spleen, lung and kidney are the 5 internal organs. To speak of “shaoyin in yin”, “shaoyang in yin”, etc. is to speak of the energy of the 5 organs. This is why, in the attack of the organs or bowels, one must needle the yuan of the corresponding channel. In the event of abdominal bloating, needle the 3 yang (taiyang, shaoyang, yangming), and in the event of diarrhea, needle the 3 yin (taiyin, jueyin, shaoyin). This means to say that in disorders of the energy of the 3 yang or 3 yin, one must needle the channel effected. In total, this paragraph studies the sources of production of the energy and blood and their movements of entering and exiting. For this reason, Chapter 1 is named “9 Needles and 12 yuan”; this means to say that the methods of the “9 Needles” are all united to yin and yang, blood and energy.” II - Ma Shi comments: “This paragraph stresses the use of the 12 yuan points in treating the 5 organs and 6 bowels. The 5 organs and 6 bowels constitute a system of “Internal-External” relationship and have 12 yuan points which manifest at si guan (4 limbs). • “Siguan” designates the elbows and knees where the energy of the “articulations” (“reunions”, acupuncture points) gather together. This is why the localization of the jing, ying, shu, jing and he (5 shu-antique) points goes past neither the elbows nor the knees. From this fact, the si guan have a therapeutic action on the 5 organs. • Illnesses of the 5 organs must be treated at the level of the 12 yuan because the yuan are the 365 “articulations” (“reunions”, acupuncture points). For this reason, the yuan points are the reactive sites of the 5 organs and 6 bowels. One must, therefore, know the existence of the yuan well to observe the reactions at the exterior in order to determine the illnesses of the 5 organs. • The heart and lung located above the diaphragm are yang: “Taiyin in yang” is the lung. Its yuan point is Taiyuan (Lu 9), located at the crease of the

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wrist outside the artery in the radial groove. This point is bilateral; it is the site of flowing down of the lung channel called “earth-shu”. Needle depth of 0.2 cun; left in place for 2 expirations; moxa 3 times; The yin channel does not possess a yuan point; the shu point substitutes for it (11). “Taiyang in yang” is the heart. Its yuan point manifests at Daling (XB 7). This point is bilateral. Daling belongs to the Hand Jueyin (xin bao, XB); it is the site of flowing down of the xinbao called “earth-shu”. The Hand Jueyin channel substitutes for that of the heart in material activities which is why one does not speak of using Shenmen (He 7). Daling is located at the middle of the anterior crease of the wrist between 2 large tendons. Needle depth 0.6 cun; left in place during 7 expirations; moxa 3 times. 48. • The kidney and liver, located underneath the diaphragm, are yin, as is the spleen : “Shaoyang in yin” is the liver. Its yuan manifests at the point Taichong (Li 3). This point is bilateral and located in a crease in front of the juncture of the 1st and 2nd metatarsals where an artery (dorsal pedalis) is found. It is the site of flowing down of the liver vessel called “earthshu”. Needle depth 0.3 cun; left in place during 7 expirations; moxa 3 times. “Zhiyin in yin” is the spleen. Its yuan point manifests at Taibai (Sp 3). This point is bilateral and located at the internal side of the foot behind the 1st metatarsophalangeal joint. It is the site of flowing down of the spleen vessel called “earth-shu”. Needle depth 0.3 cun; left in place during 7 expirations; moxa 3 times. “Taiyin in yin” is the kidney. Its yuan point manifests at the Taixi (Ki 3). This point is bilateral and located behind the internal malleolus above the calcaneus where one finds an artery (posterior tibialis). In the event of illness, the absence of beating of this artery has a fatal prognosis. It is the site of flowing down of the kidney vessel called “earth-shu”. Needle depth 0.3 cun; left in place during 7 expirations; moxa 3 times. • The yuan of Gao manifests at Jiuwei (CV 15). This point is on the renmai (CV) on the anterior midline. It is located 0.5 cun below the tip of the xiphoid. In some individuals with absence of the xiphoid appendage, this point is located 1.0 cun below the body of the sternum. Moxa is forbidden at the risk of provoking a decrease of the energetic potential of the heart. Needling this point is reserved for good acupuncturists only because improper needling can result in too significant a loss of energy which can cause death. Needle depth 0.3 cun; left in place during 3 respirations; to disperse, watch over it during 3 respirations. • The yuan of Huang manifests at the Qihai (CV 6) located 1.5 cun below the umbilicus also on the renmai (CV) on the anterior midline. Qihai has two other names: Boyang and Xiahuang. It is the “sea” of production of the energy in man. Needle depth 0.8 cun; dispersion as soon as the arrival of the energy. The dispersion must always be followed by tonification. Moxa 7 times.” III - N.V.N. : 49. 1. This paragraph only mentions the “yuan” of the 5 organs and “Gao” and “Huang”. “Gao” is the generic name given to the serous membranes covering the organs, and “Huang”, the name given to the peritoneum, which is to say the serous membranes which blankets the inner surfaces of the abdominal cavity (therefore not comprising the exterior surfaces of the organs which instead bear the name Gao). Gaohuang (Bl 43) is therefore the site of concentration of the energy originating from all serous membranes (pleura, peritoneum, pericardium, periosteum, synovium, tendon sheaths, neural sheaths, organ capsules, etc.) associated with the secretion of interstitial and lacunar (12) liquids which facilitate the sliding of parts in contact. 11. Energetically and clinically, the yuan and Shu points of the yin channels are one and the same. On the yang channels, there are separate yuan and Shu points (ESG). 12. Anatomically, pertains to the extracellular spaces that containinterstitial fluid (tendinous, synovial, dermal, etc.) (ESG).

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2. Difficulty Number 66 of the Nanjing completes this notion of “yuan” : _ the yuan of the gallbladder manifests at Qiuxu (GB 40) _ the yuan of the stomach, at Chongyang (St 42) _ the yuan of the sanjiao (SJ), at Yangshi (SJ 4) _ the yuan of the bladder, at Jinggu (Bl 64) _ the yuan of the large intestine at Hegu (LI 4) _ the yuan of the small intestine at Wangu (SI 4). In this way, the theory of the 12 yuan is complete.

PARAGRAPH

15

“In the event of abdominal bloating, one must choose the 3 yang, and in the event of diarrhea, the 3 yin.” EXPLANATIONS AND COMMENTARIES N.V.N : This paragraph emphasizes the use of the points of the channels in bloating and diarrhea. In the event of bloating, it is advised to needle points belonging to the 3 yang, that is to say, stomach, bladder and gallbladder, and, in case of diarrhea with undigested food, points belonging to the 3 yin: spleen, liver and kidney.

PARAGRAPH 16 “The illnesses of the 5 organs are comparable to the pricks of thorns, dirty stains on the body, the knots of a rope and an obstruction by a mass. The thorns can be removed, even implanted a long time; the stain can be cleansed, even when old; the knots can be undone, even formed for a long time; the mass can be leveled, even when very old. 50. Some maintain that chronic diseases cannot be treated. This opinion is false because the good physician utilizes the needle to treat diseases like one removes thorns, cleans up stains, undoes knots, shaves down a mass. Chronic diseases are treatable. Those who pretend that they are not have still not mastered the art of acupuncture and moxabustion.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi comments: “In the “hundred diseases” caused by wind, rain, cold, heat, joy, anger, diet, fright, unexpected fear... the blood and energy become separated, yin and yang scatter, the jingluo exhaust and the circulatory paths are obstructed. The aggression of the wind, rain, cold, heat, fright and unexpected fear are like the pricks of thorns and dirty stains, which is to say of external origin. Joy, anger and diet are like knots

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and obstructions, which is to say of internal origin. The “thousand diseases” are not separate from the etiologic context of “internal and external”. This is why one must remove and “cleanse” them in order to liberate the interior. Once these two causes are known, one can cure diseases, even chronic ones. Those that claim that they are incurable fail to appreciate these two causes. Yang Yu Lu clarifies: “The stains involve the skin and hair; the pricks of the thorn reach to the fibers of the flesh; the knots are located at the level of the vessels and the masses and barriers at the level of the bones”. II - N.V.N. : This paragraph emphasizes the possibility of treating chronic diseases with acupuncture.

PARAGRAPH 17 “To treat (needle) the “re” (heat) diseases is like soaking a hand in hot water (cold); treating the “han” (cold) diseases” is to remain a long time as if one did not wish to leave. In the case of yang disease manifesting in the yin region, one must needle Xialing Sanli (Zusanli, St 36). Needling must be performed vertically and meticulously; withdrawal of the needle can only be carried out after regression of the energy; otherwise, it is necessary to start the process over again. 51. If disease localizing in the upper part of the body belongs to the interior (organ), one must needle Lingquan of the yin channel, that is to say Yinlingquan (Sp 9), and if the disease localizing in the upper part of the body belongs to the exterior (skin, flesh, muscle, bone), it is necessary to needle Lingquan of the yang channel, that is to say, Yanglingquan (GB 34).

EXPLANATIONS AND COMMENTARIES: I - Zhang Shi explains: “The “cold, heat, wind and rain” energies come from the exterior. “Needling of diseases of heat is like bathing the hand in hot water” means to say that in illnesses of heat (re) localizing within the skin and flesh, needling is superficial. Diseases of cold (han) are syndromes of yin emptiness localizing within the interior; here the needling is deep. Calmly, the physician waits for the arrival of the energy (deqi) as if ready to leave, he hesitates instead of leaving immediately. “Within the yin part with manifestations of yang disease” means to say: the infiltration of perverse yang energy into the interior (organ). One must needle Xialing Sanli (St 36) located 3 inches (cun) below the knee on the external edge of the tibia. This point belongs to the Foot Yangming channel which controls closure (like that of a door). “Needling is done vertically and meticulously... and withdrawal...only after regression of the energy...” implies the sense of liberation of the perverse energy by the lower (urinary, intestinal) routes. “The disease is located in the upper part of the body and belongs to the interior (organ)” means to say that in yin diseases manifesting in the upper part, one must needle Yinlingquan

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(Sp 9) belonging to the yin (spleen) channel governing opening (like that of a door). The energy is evacuated via this opening, that is to say, by the upper (cutaneous) route. In brief, this paragraph stresses that when yang disease contaminates the interior, it is necessary to evacuate it by the lower (urinary, intestinal) route (11), and when yin disease reaches the exterior it is necessary to evacuate it by the exterior, superficial (cutaneous) route (12). Zhang Yu Lu clarifies: “Needling Lingquan (Sp 9) of the yin channel and Lingquan of the yang channel (GB 34) is in accord with the law of “sitian-taiguan”. The top and bottom are, in this way, aerated”.”

II - Ma Shi explains: “Each disease has its specific therapeutic point”. “To treat heat diseases is like soaking the hand in warm water”. This means to say that one can easily be easily damaged by the heat. “To treat cold diseases as if one did not want to leave” implies also the sense that one is able to be easily damaged by cold. “Attack of the yin channel by yang disease”, it is necessary to needle Xialing Sanli belonging to the Foot Yangming (St). These four words (Xialing Sanli) are none other than Zusanli (St 36). This name is recalled in Chapter 2 (“Origin of the shu-antique Points”) of the Lingshu. 52. “Needle vertically and carefully, then wait for the arrival of the energy...” After needling, if the disease does not regress, it is necessary to needle again. “The disease being at the top and belonging to the internal organ” one must needle Yinlingquan (Sp 9) located at the bottom, at the internal side of the knee, belonging to the Foot Taiyin (Sp). “The disease is at the top and belonging to the exterior”, one must needle Yanglingquan (GB 34) located at the external side of the knee. This point belongs to the Foot Shaoyang (GB).”

III - N.V.N. : This paragraph is devoted to the superficial needling of heat diseases and deep needling of the cold diseases and to the use of the points Zusanli (St 36), Yinlingquan (Sp 9) and Yanglingquan (GB 34).

13. In the “Eight Therapeutic Methods”, this represents the method of “purgation” (see Traditionnelle Chinese Medicine, NVN Edition, Chapter , Page VVVV (SCM) 14. ibid. The method of“sudorification” (SCM).

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53.

CHAPTER II Origin of the Shu-Antique Points (Ben Shu)

Chapter 2 of the Lingshu, comprising 18 paragraphs, defines the energy of the jingmai located below the elbow and knee where the sites of entry and exit, of flowing down and flowing out, of passage and of gathering of the energy are found. These sites are successively called jing, ying, shu, jing and he (1). This chapter also presents the points of the cervical region belonging to the six yang channels of the hand and foot and the two curious vessels ren (mai) and du (mai) with point naming, point location and classification. The reciprocal action of the organs and bowels and the method of choice of points according to the four seasons are also studied. The object of this chapter is to present the shu-antique points which are a group of important points of the channels according to the principle: “Judge the origin in order to study the cause”. This is why it is entitled: “Origin of the shuantique Points.”

1. Recall that the actions of 5 shu-antique points (wushu), jing, ying, shu, jing and he, are energetically reminiscent of the

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properties of water, thus the water analogies utilized to portray them: jing-well, ying-spring, shu-stream, jing-river, he-sea. (SCM)

PARAGRAPH 1 Huangdi : “The art of acupuncture demands perfect knowledge of _ _ _ _ _ _ _ _ _

the the the the the the the the and

departure and termination of the 12 jingluo sites of “detachment” of the luomai sites of “flowing out” of the wu shu (5 shu-antique points) sites of “reunion” of the 6 bowels sites of “entry” and “exiting” of the 4 seasons sites of “flowing out” of the 5 organs variations in diameter of the jing and luo degree of depth of their distribution 54. their success at the top and at the bottom, etc.

Will you clarify all this for me?”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The departure and termination of the 12 jingmai are established in the following manner : _ the 3 yang channels of the hand begin on the hand and end at the head _ the 3 yang channels of the foot leave from the head and arrive at the foot _ the 3 yin channels of the foot begin on the foot and end at the abdomen (2) _ the 3 yin channels of the hand leave from the thorax (2) and arrive at the hand. The circulatory cycle of the 12 jing (principal channels) start at the lung and ends at the liver. Such are the departure and termination of the circulatory cycle of the blood and energy. At the level of these jingmai, the energy of the 5 organs and 6 bowels exteriorizes at the jing point of the tip of the digits, arrives at the ying point, flows down to the shu point, flows out toward the jing point and gathers at the he point. It is via these points that the energy of the vessels returns to the organs and bowels. This circulation constitutes what one calls “the ”beginning and ending” of the jing (principal channels)”. _ “The sites of detachment of the luomai (secondary vessels)”designates the sites where the great luos leave the jingmai (principal channels) and where the sites of the sunluo (energetic capillaries or little secondary vessels) leave the great luos to branch at the level of the skin. _ “The sites of flowing out of the 5 organs and the sites of reunion of the 6 bowels” designates the 5 shu-antique points of the 5 organs and 6 shu-antique points of the 6 bowels. _ “reentry” and “exit” of the 4 seasons” designates the circulation of blood and energy obeying the laws of the energies of the 4 seasons in order to “be born, grow, accumulate and be conserved”. _ “The sites of “flowing out” of the 5 organs” are the sites by which the blood and energy penetrate into the vessels and appear at the level of the radial pulse, and also the sites by which the blood and energy exteriorize outside the channels and by the intermediary of the point Wuli (LI 13), reaching the skin and flesh. Such is the circulation of the blood and energy at the epidermo-dermal level and at the level of the jing (principal channels). 55. _ The jingmai have 365 reunion points. As a result, the luomai (secondary vessels) also have 365 sites of reunion just as do the sunmai (energetic capillaries). The jingmai are large and wide and the luomai are small and narrow; this is why the text states: “ ...variations in diameter 2. The use of the terms “abdomen” and “thorax” instead of “chest” highlight the internal nature and the internal origins

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of these organs within the sanjiao: Sp, Li, Ki in the lower jiao, He L, XB in the upper jiao (SCM).

of the jing and luo”. _ “...The degree of depth of their distribution” designates the jing (principal channels) which are deep and luo (secondary vessels) which are superficial. _ “Success at the top and bottom” means that the blood and energy circulate everywhere in the body.” II - N.V.N. : The Dao of the use of the needles consists of knowing clearly: _ the trajectories of the 12 jingmai _ the sites of detachment of the luomai _ the sites of flowing out of the 5 shu-antique points whose localization is determined at the level of the 4 limbs _ the system of “internal-external” relationships of the organs and bowels _ the influence of the 4 seasons on the organism and the reactions at the level of ` the blood and energy characterized by the phenomena of fullness and emptiness _ the circulation and concentration of the energy of the jingluo of the 5 organs and 6 bowels _ the diameter of the jing, luo and sunluo _ the level of depth of distribution of the jingluo at the head and 4 limbs.

Note: The energy and blood of the 6 bowels exteriorizes towards the skin by way of the “great luo” (3) and infiltrate into the channels by way of the jing points at the tips of the digits. This is why, in clinical practice,“one must ventilate the sites of detachment of the luomai”, that is to say, at the level of the luo points.

PARAGRAPH 2 Qi Bo:

“Permit me to show them to you according to the following order: The lung vessel begins at Shaoshang (Lu 11) responding to the movement “jing-wood”, located at the internal ungual angle of the thumb. From this point, the energy flows out toward the point Yuji (Lu 10) responding to the movement “ying-fire”. From this point, the energy flows down into the point Taiyuan (Lu 9) responding to the movement “shu-earth”, located at a crease 1 cun behind Yuji (Lu 10) . From this point, the energy is directed towards the point J i n g q u (Lu 8) corresponding to the movement “jing-metal”. From this point, the energy gathers at Chize (Lu 5) responding to the movement “he-water”, located on the artery of the elbow. Such are the 5 shu-antique of the Hand Taiyin (Lu). 3. The “sites of detachment” of the “3 great luo” are Dabao (Sp 21), Changqiang (GV 1) and iuwei (CV 15) (ESG).

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56.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “ • The word “jing” is a symbol which represents “water preceding wood”, that is to say, the movement “jing-wood” has a double action: a - penetration of water in the pilocutaneous system. b - activation of the energetic movements at the level of the channel: _ movement of flowing down toward the shu-earth point _ movement of flowing out toward the jing-metal point _ movement of gathering toward the he-water point to unite with the blood and energy already existing in the channel. •The lung, heart, liver, spleen and kidney are the 5 internal organs; gallbladder, stomach, large intestine, small intestine, sanjiao and bladder are also internal. On the other hand, the channels of the hand (shou) and foot (zu) of these organs and bowels, such as the taiyin, shaoyin, taiyang, shaoyang... are the external energetic paths. • “The lung vessel begins at the point Shaoshang (Lu 11)” has a double meaning: _ on the one hand, the energy of the lung organ, via the route of the great luo, reaches the sunluo and spreads out to the level the skin and flesh _ and on the other hand, this energy infiltrates into the Hand Taiyin channel (Lu) to successively activate the movements jing-wood, ying-fire, shu-earth, jing-metal and he-water. In this manner, the point Shaoshang (Lu 11), located 1 he leaf from the internal ungual angle of the thumb, responds to the movement jing-wood. The point Yuji (Lu 10), located 1 cun below the thumb joint at the place where the “white muscle” is found, evoking the image of a fish belly (thenar eminence), corresponds to the movement jing-fire. The point Taiyuan (Lu 9) is located at the wrist crease 1 cun behind Yuji (Lu 10) and responds to the movement shu-earth. Jingqu (Lu 8), located on the artery (radial), responds to the movement jing-metal. Chize (Lu 5), located on the elbow, corresponds to the movement he-water.”

II - Ma Shi comments: “This paragraph defines the jing (wood), ying (fire), shu (earth), jing (metal) and he (water) points. _ “The 12 channels” designates the 3 yin and 3 yang of the foot and hand: taiyang, shaoyang, yangming, taiyin, jueyin and shaoyin. _ “The “12 luo” belong to the 12 jing (principal channels). Each jing has a luo point, 57. except the spleen which has two: Gongsun (Sp 4) and Dabao (Sp 21). Dumai (GV) also has its luo; it is also the same for renmai (CV) which also has its luo, making a total of 15 luo. _”The 5 shu” designates the movements of the jing, ying, shu, jing and he points: The movement of the departure of the energy of the channel is the jing and the movement of the gathering, the he point. The site of departure of the energy is therefore the “cereal jing” (food essence) which has the property of provoking the movements of flowing down, flowing out and passage to end up at the movement of gathering. Each yang channel has a yuan (source) point (4). When the energy flows out towards the shu point, it passes immediately to the yuan point. The yuan and shu therefore have the same property. This is why, in disorders of the yang channels, treatment carried out at the yuan point is equivalent to that carried out at the shu point. The yin channel does not have a yuan point, and it is the shu point which replaces it. In this manner, treating the shu also treats the yuan.

4. See Chapter 1 (“9 Needles and 12 yuan”).

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• The jing point of the yang channel responds to the movement geng-metal, while that of the yin channel corresponds to the movement yi-wood (5). _ As a result, the jing point of the yang channel responds to the movement metal which creates the ying point corresponding to water. The movement ying-water creates the shu point responding to wood. The movement shu-wood creates the jing point responding to fire. The movement jing-fire creates the he point responding to earth. _ The jing point of the yin channel responds to the wood movement which creates the ying point corresponding to fire. The ying-fire movement creates the shu point responding to earth. The shu-earth movement creates the jing point corresponding to metal. The jing-metal movement creates the he point responding to water. Such is the order of the 5 movements of production of the 5 shu-antique points. • In this manner, the energy of the lung begins at Shaoshang (Lu 11), responding to the jing-wood movement, located at the ungual angle of the thumb; needle depth 0.1 cun, left in for 5 expirations, no moxa. _ The energy of jing-wood flows out towards Yuji (Lu 10), responding to the ying-fire movement, located 1 cun below the metacarpo-phalangeal joint of the thumb at the place of the “white muscle” resembling the belly of a fish, needle depth 0.1 cun, left in for 3 expirations, moxa 3 times. _ The energy of ying-fire flows down into Taiyuan (Lu 9), responding to the shu-earth movement, located in a crease on the line of the wrist 1 cun below Yuji (Lu 10); needle depth 0.1 cun, left in for 2 expirations, moxa 3 times. _ The energy of shu-earth is directed toward Jingqu (Lu 8), responding to the jing-metal movement, located within the radial pulse (always in motion, never ceasing), needle depth 0.1 cun, left in during 3 expirations, moxa forbidden. 58. _ The energy of jing-metal gathers at Chize (Lu 5), responding to the he-water movement, located on the artery of the elbow; needle depth 0.3 cun, left in during 3 expirations, moxa 3 times.”

III - N.V.N. : This paragraph and the following ones are devoted especially to the study of the shuantique points and their power to flow. The shu-antique points are propelled by the “5 movements”. For example: Under the action of the movement of wood-jing, the energy of Shaoshang (Lu 11) passes to Yuji (Lu 10); under the action of the ying-fire, the energy reaches Taiyuan (Lu 9), etc. As a result, the words “wood, fire, earth, metal, water” are the generic names given to these movements.

5. Geng-metal and yi-wood refer to associations with the “Celestial Stems”. See Medecine Traditionnelle Chinoise. NVN edition. 1984. Chapter II, page 26ff (SCM).

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PARAGRAPH 3 The heart vessel begins at the point Zhongchong (XB 9) , responding to the jing-wood movement, located at the tip of the middle finger. From this point, the energy flows out towards Laogong (XB 8) , responding to the ying-fire movement, located at the middle of the palm at the medial metacarpo-phalangeal joint of the middle finger. From this point, the energy flows down into Daling (XB 7) , responding to the earth-shu movement, located in the bony space at the base of the hand. From this point, the energy is directed towards Jianshi (XB 5), responding to the jing-metal movement, located between two tendons, 3 cun behind the wrist. If the energy passes here, it arrives; if not, it stops. From this point, the energy gathers at Quze (XB 3), responding the he-water movement, located in the elbow crease. One locates this point with the elbow flexed. Such are the 5 shu-antique points of the Hand Shaoyin (He).

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “Hand Shaoyin is the channel of the heart, and Zhongchong (XB 9) is the jing point of the xin bao luo (XB). The heart governs the blood, and xinbao, the vessels. The heart and xinbao constitute a “emperor-minister” system of union. _ “The heart vessel begins at Zhongchong (XB 9)” means the energy of the heart organ, after having permeated the pilocutaneous system, is directed towards Zhongchong (XB 9) in order to infiltrate into the Hand Jueyin (XB). 59. _ Jianshi (XB 5) is a route of passage which evokes the image of the ascent of a hill by soldiers and officers. “If the energy passes, it arrives; if not, it stops” indicates: when the energy and blood of heart organ arrives at the jing point (Jianshi, XB 5), they reach the elbow in order to unite with the energy and blood of the xin bao luo (XB). Otherwise, it stays at the jing of the Hand Shaoyin (He). This is why this paragraph begins with the words “ Hand Shaoyin (He)”. Because the formation of blood depends on the xin-shen (heart-mental) and because the heart and xinbao (XB) forms a whole, the blood and energy produced by the heart reaches the two channels Hand Shaoyin and Hand Jueyin.

II - Ma Shi comments “This paragraph is devoted to the Hand Jueyin channel (XB). The text has employed the words “heart-vessel” to stress the importance of the relationship of the heart and xinbao (XB). _ The xin bao luo (XB) begins at Zhongchong (XB 9) responding to the wood-jing movement, located at the tip of the middle finger at 1 he leaf from the internal ungual angle; needle depth 0.1 cun, left in during 3 expirations, moxa 3 times.

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_ From this point, the energy flows down into Laogong (XB 8) corresponding to the yingfire movement, located in the palm of the hand at the base of the joint of the middle finger; needle depth 0.3 cun, left in in during 7 expirations, moxa 3 times. _ From the point Laogong (XB 8), the energy flows out towards Daling (XB 7) responding to the shu-earth movement, located between 2 bones on the wrist line; needle depth 0.5 cun, leave the needle in during 7 expirations, moxa 3 times. _ From the point Daling (XB 7), the energy passes to Jianshi (XB 5) responding to the metal-jing movement, located between 2 tendons 3 cun below the wrist line; needle depth 0.3 cun, left in during 7 expirations, moxa 3 times. “If the energy passes, it arrives; if not, it stops” means to say that, when there is illness, it is at the level of Jianshi (XB 5) that it stops. In the opposite case, the energy passes there before being directed to Quze (XB 3). _ From the point Jianshi (XB 5), the energy gathers at Quze (XB 3) responding to the hewater movement, located in the crease of the elbow. Bend the elbow to locate the point. Needle depth 0.3 cun, left in during 7 expirations, moxa 3 times. Such are the 5 shu points of the Hand Jueyin controlled by the heart organ. • The heart is the “great director” of the 5 organs and 6 bowels. It must not be affected by perverse energy. The xin bao luo (XB) and the heart channel communicate and substitute for the “royal master” (heart) in order to command all functions of the organism. 60. When one uses needles, the needling is generally performed only on xinbao (XB). This is why the points cited in the above paragraph belonging to xinbao (XB) are used in place of those of the Hand Shaoyin (He). III - N.V.N. : The commentaries of Zhang and Ma emphasize the notions of the close relationship of the heart and xin bao luo (XB). Regarding the phrase “If the energy passes, it arrives; if not, it stops”, Ma Shi’s explanation appears to us clearer and more plausible because, in clinical practice, Jianshi (XB 5) is a specific point to needle in all rebellious and chronic illnesses, all febrile illnesses, intermittent fever and chills and all cases of schizophrenia, paranoid dementia and insanity.

PARAGRAPH 4 The liver vessel begins at the point Dadun (Li 1), corresponding to the jing-wood movement, located atop the great toe at the spot called “3 hairs”. From this point, the energy flows out toward Xingjian (Li 2), responding to the ying-fire movement, located in the interdigital space of the 1st and 2nd toes. From this point, the energy flows down towards Taichong (Li 3), responding to the shu-earth movement, located in a crease, 2 cun below Xingjian (Li 2). From this point, the energy is directed toward Zhongfeng (Li 4), responding to the jing-metal movement, located in a crease, 1.5 cun in front of the internal malleolus. Countercurrent needling of this point is the cause of an energetic compression (obstruction); on the other hand, needling for a regulating effect ventilates the circulation that one can notice at the level of the foot.

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From this point, the energy gathers at Ququan (Li 8) , responding to the he-water movement, located below the femoral condyle, on the large tendon visible to the naked eye when the knee is flexed. Such are the 5 shu-antique points of the Foot Jueyin channel (Li). EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The jing-metal movement is a movement of passage. If one blocks this passage by a counter-current needling, the blood and energy of the channel stagnate and are found in a state of compression/obstruction. On the other hand, a regulatory needling (needling following the direction of the current) harmonizes the blood and energy. Also, Zhong Yu Si has said: “The one energy of the channel arrives at the he-sea point thanks to the action of the jing-well point. If blocks the passage, jing-river point, one produces the phenomena of stagnation/obstruction of the channel”. 61.

II - Ma Shi comments: “This paragraph demonstrates the 5 shu-antique points of the liver. _ The energy of the liver begins at Dadun (Li 1) corresponding to the jing-wood movement, located at the middle of the “3 hairs”. Another theory states: “At the side of the internal ungual angle is Yinbai (Sp 1) and at the side of the external ungual angle is Dadun (Li 1).” _ From the point Dadun (Li 1), the energy flows out towards Xingjian (Li 2) responding to the ying-fire movement, located in a crease on the artery, on the interdigital crease of the 1st and 2nd toes. Needle depth 0.3 cun, left in during 3 expirations, moxa 3 times. _ From the point Xingjian (Li 2), the energy flows down into Taichong (Li 3) responding to the shu-earth movement, in a crease, on the artery, 2 cun above Xingjian (Li 2). Needle depth 0.3 cun, left in during 10 expirations, moxa 7 times. In Chapter 1 of the Suwen, it is written: “In young girl (2 X 7), Taichong (Li 3) is plethoric, the menstrual cycle is activated and she can conceive. During diagnosis, examining Taichong (Li 3) can allow predicting life or death.” _ From the point Taichong (Li 3), the energy is directed towards Zhongfeng (Li 4) responding to the jing-metal movement, located 1.5 cun in front of the internal malleolus, in a crease between two tendons. Needle depth 0.4 cun, left in during 7 expirations, moxa 3 times. Needling this point in order to demonstrate its existence provokes a circulation in the wrong way whereas needling for the purpose of regulating the energy and ventilating the channel causes a sensation of fatiguability of the foot. _ From the point Zhongfeng (Li 4), the energy gathers at Ququan (Li 8) responding to the he-water movement, located above the internal condyle of the knee, by the large tendon, easily located when the subject bends his knee. Needle depth 0.6 cun, left in during 10 expirations, moxa 3 times.” III - N.V.N. : This paragraph raises the problem of needling done at the level of the point Zhongfeng (Li 4) in the direction of and against the current. In effect, needling Zhongfeng (Li 4) counter-current amounts to preventing the jing-metal movement from progressing towards Ququan (Li 8) and obliges it to move back towards Taichong (Li 3). It is, then, a harmful effect, provoking stagnation and obstruction at the level of the Foot Jueyin (Li) channel. In contrast, needling in the direction of the current of Zhongfeng (Li 4) amounts to activating the jing-metal movement towards Ququan (Li 8). The effect is, therefore, balancing and beneficial, provoking ventilation of the channel. These effects are felt at the level of the needling.

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PARAGRAPH 5

62.

The spleen vessel begins at Yinbai (Sp 1), responding to the woodjing movement, located at the internal ungual angle of the great toe. From this point, the energy flow out towards Dadu (Sp 2), responding to the ying-fire movement, located in front of the metatarso-phalangeal joint of the great toe. From this point, the energy flows down to Taibai (Sp 3), responding to the shu-earth movement, located behind the metatarso-phalangeal joint of the great toe. From this point, the energy is directed towards Shangqiu (Sp 5), responding to the jing-metal movement, located in a crease below and in front the internal malleolus. From this point, the energy gathers at Yinlingquan (Sp 9), responding to the he-water movement, located under the internal condyle of the tibia. Such are the 5 shu-antique points of Foot Taiyin (Sp) channel. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The energy of heaven is at the top; water and its source are below; the earth is in the intermediary space. The spleen makes up part of the zhi yin in yin and responds to kun-earth (6). Yinglingquan (Sp 9) belongs, therefore, to the yin part, that is to say that it designates the source of water in the center of the earth.” II - Ma Shi comments: “This paragraph presents the 5 shu-antique points of the Foot Taiyin (spleen) channel. _ The spleen vessel begins at the point Yinbai (Sp 1) corresponding to the jing-wood movement, located at the internal ungual angle of the great toe; needle depth 0.1 cun, left in during 7 expirations, moxa 3 times. _ From the point Yinbai (Sp 1), the energy flows out towards Dadu (Sp 2), responding to the ying-fire movement, located in front of the metatarso-phalangeal joint of the great toe on the line of demarcation of the skin of white and red color of the foot. Needle depth 0.3 cun, left in during 3 expirations, moxa 3 times. _ From Dadu (Sp 2), the energy flows down into Taibai (Sp 3), responding to the shu-earth movement, located behind the metatarso-phalangeal joint of the great toe; needle depth 0.3 cun, left in during 3 expirations, moxa 3 times. _ From Taibai (Sp 3), the energy gathers at Shangqiu (Sp 5) responding to the jing-metal movement, in a crease below and in front of the internal malleolus; needle depth 0.3 cun, left in during 3 expirations, moxa 3 times. _ From Shangqiu (Sp 5), the energy gathers at yinglingquan (Sp 9), responding to the he-water movement, located under the internal condyle of the tibia, in a crease. Bend the leg to locate this point; on the other hand, to locate Yanglingquan (GB 34), extend the leg. Needle depth 0.5 cun, left in during 5 expirations, moxa 3 times.” 6. “Kun” designates one of the eight tempero-spatial signs (trigrams) of ancient times.

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III - N.V.N.: Zhang Shi defines the word “Quan” from the term “Yinlingquan (Sp 9)” as the source of subterranean water in order to explain that water is at the bottom; but this interpretation turns out to be a subject of caution because the word “quan” that occurs in “Taiquan”, employed in the “cyclic movements of energy”, indicates the seasonal energy located at the surface and not within the earth.

PARAGRAPH 6 The kidney vessel begins at the point Yongquan (Ki 1), responding to the jing-water movement, located in a crease on the sole of the foot. From this point, the energy flows out toward Rangu (Ki 2), responding to the ying-fire movement, located in a crease below the scaphoid bone. From this point, the energy flows down to Taixi (Ki 3), responding to the shu-earth movement, located in a crease behind the internal malleolus on the upper edge of the calcaneus. From this point, the energy is directed to Fuliu (Ki 7), responding to the jing-metal movement, located 2 cun above the internal malleolus. From this point, the energy gathers at yinqu (Ki 10), responding to the he-water movement, located behind the tibial plateau, between the large and small tendons, at the level of the artery whose beat one can feel. Bend the knee to locate this point. Such are the 5 shu-antique points of the Foot Shaoyin (Ki). EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: 64. “Water from the subterranean source is created by the number 1. This is why the shaoyin channel of the kidney begins at yangquan (Ki 1 = “Gushing Source”). Fuliu (Ki 7 = “Return of Flow”) implies that the flowing out of water returns to its subterranean source. For this reason, the he-water movement of the kidney carries the name yingu (Ki 10 = Cavern of yin). I am engaged in defining the names of the points in order to demonstrate that the Dao of Man becomes united with the Dao of heaven and earth, to yin and yang, to the 5 movements and 6 energies. As for measurement in cun of the localization of points, it is necessary to refer to the Statue of Bronze (Tongren). The depth of needling, duration of placing the needles and number of moxas, etc. are variable facts.” II - Ma Shi comments: “This paragraph demonstrates the 5 shu-antique points of the channel of the kidney. _ The kidney vessel begins at Yongquan (Ki 1) responding to the jing-wood movement, located on the sole of the foot, in the crease which is formed when the subject places the knee with the toes flexed. Needle depth 0.3 cun, left in place during 3 expirations, moxa 3 times. Do not make this point bleed.

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_ From the point Yongquan (Ki 1), the energy flow out toward Rangu (Ki 2), responding to the ying-fire movement, located below the scaphoid bone. This point has another name: Long-yuan. According to some authors, Yongquan is located 1 cun in front and below the internal malleolus. Needle depth 0.3 cun, left in place during 3 expirations. Do not bleed this point, otherwise the patient will immediately feel a sensation of hunger and asks to eat. From the point Rangu (Ki 2), the energy flows down toward Taixi (Ki 3), responding to the shu-earth movement, located behind the internal malleolus in a crease where the artery (posterior tibialis) is found, above the calcaneus. In boys and girls, absence of the beat of this artery is of fatal prognosis. Needle depth 0.3 cun, left in during 7 expirations, moxa 3 times. From the Taixi (Ki 3), the energy is directed to Fuliu (Ki 7), responding to the jing-metal movement, located 2 cun above the internal malleolus right between the tibia and the tendon (Achilles). Behind Fuliu (Ki 7), at the side of the tendon, Jiaoxin (Ki 8) is found. These two points are separated by a tendon. Needle depth 0.3 cun, left in during 7 expirations, moxa 3 times. From Fuliu (Ki 7), the energy gathers yingu (Ki 10), responding to the he-water movement, located behind the tibial plateau, below the large tendon and above the little tendon, at the level of the artery whose beat one can feel. Bend the knee to locate this point. Needle depth 0.4 cun, left in place during 7 expirations, moxa 3 times.” III - N.V.N. : “The number 1 creates water” is a phrase of the yi jing (I Jing: “Book of Changes”). Zhang Shi has recaptured this phrase in order to define the word “quan” of the point Yongquan (Ki 1: “Gushing Spring”) (see p. 49).

PARAGRAPH 7

65.

The bladder vessel begins at Zhiyin (Bl 67), responding to the jingmetal movement, located at the external side of the little toe. From this point, the energy flows out towards Tonggu (Bl 66), responding to the ying-water movement, located in a crease on the antero-external part of the 5th metatarso-phalangeal joint. From this point, the energy is flows down into Shugu (Bl 65), responding to the shu-wood movement, located behind the metatarsophalangeal joint. From this point, the energy is directed into Jinggu (Bl 64), which is the yuan point, located at the external side of the foot, below the large bone (cuboid). From this point, the energy passes to Kunlun (Bl 60), responding to the jing-fire movement, located behind the external malleolus below the calcaneus. From this point, the energy gathers at Weichong (Bl 40), responding to the he-earth movement, located at the middle of the popliteal crease. To locate this point, the subject must be face down, legs held very taut. Such are the 6 shu-antique points of Foot Taiyang channel (Bl).

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EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “Within the Foot Taiyang channel, “cold” energy dominates. This is why this channel begins at Zhiyin (Bl 67) (7). _ The lung, by its location, is comparable to heaven. _ The energy of “yang birth” comes from water and unites with heaven. water follows the energy in order to move toward the exterior. For this reason, one studies the relationship of the lung and bladder according to the principles of “Movements and Energies” of si Tian and Taiquan. _ Tongshu (Bl 66) is in communication with Rangu (Ki 2). _ Kunlun (Bl 60) is the source place of water, the “sea of stars”.” II - Ma Shi comments: “This paragraph studies the 6 shu-antique points of the bladder channel. _ The bladder vessel begins at the point Zhiyin (Bl 67), responding to the jing-metal movement, located at the external side of the tip of the little toe (at a distance of a he leaf from the ungual angle). Needle depth 0.1 cun, left in place during 5 expirations, moxa 3 times. 66. _ From Zhiyin (Bl 67), the energy flows out towards Tonggu (Bl 66), responding to the ying-water movement, located on the external surface of the little toe, in front of the metatarsophalangeal joint. Needle depth 0.2 cun, left in place during 5 expirations, moxa 5 times. _ From Tonggu (Bl 66), the energy flows down into Shugu (Bl 65), responding to the shuwood movement, located behind the metatarso-phalangeal joint. Needle depth 0.3 cun, left in place during 7 expirations, moxa 3 times. _ From Shugu (Bl 65), the energy passes to Jinggu (Bl 64), which is the yuan point, located at the external side of the foot, at the site of change in color of the flesh, below and in front of the 5th metatarsal tuberosity. Needle depth 0.5 cun, left in place during 7 expiration, moxa 3 times. _ From Jinggu (Bl 64), the energy is directed toward Kunlun (Bl 60), responding to the jing-fire movement, located behind the external malleolus, above the calcaneus, on a little artery whose beat one can feel. Needle depth 0.5 cun, left in during 10 expirations, moxa 3 times. In women, needling this point can provoke miscarriage. _ From Kunlun (Bl 60), the energy gathers at Weichong (Bl 40), responding to the he-earth movement, located behind and at the middle of the knee where the artery (popliteal) is found. To locate this point, the subject must be prone with legs very taut. Needle depth 0.5 cun, left in place during 7 expirations, moxa 3 times.”

III - N.V.N. : In this paragraph, we discover the abortive effect of Kunlun (Bl 60) and therapeutic effect of Tonggu (Bl 66) (8).

7. Zhiyin means “Extreme Yin”, and, therefore, by definition,describes a place where there is abundant water. 8. See “Art and Practice of Acupuncture and Moxabustion (Zhen Jiu Da Cheng)”. Volume II, N.V.N. Edition.

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PARAGRAPH 8 The gallbladder vessel begins at Qiaoyin (GB 44), responding to jing-metal, located at the external ungual angle of the 4th toe. From this point, the energy flows out towards Xiaxi (GB 43) , responding to ying-water, located at the junction between the 4th and 5th toes. From this point, the energy flow down into Linqi (GB 41), responding to shu-wood, located in a crease 1.5 cun from Xiaxi (GB 43) . From this point, the energy passes to Qiuxu (GB 40), which is the yuan point, located in a crease in front of the external malleolus. From this point, the energy is directed to Yangfu (GB 38), responding to jing-fire, located 4 cun above the external malleolus, in front of the fibula and at the lower end of the tibia. . 67. From this point, the energy gathers at Lingquan of the yang part (Yanglingquan: GB 34), responding to he-earth, located in a crease outside and below the knee. Such are the 6 shu-antique points of the Foot Shaoyang (GB) channel.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The 5 organs join together with the “5 movements”, and 6 bowels respond to the “6 energies”. _ Among the 6 energies, one distinguishes two fires. This is why the yuan points belong to fire and are auxiliary to the channels. _ The shu-antique points of the 5 organs begin with the jing-wood movement because the 5 organs join together with the 5 movements of earth to respond to energy of birth, growth, transformation, concentration and conservation. This is why these shu-antique points circulate following the “wood-fire-earth-metal-water” movements.” _ The shu-antique points of the 6 bowels begin with the jing-metal movement because the bowels respond to the “6 energies” of heaven. The 6 energies are created by yin and the “birth” energy originates from earth. For this reason, the energy of the 6 bowels begins in autumn and winter, then arrives in spring and summer. Such are the energies called “contrary” and “favorable” of yin and yang. _ In Chapter 81 of this classic, “yin and yang, blood and energy, left and right, front and back are developed in the “contrary” sense while taking into account the “favorable”. If one develops them in the “favorable” sense, one takes in account the “contrary”. _ qin Yue ren (alias Bian Que) states: “yin-jing (-well) is yi-wood; yang-jing (-well) is Keng-metal. If yang-jing corresponds to geng (7th Celestial Trunk), it is that it is “hard” from yi (2nd Celestial Trunk); if yin-jing corresponds to yi, it is that it is “soft” from geng.”

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II - Ma Shi comments: “This paragraph describes the 6 shu-antique points of the Foot Shaoyang (GB) channel. _ The gallbladder vessel begins at the point qiaoyin (GB 44), responding to the jing-metal movement, located at the external ungual angle of the 4th toe, at a distance of a large “he” leaf. Needle depth 0.1 cun, left in place during 3 expirations, moxa 3 times. _ From qiaoyin (GB 44) the energy flows out towards Xiaxi (GB 43), responding to the ying-water movement, located at the juncture of the 4th and 5th toes. Needle depth 0.3 cun, left in place during 3 expirations, moxa 3 times. _ From Xiaxi (GB 43) the energy flow down into Linqi (GB 41), responding to the shu-wood movement, located 1.5 cun above Xiaxi (GB 43). Needle depth 0.3 cun, left in during 3 expirations, moxa 3 times. 68. _ From Linqi (GB 41) the energy passes to qiuxu (GB 40) which is the wood-yuan point, located below and in front of the external malleolus, in a crease, 3 cun above Linqi (GB 41). Needle depth 0.3 cun, left in place during 3 expirations, moxa 3 times. _ From the point qiuxu (GB 40) the energy is directed towards yangfu (GB 38), responding to the ying-fire movement, located 4 cun above the external malleolus, in front of the fibula and 0.3 cun above Quegu (also named Xuanzhong- GB 39). The distance between Xiaxi (GB 43) and yangfu (GB 38) is 7 cun. Needle depth 0.3 cun, left in place during 7 expirations, moxa 3 times. _ From yangfu (GB 38) the energy gathers at Yanglingquan (GB 34), responding to the he-earth movement, located below and in front of the head of the fibula. To locate this point, the leg must be taut. Needle depth 0.7 cun, left in place during 10 expirations, moxa 7 times.” III - N.V.N. : 1. The “5 movements” of the earth respond to the “6 energies” of heaven. In man, the energy of heaven responds to the 3 yang and 3 yin channels of earth (9). 2. In order to locate the point sought in exact fashion, it is necessary to determine the painful reaction of the point by palpation. The efficacy of the needling depends on this.

PARAGRAPH 9 The stomach vessel begins at Lidui (St 45), responding to jing-metal, located at the external ungual angle of the 2nd toe, at a distance of a “he” leaf. From this point, the energy flows out toward Neiting (St 44), responding to the ying-water, located in a crease at the juncture of the 2nd and 3rd toes. From this point, the energy flows down into Xiangu (St 43), responding to shu-wood, located in a crease 2 cun above Neiting (St 44) . From this point, the energy passes to Chongyang (St 42), which is the the yuan of Foot Yangming, located in a crease at the top of the foot 2 cun from Xiangu (St 43). From this point, the energy is directed to Jiaxi (St 41), responding to jing-fire, located 1.5 cun behind Chongyang (St 42), in a crease. 9. See “Medecine Traditionnelle Chinoise”, N.V.N. Edition. 1984. Chapter II, “”5 Movements and 6 Energies”.

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From this point, the energy gathers at Xia Ling (Sanli - St 36), responding to he-earth, located 3 cun below the knee at the external side of the tibia.

69.

From this point, the energy descends to Shangjuxu (St 37), located 3 cun below Sanli (St 36). From this point, the energy descends again toward Xiajuxu(St 39) .

Shangjuxu (St 37) belongs to the large intestine and Xiajuxu (St 39) the small intestine . The large intestine and small intestine depend therefore on the stomach, that is to say on the Foot Yangming (St) channel.

to

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “In this way, the energy of the 3 yang channels originates from yin and manifest from the earth. The energy ascends, therefore, from the feet. _ The 6 channels of the foot and hand unite with the energy of the 3 yang channels and distribute next into the channels of the hand (Shou) and foot (Zu). It is a question of a study of the formation of the 6 channels of the foot and hand and not of a study of the energy of the 3 yang channels. This is why it is said: “The 6 bowels exteriorize at the 3 yang channels at the level of the foot to unite with those of the hand.” • Huang Tai Hua clarifies: “The large intestine and small intestine receive the waste of the cereals coming from the stomach-bowel. The liver decants the water of the residue. They are, therefore, subordinate to the stomach. For this reason, the large and small intestines “breathe in” the energy of the stomach channel at the level of Shangjuxu (St 37) and Xiajuxu (St 39).” II - Ma Shi comments: “This paragraph describes the jing, ying. shu, yuan, jing and he points of the Foot Yangming (St) channel. _ The stomach vessel begins at Lidui (St 45), responding to the jing-metal movement, located at the external ungual angle of the 2nd toe, at a distance of the width of a “he” leaf. Needle depth 0.1 cun, moxa 1 time. _ From Lidui (St 45), the energy flow out towards Neiting (St 44), responding to the yingwater movement, located at the commissure of the 2nd and 3rd toes. Needle depth 0.3 cun, left in during 10 expirations, moxa 3 times. _ From Neiting (St 44), the energy flows down into Xiangu (St 43), responding to the shuwood movement, located 2 cun from Neiting (St 44). Needle depth 0.5 cun, left in during 7 expirations, moxa 3 times. _ From Xiagu (St 43), the energy passes to Chongyang (St 42), the yuan-wood point, located in a crease at the top of the foot, 5 cun above Neiting (St 44) and 3 cun from Xiangu (St 43). _ From Chongyang (St 42), the energy is directed to Jiexi (St 41) responding to the jingfire movement, located in a crease 1.5 cun above Chongyang (St 42). Needle depth 0.5 cun, left in during 3 expirations, moxa 7 times. 70. _ From Jiexi (St 41), the energy gathers at Xua Ling (Sanli-St 36), responding to the waterearth movement, 3 cun below the knee, located outside the tibia. Needle depth 0.5 cun left in during 5 expirations, moxa 7 times, sometimes up to 100 times according to the case. _ From Sanli (St 36), the energy flow out towards the bottom, that is to say towards Shangjuxu (St 37), then towards Xiajuxu (St 39), because the stomach is the sea of the 5 organs/

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6 bowels and the energy of the large and small intestines responds to the points of the stomach.” III - N.V.N. : This paragraph emphasizes the circulation of the energy at the level of the shu-antique points of the Foot Yangming channel (St) whose significance is carried on the shu-earth point, Sanli (St 36). In effect, the cereal jing (cereal essence) at the level of the pilocutaneous system infiltrates into the jing-metal point and provokes successive movements to the he-earth point (St 36). From this point, the energy descends again to penetrate into the points Shangjuxu (St 37) and Xiajuxu (St 39). This movement, according to Qi Bo, is transmitted under the action of the large and small intestines. The origin of the inferior (lower) mu points of the large and small intestines is diagramed in the following figure:

Figure 5 Circulation of cereal jing in the 6 shu-antique points of Foot Yangming (St) and formation of the mu points (breathing in) of the large and small intestines.

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PARAGRAPH 10

71.

At the top, the sanjiao (SJ) unites with the shaoyang of the arm whose circulation begins at Guanchong (SJ 1), responding to jing-metal, located at the external ungual angle of the 4th finger. From this point, the energy flows out toward Yemen (SJ 2), responding to ying-water, located at the juncture of the 4th and 5th finger. From this point, the energy flows down into Zhongzhu (SJ 3), responding to shu-wood, located in a crease formed by the 4th and 5th metacarpals. From this point, the energy passes to Yangchi (SJ 4), which is the wood-yuan point, located in the crease of the wrist. From this point, the energy is directed towards Zhigou (SJ 6), responding to jing-fire, located 3 cun above the wrist crease between 2 bones. From this point, the energy gathers at Tianjing (SJ 10), responding to he-earth, located in a crease above the olecranon. Cross the arms to locate this point. • At the bottom, Xiashu (inferior Mu point) of the sanjiao is located behind the Foot Shaoyang (GB), at the external side of the bend of the knee and bears the name Weiyang (Bl 39) . A vessel leaves from this point which therefore at the same time, belongs to the Foot Taiyang (Bl) and Hand Shaoyang (SJ). This secondary and lower vessel of the sanjiao (SJ) runs parallel to the Foot Taiyang (Bl) and Foot Shaoyang (GB). A branch of the taiyang (Bl) located 5 cun above the malleolus penetrates deeply into the calf and comes back out at Weiyang (Bl 39) , and, with the principal channel of the bladder, it attaches firmly to the lower vessel of the sanjiao (SJ). Fullness of this lower vessel of the sanjiao manifests as urinary retention with cystitis and painful micturition, and the emptiness of this vessel by urinary incontinence. In the first case, one must disperse weiyang (Bl 39), and in the second case, tonify it. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “Huang Tai Hua instructs: “The sanjiao (SJ) is a bowel responsible for the irrigation of the organism. This is why its xiashu (lower mu point: Bl 39) manifests at the level of a vessel of the taiyang (Bl) located at the knee which, with the principal channel (Bl), firmly attaches to the

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sanjiao located at the lower part of the body. Obstruction of this vessel provokes dysuria with painful micturition, and emptiness of the vessel, urinary incontinence. Tonify Weiyang (Bl 39) in case of incontinence and disperse it in case of dysuria (cystitis). _ The energy of sanjiao manifests from the kidney and diffuses everywhere, as much at the top as the bottom, in reaching the parts which belong to it; then it circulates within the Hand Shaoyang channel (SJ). 72. _ The longitudinal routes form the jing (principal channels) and the transervsal routes, the luo (transversal). As for the “luobie” (longitudinal luos) of the taiyang (SI), they run alongside the space located between the Hand Shaoyang (SJ) and Hand Taiyin (Lu) channels. This is why it is said: The shaoyang and taiyin are the Bie of the taiyang.”

II - Ma Shi comments: “This paragraph describes the jing, ying, shu, yuan, jing and he points of the Hand Shaoyang (SJ). In Chapter 41 of this classic, we note: “The kidney unites with the sanjiao and bladder...”. This implies that the right kidney goes to the bladder and the left kidney to the sanjiao. But the lower portion of the sanjiao also unites with the right kidney and ascends to the 4th finger. This is why it is said: _ Above, the sanjiao unites with the Hand Shaoyang (SJ) which begins circulation from guanchong (SJ 1), located at the external ungual angle of the 4th finger and responds to the jingmetal movement. Needle depth 0.1 cun, left in during 3 expirations, moxa 3 times. _ From guanchong (SJ 1), the energy flows out towards Yemen (SJ 2), located in a commissure formed by the 4th and 5th fingers and responds to the ying-water movement. Needle depth 0.1 cun, left in during 2 expirations, moxa 3 times. _ From Yemen (SJ 2), the energy flows down into Zhongzhu (SJ 3), responding to the shuwood movement, located in a crease formed by the 4th and 5th metacarpals, 1 cun above Yemen (SJ 2). Needle depth 0.1 cun, left in during 2 expirations, moxa 3 times. _ From Zhongzhu (SJ 3), the energy passes towards yangchi (SJ 4), responding to the yuanwood movement, located at the wrist crease. Needle depth 0.2 cun, left in during 6 expirations, moxa prohibited. _ From yangchi (SJ 4), the energy is directed towards zhigou (SJ 6), responding to the jing-fire movement, located 3 cun below the wrist crease, between the two bones of the forearm. This point also is called Fihui. Needle depth 0.2 cun, left in for 7 expirations and moxa 3 times. _ From zhigou (SJ 6), the energy gathers at Tianjing (SJ 10), responding to the he-earth movement, located in a crease above the olecranon. Cross the arms to locate this point. Needle depth 0.3 cun, left in during 7 expirations, moxa 3 times. • Although the sanjiao (SJ) channel is directed towards the hand, its bowel attaches itself strongly to the kidney and sends off a vessel to xiashu (lower point = Mu point- weiyang Bl 39). _ From weiyang (Bl 39), a vessel emerges which descends to the foot, to the front of the 5th toe, between Foot Taiyang (Bl) and Foot Shaoyang (GB). Therefore, this vessel is, at the same time, the “luobie” (longitudinal luo) of the Foot Taiyang (Bl) and Foot Shaoyang (GB) channels. _ From weiyang (Bl 39), another vessel also emerges which reaches the area located 5 cun above the external malleolus where guanming (GB 37- luo of the gallbladder) is found. Then from there, it passes to Feiyang (Bl 58- luo of the bladder) to deeply penetrate into the calf before rejoining weiyang (Bl 39) and flowing down into the principal channel of the bladder in order to reach the bladder bowel and to link firmly to the xiajiao (Lower Jiao- LJ). • Fullness of this lower vessel of the sanjiao (SJ) causes cystitis with painful micturition. In this case, one must disperse weiyang (Bl 39). Emptiness of this lower vessel is the origin of urinary incontinence; one must tonify it.

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III - N.V.N. : The lower Mu point of the sanjiao (SJ) had been described in 1969 by Chamfrault and ourselves in “The Energetic Human” and in “Energetic Pathogenesis and Pathology” without dwelling over the pathophysiologic mechanism of this point. Today, we propose the diagram below (Fig. 6):

Figure 6 Internal canal and lower vessels of sanjiao (SJ): _ In event of fullness of lower vessels: urinary retention, cystitis. Disperse weiyang (Bl 39). _ In event of emptiness: urinary incontinence, polyuria: Tonify weiyang (BL 39).

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PARAGRAPH 11

74.

At the top (hand), the energy of the small intestine unites with the Hand Taiyang (SI channel). It begins at Shaoze (SI 1), located at the external ungual angle of the 5th finger, responding to jing-metal. From this point, the energy flows out towards Qiangu (SI 2), located in a crease at the external side of the base of the little finger, responding to ying-water. From this point, the energy flows down into Houxi (SI 3) , located in a crease behind the base of the little finger, responding to shu-wood. From this external side of yuan-wood. From this in a crease in

point, the energy passes to Wangu (SI 4), located at the the hand, in front of the wrist bone, responding to point, the energy is directed toward Yanggu (SI 5), located front of the ulna, responding to jing-fire.

From this point, the energy gathers at Xiaohai (SI 8), located in a crease of the elbow, between the olecranon and internal (medial) condyle of the humerus, responding to he-earth. Extend the arm to locate this point. Such are the 6 shu-antique points of the Hand Taiyang (SI).

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “Huang Tai Hua teaches: “The large and small intestines make up part of the stomach. These two bowels manifest at Shangjuxu (St 37) and at Xiajuxu (St 39). This is why it is said: “At the top, the small intestine unites with the Hand Taiyang (SI).” “ II - Ma Shi comments: “This paragraph defines the jing, ying, shu, yuan, jing and he points of small intestine. • This Hand Taiyang channel (SI), whose bowel is in the abdomen, is found on the hand. This is why the text states: “Above, the small intestine unites with the Hand Taiyang (SI)”. _ The energy of this channel begins at Shaoze (SI 1), is located at the external ungual angle of the 5th finger at a width of a “he” leaf, responding to the jing-metal movement. Needle depth 0.1 cun, left in during 3 expirations, moxa 3 times. _ From Shaoze (SI 1), the energy flows out towards Tiangu (SI 2), located in a crease at the external edge of the hand in front of the metacarpo-phalangeal joint, responding to the jing-water movement. Needle depth 0.1 cun, left in during 3 expirations, moxa 3 times. _ From Tiangu (SI 2), the energy flows down into Houxi (SI 3), located behind the metacarpo-phalangeal joint of the little finger, responding to the shu-wood movement. Bend the hand to locate this point. Needle depth 0.1 cun, left in during 2 expirations, moxa 3 times. 75. _ From Houxi (SI 3), the energy passes to Wangu (SI 4), located at the external edge of the hand in front of the wrist bone, responding to the yuan-wood movement. Bend the hand to locate this point. Needle depth 0.3 cun, left in during 3 expirations, moxa 3 times.

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From Wangu (SI 4), the energy is directed to yanggu (SI 5), located in a crease in front of the ulna, outside the wrist, responding to the jing-fire movement. Needle depth 0.2 cun, left in during 3 expirations, moxa 3 times. From yanggu (SI 5), the energy gathers at Xiaohai (SI 8), located in the elbow crease between the olecranon and medial epicondyle of the humerus, responding to the he-earth movement. Cross the arms to locate it. Needle depth 0.3 cun, left in during 7 expirations, moxa 5 times.” III - N.V.N. : Note, however, that the small intestine has its lower Mu point (Xiajuxu: St 39) (Figure 5).

PARAGRAPH 12 At the top, the large intestine unites with the Hand Yangming (LI). This vessel begins at Shangyang (LI 1), located at the tip of of the index finger, responding to the jing-metal movement. From this point, the energy flow out towards Erjian (LI 2), located in front of the metacarpo-phalangeal joint, responding to the ying-water movement. From this point, the energy flows down to Sanjian (LI 3), located behind the metacarpo-phalangeal joint, responding to the shu-wood movement. From this point, the energy passes to Hegu (LI 4), located at the angle formed by the 1st and 2nd metacarpals, responding to yuan-wood. crease fire.

From this point, the energy is directed to Yangxi (LI 5), located in a between 2 tendons (anatomical snuffbox), responding to jing-

From this point, the energy gathers at Quchi (LI 11), located in a crease outside the epicondyle, at the external side of the elbow, responding to he-earth. Cross the arms to locate it. Such are the points belonging to the Hand Yangming (LI). EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: This paragraph describes the jing, ying, shu, yuan, jing and he points of the large intestine channel. The large intestine bowel is found down at the bottom, and its channel is directed towards the hand; this is why it is said: “At the top, the large intestine unites with the Hand Yangming (LI).” _ This vessel begins at Shangyang (LI 1), located at the internal ungual angle of the index finger, responding to the jing-metal movement. Needle depth 0.1 cun, left in during 1 expiration, moxa 3 times.

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_ From Shangyang (LI 1), the energy flows out towards Erjian (LI 2), located in front of the metacarpo-phalangeal joint of the index finger, responding to the jing-water movement. Needle depth 0.3 cun, left in during 3 expiration, moxa 3 times. _From Erjian (LI 2), the energy flows down into Sanjian (LI 3), located behind the metacarpo-phalangeal joint, responding to the shu-wood movement. Needle depth 0.3 cun, left in during 3 expirations, moxa 3 times. _ From Sanjian (LI 3), the energy passes to hegu (LI 4), located in a crease formed by the 1st and 2nd metacarpal bones (of thumb and index), responding to the yuan-wood movement. Needle depth 0.3 cun, left in during 6 expirations, moxa 3 times. _ From hegu (LI 4), the energy is directed towards yangxi (LI 5), located in a crease between 2 tendons (in the anatomical snuffbox), at the side of the anterior fold of the wrist, responding to the jing-fire movement. Needle depth 0.3 cun, left in place during 7 expirations, moxa 3 times. _ From yangxi (LI 5), the energy gathers at Quchi (LI 11), located in a crease at the external side of the lateral epicondyle, responding to the he-earth movement. Cross the arms to locate it. Needle depth 0.5 cun, left in during 7 expirations, moxa 5 times. II - N.V.N. : We emphasize the pathophysiology and treatment of the lower vessel of the large intestine (Figure. 5).

PARAGRAPH 13 Such is the significance of the shu points of the 5 organs and 6 bowels: 5 X 5 = 25 shu and 6 X 6 = 36 shu. The 6 bowels manifest at the 3 yang channels of the foot and unite with the 3 yang channels of the hand. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: 77. “Zhang Gai Chi teaches: “The large and small intestines belong to the stomach. The sanjiao (SJ) manifests at the “luo” of the taiyang (Bl) and unites with the Hand Shaoyang (SJ). The 6 bowels manifest at the 3 yang channels of the foot and gather together with the 3 yang channels of the hand. The upper half of the body responds to heaven and the lower half to earth. If the 6 bowels manifest from the 3 yang channels of the foot, it is because their origin comes from earth.” II - Ma Shi comments: “This paragraph tabulates the shu-antique points of the 5 organs and 6 bowels and the channels. The channels of the 6 bowels are: a - At the foot, taiyang-bladder, and at the hand, taiyang-small intestine. b - At the foot, yangming-stomach, and at the hand, yangming-large intestine. c - At the foot, shaoyang-gallbladder, and at the hand, shaoyang-sanjiao.

Such are the connections of the yang channels of the foot with those of the hand. In reality, if they are called “channels of the foot” (zu), it is because of the presence of the shu-antique points which circulate from the foot, and if they are called “channels of the hand” (shou), it is

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because their shu-antique points circulate from the hand.” III - N.V.N. : At the exterior, the 3 yin and 3 yang respond to the “6 energies” of heaven, and, at the interior, they unite with the energy of the 12 jingmai. The 3 yang channels of the hand have their root at the foot; this is why the text stresses: “At the top, the large intestine unites with the Hand Yangming”, because, at the exterior, the 5 organs and 6 bowels receive the energy of the 3 yin and 3 yang to join to that of the channels. The diagram of the circulation of the 3 yin and 3 yang of the foot and hand, proposed in 1969 by Chamfrault and ourselves, has become standard (Fig. 7).

Figure 7 Position and circulation of the 3 yin and 3 yang of the foot and hand.

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PARAGRAPH

14

“Inside of Quepen (St 12) is Tiantu (CV 22), vessel No. 1 belonging to renmai (CV).

located on medial anterior

The artery is contiguous with renmai (CV) and belongs to Foot Yangming (St) where Renying (St 9) is found, located on lateral vessel No. 2.

Futu (LI 18) belonging to the Hand Yangming (LI) is located on lateral vessel No. 3. Tianchuang (SI 16) belonging to the Hand Taiyang (SI) is located on lateral vessel No. 4. 78. Tianrong (SI 17) (10) belonging to the Foot Shaoyang (GB) is located on lateral vessel No 5. Tianyou lateral vessel Tianzhu lateral vessel

(SJ 16) belonging to the Hand Shaoyang (SJ) is located on no. 6. (Bl 10) belonging to the Foot Taiyang (Bl) is located on no. 7.

Fongfu (GV 16) belonging to the Dumai (GV) is located on medial posterior vessel no. 8. Tianfu (Lu 3) axilla.

is located of the artery (of the arm) equal with the

3 cun below the axillary artery Tianchi (XB 1) is found, belonging to the Hand Jueyin (xin bao luo)”.

EXPLANATIONS AND COMMENTARIES

79.

I - Zhang Shi explains: “ The 12 jingmai of the foot and hand adhere to the 3 yin and 3 yang channels. These both are the “6 energies” circulating outside of earth, while the organs and bowels form a couple like “male and female” and the “5 movements” spread out within the entire universe. This paragraph defines the 3 yin channels and 3 yang channels. This energy, originating from the 4 cardinal directions, infiltrates into these channels to vitalize the organs and bowels so that they respond to that of heaven in the same manner as when they deeply penetrated into the earth. This paragraph describes moreover the specific direction of the circulation of the 3 channels, according to a precise order, towards the neck and nucha, exactly like that of the yang 10. “Tianrong (SI 17) belonging to the Foot Shaoyang (GB)” has been the object of discussion through the ages. For Ma Shi, it is concerns an error in printing, and he corrected it via Tianchong (GB 9), and, since that day, this thesis was unanimously accepted. Yet, Ma Shi himself has written: “This paragraph describes the localization of the cervical and nuchal points.” Consequently, we do not think that it was a matter of an error in printing because Tianchong (GB 9) is located on the skull and not on the neck. We are inclined to favor the following thesis: Before the Tang Dynasty (618-906 AD), Tianrong (SI 17) had been

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classified among the points belonging to Foot Shaoyang (GB), probably because of the close connection between taiyang and shaoyang (shaoyang being the “half-internal” channel and “half-external” channel = “barrier”).

energy coming to leave the surface of the earth. The two vessels ren (mai) and Du (mai) manifest from the kidneys and have the power to communicate with the yin and yang energy of the entire organism. The Hand Taiyin (Lu) and xinbao (XB) manifest thanks to the sanjiao (SJ) and have the power to activate the circulation of energy and blood a posteriori. By way of this, yin and yang, blood and energy are directed from the top downward and from the interior to the exterior. Yu Shi states: “ The jingmai respond to the jing shui (routes of water; rivers) of the earth and communicate with heaven. This is why certain points of the neck and nucha bear the name “Tian” (heaven): Tiantu - CV 22 Tianchuang - SI 16 Tianrong - SI 17 Tianyou - SJ 16 Tianzhu - Bl 10 Tianfu - GV 16, etc .... . II - Ma Shi comments: “This paragraph describes the points of the channels of the cervico-nuchal region beginning with the anterior medial vessel (No. 1) and finishing with the posterior medial vessel (No. 8) and the localization of certain points in the brachio-thoracic region. here, it is a matter of instruction on the search for points intended for future generations. The anterior medial vessel is renmai (CV) where Tiantu (CV 22), located in a crease 4 cun below the pharynx between the 2 supraclavicular points Quepen (St 12), is found. renmai (CV) is line No. 1, and Quepen (St 12), belonging to the Foot yangming (St), is located above and in the middle of the superior border of the clavicle. • Two cun outside of renmai (CV) the Foot Yangming (St) is found whose arterial point (carotid) bears the name renying (St 9), located 1.5 cun lateral from the pharynx (Adam’s apple). The Foot Yangming (St) is line No. 2. 80. The point belonging to the Hand Yangming (LI) is Futu (LI 18), located 1 cun below the maxillary angle and 1.5 cun lateral to renying (St 9). The Hand Yangming (LI) is line No. 3. The point belonging to the Hand Taiyang (SI) is Tianchuang (SI 16), located behind the posterior fascia of the sternocleidomastoid muscle, 0.5 cun from Futu (LI 18) in a crease at the spot where one feels the arterial beat. The Hand Taiyang is line No. 4. The point of the Foot Shaoyang (GB) is Tianchong (GB 9), located above and behind the pinna of the ear, 2 cun above the hairline. The Foot Shaoyang is line No. 5. The point of the Hand Shaoyang (SJ) is Tianyou (SJ 16), located behind Tianrong (SI 17) and in front of Tianzu (Bl 10). The Hand Shaoyang (SJ) is line No. 6. The point of the Foot Taiyang (Bl) is Tianzhu (Bl 10), located outside the large tendon (of the trapezius) and 0.5 cun below the edge of the scalp. The Foot Taiyang (Bl) is line No. 7. • From anterior medial line No. 1 (renmai-CV), in passing by the anterior then lateral surface of the thorax and the back, up to the posterior medial line, one counts a total of 8 lines. The posterior medial line No .8 designates the Dumai (GV) whose point is Fengfu (GV 16), located above the scalp line in a crease between 2 large tendons. Fengfu (GV 16) also has the name Sheban (root of the tongue); to locate this point, have the patient speak quickly and loudly- the point swells. It is prohibited to moxa this point at the risk of causing mutism. Tianfu (Lu 3) is located 3 cun outside of the axillary crease, 5 cun above the elbow fold, where an artery beats. To locate this point, lift the elbow and touch the nose with the arm. The points located from Tianfu (Lu 3) to the elbow and from the elbow to Shaoshang (Lu 11), that is to say to the tip of the thumb, all belong to the Hand Taiyin (Lu). Three cun below the axilla, that is to say 1 cun behind the breast, in an intercostal space,

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one finds Tianchi (Pe 1) belonging to the xin bao luo (XB). From this point, a vessel passes to Tianquan (XB 2) located 2 cun below the end of the anterior axillary fold, reaches the elbow and forearm and arrives at Zhongchong (XB 9) at the tip of the middle finger. This vessel and these points belong to the Hand Jueyin (XB-xin bao luo)”.

III - N.V.N.: This method of detection of the localization of points of the cervico-nuchal region is very precise and constitutes again, in our era, a wise teaching. Note, however, that in practice, we have stated that: 81. 1. The localization of points is variable according to the individual (therefore sometimes vary according to the author). 2. All points of acupuncture are located on nerve fibers or blood capillaries (results from our acupuncture analgesic studies in 1971). (7) 3. Pathological points are always found to be painful. (7) See “Theory and Practice of Acupuncture Analgesia”, NVN Edition.

Therefore, the therapeutic efficacy of acupuncture depends not only on precise point localization and needle manipulation, but also on detection of the sensitivity of these points.

PARAGRAPH 15 The Foot Yangming (St) is a vessel contiguous with the throat; their shu (points) are on the thoracic cage. The Hand Yangming (LI) is a vessel located 1 cun outside Qu Jia (maxillary angle). The Hand Taiyang (SI) is found at Qu Jia. The Foot Shaoyang (GB) is found below the ear and behind Qu Jia. The Hand Shaoyang (SJ) circles behind the ear, above Wangu (mastoid; GB 12). The Foot Taiyang (Bl) joins to the nucha, outside the large tendon (trapezius) at the edge of the scalp.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The preceding paragraph gives an account of the ascent of the energy of the 3 yang channels, while this one inform us on the descent. In other words, as soon as the yang energy arrives at the head, it begins making movements of descent. Tian Tong si describes: “When the energy of Foot Yangming (St) is found in the upper part of the body, it flows down into the lung, and “Xian qi” (fierce energy) rises up towards the head via the laryngo-pharyngeal route, reaches the “orifices”, encircles the eyes and penetrates into the brain without any order. Then from the brain, it reappears at Gua shu ren (also ShangquanGB 3), descends to the mandible, encircles the gums and unites with the yangming in order to

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descend to renying (St 9). Such is the circulation of the energy which goes from the bottom upwards to the brain, then from the top downward. Then, from renying (St 9), the energy joins the points located at the thorax. The energy of the other yang channels follows the same path as that of the yangming, but next to and outside of it. These ascents and descents respond exactly to those of the energy of heaven.” 82. II - Ma Shi comments: “This paragraph completes the previous one and deals with the energetic paths of the thoraco-dorsal region. _ In effect, between the 2 Quepen (St 12) is Tiantu (CV 22), to the bottom is medial path No. 1. _ The vessel next to renmai (CV) belonging to Foot Yangming (St), where one finds renying (St 9), is path No. 2. This yangming runs alongside the neck and descends successively towards the points shuitu (St 10), qishe (St 11) and Quepen (St 12)... and then from there to the points qihu (St 13), Kufang (St 14), Wuyi (St 15), etc. This is why the text states: “The Foot Yangming (St) is a vessel contiguous with the throat, and its points are located on the thoracic cage.” _ “The Hand Yangming (LI) is a vessel located 1 cun outside of Qu Jia” means to say that Futu (LI 18) of the Hand Yangming is located on path No. 3. But, this path extends out beyond and outside the shu points of the Foot Yangming (St), 1 cun outside of Qu Jia (maxillary angle where Jiache- St 6 is found). In other words, Futu (LI 18) is located 1 cun below Jiache (St 6). _ “The Hand Taiyang (SI) is found at Qu Jia” means that Tianchuang (SI 16) is located on path No. 4, and that these points are positioned on the vertical line below Qu Jia and above Futu (LI 18). _ “The Foot Shaoyang (GB) is found below the ear and behind Qu Jia” indicates that Tianchong (GB 9) is located on path No. 5 and that the points are positioned either below the ear and behind Qu Jia or in front of the ear and within the scalp. _ “The Hand Shaoyang (SJ) goes around the ear, above Wangu “indicates that Tianyou (SJ 16) is located on path No. 6 and that the points are positioned behind the ear and below the mastoid (GB 12). _ “The Foot Taiyang (Bl) joins with the nucha, outside the large tendon, at the edge of the scalp” wishes to say that Tianzhu (Bl 10) is on path No. 7 and that this point is positioned behind the nucha, outside the tendon, at the root of the hair ” III - N.V.N. : a) Zhang Shi reveals to us the cranio-facial circulation of yangming (St). This teaching is of prime interest because it allows comprehension of the pathophysiologic processes of this region unknown up to today (see Figure 8). b) In this paragraph, the text again states: “The Foot Shaoyang (GB) is found below the ear and behind Qu Jia (maxillary angle)” in order to explain that path No. 5 runs from Tianrong (SI 17), and not from Tianchong (GB 9) which is located at the level of the cranium. Tianrong (SI 17) has indeed been localized below the ear and behind Qu Jia (maxillary angle). It seems to us that our thesis (see Paragraph 14) is more in accordance with the spirit of the Lingshu than that of Ma Shi. c) Paragraphs 14 and 15, as well as this Paragraph 16, can be summarized in table form below: 83.

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Figure 8 Cranio-facial circulation of the yangming (St).

Table of Classification of points of the cervico-nuchal region Line

jingmai

points

Localization

No. 1

renmai (CV)

Tiantu (CV 22)

In a crease, at upper edge of manubrium

No. 2

Foot Yangming (St)

renying (St 9)

1 cun from Adam’ Apple, on carotid artery

No. 3

Hand Yangming (LI)

Futu (LI 18)

No. 4

Hand Taiyang (SI)

Tianchuang (SI 16)

No. 5

Foot Shaoyang (GB)

No. 6

1.5 cun outside qishe (St 11) 1.1 cun below the maxillary angle; between the 2 fascia of the sternocleidomastoid muscle 3.5 cun outside Adam’s Apple behind Futu (LI 18)

Tianrong (SI 17) (Lingshu) Tianchong (GB 9) (Ma Shi)

Behind the maxillary angle, in a crease Behind and above the ear pinna, 0.5 cun behind shuigu (GB 8)

Hand Shaoyang (SJ)

Tianyou (SJ 16)

Behind the ear, below Wangu (GB 12)

No. 7

Foot Taiyang (Bl)

Tianzhu (Bl 10)

0.5 cun above the scalp line, at the external part of the trapezius muscle

No. 8

Dumai (GV)

Fengfu (GV 16)

In a crease below the occipital protuberance

PARAGRAPH 16

84.

“Wuli (LI 13) located on the artery is forbidden to be needled.”

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EXPLANATIONS AND COMMENTARIES I - Zhang Shi comments:

“This paragraph concerns the circulation of yin and yang, of blood and energy of the organs and bowels at the level of the two channels, Hand Taiyin (Lu) and Hand Yangming (LI). This circulation going from the interior to the exterior and from the exterior to the interior is none other than perpetual movements of going and returning, favorable and contrary movements. _ “The artery” designates that which is in direct communication with the radial pulse of Hand Taiyin (Lu). _ Wuli (LI 13) is a point belonging to the Hand Yangming (LI) located above the elbow, this side of the shu antique points: jing, ying, shu, jing, he of the organs. _ The energy and blood of the 5 organs manifest at the radial pulse of Hand Taiyin (Lu). _ Via the path of the Jing Bie (distinct channels), a part of the energy and blood of the 5 organs circulates outside the Hand Taiyin (Lu) channel and follows the Hand Yangming (LI) in order to manifest at the skin. _ As for the blood and energy circulating within the Hand Taiyin (Lu) channel, they leave from the thumb and successively reach the wrist, forearm and elbow. _ The energy and blood located outside the Hand Yangming (LI) channel leave from the arm and elbow and are directed toward the skin. Such is the situation of the movements of going and returning and the favorable and contrary movements located outside and inside the jing (channels), the luo (secondary vessels) and the skin. • The Hand Taiyin (Lu) is “master” of the energy of the entire organism and the “100 currents” (energetic) gather there. The Hand Yangming is its bowel. The bowel is yang; its role is to direct the energy and blood outside the channel. The organ is yin; its role is to direct the energy and blood within the channel. If the skin is rich in blood and energy, and if the movements of going and returning and the favorable and contrary movements are perpetual, it is thanks to the Hand Taiyin (Lu) and Hand Yangming (LI) which are the driving force in the first impetuses. 84. It is stated: “If Wuli (LI 13) receives the blood and energy in an incomplete fashion coming from the exterior (skin), and if one needles it more than five times, the blood and energy at the level of the five shu-antique points are destroyed.” This is why the text stresses: “The artery located at Wuli is forbidden to be needled.” In other words, the blood and energy, always in motion at the level of the radial pulses, comes from the exterior, and it is Wuli (LI 13) which brings them into the interior (pulse). By this fact, needling Wuli (LI 13) is strictly prohibited at the risk of fatal accidents. • The previous paragraph demonstrates the ascending and descending movements of the yang energy which responds to the ascending and descending energies of heaven, while this paragraph addresses the entry and exit movements of the blood and energy which respond to the movements of jing shui (routes of water; rivers) of heaven and earth becoming transformed into clouds and rain in order to humidify the surface of the earth.” II - Ma Shi comments: “This paragraph concerns Wuli (LI 13) of the large intestine channel, forbidden point of the 5 organs. Three cun above Chize (Lu 5), that is to say above the elbow, on the external side of the muscle (biceps), on the large artery of the arm (brachial), Wuli (LI 13) is found, a point which is forbidden to be needled. Huangdi questions: “One can kill a living man and not resuscitate a dead man. Can you do

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the opposite? Qi Bo replies: “The perfect channels are the “Great luos”. One waits for them and monopolizes them. On the other hand, if one waits for Wuli (LI 13), one must stop; if one needles it five times, and if each time one awaits the arrival of the energy (deqi), the energy of the 5 organs becomes empty. This is why needling Wuli (LI 13), the point which controls the five shuantique points of the five organs (5 X 5 =25), comes down to monopolizing the celestial energy.” It is also written: “When one needles in front of the door, the patient dies in the house; and when one enters nearby the door in order to needle, the patient dies on the steps.” In Chapter 1 (“9 Needles and 12 yuan”) of the Lingshu, it is stated: “To monopolize yin is to provoke death.” The explanation is found in Chapter 3 (“Explanations of the Little Needles”): “That means that Wuli (LI 13) must not be needled more than five times. If one contacts the artery, the five shu-antique of the five organs (5 X 5 = 25) are paralyzed, and it is death.” In this manner, Wuli (LI 13) is a strictly forbidden point; we must take this into account.” III - N.V.N. : This paragraph gives the reason why Wuli (LI 13) is forbidden to be needled. Wuli (LI 13) is an arterial point which controls and maintains not only the pulse movements of Cun Kou (radial pulses), but also the energetic transformative movements at the level of the 5 shu antique points of the 5 organs: 5 X 5 = 25; that is to say, the collection of energy and blood of the organism. This is why it is strictly forbidden to needle it at the risk of provoking fatal accidents. See the particular pathophysiologies of the points demonstrated by Zhang and Ma which can be synthesized in the following diagram (Figure 9). 86.

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Figure 9 The returning circulation of blood and energy at the level of Wuli (LI 13).

PARAGRAPH 17

The lung unites with the large intestine. The large intestine is a bowel of transit, transformation, secretion and excretion. The heart unites with the small intestine. The small intestine is a bowel where the food products coming from the stomach are conveyed. It has the role of separating the “pure” and “impure”; for this reason, its function consists of controlling liquid formation. The liver unites with the gallbladder. The gallbladder is a bowel of “propriety”. It judges all physiologic activities of the organism. The spleen unites with the stomach. The stomach is a bowel of the “5 cereals”. The five sapors originate from there. the

The kidney unites with the bladder. The bladder is a bowel where organic liquids gather. It is responsible for urinary excretion.

The shaoyang (sanjiao-SJ) belongs to the kidney. At the top, the kidney is connected to the lung; this is why the kidney coalesces with these two organs. The sanjiao (SJ) is a “faithful and solitary” bowel; the liquid routes originate from there and reach the bladder; it is, then, bowel called “isolated”. 87.

Such are the principles of “union” of the 6 bowels. EXPLANATIONS AND COMMENTARIES I - Zhang Shi comments:

“This paragraph defines the systems of yin-yang union of the 6 organs and 6 bowels. The organs which store the grains and transform them and which excrete the food residues

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and collect the pure water are called “bowels”. The large intestine is an excretory organ; the transformations originate there, hence the name “evacuating bowel”. The small intestine is an absorptive bowel. It has the role of propelling the food residues and handling them in light of transforming them into nutritive substances, hence the name “transformative bowel”. The gallbladder receives the pure liquid, hence the name “bowel of Pure water”. The stomach is a depot of cereals, hence the name “bowel of the five sapors”. The bladder is an organ of “strong concentration”; the organic liquids gather there, hence the name “bowel of organic liquid”. In Chapter 61 (“Study on the “water-heat” points”) of the Suwen, it is stated: “The kidney belongs to zhi yin, and zhi yin is the site of conservation of water. The lung is taiyin and shaoyin (Ki) responds to the pulse of winter, having for “root” the kidney and for “summit” the lung. The lung and kidney are organs which receive water.” Therefore, the kidney unites on the one hand with the shaoyang (SJ) which responds to fire, and on the other hand with the lung which responds to water. This is the reason for which the text states: “The kidney coalesces with these two organs. (8)” • The sanjiao (SJ) channel begins at the stomach. A vessel branches to the kidney and ties up to the xiajiao (LJ). This vessel is “solitary”. This is why the text states: “The sanjiao (SJ) is a solitary organ. The liquid pathways come from there and reach the bladder.” The zhongjiao (MJ) is the energy of the shaoyang (SJ), that is to say the energy which produces “Budding yang” from water. Ministerial fire of the Hand Jueyin (XB) manifests from kidney-yang and gathers in the area below the heart in order to form an organ system. • The two kidneys respond to the number 1 corresponding to celestial water and to the number 2 corresponding to terrestrial fire. One determines them in this manner in order to better examine them. The shaoyang (SJ = fire) belongs to the kidney, and the kidney is linked to the taiyin (Lu = water) in such a way that in the “kidney-lung-sanjiao” system, yin and yang, water and fire make a pact. yin and yang, water and fire are interdependent with the jing of the five organs to represent the source of vital energy. The two kidneys have as a bowel the bladder. As for the sanjiao (SJ), it is linked to the xinbao (XB) which is why the sanjiao is a “isolated” bowel. • On the other hand, the sanjiao (SJ) originates from the energy of the shaoyang which manifests from the kidney organ. This energy spreads everywhere, up to the pores at the exterior, then returns to the stomach, that is to say, _ to the shangjiao (Upper Jiao = cardia) _ to the zhongjiao (middle jiao = fundus) _ to the xiajiao (Lower Jiao = pylorus). This is why it is stated: _ the non-return of the shangjiao (UJ -> cardia) is the cause of sour eructations _ the non-return of the Zhangjiao (MJ -> fundus) is the cause of dyspepsia _ the non-return of the xiajiao (LJ -> pylorus) is the cause of urinary incontinence. • The sanjiao (SJ) is an “formless” energy which spreads everywhere in the organism; it penetrates there and comes back out from every part, then reaches again the stomach which is an organ with “form”. This is why the sanjiao is a specific bowel which has its own channel and its own points. • The energy of Hand Jueyin (XB-xinbao) is yin-fire originating from the “terrestrial

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branches”. It also manifests from the kidney organ and returns to the xinbao whose location is found under the heart. The xinbao plays a role as the official which directs the circulation of blood in the vessels. • To speak of the energy a priori is to speak of the shaoyang belonging to the kidney; and to speak of the organ and bowel a posteriori is to speak of the xinbao located under the heart and of the sanjiao located in the stomach in order to form a distinctive system of energy of the organ and bowel. II - Ma Shi explains: “This paragraph defines the system of union of the five organs and six bowels. _ The lung and large intestine are “internal-external”. The lung therefore unites with the large intestine channel. The large intestine is a bowel of transit; the products already metabolized by the small intestine pass there and are driven towards the bottom. _ The liver and gallbladder are “internal-external”. The liver therefore unites with the e 8. hence the existence of “kidney-yin” and “kidney-yang” (yin function and yang function of the kidney).

gallbladder channel. The gallbladder is a bowel that is filled with Zhong jing (essence of the center: extremely pure liquid). In effect, the products transformed by the other bowels are impure substances, except that of the gallbladder which only conserves the pure liquid. _ The spleen and stomach are “internal-external”. The spleen therefore unites with the stomach channel. The stomach is a bowel of “cereal liquids” (shui-Gu). In effect, the ingested cereals are received by the stomach 89. _ The kidney and bladder are “internal-external”. The kidney therefore unites with the bladder channel. The bladder is a bowel which contains the organic liquid. In effect, after ingestion of liquids, the jing qi (energetic essence) flows towards the lungs in order to balance and bring the liquid pathways towards the bladder which is the bowel of liquids. • The Hand Shaoyang (SJ) belongs to kidney yang and the kidney itself is linked to the lung. In this manner, _ the sanjiao (SJ) and kidney yang are at the right side (“foot” pulse of the right side) _ the bladder and kidney yin are at the left side (“foot” pulse of the left side). In these two cases, it is always the kidney which commands them. But the sanjiao (SJ) is a bowel which widens the water routes (Zhong Du). This is why the liquid routes come from there.

In Chapter 8 (“Temple of Sacred Books’) of the Suwen it is stated: “The sanjiao is an irrigation system; it constitutes the source of water routes of the entire economy.” This assertion defines the role of the xiajiao (Lower Jiao), site of accumulation of water (Du) having the property of collecting it and making it flow, hence the name Zhong Du. In the same chapter it is also stated: _ The sanjiao (SJ) is a bowel of irrigation. _ The bladder unites with the left kidney and the sanjiao to the right kidney (9). _ The bladder and the sanjiao have the same function. But in practice, the bladder and the kidney are reunited in order to form the “externalinternal” system, while the sanjiao is linked to the Hand Jueyin (xinbao - XB). The sanjiao therefore is a bowel which is “isolated” from the kidney.”

III - N.V.N. : The explanations and commentaries of Ma and Zhang bear importance to the laws of the

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“5 movements” in pulsology: a) kidney yang and sanjiao must be placed at the “foot” pulse on the right side in order to respond to the “fire” movements which soften metal (Lung). b) kidney yin and bladder must be placed at the “foot” pulse of the left side in order to respond to the “water” movement which moderates the potential of fire (heart).

Note: In 1969, with Chamfrault, in our “Energetic Human”, we had already placed the “internal canal of the sanjiao” and kidney yang at the “foot” pulse on the right side.

9. here, “Left kidney” designates the yin function of the kidney and “Right kidney”, the yang function of the kidney. Ignoring this information risks the worst errors.

PARAGRAPH 18

90.

“In spring, needle the luomai; these respond to the ying point and are located between the large channel and the flesh. Needling must be deep in serious cases and light in benign cases. In summer, needle the sunluo; these respond the shu point and are located between the flesh and the skin. used

In autumn, needle the he points according to the same methods in spring.

In winter, needle deeply the jing and shu points and leave the needle in place a long time. Such is the order of needling according to the four seasons in accordance with the localization of the energy, the location of the illness and response of the energy of the organ to that of the season. In the event of cramps, one must needle the patient in the standing position; cure is immediate. In the event of impotence and of cold feet, one must needle the patient supine with limbs well spread out; a sensation of relief is immediately felt.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi comments: “This paragraph defines yin and yang, blood and energy according to the rules of “birth, growth, stagnation, conservation” of the four seasons and according to the characteristics of their movements (deep and superficial, entering and exiting).

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_ In spring, the energy of heaven is born; the energy of man is found in the luo vessels. This is why one must needle the luomai (secondary vessels). _ In summer, the energy is found in the sunluo (branches of the luo) and, at the end of summer, it is found in the “flesh” (dermis). This is why one must needle the sunluo located between the flesh and skin. Such is the energy of these two seasons, spring and summer, which become manifest from interior toward exterior. _ The energy of autumn descends and becomes condensed. This is why the technique of needling is the same as that employed in spring; that is to say the needling must be performed at the luomai in passing by the sunluo. _ The energy of winter becomes accumulated and conserved. This is why one must needle deeply and allow the needle to remain in place. Such is the order of “exiting” and “entering” of the energy of the four seasons, of the localization of the energy of man, of the site of the illness and of the manifestation of the energy of the five organs responding to that of the five seasons (four seasons + end of summer). • In conclusion, _ in spring, needle the ying _ in summer, the shu _ in autumn, the he 91. _ in winter, the jing. Such is the technique known as “Mother-Son” which consists of using the son in order to lead the mother (10). “Cramps” are involuntary, painful and transitory contractions of a muscle or group of muscles. “Impotence” is a generic name given to the inability or difficulty of using a limb. “Cold feet” has the name Jue. “The standing position and distance between the four limbs” responds to heaven and earth, to the four cardinal directions and to the energy of the four seasons, and permits facilitating energetic movements, therefore correcting certain flows going the wrong way (jue nie). This is why the texts emphasizes the fact that, in the event of obstruction of the energy and blood causing spasms or sensations of cold, one must spread the four limbs out so that their energy has the ability to circulate in accordance with that of the four season.” II - Ma Shi explains: “The energy of the four seasons responds to that of the specific shu-antique points. Those who judiciously use them can obtain rapid cure. a) The twelve channels each have a luo point such as Lieque (Lu 7) of the Hand Taiyin (Lu) and Pianli (LI 6) of the Hand Yangming (LI). The twelve channels each have a ying point such as Yuji (Lu 10) of the Hand Taiyin (Lu) and Erjian (LI 2) of the Hand Yangming (LI). The twelve channels each have jing point such as jingqu (Lu 8) of the Hand Taiyin (Lu) and yangxi (LI 5) of the Hand Yangming (LI)... . Consequently, in spring, one must needle the luomai in the space located between the ying point and the large channel and determine gravity or benignity in order to perform a deep or superficial needling. b) The 12 channels each have a shu point such as Taiyuan (Lu 9) of the Hand Taiyin (Lu) and Sanjian (LI 3) of the Hand Yangming (LI). The sunluo are little branches of the luo. In summer, one must needle the shu points and the sunluo, located in the space between the skin and flesh. c) The 12 channels each have a he point such as Chize (Lu 5) of the Hand Taiyin (Lu) and Quchi (LI 11) of the Hand Yangming (LI). In autumn, one must needle the he points and luo points in the flesh, the ying points and the large muscles, etc; that is to say following the method of needling in spring. d) The 12 channels each have a jing point such as Shaoshang (Lu 11) of the Hand Taiyin

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(Lu) and Shangyang (LI 1) of the Hand Yangming (LI). In winter, one must needle the jing point, the shu points... but it is necessary to needle deeply and leave the needle in place a long time because the energy of winter has already reached deeply into the interior, to the level of the organ. Such is the method of “needling according to the four seasons”, as a function of the localization of the energy of the channels, of the determination of the location of the illness and of the response of the energy of the organ to that of the seasons.” III - N.V.N.:

92.

This paragraph defines the needling technique of the shu-antique points according to the four seasons which consist of “taking the son in order to lead the mother”. 10. Not to be confused with the “Mother-Son” technique intended for tonification/dispersion. (See “Medecine

Traditionelle Chinoise” - N.V.N. Edition).

Example: As spring corresponds to jing-wood, one must employ the ying-fire point which is the son of jing-wood. In other words, when the illness is found at the sunluo (branches of the luo in the superficial layer; skin = spring = jing-wood), one must needle the ying-fire point located within the layer of the luo (great luo in relation to the sunluo: dermis = summer = ying-fire). Consequently, the luo points (ex: Lieque lu 7) not belonging to the shu-antique group of points, as cited by Ma Shi, are not in accordance with the spirit of the text. In the “Lingshu Explained” published in 1965 in Shanghai (11), one finds again the same error.

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11. Translated into French and published by Masson. 93.

CHAPTER III Explanations of the “Little Needles” (Xiao Zhen Jie)

While Chapter 1 of the Lingshu defined the knot and ankle of the “Little Needles”, Chapter 3 returns to and explains certain classical terms contained in Chapter 1. For this reason, Chapter 3 is entitled: “Explanations of the Little Needles”. Zhang Shi and Ma Shi present the full text devoid of all commentary because these have been largely put forward in Chapter 1. Nevertheless, the analysis of this important chapter seems necessary to us because it concerns the basic fundamental elements of the practice of acupuncture. In effect, ignorance of them places in serious question the efficacy of this medical method. We have already shown in Chapter 1 of the Lingshu the reason for which the Western translations of this great classic are not very loyal to the thinking of the original text. In order to preserve the foundations of traditional acupuncture, our duty is, chapter by chapter, to emphasize and analyze the fundamental notions of energetic physiology, pathology and therapeutics, still poorly explored because of difficulties in translation and adaptation by a Western mind of the realities of

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thinking in the Orient. recall that the Lingshu and Suwen are not philosophical documents and that each possesses 81 chapters composed of numerous paragraphs holding the key to the theoretical basis and practice of energetic medicine. It proves, therefore, to be indispensable to translate them in the most faithful way possible so that researchers are able to labor on these works without distortion. Chapter 3 contains 7 paragraphs.

PARAGRAPH 1

93.

_ “To speak about is easy ...” implies: To discourse on needling is easy. “To practice is difficult” means: Needling the human body is difficult. _ “The little worker watches over the form” implies: The inferior physician only knows to base his judgment on the techniques of needling. “The great worker watches over the shen” means: The good physician knows how to appreciate the emptiness and fullness of the blood and energy of the patient in order to practice tonification and dispersion. _ “Mental (shen)... guest (Ke)” speaks of the meeting of the perverse energy and essential energy. “shen (mental)” designates the essential energy and “Ke (guest)”, the perverse energy. “ ... next to the door” means to say: The perverse energy follows the routes of access (entering and leaving) of the essential energy. _ “Still not determining the illness” implies: One must understand clearly the perverse energy and essential energy and specify clearly the channel affected. “How to know the source” insinuates: Before needling, one must specify the site of the illness at the level of the channel in order to choose the points. EXPLANATIONS AND COMMENTARIES N.V.N.: This paragraph, as well as the following ones, make explicit the information cited in Chapter 1. This information is an introduction to the fundamental bases of the practice of acupuncture. 1 - The “knot” and “ankle” of the mode of use of the little needles are easy to argue, but the subtlety of needling is difficult to demonstrate. 2 - The inferior acupuncturist utilizes the needles in mechanical fashion without reasoning. The good acupuncturist discerns the emptiness and fullness of the blood and energy so as to tonify the areas of insufficiency or disperse those in excess. 3 - The essential energy is designated under the name of shen (mental) and the perverse energy under the name of Ke (guest). Stagnation of these two energies within the blood and within the jingluo is the principal cause of numerous illnesses. 4 - It is absurd to practice acupuncture without deeply delving into the patho-physiologic

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nature of the illness. The diagnosis of the causes and forms of the illness and of the sites affected are vital in the evaluation of the state of emptiness or fullness of the blood and jingluo in light of establishing an adequate therapy.

PARAGRAPH 2 _ “The art of needling resides in rapidity and slowness” means: Needling must be carried out rapidly or slowly. 95. _ “The little worker watches over guan” wishes to say: The inferior physician only takes into account the 4 limbs and ignores the movements of going-returning of the blood and energy, of the perverse energy and of the essential energy. “The great worker controls go” implies: The good physician knows how to master the energetic driving force. “The propulsive movements of the go do not leave the points ...” means to say: One must know how to determine the emptiness and fullness in order to apply a slow or rapid needling. “go at the level of the point is subtle” suggests: After needling, once daqi is obtained, one must know how to conserve it. _ “At the time of arrival, do not go against it” implies: At the time of fullness, tonification is forbidden. “At the time of departure, do not go in pursuit” means: At the time of emptiness, dispersion is contraindicated. _ “Do not deviate the slightest...” implies: The energy is easily lost. _ “ Unable to expel, even by hammering...“ implies: By failing to recognize the methods of tonification and dispersion, needling does not modify the state of insufficiency of the essential energy and blood, and the perverse energy does not regress.

EXPLANATIONS AND COMMENTARIES I - N.V.N.: This paragraph defines the first basic notions of the practice of acupuncture: 1 - The effect of needling depends on the type of manipulation of the needle. The arrival of the essential energy resides in slow manipulation and rapid manipulation during insertion and removal of the needle. 2 - The inferior acupuncturist only knows a limited number of points located on the 4 limbs. The qualified acupuncturist wisely utilizes tonification and dispersion and detects the harmonious and peaceful nature of the energy. 3 - The hole (acupuncture point) is the site of pathophysiologic activity of the blood and

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energy. Knowledge of it permits a diagnostic evaluation of the state of emptiness or fullness of the blood and energy, and, in this manner, authorizes the good choice of needling technique, slow or rapid manipulation, during tonification or dispersion. The reactive phenomena at the level of the points are subtle. During insertion of the needle, one must observe not only the sensation of daqi, but also the going-returning movements of the energy in order to avoid technical errors. 4 - If the perverse energy is in fullness, one must not go to meet it in order to tonify. During its departure, dispersion is strictly forbidden at the risk of provoking an escaping of the source energy into a state of emptiness. 5 - During insertion and the obtaining of daqi, one must use the appropriate technique without even the minutest of deviations because this type of daqi easily disappears. 96. 6 - Ignoring the principle of tonification and dispersion often carries with it lost opportunities like an arrow on a bowstring which is not released at the opportune moment. The blood and energy of the patient becomes exhausted, and the perverse energy is not eliminated.

PARAGRAPH 3 _ “To know the going-returning movements” is to know how to determine the contrary and favorable movements, the insufficient and excess. “The little worker gets lost in the dark” shows the incapacity of the inferior physician to comprehend the fineness and complexity of the energy. _ “Efficacy resides in learning the technique” implies the mastering of acupuncture methods. _ “ going is contrary” means: the departure of the energy in a state of emptiness is contrary. “return is favorable” designates: The returning movement of the energy in a peaceful and harmonious state is favorable. _ “To know clearly the contrary and favorable is to act correctly without error” contains the sense of knowledge of the the points to needle, _ “To go in opposition and eliminate” is to disperse. “To go in pursuit and help” is to tonify. EXPLANATIONS AND COMMENTARIES N.V.N.: This paragraph stresses the notions of waiting for the energy, of the “favorable” and “contrary” movements necessary to the application of the methods of tonification and dispersion. 1 - The practice of acupuncture demands the following fundamental knowledge: _ the going-returning movements of the energy, _ the rules of “contrary-favorable” and “empty-fullness”, _ the essential nature of waiting for the energy for the purpose of seizing the opportune moment to perform the needling. The incompetent acupuncturist ignores these rules and understands neither the fantastic and subtle effects of the energy nor the mechanism of its functioning. 2 - The qualified acupuncturist knows perfectly the importance of the use of acupuncture

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methods and the meaning of waiting for the energy. 3 - The departure of the perverse energy leaves the essential energy on the spot in a state of emptiness; it grows weak and has the name of “ni” (contrary). on the other, the arrival of the essential energy denotes that it is normal, therefore peaceful and harmonious. One give this the name “shun” (favorable). 97. 4 - Comprehension of the importance of the favorable and contrary movements of the energy no longer creates doubt in the choice of points for therapeutic purpose. 5 - In basing one’s judgment on the direction of the circulation of the jingmai (principal channel), to go in front of the energy and transmit to the needle rotatory movements is the process of dispersion; to follow the direction of circulation of the jingmai and transmit to the needle rotatory movements is to master the technique of tonification.

PARAGRAPH 4 _ “To render emptiness into fullness” means: one must apply the technique of tonification in the event of emptiness of “qi Kou” (mouth of the energy: radial pulse). “To excrete that which is full”, One must apply the technique of dispersion in the event of fullness of “qi Kou”. _ “To eliminate compressions” is to dissolve the stagnation of perverse energy in the jingmai. “To render fullness into emptiness” is to disperse the perverse energy in fullness located within the channel. _ “First slow, then rapid, is to render full” implies the sense of slow implantation and rapid withdrawal of the needle (in the case of tonification). “First rapid, then slow, is to render empty” implies the sense of rapid implantation and slow withdrawal of the needle (in the case of dispersion). _ “To speak of emptiness and fullness, like to be or not to be” means to say: To speak of fullness when the energy is present, and to speak of emptiness when the energy is absent. “To examine before and after, like to lose and not to lose” means to say: one must determine the emptiness and fullness of the energy to order to apply in the first place or second place tonification or dispersion and to examine for the regression or persistence of the energy. _ “This is emptiness, this is fullness- like gain and loss” means: During tonification, the subject quivers as if he gained something, and during dispersion, he jumps as if he lost something. EXPLANATIONS AND COMMENTARIES N.V.N.: This paragraph defines the terms used in the techniques of tonification and dispersion. 1 - In the event of emptiness of the radial pulse, one must utilize the method of tonification to reinforce the potential of the essential energy; and in the event of fullness, one must utilize the method of dispersion to excrete the perverse energy. 98. Qi kou is located in the radial groove where jingqu (Lu 8) is found. The lung being the “Mother” of energy, the emptiness and fullness of the collection of the energy must be examined

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at this level, hence the name “mouth of the energy” (qi Kou). Qi kou is located 1 cun (thumb, inch) from Yuji (Lu 10), which is why it has the name “cun kou” (“mouth at 1 cun”). 2 - In the event of chronic compression/stagnation at the level of the channels, one must use the method of dispersion to dissolve it; and, in the event of illness of perverse energy in an evolutive period, one must also use the method of dispersion to excrete it by the path of the needle. 3 - Slow implantation and rapid withdrawal of the needle are the actions of tonification. This method can tonify emptiness and render it full. Rapid implantation and slow withdrawal of the needle is associated with the method of dispersion; this technique can eliminate fullness and render it empty. 4 - During tonification in order to render full the essential energy when it is in a state of emptiness, the subject feels a sensation of heat or warmth at the tip of the needle. During dispersion in order to render empty the perverse energy when it is in a state of fullness, the subject feels a sensation of freshness or cold. This is why, before needling, one must determine the emptiness or fullness in order to perform, before or after, the technique of tonification or dispersion; at the same time, observe for the phenomena of regression or persistence of the perverse energy. 5 - During tonification, it is necessary to provoke a feeling of gain in the patient, and, during dispersion, it is necessary to provoke a sensation of loss in the patient.

PARAGRAPH 5 _ “Perverse energy (xieqi) is at the top” means to say: the attack of perverse energy always occurs in the upper part of the body. _ “Impure energy (Zhuo qi) at the center” implies: in the course of food metabolism, the jing (pure energy, essence) of the cereals reaches the lung, while Zhuo qi (impure energy) passes to the intestines. A diet disturbance or an exposure to cold or heat after a meal is the origin of an intestinal ailment. _ “Clear energy (qing qi) is down below” means: the “humid” energy of earth, during its aggression, always infiltrates into the organism via the feet. _ “To needle the top” implies: needling must be done at Xian Mai (vessels of the fossa: vessels located at the nucha) in order to eliminate the perverse energy. _ “To needle Zhongmai (center vessels)” means: needle the Ho point of yangming to disperse Zhuo qi (impure energy).

99.

_ “Needling deeply immerses the perverse energy” means to say: in the superficial illnesses, needling must not be deep because the perverse energy can follow the path of the needle to infiltrate more toward the interior. _ “Skin, flesh, muscles and vessels have their location” means: The jingmai have their specific localizations. _ “To needle the 5 vessels is to provoke death” implies: in illnesses caused by insufficiency of energy of the “center”, use the needle to disperse

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the vessels of the 5 organs is a fatal procedure. _ “To needle the vessels of the 3 yang channels” means: dispersion of the totality of the energy of the 3 yang channels can trigger a grave weakness that is difficult to restore. _ “To monopolize yin is to also provoke death” means to say: Needling Wuli (LI 13) 5 times in succession is fatal. _ “To monopolize yang” is to provoke violent madness” implies: the needling the 3 yang channels causes frenzy. EXPLANATIONS AND COMMENTARIES N.V.N.: This paragraph defines 3 types of perverse energy: _ cosmic perverse energy (xieqi), _ dietary perverse energy (Zhuo qi), _ terrestrial perverse energy (qing qi). 1 - Infiltration of cosmic perverse energy (wind-Cold) occurs in the cephalic region, hence the expression: “The perverse energy is at the top”. 2 - During food metabolism at the level of the stomach, it transforms the cereals into energy called “terrestrial” immediately absorbed by the spleen, which has the essential role of conversion of this cereal energy into jing (essence) and conducts it to the lung (according to the “mother-son” law). The lung has the function of combining the Cereal jing and celestial energy (air) to transform them into ying (nutritive) energy. As for the residues of the cereals, they are repelled toward the intestines in order to undergo a new transformation: the pure energy goes to the kidney by the mesenteric routes and the impure energy (Zhuo qi, in the form of feces and urine) is evacuated to the exterior (anal and urinary routes). A dietary disorder influences digestion and can trigger gastrointestinal pathology. For this reason, the text states: “The impure energy is at the center”. 3 - “Cold-Damp” energy, in order to infiltrate into the organism, always manifests in the first place at the feet, hence the expression: “The clear energy is down below”. 100. 4 - Perverse energy always attacks the upper part of the body, particularly the head region. One must always choose the points of this region to evacuate it by the route of the needle. 5 - To excrete perverse energy lodged in the stomach and intestines, one must always choose the he point, which is Sanli (St 36) belonging to the “earth Channel” and “earth point”. here, the term “Zhongmai” does not designate the Chongmai of the curious vessel group, but the “Center Vessel” which is none other than the spleen-stomach system because spleen = Center = earth. 6 - In the external syndromes, deep needling is strictly forbidden. An erroneous technique does not eliminate the perverse energy, but, to the contrary, helps it to progress toward the interior to aggravate the illness. 7 -Skin, flesh, muscles and vessels each have their own specific site. These are also the sites of appearance of the syndromes and therapeutic sites of the jingluo of the entire organism. 8 - In the illnesses of the internal organs, the source energy is always in a state of insufficiency. Needling done on the yin channels of the 5 organs according to the “great dispersion” method always worsens the illness and accelerates death, hence the expression: “To needle the 5 vessels is to provoke death”.

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9 - During needling, the non-determination of emptiness and fullness of the 3 yang channels is the cause of physically exhaustion of the individual which is difficult to restore, hence the expression: “To needle the 3 yang channels is to exhaust the patient”. 10 - An erroneous needling of the arterial point Wuli (LI 13), located 3 cun above Chize (Lu 5), can exhaust the energy of the 5 organs and cause death, hence the expression: “To monopolize yin is to provoke death”. (1).

1. See explanation in Chapter 2 (“Origin of the shu-antique points”) of this Classic.

11 - An erroneous needling of the 3 yang channels can provoke an intense exhaltation which puts one outside oneself, hence the expression: “To monopolize yang is to provoke violent madness” (Kuang). These therapeutic recommendations are not negligible in acupuncture practice because the effectiveness of treatment depends on it.

PARAGRAPH 6 _ “To observe the complexion of the face and examine the color of the eyes in order to appreciate the victorious energy and submissive energy; look at the body to determine what is in motion and what is in repose...” means: the great worker knows all of these problems. “... and to evaluate the beating pulses which can be small or large, slow or rapid, slippery or rough”. This means: examining the “foot” pulse and “inch” pulse allows study of the cause of the illness. _ “To know the essential energy and perverse energy...” is to know how to discern the “Empty Perverse” and “True Perverse”. “The right hand implants the needle and the left hand presses' against the side of the point of impact, etc.” means: The method of needling resides in the precise identification of the opportune moment for the insertion and withdrawal of the needle. _ “During the arrival of the energy, remove the needle...” implies that the removal of the needle can only take place after balancing the energy by tonification or by dispersion; “Balancing is realized before and after...” implies: The success of the act of acupuncture can only be obtained after having knowingly performed the methods of tonification and dispersion. _ “Articulation/Liason; 365 reunions, etc.” implies: the effects of the permeation of the luomai (secondary vessels) takes place at the level of the “articulations” (points). 101.

EXPLANATIONS AND COMMENTARIES N.V.N.: Examination of the complexion and pulses, discernment of perverse energy and essential energy, arrival (daqi) of the energy and removal of the needle, and appreciation of the effect of

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needling at the level of the points of impact are also fundamental components of the practice of acupuncture.

1 - The good physician examines the body and studies the complexion and change in color of the eyes (2) in order to determine the benignness and seriousness of the illness. From the character of the pulse, in particular the small or large, slow or rapid, slippery or rough natures of the “foot” and “inch” pulses, one can evaluate the pathologic state of the patient. 2 - The good physician knows perfectly the agents of aggression which are none other than “Empty perverse” or “True perverse” (3). To eliminate it, and during insertion and removal of the needle, the use of the right hand and left hand is not the same. 3 - Before implanting the needle, one must wait for the arrival of the energy (daqi) and use the methods of tonification or dispersion to realize the harmonization of the “opening” and “closing”, of the “ending” and “beginning”, of the “interior” and “exterior”. Only the devoted physician can realize it. 4 - The 365 articulations or “reunions” are the 365 points located in the places called “articular” formed by the luomai, carriers of blood and energy from the “jinmai” (tendinomuscular channels) to permeate and irrigate the tendons and bones, flesh and skin of the entire organism.

PARAGRAPH 7

102.

_ “The energy of the 5 organs is exhausted in the interior...” . This means to say that qi Kou (mouth of the energy: radial pulse) being in emptiness, if one needles the he points of the yang channels in order to treat yang (external) illnesses, or else, if one allows the needle to remain in place in order to await the arrival of the yang energy, the energy of the interior will be destroyed. At the moment of death, the subject is calm because the yin energy is totally absent. _ “The energy of the 5 organs is exhausted at the exterior...” means: At the exterior, the energy of qi Kou being in emptiness, if one needles the shu points (3rd shu antique point), and if one leaves the needle in place in order to await the arrival of the yin energy, when it arrives, it drives the yang energy back toward the interior and provokes a contrary circulation, responsible for death. At the moment of death, the subject is agitated because the yin energy is excessive.

2. regarding the color of the eyes, see the explanation of Ma Shi: “The jing (essence) of the 5 organs and 6 bowels gather at the eyes, site of reflection of the colors. The appearance of a fresh and brilliant color at the eyes is an indication of good health. similarly, a “clear” speaking voice with clear “tone” permits differentiation of the physiologic state and pathologic state. 3. As for “Empty Perverse” and “True Perverse”, here is the definition of these phenomena described in the Suwen (Chapter 26- N.V.N. Edition):

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“a) “Empty perverse” designates the emptiness of the 8 principal astronomic rhthyms which are: _ spring equinox, _ beginning of spring, _ autumn equinox, _ beginning of summer, _ summer solstice, _ beginning of autumn, _ winter solstice, _ beginning of winter. b) “True perverse” designates wind which penetrates into the organism by the sweat glands during a sweat during physical effort. In other words, the energy of the four seasons and of the 8 annual divisions profits from the emptiness of the organism in order to infiltrate there, hence the name “Empty Perverse”; and, during sweating, opening of the sweat glands favor the penetration of wind into the organism, hence the name “True Perverse”.

EXPLANATIONS AND COMMENTARIES N.V.N.: This paragraph defines the causes of the “Empty” nature of the radial pulse and their consequences. 1 - The very small, very supple and superficial radial pulse only being perceived with a light touch of the fingers and disappearing with a stronger touch, is the sign revealing emptiness of the kidney with exhaustion of the marrow and disorder of the jing (essence). It is a sign of emptiness/destruction of the yin of the interior. During needling, the choice of the he points of the yang channels and use of the method of leaving the needle in place in order to tonify the yang energy are harmful to the yin part because this maneuver augments the exhaustion of the energy of the interior, a fatal phenomena. At the moment of death, the subject is calm because the energy of the organs is totally exhausted and is found in the state of Emptiness/Escape. 2 - The very galloping, very soft radial pulse disappearing with a light touch of the fingers is a grave, pathognomic sign of the yang energy which tends towards exhaustion. During needling, the choice of the shu points (3rd shu antique point) of the limbs and the use of the method of allowing the needle to remain in place in order to tonify the yin energy at the interior is detrimental to the yang energy in a state of emptiness because this maneuver augments the exhaustion of this energy and traps it in the interior following a flow in the wrong way (afflux), responsible for death. At the moment of death, the subject is agitated because, relative to yang, the yin energy is in excess.

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103.

CHAPTER IV Pathologic Forms of Attack on the Organs and Bowels by Perverse energy (xieqi Zang Fu Bing xing)

Chapter 4 of the Lingshu studies the infiltration of perverse energy into different parts of the organism. From the differentiation of yin and yang, the etiologic factors of aggression are multiple. Examination of the complexion and pulse in that case constitutes one of the fundamental elements of diagnosis. The 6 types of pathological pulses _ hurried _ slow _ changeable/unsettled _ small _ slippery _ rough allow solution to the choice of points. Ma Shi notes: “In this chapter, the first 3 paragraphs study the processes of the attack of perverse energy and the 4th, 5th... describe the pathological forms

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which result, hence the title: “Pathologic Forms of Attack on the Organs and Bowels by Perverse energy” (xieqi Zang Fu Bing xing). This chapter contains 23 paragraphs.

PARAGRAPH 1 Huangdi: “How does perverse energy attack the human body?” Qi Bo:

104.

“It attacks the upper part of the body.” Huangdi: “Are its limits the top and bottom?” Qi Bo:

“The upper half of the body is attacked by perverse energy, and the lower half by humidity. This is why it is said: “When perverse energy affects man, it is not localized in a constant way. In attacking yin, it implies towards the bowel, and, in attacking the yang, it reaches the channel.” EXPLANATIONS AND COMMENTARIES Zhang Shi explains: “This paragraph implies the fundamental relationships between the organs and bowels. yin and yang, complexions and pulse, energy and blood, skin and dermis, jing and luo..., interior and exterior. The combination of these pieces of information for a therapeutic objective can only be accomplished by the good physician. 1 - “Perverse energy (xieqi)” is an energy produced by wind, rain, cold, heat; that is to say, by an energy originating from heaven (energy of the environment; celestial energy). This perverse energy attacks the upper part of the body. 2 - “Humidity” is an energy belonging to water, to earth (terrestrial energy). For this reason, it attacks lower part of the body. Briefly, this paragraph concerns the processes of attack of the perverse energy on the human body differentiated into upper and lower parts. But once within the organism, its site of fixation is not constant; it hits either the yin or the yang to localize in the bowel or organ. The problem then becomes very complex.”

PARAGRAPH 2 Huangdi: “yin and yang are only different by their names. They are associated with the same system; the top and bottom are united; the jingluo traverse the body in a circle without end; perverse energy infiltrates into the organism at the level of yin or yang, at the top or down below, to the right or left, without fixed rules. Why?

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Qi Bo:

“The places of reunion of the perverse energy are found on the f a c e . Perverse energy only affects man at the moment of emptiness of his yang or during physical fatigue... . similarly, the opening of the pores during perspiration after a favored meal also allows infiltration of perverse energy into the organism. When it attacks the face, it descends to the yangming; when it attacks the nucha, it descends to the taiyang; when it attacks the cheek, it descends to the shaoyang; when it attacks the thorax, back or flanks, these are the channels which are injured.” Huangdi: “Where does it proceed to attack yin?” Qi Bo:

“Generally, the attack of yin starts at the level of the arms and legs where the skin of the internal surface is thin and the flesh flaccid. For this reason, attack of the wind is always located at the yin part of the limbs.” Huangdi: “Can that cause disturbances of the organs?” Qi Bo:

“During attacks of the wind, the organs are not necessarily affected because, when it arrives at the channel, it provokes fullness of the energy of the organ. Therefore, it is obliged to deviate toward the bowel. This is why when perverse energy attacks yang, it flows out into the channels, and when it attacks the yin, it slips into the bowels.” EXPLANATIONS AND COMMENTARIES 1 - Zhang Shi explains: “This paragraph addresses the problem of the energy and blood at the level of the epidermo-dermal system linked to the jingluo and the organs and bowels. 1 - “yin and yang” designates the blood and energy of the organs and bowels. Despite different names, it constitutes, in reality, a single system, “blood-energy”. 2 - “Top and bottom are united” implies the processes of “entry-exit” and “root” and “summit”. 3 - “The jing and luo traverse the body” concerns the circulation of ying (nutritive) energy beginning with the Hand Taiyin (Lu) and ending with the Foot Jueyin (Li); then, from the jueyin, it returns to the taiyin in order to restart another cycle, realizing, in this manner, a circle without end. 4 - “Top, bottom, left, right ...” designates the head, face, arms and feet. Perverse energy attacks the yang (head, face) or yin (arms and legs). This is why, there are not fixed rules for the

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perverse energy.

106.

5 - “The sites of reunion of yang energy are all found on the face”. This means to say that the yang energy arrives at the face in order to reach the “orifices”. 6 - “When perverse energy affects the face, it descends to the yangming; when it affects the neck, it descends to the taiyang; when it affects the cheeks, it descends to the shaoyang, etc.” These vessels (yangming, taiyang, shaoyang) designate the luo of the 3 yang channels of the foot and hand; they pass everywhere via the nucha and neck to reach the head and face, then, encircle the head to redescend to the thorax and abdomen, to the shoulders and back. These parts of the body constitute the sites of circulation of the luomai of the 3 yang channels. 7 - “Skin” makes up part of the external area of the body associated with the 3 yang channels. During the aggression of the perverse energy, it is the skin and dermoskeleton which are the first affected. The perverse energy remains there before infiltrating into the luomai. 8 - The term “it descends ...” means that the perverse energy is first found in the skin which is yang belonging to the sunluo (energetic capillaries) and luo (secondary vessels) before being directed deeply towards the yang channels. This is why the text states: “When the perverse energy attacks yang, it flows out toward the channels.” 9 - “Attack of the yin starts ...” at the internal surface of the arm and leg, sites of the circulation of the luomai of the 3 yin; the external surface is associated with yang and the internal surface with yin. The skin of these areas is thin and the flesh flaccid. For this reason, the text emphasizes: “Attack of yin starts at the internal surface of the arm and leg”, that is to say at the level of the skin belonging to the 3 yin to be directed toward the luomai of the 3 yin. 10 - In Chapter 63 (“Discourse on Needling on the Opposite side”) of the Suwen, it is written: “When the “guest” (Ke) perverse energy” infiltrates into the organism, it first settles within the pilocutaneous system. From there, it spreads out or it takes the route of the sunluo (small luo or interstitial luo); from the sunluo, it spreads out or reaches the luomai (secondary vessels); from the luomai, it spreads out or reaches the jingmai (principal channels-vessels) linked to the 5 organs. From these latter, it invades the stomach and intestines.” Note, however,

that the vessels of the 5 organs reaches the 6 bowels and that the vessels of the 6 bowels pass to the 5 organs to constitute the system of mutual relationship of the organs-bowels and of the jingmai (principal channels-vessels). 11 - The blood and vessels belonging to yin are specific components of the organs. Infiltration of perverse energy into the jing (channel) is a triggering factor of the fullness of the energy of the organ which prevents it from staying there. It is forced to divert toward the bowels, particularly to the stomach and intestines. In this way, once it arrives in the yangming belonging to the area called “Center-earth”, site of convergence of the thousand beings, the perverse energy remains there and does not go elsewhere.”

II - Ma Shi comments:

“The text clearly explains the process of infiltration of perverse energy into the human body. If perverse energy infiltrates into the yin channel at the moment when the energy of the organ is still strong, that is to say in a state of plethora, it is directed towards the bowel. In contrast, if it penetrates into the yang channel, it circulates within the channel affected. 107. Huangdi’s question shows that this is the source of health problems, and Qi Bo’s reply

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explains to him that the sites of infiltration of perverse energy could be: _ the upper half of the body, site of attack of wind, cold and heat, _ the lower half, site of penetration of humidity. Penetration of perverse energy into the organism does not obey absolute rules. Therefore, for example, when it infiltrates into the yin channel, it reaches the yangming bowel (St), and when it infiltrates into the yang channel, it only evolves in the affected channel. 1 - Why does it only evolve only in the affected channel? All the sites of reunion are found at the face. Perverse energy profits from the state of emptiness of the organism caused by being overtaxed, by a dietary disturbance or by the opening of the pores during sweating in order to infiltrate there. If it attacks the face, it penetrates into the areas belonging to the hand and Foot Yangming where the points yingxiang (LI 20), Chenqi (St 1), etc. are found. In this case, the text states: “Perverse energy “descends” into the yangming”. If it attacks the angle of the mandible, it penetrates into the hand and Foot Shaoyang where the points Tianyou (SJ 16), Tongqi (GB 20), etc. are found. In this case, the text states: “ The perverse energy “descends” into the shaoyang”. The shoulder, back and the 2 sides of the thorax (flanks) are the areas belonging to the 3 yang. When these regions are attacked, the energy is directed toward the channels that are found there. In this case, the text clarifies: “When perverse energy attacks yang (the yang part of the body), it “descends” into the corresponding channels”. 2 - What is the process of attack of the bowel when perverse energy infiltrates into the yin channel? If the perverse energy attacks the yin channel of the hand, the affliction starts at the arm, and if it attacks the yin channel of the foot, the affliction starts at the leg because, at these sites, the skin is thin and the flesh is flaccid... . This aggression only involves the yin channels and not necessarily the internal organs because the energy of the organ is still in fullness; the perverse energy, not able to transform into “guest energy” (Ke qi), is pushed away towards the bowel. This is why the text states: Attack of yin (yin channel) causes that of the bowel.”

III - N.V.N.: Zhang Shi’s and Ma Shi’s explanation is very clear. Nevertheless, we emphasize the word “descends” used in this paragraph. In effect, in order to infiltrate into the jing (principal channel), the perverse energy must pass through the epidermo-dermal system, where the sweat glands, sunluo (small energetic capillaries) and luo (secondary vessels) are found. The “descent” of perverse energy simply represents the movement from the superficial towards the deep. The interpretation of this word in the sense of movement towards bottom of the body along the length of the channel is false. 108.

PARAGRAPH 3 Huangdi: “How can the organ be attacked by perverse energy?” Qi Bo:

“Worries,

sadness,

fear

and

fright

injure

the

heart.

Cold attacks the body and swallowing cold liquids damages the

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lung. Aggression of these two types of cold injures, at the same time, the interior and exterior provoking an afflux of energy toward the top. When a fall causing blood stasis in the interior, or else when there is a strong anger, the energy rises and does not come back down; it accumulates in the hypochondria and injures the liver. Blows and injuries, sexual relations during intoxication or an exposure to wind during perspiration injures the spleen. Physical effort like lifting a heavy weight, sexual excess or a bath during perspiration injures the kidney.” Huangdi: “How are the 5 organs when attacked by wind?” Qi Bo:

“yin and yang are affected simultaneously. The perverse energy is victorious at that time.” Huangdi: “good.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph studies the pathological processes of the organs during attack by perverse energy. 1 - “Perverse energy infiltrates into yin and passes to the bowels” because the energy of the organ is still strong and in a state of fullness. shen qi (mental energy) still being conserved in the interior, the blood and vessels are full. If the disturbance of the energy is of internal origin, the perverse energy profits from the state of emptiness to infiltrate into the interior. 109. wind is the first causal agent of the “hundred diseases”; it has the power to propagate and be transformed.

2. “yin and yang are affected simultaneously means: the interior and exterior are disordered together. The text states: “The 8 types of wind follow the emptiness (of the energy of the body) in order to provoke disease. simultaneous attack of the 3 yin is serious and fatal.” In this way, the internal peturbation of the organs (by psychological and digestive elements) is a factor favoring attack by perverse energy. This is why the patient always looks to avoid the wind as one would avoid a projectile (launching stones or arrows). Briefly, this paragraph is divided into 2 parts: _ the first part concerns shen-zhi (mental-will) of the interior which must be maintained _ and the second concerns wind coming from the exterior which must be avoided. II - Ma Shi explains: “This paragraph studies the causes of disease of the 5 organs. They can be of external or internal origin. But in order for strong perverse energy to infiltrate into the organ, yin and yang must originally be disordered. This notion completes the previous one, according to which “perverse energy cannot penetrate into the organ when the energy of that organ is in fullness”.

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Also, Qi Bo says that the energies do not resemble one another. There are different types originating from internal peturbations: a - Worries, sadness, fear and fright which injure the heart. b - Cold body and cold coming from ice cold drinks which injures the lung. The presence of these 2 types of cold simultaneously damage the interior and exterior of the organism causing an energetic afflux towards the top responsible for disease. c - Falls and contaminated blood accumulations (hematoma) in the interior or strong anger provoking an accumulation of energy in the hypochondria, which injures the liver. d - Blows and injuries, sexual relations in a drunken state or exposure to wind while perspiring injure the spleen. e - Lifting of heavy weights, sexual excess or bathing while perspiring injures the kidney. Roughly, such are the diseases of internal origin favoring the penetration of perverse energy into the organism. In reality, although one speaks of exposure to wind, bathing while perspiring, etc., disease caused by perverse energy always starts originally by an internal disturbance. 110. On the one hand, in order for there to have been an attack on the 5 organs by wind, the 3 yin and 3 yang channels must originally be affected. On the other hand, if a single yin channel is affected, infiltration of perverse energy into the organ is impossible because the energy of this organ is in a state of fullness.”

PARAGRAPH 4 Huangdi: “The head, face, body, bones and muscles are all related. similarly, the blood unites with the energy in order to circulate throughout the entire body. When the climate is cold, the earth is chapped and water transforms into ice. If this cold is sudden and harsh, it is the hands and feet that become numb, not the face. Why?” Qi Bo:

“The blood and energy of the 12 jingmai and the 365 luo are directed together toward the face in order to reach the “orifices”. The energy “jing yang” (yang essence) comes back up to face to attend to vision. The energy “Bie” (distinct energy) comes back up to the ears to attend to hearing. The energy “Tong” (Dong) (innate, a priori energy) comes back up to the nose to attend to the sense of smell. The energy “Zhou” (impure energy) created at the level of the stomach comes back up to the lips and the tongue to attend to the sense of taste. The liquid substances follow these energies and gather together at the face. The skin there is thick, the flesh firm... .

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This is why the weather, even very cold or very hot, cannot triumph over these energies.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi comments: “This paragraph studies the gathering of the blood and energy of the organs and bowels, of the jing and luo, at the level of the “orifices”. 1 - “The head, face, bones and muscles... energy and blood” implies: the blood and energy of the different parts of the body are identical. 111. 2 - The taiyin makes up part of zhi yin in yin; it responds to the earth and to the 4 limbs. This is why when the cold is excessive, the earth becomes chapped... and water is transformed into ice. In man, “the hands and feet become numb”; this reactive phenomena is due to the effect of the response of the spleen to influences of earth on the living being. 3 - “The blood and energy gather at the face... celestial (climatic) cold and heat cannot triumph over these energies” implies that the yin and yang energies, organic cold and heat, rise from below toward the top and that the upper half of the body responds to the energies of heaven. 4 - The energy and blood of the jingmai and the 365 luo have their source in the shaoyin (Ki). They are born of the Foot Yangming (St), are directed toward the Hand Shaoyin (He) and flow out toward the Hand Taiyin (Lu)... . “jing yang” (yang essence) is the “jing-shen” energy (mental essence) of the heart and kidney; at the top, it reaches the eye to form the pupil. “Bie qi” (“distinct” or “different” energy) is also the energy of the heart and kidney, but it deviates towards the ear to attend to hearing. “Tong qi” (“innate” or “ancestral” energy) is the “great energy” (Daiqi) coming from the kidney. It accumulates in the thorax and reaches the lung to fulfill its respiratory function, then passes to the nose to attend to the sense of smell. “Zhou qi” (impure energy) is the “jing” energy of the cereals. It comes from the stomach and ascends to the lips and tongue to attend to the sense of taste. “All the liquid substances of the energy flow towards the face ...” This means to state that the organic liquids follow the energy up to the face to make the skin and dermoskeleton shiny, then gather at the “orifices”. The lung governs the skin and responds to heaven; the spleen rules the flesh and responds to earth. “The skin is thick and the flesh is firm ...” implies: the “cold” and “heat” energy of heaven cannot prevail over that of man... . This means to state that the human energy defeats the celestial (climatic) energy.

In conclusion, this paragraph defines the head and face as the site of reunion of the energies of the 3 yang channels. But when it is concerns the yin energy and yang energy, of cold and of heat, these go from the bottom upwards; this is why the study of the energy of the channels must be completed by that of the jing (essence) of the different organs.” II - Ma Shi explains: “If the face can withstand the cold, it is because it is the site of gathering of the organic liquids. If the head, face and body form a whole, it is because the bones are bound by the tendons and muscles and that they are irrigated by the same blood and the same energy. In principle, when it is cold or hot, in all the parts of the body one must feel the same sensation of cold or heat; then how is it that the hands and feet become cold while the face does not? 112. Qi Bo replies: “Man has 12 jing and 365 luo and places called “orifices” (eyes, ears, nose, mouth) which

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are all located on the face. These are the site of gathering of the energy of the organic liquids; the skin there is thick and the flesh firm; this is why excessive cold and heat cannot attack the face.”

III - N.V.N.: According to Quin Yue ren (also known as Bian Que), the face is the only part of the body that can withstand the cold. In effect, “the cranium is the site of reunion of the yang channels. The yin channels distribute to the neck or thorax, then return toward the bottom. Only the yang channels arrive at the cranium. For this reason, the face withstands the cold.” This explanation appears incomplete to us because the head and face are also the sites of gathering of the “jing” energy (essence) of the 5 organs.

PARAGRAPH 5 Huangdi: “What are the clinical manifestations during infiltration of perverse energy into the organism?”

the

Qi Bo:

“The attack by “Empty Perverse” (Xu Xie) manifests by piloerection shivers. Attack by “True Perverse” (Zheng Xie) is indicated by a slight change in complexion; the clinical signs are also imprecise like “to be or not to be”, “to persist and to disappear”, “without form and with form”. The situation is confusing... .” and

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph studies the confrontation of cosmic energy and human energy. heaven has 6 energies: wind, cold, heat, humidity, dryness and fire. Man also has these 6 energies. This is why when “True Perverse” (Zheng Xie) attacks man, the complexion is slightly altered because the complexion is the color of the energy. As for the bodily manifestations, they are more imprecise like being or not being. 113.

The 6 energies of heaven are classified as: _ Empty Perverse (Xu Xie) _ True Perverse (Zheng Xie). Empty Perverse energies belongs to Ba Zheng (8 astronomic rhythms = 8 cardinal directions), and True Perverse energies are the seasonal energies of the year (see Chapter 2). In total, this paragraph studies the infiltration of perverse energy. Disease sometimes manifests at the level of the qi (energy) with change in complexion, sometimes at the level of xing (form) with change in the pulse. Sometimes the disease of the energy becomes reflected at “Chi Fu” (region which extends between the elbow and wrist), sometimes that of the form at the “foot” (Chi) pulse, sometimes at the “inch” (Cun) pulse. Perverse energy can transform unexpectedly, and in man it can materialize or not. It is therefore difficult to apprehend it. Only circumstantial reasoning allows its determination; such

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is the behavior of the experienced and qualified physician. Yu shi clarifies: Zheng qi (True Perverse) of heaven have their “cold, heat, humidity, dryness ...” predominance. This is why it carries the name “True Perverse”. II - Ma Shi comments: “When perverse energy attacks man, the “True Perverse” (Xu Xie) is generally perceived and the “Empty Perverse” (Zheng Xie) (1) is difficult to feel. According to Chapter 26 of the Suwen (Ba Zheng shen Ming lun: The Eight Astronomic Rhthyms): “The “Empty Perverse” designates wind in a state of emptiness coming from Ba Zheng (8 cardinal directions). As for the “True Perverse”, for example, in the course of physical overwork with abundant sweating and opening of the pores, the attack of wind is usually temporary and benign, explaining the difficulty in describing it.”

PARAGRAPH 6 Huangdi: “I have understood it said that: _ examination of the complexion in the determination of the disease is called “Ming” ( p e r c e p t i o n ) . _ palpation of the pulses in the determination of the disease is designated “Chen” ( g e n i u s ) . _ questioning the patient in the determination of the disease is designated by the name “gong” (good worker; qualified physician). In order to go thoroughly into these methods: examine the complexion, palpate the pulses, question the patient ... What should I do?”

114.

Qi Bo:

“The complexion, pulses and Chi (Chi Fu)”... are 3 components repercussing like drumstick and drum, shadow and echo, exactly replicated. It is also like the relationship between root and summit; if the root dies, the leaves dry up. The complexion and pulses, form and flesh, cannot be considered separately. To know one of these components is “ g o n g ” ; knowing two of them is “ C h e n ” ; knowing three is “ M i n g ” . ” Huangdi: “I would like you to clarify the advantage for me .” Qi Bo:

“The greenish complexion responds to the tense pulse. The red complexion responds to the cramped pulse. The yellowish complexion responds to the changing pulse. The whitish complexion responds to “feather” pulse ( s u p e r f i c i a l ) . The blackened complexion responds to the “stone” pulse ( d e e p ) .

If, upon examining corresponding pulse the (chain of inhibition), it pulse coming from the cure.”

the pulses, one detects at the place of the pulse coming from the “victorious” chain is death. In contrast, the appearance of the “productive” chain (chain of stimulation) is

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1. See also definition of “Empty Perverse” and “True Perverse”, page 85, footnote 3.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph studies the relationship between the complexion, pulse and “Chi” (Chi Fu) which are intimately linked like drumsticks and drum, shadow and echo... . 1 - The 5 bright complexions are the reflection of the essence energy (jing qi). The pulses are the result of the circulatory movements of ying-blood. here, “Chi” designates a type of energy and blood circulating outside the channels following the “luo” routes of the Hand Yangming (LI) and associated with the level of Chi Fu (area located between the elbow and wrist) of one part, and of the other part, another type of energy and blood circulating in Hand Taiyin (Lu) and belonging to “Chi-Cun” (“foot-inch”). These types of energy and blood are none other than the energy and blood produced at the level of the stomach and 5 organs. They are intimately linked like root and summit. 115.

2 - Form, flesh ...” designate Chi Fu.

Knowing these three essential pieces of information (complexion, pulse and “Chi”), the practitioner is at once genius (Chen) and perceptive (Ming). 3 - “Green, yellow, red, white and black” are the colors of the energies of the 5 organs and 5 movements. “Tense, cramped, slippery, superficial and deep” designate the pulsologic natures of these organs and movements. Because they reflect like shadow and echo, the green complexion responds to the tight pulse, the red complexion to the cramped pulse, etc. The lone examination of the complexion allows the determination of the corresponding type of pulse, like Kun ( : earth) responding to Quan ( : heaven). If with a green complexion, one finds a superficial (feathery) pulse, and if with a red complexion one finds a deep (stone) pulse, etc., it is death because these pulses issue from the “victorious” (inhibitory) chain of yin and yang. In contrast, the green complexion associated with a deep pulse, the red complexion associated with a changing pulse, etc. are signs of cure because these pulses originate from the chain of production (stimulation); yang produces yin in accordance with the Dao of “birth of yang and growth of yin”.

III - N.V.N.: remember the two types of pulses: _ the pulse responding to the 4 seasons (normal pulse) _ pathologic pulses.

a - Pulses of the 4 seasons: These pulses are in agreement with the complexion: _ with the appearance of green color, the pulse is tense, and long (liver pulse). _ with the appearance of red color, the pulse is cramping excessive on arriving and insufficient on departing (heart pulse). _ with the appearance of yellow color, the pulse is changing and supple (spleen pulse). _ with the appearance of white color, the pulse is superficial and light (Lung pulse). _ with the appearance of black color, the pulse is deep and firm (kidney pulse).

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b - Pathologic pulses These are not in agreement with the complexions: _ pulse coming from the chain of production of yin, yang and the 5 movements. Example: the deep pulse of the liver is a reactive pulse coming from the kidney. When water (kidney) stimulates wood (liver), it indicates cure. _ pulse coming from the chain of destruction. Example: The superficial pulse of the liver and a reactive pulse coming from the lung. In effect, attack of wood (liver) by metal (Lung) is a fatal sign.

116.

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Figure 10 Radial pulse and “Chi Fu”

PARAGRAPH 7 Huangdi: “From the attack of the organs, what is the evolution of diseases?” Qi Bo:

“It is necessary to determine the agreement of the 5 complexions and 5 pulses before any study on the evolution of the diseases.” Huangdi: Once complexion and pulse is determined, how do you practice?” Qi Bo:

“By a meticulous examination of the nature of the pulses, late, hurried, changing, small, slippery, rough, one can determine the evolution of the disease. Huangdi: “How does one examine them?” Qi Bo:

“When the pulse is h u r r i e d , the “Chi” area of the skin is also hurried. When the pulse is l a t e , the “Chi” area of the skin is also late.

117.

When the pulse is s m a l l , the “Chi” area of the skin is reduced and the energy there is weak. When the pulse is c h a n g i n g , the “Chi” area of the skin is raised. When the pulse is s l i p p e r y , the “Chi” area of the skin is also slippery. When the pulse is r o u g h , the “Chi” area of the skin is also rough. These modifications are minimal or considerable. In this manner, by the lone examination of “Chi”, one can manage to do without the use of the “Cun” (”inch” pulse), and by the lone examination of the pulse one can manage without the study of the complexion; but their association for therapeutic purpose permits one to become a great practitioner. The excellent practitioner cures 9 cases out of 10. The good practitioner who uses these 2 methods cures 7 of 10 cases. The poor practitioner who uses one of these two methods cures 6 cases out of 10.

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EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph studies the diseases of the 5 organs whose evolution must be evaluated by a precise examination of the colors and pulses. 1 - “Once the colors and pulse are determined” one begins by examining the “Chi Fu” pulse (pulse reflecting at the level of the “Chi” zone up to the point Chize- lu 5”), the “Chi” (“foot”) pulse and “Cun” (“inch”) pulse. The energy and blood at the level of Chi Fu originates from the “jing” substance (essence) of the grains of the stomach which is directed toward the deep channels of the organs and bowels and spreads to the skin. 2 - The energy and blood at the level of Cun Kou (radial pulse) and the “Chi” pulse (“foot” pulse) also originates from the “jing” substance of the cereals metabolized by the stomach. This flows out into the organs and bowels and into the jingmai and appears at the radial pulses belonging to the Hand Taiyin (Lu). By this fact, blood and energy originate from the 5 organs. This is why “when the pulse is hurried, the skin of Chi is hurried as well; when the pulse is late, the skin of Chi is late as well.” These reactive phenomena are as spontaneous as that of the reflection of drumsticks on the drum, of shadow and echo. 118.

3 - In this manner, when one carefully examines Chi, it is not necessary to examine the “Cun Kou” pulse, and when one examines well the pulse, one does not need to examine the complexion. But if one associates these two processes for therapeutic purpose, one becomes a great practitioner. The “numbers” begin with 1 (odd) and 2 (even). Their union (1 + 2) forms 3 whose double (3 + 3) is 6 and whose product (3 X 3) is 9. Such is the Dao of the “3 Cun” (“inch”: unity of superficial = 2 m2 40 , being: 2 m2 40 x 3 = 7 m2 20) and of the “3 Ju” (first three principles). The number 1, number of birth, and 10, number of transformation, the concordance and union of yin and yang, are the numbers of the Ha Du of the I jing (Book of Changes).

II - Ma Shi comments: “This chapter defines the agreement of complexion, pulse and disease. Perfect comprehension of these three principles proves to be difficult. This is why the text specifies: “To examine the complexion and to know the disease is “Ming” (clear-sightedness), to palpate the pulse and to know the disease is “Chen” (genius), to question the subject and to know the disease is “gong” (common). This is due to the speed of the response of the complexion, pulse and “Chi” like that of the drumsticks, of shadow and echo, of root and summit, of root and summit... . To know one of these methods is common; to know two is genius; to know three is at one time genius and clear-sighted.

How do you explain this? The The The The The

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liver, whose complexion is green, answers to wood; its pulse must be tense. heart, whose complexion is red, answers to fire; its pulse must be cramped. spleen, whose complexion is yellow, answers to earth; its pulse must be changing (Da). lung, whose complexion is white, answers to metal; its pulse must be superficial. kidney, whose complexion is black, answers to water; its pulse must be deep.

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In contrast, if the pulse is not in agreement with the complexion and it presents in the form of “victorious” pulse (like the green complexion with the superficial, rapid and short pulse), one is in the presence of the phenomenon of “destruction”: metal (Lung) destroys wood (liver). The disease becomes worse. If the complexion accompanies a deep, full and slippery pulse, one is in the presence of the phenomenon of “production”: water (kidney) produces wood (liver). The disease disappears. This is why, despite the diversity of pathological aspects in the course of the evolution of a disease, one can always analyze and determine them according to the complexion and pulse 119. In total, “to analyze and determine the pathological aspects of the disease” consists of examining and studying the late, hurried, changing, small, slippery and rough nature of the “foot” (Chi) pulse and the state of “Chi Fu”. In this way, the complications of the evolution of the the disease which are tiny or important can be diagnostically assessed because: _ via the “foot” pulse (Chi), one can determine the “inch” pulse (Cun), _ and via the pulse, one can determine the complexion. In other words, by the pulse and complexion, one can judge the disease. Also, in Chapter 25 of this classic it is stated: “By the sole appreciation of the late, hurried, changing, small, slippery and rough nature of the “foot” pulse and the state of Chi Fu, one can already evaluate the state of the disease.” The physician utilizing these three methods is a great worker; the one who utilizes two is a good worker and that one utilizes only one is a little worker. One distinguishes these three categories of physician by the percentage of cures: 9/10, 7/10 and 6/10.

III - N.V.N.: 1 - The changing pulse or “Da pulse” has been translated by German and French sinologists as “large pulse” which does not conform to the thinking of the text. In this paragraph, it concerns a pathological pulse called “changing” pulse which stops at regular intervals. See the explanation of this pulse in Chapter 5 of this classic and in the Mai jing (Classic of Pulses, N.V.N. Edition). 2 - We emphasize the presence of Chi Fu (see explanation of Zhang Shi, Paragraph 6).

PARAGRAPH 8 Huangdi: “What are the characteristics of the late, hurried, changing, small, slippery and rough pulses?” Qi Bo:

“That His Majesty allows me to demonstrate the pulses during the course of the evolution of the disease of the 5 organs! The very hurried pulse of diseases of the heart is the sign of contracture and muscular laxity (“Che Zong”; spasm); if it is barely hurried, it is the sign of cardialgia with dorsal radiation. The very late pulse of the disease of the heart is the indicator of the smile or silent laugh; if it is barely late, it is a sign of Fu Liang (accumulation of energy of the heart in the form of tumor) characterized by rising and descending movements, sometimes with hematemesis 120.

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The very changing pulse of the disease of the heart is the sign of congestion of the throat with respiratory noises; if it is barely changing, it is a sign of “Xin Bi” (obstruction of the energy of the heart) with cardialgia with dorsal radiation and tearing. The very small pulse of the disease of the heart is the sign revealing vomiting ( Y u e ) ; if it is barely small, it is the sign of “Jiao Dan” (overheating of the San Jiao- SJ); emaciation. The very slippery pulse of the disease of the heart the sign of polydipsia; if it is barely slippery, it is a sign of “Xin Shan” (heart pains) w i t h umbilical radiation and boborygmi. The very rough pulse of the disease of the heart is the sign of aphonia; if it is barely rough, it is the sign of overflowing of the blood (hemorrhage) with icy limbs (wei Jue), buzzing in the ear and cranial ailments (headache of the vortex). EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph studies the 6 types of evolution of disease of each of the 5 organs. These afflictions are of a different nature when it is a matter of externally-caused syndromes by the cold or when it is a matter of internally- caused syndromes by worry, fear... . The pulses called late, hurried, unsettled, small, slippery and rough are the particularities belonging to yin and yang, to the energy and blood of the 5 organs; they are defined in Paragraph 13 (see further on): “Usually _ the hurried pulse is caused by cold, _ the late pulse, by heat, _ the changing pulse, by the abundance of the energy and shortage of blood, _ the small pulse, by insufficiency of energy and blood, _ the slippery pulse, by abundance of yang energy with slight fever, _ the rough pulse, by abundance of energy and insufficiency of blood with not much cold (shivers).. 1 - The heart responds to the fire organ. Excessive cold can bring about “Che Zong” (shivering of the limbs) because the articulations are the sites of entering-exiting of the shen qi (mental energy). Stated otherwise, it is the cold that injures the shen qi provoking spasm and laxity of the limbs with “a very hurried pulse”. “The barely hurried pulse” of the heart is the sign of cardialgia with dorsal radiation. It is hurried because the shen qi is damaged, and it is barely hurried because the “royal palace” is affected. During the production of food energy of the stomach, Zhou qi (impure energy) is directed towards the heart to provoke there an afflux of energy towards the top. This is why the food products cannot descend.

2 - “The very late pulse” of the heart is the sign of the excess of the energy of the heart. The heart conserves the shen; when the shen is in excess, the laugh is uninterrupted. “Fu Liang” is an ailment characterized by an accumulation caused by an energetic excess in the region under the heart. “The barely late pulse” is an indicator of the attack of this region. The heart governs the blood. This is why the dissemination of heat in this region of the heart causes hematemesis. 121.

3 - Tong qi (innate energy or thoracic energy) accumulates in the thorax and communicates with the vessels of the heart in order to carry out respiratory function. When the

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energy of the heart is in fullness, respiration is strong and loud, and when this energy is barely in fullness it produces the opposite phenomena in the region under the heart to activate “Xin Bi” (obstruction of the energy of the heart and cardialgia) with dorsal radiation. These phenomena can reach the eyes to provoke tearing. 4 - In the emptiness of the heart, the weakening of “fire-earth” energy (heart-spleen system) causes vomiting (Yue) (2). The 5 organs produce jing (essence). If the blood and energy of these organs are in insufficiency, the organic liquids become exhausted, hence: “Jiao Dan” (overheating of the sanjiao- SJ; dehydration, polydipsia and weight loss). Jiao Dan is a disease of the sanjiao (SJ) whose shangjiao (Upper Jiao) belongs to the heartlung, zhongjiao (middle jiao) to the spleen-stomach system and xiajiao (Lower Jiao) to the liverkidney system. 5 - “The very slippery pulse” of the heart is the indicator of excess energy of the heart with heat formation. If this excess is located in the upper of the body, it causes thirst. If it is barely slippery, this excess is located down below; it is the origin of cardialgia with abdominal bloating. 6 - The heart governs speech. Dysarthria therefore comes from the insufficiency of energy of the heart. On the other hand, the excess of energy and blood causes overflowing of the blood (hematemesis). The heart is taiyang in yang. Insufficiency of yang energy produces frozen feet and hands. South responds to the color red and communicates with the heart, and “opens” the ears. This is why emptiness of the heart is the origin of buzzing in the ear (tinnitus) and cranial ailments (ex: cephalgia of the vortex). jin Qui (Box of gold) states: ”The 5 organs each have 18 forms of disease, making a total of 18 x 5 = 90 diseases because each organ has 6 types of complications, making 3 x 6 = 18 forms of disease.”(3) Yu Shi adds: “Late, hurried, changing, small, slippery and rough are 6 qualities of the pathological pulse. The organs, therefore, have: 5 x 6 = 30 and 30 x 3 = 90 forms of disease. Only the scholar understands this information; this is why only the qualified physician can cure 9 times out of 10”. . 122. II - Ma Shi comments: “This paragraph is devoted to the study of the changes of the pulses during the course of the evolution of the disease of the 5 organs and starts with the pathologic pulses of the heart. These pulses are described according to their characteristics: hurried, late, changing, small, slippery and rough responding to change in symptoms. In this manner, for example: 1 - The hurried pulse belongs to the liver. But here, the very hurried pulse of the heart is an indicator of infiltration of perverse wind into the heart, triggering factor of spasm (Che) and muscular laxity (Zong), terms corresponding in our era to convulsions, acute or chronic. If the heart pulse is barely hurried, it is an indicator of cardialgia with dorsal radiation and trouble swallowing. In the case of the very hurried pulse, the illness settles in the interior with external manifestations: contracture and muscular laxity (Che Zong), and in the case of a barely hurried pulse, the illness is benign and the clinical signs are internal: cardialgia. 2 - The late pulse belongs to the spleen. If the illness of the heart is signaled by a very late pulse, it is the sign of gathering of

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“earth” energy and perverse energy at the level of the heart which activates the illness “Insane2. Some authors translate Yue as eructation (!?) which does not conform to the thinking of the text. 3. here, 3 designates the number of the trilogy, heaven-earth-Man, acting as factors in disorders .

Laugh” (to laugh like a madman). The heart governs the voice and laughter. But “to laugh like a madman” is the sign of loss of the mind. If the heart pulse is barely late, it is the sign revealing the presence of “Fu Liang” (energetic accumulation in the form of a movable tumor), sometimes accompanied by blood-tinged salivation. The very late pulse is the sign of worsening of the illness. On the other hand, if the pulse is barely late, the illness is chronic and transforms into Fu Liang. 3 - The changing pulse belongs to the heart. The very changing pulse of the heart is the sign indicating an overflowing of fire of the heart with respiratory noises (crepitant rales). If the pulse of the heart is barely changing, it is the sign of “Xin Bi” (obstruction of the heart energy with cardialgia) radiating dorsally with tearing. Because the energetic system of the heart is linked to the laryngopharyngeal apparatus, the back and eyes, the very changing pulse is the sign of abnormal respiratory sounds, and the barely changing pulse is the sign of cardialgia radiating dorsally with tearing. 4 - The small pulse is contrary to the changing pulse. The very small pulse of the heart denotes an insufficiency of energy of this organ; in this case, the spleen is not maintained, hence vomiting (Yue). 123. A barely small pulse of the heart is the sign revealing dryness of the organic liquids, that is to say, of the illness “Jiao Dan” (overheating of the sanjiao- SJ; dehydration). 5 - The slippery pulse is contrary to the rough pulse. The very slippery pulse of the heart indicates an excess of fire of the heart with thirst (polydipsia). A barely slippery pulse is the sign of “Xin Shan” (cardialgia and peri-umbilical pain) with boborygmi. 6 - The very rough pulse belongs to the lung. The very rough pulse of the heart is the sign of overheating of metal by fire and vice versa hence, dysarthria. A barely rough pulse of the heart is the sign revealing disorder of the blood with overflowing (hemorrhage); the yinwei and yangwei vessels (4) then are cooled down causing buzzing (tinnitus) and cranial ailments. These are due to the insufficiency of fire of the heart with invasion of metal. This is why the very rough pulse is the sign of insufficiency just as easily in the interior as at the exterior, and the barely rough pulse denotes an intricacy of external signs.”

III - N.V.N.: This paragraph, 8, and the following ones (9, 10, 11 and 12) define the 6 pathological characters of the pulses: hurried, late, changing, small, slippery and rough. Each character is studied according to the degree of attack of the organ; ex: very hurried pulse of the heart and barely hurried pulse of the heart. This comparative study is fundamental to the comprehension of the natures of the pulse.

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4. These vessels make up part of the “curious vessels” (Ba qi Mai).

PARAGRAPH 9 “The very hurried pulse of the disease of the lung is the indicator of cranial ailments (Dian Xi); if it is barely hurried, it is the sign of attack on the lung by cold-heat with such symptoms as: fatiguability, cough, blood-streaked expectoration, thoraco-dorsalgia with radiation to the lumbar region, or nasal polyps with difficulty breathing. The very late pulse of the disease of the lung is the sign of excessive sweating; if it is barely late it is the sign of amyotrophy/myatrophy (wei), adenititis (shu Lou), hemiplegia (Tian Feng) and unremitting perspiration from the head to the back. 124.

The very changing pulse of the disease of the lung is the sign of leg edema; if it is barely changeable, it is “Fei-Bi” (obstruction of the energy of the lung) with thoraco-dorsalgia and photophobia. The very small pulse of the disease of the lung is the sign of diarrhea; if it is barely small, it is the sign of “Jiao Dan” (overheating of the sanjiao- SJ). The very slippery pulse of the disease of the lung is the sign of “Xi Bun” (accumulation of the energy of the lung) with dyspnea followed by ascent of the energy; if it is barely slippery, it is the sign of overflowing of blood (hemorrhage) just as easily at the top as down below. The very rough pulse of the disease of the lung is the sign of hematemesis; if it is barely rough, it is the sign of cervical and axillary adenitis (shu Lou); the bottom not being able to defeat the top is the origin of the disease “Zan” (disorders of motility). EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: 1 - “The lung belongs to metal-Coolness. It fears the cold; a great cold is the origin of cranial ailments (cephalgia). “Attack of the lung by Cold-heat” implies the skin is affected. In effect, the fixation of cold at the level of the pilocutaneous system is the cause of a hurried pulse. The lung is the master of the energy. signs like: “fatiguability, cough and expectoration, lumbar, dorsal and thoracic pains, nasal polyps and nasal obstruction...” are signs of wind-Cold. 2 - The late pulse of disease of the lung is the sign of excess heat, hence abundant sweating. When the lung is affected by heat, the lobes dry out triggering “wei” ailments (atrophic impotence).

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“Zhou Lou” (adenitis) are of “Cold-heat” origin; their “root” is found in the lung organ, and their “summit” in the channel-vessel. This is why the barely late pulse is the sign of the presence of heat, and the barely rough pulse, the presence of cold. As a result, these pulses indicate the presence of cervico-axillary adenitis. The lung is master of the energy of the entire organism and commands the “hundred vessels”. Because of the opening of the pores, sweat flows out abundantly “ from the head to the bottom”. “From the head to the bottom” implies the following regions: neck, nucha, thorax and back which are controlled by the energy of the lung. 125.

3 - The changing pulse of the disease of the lung signifies abundance of energy and shortage of blood. When the energy is plethoric at the lower part of the body, it is cervical arthritis which is set up at the top, and when it is slightly in excess at the upper part, it causes “Fei Bi” (obstruction of the lung energy) with thoraco-abdominal pains, followed by a blockage of the energy coming from down below. “The light” is the fire of taiyang. Insufficiency of yin-blood provokes fear of the light (photophobia). In this case, one says “metal fears fire”. 4 - The small pulse of the disease of the lung is the sign of emptiness of the blood and energy responsible for diarrhea because the lung and large intestine constitute a “yin-yang”, “interior-exterior” system. If it is slightly small or barely small it is the sign of the ailment “Jiao Dan” (overheating of the sanjiao- SJ: dehydration, polydipsia) because the lung is the source of the production of the organic liquids. 5 - The slippery pulse of the disease of the lung indicates an excess of yang energy, triggering factor of “Xi Bun” (accumulation of the energy of the lung). If it is barely slippery, it is the sign of overflowing of blood (hematemesis) just as easily at the top as down below. This is due to a propulsion of blood by energy. 6 - The very rough pulse indicates an abundance of blood and shortage of energy. In this case, the blood is no longer centralized by the energy, hence chaotic circulation causing hematemesis. “Zan” is an ailment of yin-Cold characterized by a progressive degradation of the essential energy provoking disturbances of motility. In effect, the lung is “master” of the energy whose source is located down below. In the event of insufficiency of energy, the bottom no longer has the capacity to respond to the top, hence trouble walking.

II - Ma Shi comments: “This paragraph studies the different pathological pulses of the lung. 1 - The hurried pulse is a pathologic pulse belonging to the liver. Illness of the lung is characterized by a very hurried pulse when the perverse energy of wood-liver invades the “non-victorious” zone (area not commanded by metal-lung: cephalic zone) triggering cranial ailments (Dan Xi). The barely hurried pulse of the lung heralds an attack of the lung by Cold-heat characterized by the following signs: asthenia, cough with thoraco-dorso-lumbar pains, hemoptysis, nasal polyps with stuffed up nose. These signs originate from the emptiness of lung energy and fullness of perverse energy. The hurried pulse of the lung is the indicator of a severe and deep infiltration of perverse energy, hence cough. In contrast, if it is barely hurried, the progression of perverse energy is slow and can cause other illnesses.

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126.

2 - The late pulse is a pathological pulse belonging to the spleen. Illness of the lung presents with a very late pulse, when the spleen is poorly maintained by the blood. In a state of insufficiency, spleen-earth cannot maintain lung-metal, hence illness of Empty-Cold. On the other hand, the barely late pulse of the lung is the sign indicating atrophic impotence (wei), adenitis (Zu Lou), hemiplegia (Tian Feng), and continuous perspiration from the head to the feet. When the pulse is very late, the illness rapidly progresses with a excessive Empty-Cold. When the pulse is barely late, the illness is chronic with a complete clinical picture. 3 - The changing pulse is a pathological pulse belonging to the heart. Illness of the lung presents a very changing/unsettled pulse when metal is overheated by fire-heart and kidney-water dries up; the legs are edematous. The barely changing pulse of the lung is the sign of obstruction of the lung energy (Fei Bi) with fear of fire and light. When it is very changing, heart, lung and kidney are simultaneously affected. Leg edema indicates the simultaneous attack of the interior and exterior. 4 - The very small pulse is contrary to the changing pulse. Illness of the lung presents a very small pulse when the “center” energy (Zhong qi) is in great insufficiency causing diarrhea. The barely small pulse of the lung is the sign of Jiao Dan (overheating of the sanjiao-SJ: dehydration, emaciation). In the case of the very small pulse of the lung, earth and metal are simultaneously in insufficiency causing diarrhea. On the other hand, the barely small pulse indicates the benignness of the illness. In that case, “Jiao Dan” only manifests in the areas associated with the lung. 5 - The slippery pulse is contrary to the rough pulse. Illness of the lung presents a very slippery pulse when there is excess of fire; the illness is serious and transforms into Xi Bun (accumulation of the energy of the lung with forceful cough). A barely slippery pulse is the sign of invasion of the lung and large intestine by fire,

causing hemorrhages as easily above as below (epistaxis and melena). When the slippery pulse designates the state of the energy, it affluxes toward the top and cannot descend. On the other hand, when it is barely slippery, it responds to the state of the blood; it affluxes just as easily toward the top as toward the bottom. 6 - The rough pulse is a pathologic pulse specific to the lung. 127. When illness of the lung presents a very rough pulse, it is the sign of excess of perverse energy; The blood spreads and provokes vomiting (hematemesis). A barely rough pulse of the lung is the sign of cervical and axillary adenitis (shu Lou). The Trunk answers to the upper part of the body with respect to the feet. “The lower part cannot defeat the upper part”, means that the feet in a state of extreme weakness become disabled (weak). In that case, the pulse is very rough because the blood is damaged. In contrast, the barely rough pulse denotes the chronicity of the illness.”

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PARAGRAPH 10 “The very hurried pulse of the illness of the liver is the sign of fear of speaking (logophobia: Yue Yon). Barely hurried, it is the sign of Fi qi (accumulation of liver energy) in the subcostal region evoking the image of an upside down bowl. The very late pulse of the liver is the sign of frequent vomiting. Barely late, it is the sign of shui Jia Bi (accumulation of aqueous substances in the form of cystic nodules). The very changing pulse of the liver is the sign of Nei Yong (internal abscess), repetitive vomiting and epistaxis. Barely changing, it is the sign of Gan Bi (obstruction of the liver energy with painful paresthesias), of yin Xi (retraction of the penis) and of cough with painful tightness of the lower abdomen. The very small pulse of the liver is the sign of Da yin (potomania). Barely small, it is the sign of Jiao Dan (overheating of the sanjiao- SJ); dehydration, weight loss despite preserved appetite. The very slippery pulse of the liver is the sign of Xiao Shan (orchi-epididymitis). Barely slippery, it is the sign of yi Nao (urinary incontinence). The very rough pulse of the liver is the sign of yi yin (limb edema). Barely rough, it is the sign of Che lun (spasm) and Gan Bi (obstruction of the liver energy; painful paresthesias).” EXPLANATIONS AND COMMENTARIES

128.

I - Zhang Shi explains:

“1 - The liver controls speech, and, among feelings it answers to anger. For this reason, the very hurried pulse of the liver is the sign of logophobia, and the barely hurried pulse, of the accumulation of the liver energy (Fi qi). These two ailments involve excess of liver energy. 2 - Once in the stomach, the food products transform into Cereal jing (food essence) flowing down toward the liver organ. In this manner, the late pulse of the liver is the sign revealing the excess of dietary heat, and, in the presence of this heat, the energy of the liver flows toward the top, hence vomiting. shui Jia Bi is cystic formation (nodules) of dietary origin. 3 - The classics state: “Worry, anger, diet disorder, insufficiency of yin energy, excess of yang energy and stagnation of ying (nutritive) energy are the principal causes of the formation of internal abcesses (Nei Yong).”

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In this manner, the changing pulse of the liver is the sign revealing excess of liver energy which does not disseminate and is transformed into internal abscess (ex: intestinal abscess). Vomiting and epistaxis are due to a flow of the liver energy in the wrong direction toward the upper part of the body, and the retraction of the penis, to a flow in the wrong direction of this energy toward the lower part of the body. The diaphragmatic vessels reach the bottom (that is to say, the lower abdomen) on the one hand, and on the other, they gather at the top (that is to say, at the lung). This is why cough and tightness of the inside wall of the pelvis are due to an flow in the wrong direction of liver energy just as easily toward the top as toward the bottom. 4 - The small pulse of the liver is the sign revealing the insufficiency of blood and energy. This insufficiency is the cause of excess “wood-fire” responsible for potomania (excessive drinking) and Jiao Dan (weight loss). 5 - The slippery pulse of the liver is the indicator of excess energy with the formation of heat, hence orchitis and pelvic pain. The liver has the function of regulating peristalsis and excretion. This is why the excess energy of the liver with formation of heat is the cause of urinary incontinence. 6 - yi yin (edema) is an ailment caused by liquid overflowing at the level of the 4 limbs. This type of edema hampers the circulation of the channel-vessels, hence a rough pulse. The liver energy in a state of emptiness with the presence of cold is a causal factor of spasm and painful paresthesias (Gan Bi) because the liver governs the neuro-muscular system. 129.

II - Ma Shi comments: “This paragraph is devoted to the 6 pathological characters of the liver pulse with clinical explanations. 1 - The hurried pulse is a pathological pulse specific to the liver. Strongly hurried, it is the sign of logophobia because the liver governs anger, This is why when liver energy is in excess, the subject refuses to speak and retreats into a stubborn silence. Barely hurried,it is the sign of Bi qi (energetic accumulation of the liver) in the subcostal region like an inverted bowl. Bi qi is a chronic illness; it is why the pulse is barely hurried.

2 - The late pulse is a pathological pulse belonging to the spleen. The strongly changing pulse of the liver is the sign of invasion of earth by wood, a phenomenon characterized by repetitive vomiting. If it is slightly late, earth cannot triumph over water; this transforms into shui Jia Bi (cystic formations). 3 -The changing pulse is a pathological pulse specific to heart. The strongly changing pulse of the liver is the sign of the exhalation of fire toward wood, responsible for Gan Yong (liver abscess), hematemesis and epistaxis. Slightly changing, it is the sign of hepatic obstruction and pain (Gan Bi), penile retraction (yin Xi) as a result of the ascent of the fire of the yin channels. This pulse only differs from the very changing pulse by the absence of hematemesis. 4 - The small pulse is contrary to the changing pulse. The very small pulse of the liver is the plethoric sign of blood indicated by potomania. Slightly small, it is the sign of Jiao Dan (weight loss despite preserved appetite). In summary, potomania and emaciation are ailments of the same type.

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5 - The slippery pulse is contrary to the rough pulse. The very slippery pulse of the liver is the sign of orchi-epididymitis because the testicles are controlled by the liver. If it is barely slippery, excretory function is no longer under control, hence urinary incontinence. 6 - The rough pulse belongs to the lung. If the liver pulse is very rough, it is the sign of invasion of wood by metal. In this case, earth invaded by perverse energy cannot triumph over water, hence overflowing of water at the 4 limbs (edema). If it barely rough, the blood does not maintain the muscles, hence painful spasms. 130.

PARAGRAPH 11 “The very hurried pulse of the spleen is the sign of “Che” (spasms). If it is barely hurried, it is the sign of “Ge Zhong” (attack of the diaphragm) characterized by post-prandial vomiting and frothy stools. The very late pulse of the spleen impotence caused by an afflux of cold). “Feng wei” (atrophic impotence caused the hands and feet, but preservation

is the sign of “wei Jue” (atrophic If it is barely late, it is the sign of by wind) with loss of the use of of intellectual power.

The very changing pulse of the spleen indicates the sensation of being struck down by blows and wounds. Barely changing is the sign of “Shan qi” (storage of spleen energy) with large abdomen and bloodypurulent accumulation outside the stomach and intestines. The very small pulse of the spleen heralds the illness “Cold-heat”. Barely small, it is the sign of “Jiao Dan” (emaciation). The very slippery pulse of the spleen is the sign of “Hui Long” (painful micturition). Barely slippery, it is the sign of parasitosis (Shan Xiao) with sensations of heat within the abdomen. The very rough pulse of the spleen is the sign of Zhang Xiao (heat in the intestines). Barely rough, it is the sign “Nei Hui” (perforation of intestinal abscess with bloody-purulent stools). EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: 1 - The spleen commands the 4 limbs. The very hurried pulse of the spleen is the sign of spasms of the limbs caused by cold. At the time of attack of the spleen by the cold, the non-metabolization of food is the origin of Ge Zhong (attack of the diaphragm) responsible for post-prandial vomiting and frothy stools. Frothy stools are a consequence of disturbance in the function of the liquid distribution of the spleen; this, not able to bring the nutritive liquid toward the lung in order to irrigate the pilocutaneous system, is obligated to be evacuated by the anal route in the form of frothy stools.

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2 - wei Jue and Feng wei are atrophic impotencies of the limbs. 131. The very late pulse of the spleen denotes illnesses of internal origin with external manifestations. On the other hand, in the case of the barely late pulse, the illnesses are external without internal manifestations which is why the subject still is in possession of all his faculties. 3 - The changing pulse is an excessive pulse. The spleen is the only organ belonging to the “center” having the ability to humidify the “4 sides”. If the pulse of the spleen is very changing, it is the sign of the loss of motility of the 4 limbs as if a subject was struck down by blows and wounds. Shan qi is an ailment characterized by a large abdomen as a result of an accumulation of blood and pus outside the gastrointestinal system. This phenomenon is due to an accumulation of the energy in an excessive state. 4 - The emptiness of the blood is favorable to the illness Cold-heat. The spleen in a state of emptiness is incapable of aiding the stomach in the function of distribution of liquids, hence the illness “Jiao Dan”. 5 - The spleen is associated with earth-Humidity. Humidity-heat is a triggering factor of painful micturition and dysuria. 6 - The emptiness of spleen energy is responsible for intestinal inflammation and pain. The stomach and intestines are composed of much blood and little energy which is why, in the event of illness, hematuria and pyuria are not uncommon.

II - Ma Shi comments: The 6 pathologic characteristics of the spleen pulse are presented in this paragraph. 1 - The hurried pulse is a pathologic pulse of the liver. If the pulse of the spleen is very hurried, it is the sign of invasion of earth by wind-wood responsible for Che Zhong (spasms of the limbs). If it is barely hurried, this phenomenon occurs in the upper part of the body, at the level of the diaphragm, triggering post-prandial vomiting. On the other hand, if it occurs in the lower part, the stools are frothy because the spleen energy does not descend.

2 - The late pulse is a pathologic pulse of the spleen. 132. If it is very late, it is the sign of extreme weakness of energy of earth, responsible for atrophic impotence (wei) and of ice cold feet (Jue). If it is barely late, the atrophic impotence is caused by wind (Feng). Despite the loss of the use of the limbs, the subject is still in possession of all his faculties. 3 - The changing pulse is a pathologic pulse of the heart. If the pulse of the spleen is very changing, it is the sign of collapse (loss of consciousness) as if the subject had been struck down by his adversary. If it is barely changing, it is the sign of the illness “Shan” (storage of spleen energy) with large abdomen and presence of blood and pus outside the stomach and intestines. In Chapter 40 (“Study on Abdomen-Center”) of the Suwen, we note: “Huangdi questions: The lower abdomen is swollen as if it was deeply rooted at the top and down below, to the right and to the left. Is this illness curable? Qi Bo responds:

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This illness is Fu Liang. It is a kind of membranous sac containing much blood and pus located outside the stomach and intestines. It is incurable; a strong palpation can bring about death. If Fu Liang is localized within the lower abdomen, the illness is belongs to yin, and the stools are bloody-purulent. Located within the upper abdomen, Fu Liang is compressed against the stomach and transforms into Nei Yong (internal abscess), adherent to the diaphragm. Nei Yong is a chronic ailment that is very difficult to treat.” The very changing pulse of the spleen is therefore the sign revealing Fu Liang with external manifestations (bloody-purulent stools), and the barely changing pulse heralds Fu Liang with internal manifestations (cystic accumulation).

4 - The small pulse is contrary to the changing pulse. If the pulse of the spleen is very small, it is the sign of the illness of alternating Coldheat (sometimes fever, sometimes chills). This ailment is due to the insufficiency of blood. A barely small pulse is a sign of Jiao Dan (overheating of the sanjiao- SJ = emaciation). This illness results from a “dryness” of blood with shortage of organic liquids (dehydration). 5 - The slippery pulse is contrary to the rough pulse. If the pulse of the spleen is very slippery, it is the sign of “Hui Long” (painful micturition and dysuria). Because the earth cannot triumph over wood, it produces “Xiao Shan” (orchi-epididymitis), and because the earth cannot activate the “water” movements, it produces “Long” (painful micturition and dysuria). A barely slippery pulse is the sign of parasitosis with heat sensations in the abdomen. Because the slippery pulse is a yang pulse of oval and smooth form, evoking the image of a moving pearl, its presence is the indicator of parasitosis with release of toxic heat. 6 - The rough pulse is a pathologic pulse of the lung. 133. The very rough pulse of the spleen comes not only from the non-production of metal by earth, but also from the excess of perverse energy at the level of metal. The lung and large intestine constitutes an “external-internal” system. Consequently, the very rough pulse of the spleen indicates the presence of “Nei Hui” (intestinal abscess and ulcerations). If it is barely rough, Nei Hui, in the majority of cases, are formed of blood and pus. Because the abscesses burst in the interior without discharge to the exterior, the pulse is very rough. In contrast, when blood and pus are evacuated to the exterior, the pulse is barely rough.

PARAGRAPH 12 “The very hurried pulse of the kidney is the sign revealing illnesses of the cranium. Barely hurried, it is the sign of deep “Jue” (very ice-cold limbs), “Bun Dun” (accumulation of kidney energy in the form of a mobile tumor), difficult flexion of the knees and inability to defecate. The very late pulse of the kidney is the sign of “Xie Ji” (extremely intense spinal pain, like the pain of a fracture). Barely late, it is the sign of profuse diarrhea (Zung) with dyspepsia and post-prandial vomiting. The very changing pulse of the kidney is the sign of “yin wei” (sexual impotence). Barely changing, it is the sign of “Shi shui” (edema hard as stone); this illness starts at the infra-umbilical region and reaches the lower abdomen. When it ascends to the stomach, it is death.

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The very small pulse of the kidney is the sign of profuse diarrhea containing undigested food. Barely small, it is the sign of Jiao Dan (extreme thinness). The very slippery pulse of the kidney is the sign of “Long Xiao” (dysuria with painful micturition). Barely slippery, it is the sign of Gu wei (bony atrophy). Seated, the patient cannot stand up; standing, he has vertigo and trouble seeing. The very rough pulse of the kidney is the sign of anthrax; barely rough, it is the sign of internal hemorrhoids.

EXPLANATIONS AND COMMENTARIES

134.

I - Zhang Shi explains: 1 - “The kidney is a yin organ governing the bones. When yin is excessively cold, the bones and skull are affected. The kidney is the source organ of the vital energy. When the essential energy is in Emptiness-Cold, the hands and feet are ice-cold. The ascent of the energy of the kidney in a state of emptiness is the origin of the illness “Bun Dun” (kind of energetic waves which ascend from the hypogastrium toward the top of the thorax: dyspnea). When yin-Cold occurs at the lower part of the body, the legs cannot be flexed.

2 - The energy of the kidney communicates with the intestinal and urinary routes. When this energy is in a state of emptiness urinating and defecating is disturbed. The Dumai (GV) comes from the kidney, running the length of the spine. The late pulse of the kidney indicates loosening of the Dumai with sensation of a break in the vertebral column. When Wu (#5)and Gui (#10) reunite, they transform into “fire” and “earth” which are the chief metabolizers of food products at the level of the stomach. The late pulse of the kidney heralds that these principles are abolished, hence indigestion and vomiting of food. 3 - yin wei (sexual impotence) is an ailment characterized by a softening of yin energy, hence inability to have erections. Shi shui (hard edema) is an ailment of “kidney-water” origin. When this edema reaches the top, that is to say the stomach, it constitutes what one calls “phenomenon of overflowing of water with defeat of earth.” 4 - The emptiness of kidney energy is the origin of profuse diarrhea containing undigested food. Oligo-amenorrhea can trigger Jiao Dan (weight loss). 5 - The presence of heat in the kidney is the cause of dysuria and painful micturition or orchi-epididymitis. Gu wei (bony atrophy) is mainly indicated by difficulty getting up after sitting. It is due to an attack of the energy of the kidney by heat. This illness can be accompanied by vertigo and visual disturbance while in the standing position because the heat has damaged the bones and jing (essence).

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6 - blood and energy are produced at the level of the kidney. The rough pulse of the kidney denotes that blood and energy are hampered by an obstacle with formation of inflammatory tumors (anthrax). When blood and energy do not circulate, young girls do not have their menstruation (amenorrhea), and young boys present with hemorrhoids.” 135.

II - Ma Shi comments: “This paragraph studies the 6 pathologic natures of the kidney pulse. 1 - The hurried pulse is a pathologic pulse of the liver. If the kidney pulse is very hurried, it indicates illness of the bones and skull (Gu Tian) because the kidney governs the bones. This ailment is due to an infiltration of wind. In Chapter 22 (“Dian Kuang”) of this classic, we note: “The barely hurried pulse of the kidney is the sign revealing insufficiency of the kidney with infiltration of perverse wind, hence freezing cold limbs and paresthesias. This barely hurried pulse also indicates: a - the illness Bun Dun provoked by a chronic accumulation of the energy of the kidney. b - laxity of the lower limbs following the non-descent of the kidney energy. c - dysuria and difficult defecation owing to the loss of connection of the kidney energy with the intestinal and urinary routes.” The very hurried pulse of the kidney is the sign revealing illness of the bones and skull. This ailment evolves from interior to exterior. On the other hand, if the pulse is barely hurried, it evolves progressively from exterior to interior, and, once in the interior, its progression is also much slower.

2 - The late pulse is a pathologic pulse of the spleen. If the pulse of the kidney is very late, it is the sign of invasion of water by perverse earth. The kidney energy then becomes insufficient, and the subject feels a sensation of fracture in the vertebral column with inability to stand up because the kidney and bladder constitute an “Internal-External” system and because the bladder channel runs along the spine. If it is barely late, it is the sign of insufficiency of kidney energy. In this case, the energy of the spleen does not function, hence diarrhea containing undigested food or, sometimes, postprandial vomiting. 3 - The changing pulse is a pathologic pulse of the heart. If the kidney pulse is very changing, it is the sign revealing the excess of fire and shortage of water responsible for yin wei (sexual impotence). Barely changing, it is the sign of the presence of Shi shui (hard edema) of the infraumbilical region. Down below, this ailment reaches the hypogastrium giving it a ptotic appearance, and at the top it reaches the epigastrium. This illness is fatal. Also, Chapter 7 of the Suwen specifies: “yin and yang become concentrated because there is a plethora of yin and deficiency of yang. This state is the origin of hard edema”. 139. Note, however, that in Chapter 57 of this classic, Huangdi had also questioned Qi Bo on the formation of “Shi shui”, and the response occurs in Chapter 7 of the Suwen. As for this paragraph, it determines the localization of this affliction: “In the majority of cases, Shi shui manifests at the level of the abdominal segment of the kidney channel.” 4 - The small pulse is contrary to the changing pulse. If the pulse of the kidney is very small, it is the sign of the great insufficiency of the energy. The kidney can no longer control the xiajiao area (Lower Jiao), hence profuse diarrhea. Barely small, it is the sign of edema. Without treatment this ailment can transform into Jiao Dan (emaciation; extreme thinness). 5 - The slippery pulse is a pathologic pulse of the kidney.

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If it is very slippery, it is the sign of fullness of perverse energy at the level of the kidney. In this case, the bladder is contaminated, hence dysuria and cystitis or orchiepididymitis. Barely slippery, it is also the sign of insufficiency of kidney energy responsible for bony atrophy with inability to sit or stand up. sitting or standing provokes vertigo and dizziness. 6 - The rough pulse is a pathologic pulse of the lung. The very rough pulse of the kidney is the sign of insufficiency of blood and jing (essence); at the interior, it is ... (5)”.

PARAGRAPH 13 Huangdi: “In the presence of these “6 pathologic changes”, how must one needle?” Qi Bo:

“Generally, _ the hurried pulse comes from cold, _ the late pulse, from heat, _ the changing pulse, from abundance of energy and shortage of blood, _ the small pulse, from insufficiency of blood and energy, _ the slippery pulse, from fullness of yang energy with slight presence of heat, _ the rough pulse, from abundance of blood and shortage of energy with slight presence of cold. This is why. _ in the presence of a hurried pulse, needle deeply and leave the needle in place a long time 137. _ in the presence of a late pulse, needle superficially and rapidly remove the needle in order to eliminate the heat _ in the presence of a changing pulse, slightly disperse the energy without making it bleed _ in the presence of a slippery pulse, remove the needle rapidly, needle superficially to eliminate the yang energy and make it bleed _ in the presence of a rough pulse, carefully locate the channel, allowing the needle to stay in place according to the rules of “pursuit” and “go against”; as soon as the needle is removed, rapidly close the point of impact to maintain the pulsologic balance without allowing bleeding. _ in the presence of a small pulse, acupuncture is advised against because it is ineffective in cases of simultaneous insufficiency of yin and yang, blood and energy; one must resort to the sweet-flavored remedies. ”

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5. NVN: This phrase is incomplete. According to the editor of that time, he was missing two pages in the original text.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: 1 - The “6 pathologic changes” designate the 6 clinical aspects of the 5 organs responding to the 6 different types of pulses (hurried, late, changing, small, slippery and rough). They are due to a dissociation of yin and yang, of energy and blood, of cold and heat.

2 - The “cold” energy is a concentrated and tense energy; it is why this pulse is hurried. The “heat” energy is an energy which is diffuse; it is why its pulse is late. Tong qi (a priori, thoracic energy) and ying energy (nutritive) circulate within the channels, whereas wei (defensive) energy circulates outside the channels. This is why the changing (Da) pulse denotes an abundance of energy. If the energy and blood are insufficient, the pulse is small. If the yang energy in an excessive state is endowed with a weak heat, the pulse is slippery. If the energy is in insufficiency, the pulse is rough. All these pulses depend on the circulation of blood following the state of the energy. 3 - “Needle deeply and let the needle remain in place a long time”, is to await the arrival of the yang energy with sensation of heat at the point of the needle. “Superficially needle and take the needle out rapidly”, is to eliminate the heat. When the energy is in fullness, slight dispersion is necessary, without making it bleed, in the goal of harmonizing yin and yang, blood and energy. If the pulse is slippery, the removal of the needle is rapid and needling is superficial in order to clear the yang-heat energy located outside the channels. 138. If the pulse is rough, needling must fall exactly on the channel and the orientation of the needle must obey the rule known as “pursuit and in opposition”. This operation is obligatory to harmonize the energy and blood located within and outside the channel. Before needling, pressure-friction (massage) on the point of impact is necessary to make the energy located outside the channel return toward the area operated on. To rapidly close the point of impact is to prevent bleeding in the goal of regularizing the channels. Not letting the blood ooze is to maintain the harmony of blood and energy located within and outside the channels. The goal of needling is to regularize the disharmony of yin and yang, blood and energy. If the energy and blood are simultaneously insufficient, one must use the” sweet-flavored remedies” because, in this case, acupuncture does not give the expected results. The energy and blood come from yangming. In other words, under the action of the stomach, the “cereals” are transformed into energy and blood, one part of which circulates at the level of the pilocutaneous system and another part of which circulates within the channels reaching the entire body, the interior as well as the exterior, following a circle without end. This is why, if one knows how to regularize the “foot” pulse, it is not necessary to study the “inch” pulse, and if one knows how to regularize the pulse, it is not useful to observe the complexion. In practice, the great worker associates them. The great worker is one who knows the movements of Beginning and Ending and the movements of entering and exiting of yin and yang, of blood and energy.

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PARAGRAPH 14 Huangdi: “I have heard it said that the energy of the 5 organs and 6 bowels gathers at the he point in passing by the ying and shu points. By which route does it arrive in gathering and, during its gathering, through where does it pass? EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains 139. 1 - “The 12 jingmai (principal channels) of the 5 organs and 6 bowels begin at the jing point located at the tip of the digits which has the property of absorbing the energy and blood from the cutaneous level. Once in the channel, this blood and energy arrives at the ying (gushing) point and empties into the shu (transport) point, passes to the jing (passage) point and gathers at the elbow and knee at the he (gathering). For this reason, Huangdi desires to deeply explore the “5 shu” (antique) of the 5 organs and the “6 shu” (antique) of the 6 bowels and their entering and exiting movements, etc. But the “5 shu” (antiques) of the 5 organs have been shown in Chapter 2 (“Origin of the shu points”- Ban shu); this is why Qi Bo only speaks of the he points of the 6 bowels, sites of gathering of blood and energy, coming from the yuan point of the feet.

2 - wei (defensive) energy, whose production (from cereals) takes place at the level of the stomach or, more exactly, at the level of xiajiao (Lower Jiao), reaches the face and head to spread into the areas belonging to the yang channels (that is to say, outside the channels). The energy and blood circulating outside the channels comes from Wuli (LI 13) belonging to the Hand Yangming (see details, Chapter 2). In this way, the energy of the yang channels of the hand and foot circulate up and down, from superficial to deep, from the cutaneous level toward the channels. It penetrates into the channels via the jing-well of the foot, and from the foot it passes to the hand. This is why it is said: “The jingmai of the 6 bowels manifests at the 3 yang of the foot, then they anastomose with those of the hand like the yang energy of the center of earth ascends to heaven, then return to the earth to heat up the “routes of water” (jing shui: waterways)”.

PARAGRAPH 15 Huangdi: “What are the characteristics of the ying, shu and he points?” Qi Bo:

“The ying and shu points treat the channels, therefore the exterior, and the he point, the bowels, therefore the interior. Huangdi: “How do you treat the bowels?”

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Qi Bo:

“One treats them by the he point.”

Huangdi: “Do the he points have particular names?” Qi Bo:

“The he point of the stomach is Sanli (St 36). The he point of the large intestine is Juxu-Shanglian (St 37). The he point of the small intestine is Juxu-Xialian (St 39). The he point of the sanjiao (SJ) is weiyang (Bl 39). The he point of the bladder is weizhong (Bl 40). The he point of the gallbladder is Yanglingquan (GB 34)”.

Huangdi: “How Qi Bo:

140.

are

they

needled?”

“To needle Sanli (St 36), the leg is lowered. To needle Juxu (St 37 and 39), the leg is bent. To needle weiyang (Bl 39), the leg is first flexed, then extended. To needle weizhong (Bl 40), the 2 knees are bent. To needle Yanglingquan (GB 34), the 2 knees are bent to the same height; this point is found at the exterior of weiyang (Bl 39). To needle the points outside the channel, one must also have them precisely localized.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph defines the energy of the 3 yang as a synergistic energy of the 3 yang channels of the exterior and of the bowels of the interior.

taiyang, shaoyang and yangming are the energies of the 3 yang. These energies circulate outside the channels and penetrate into the jingmai of the 6 bowels via the ying (gushing) and shu (transport) points. This is why these 2 points treat ailments associated with the jingmai at the exterior. The blood and energy circulating within the channels and the energy of the 3 yang gather at the knees and elbows; this is why the he (gathering) point treats illnesses of the bowels. Because the blood circulating within the channels comes from the 6 bowels, the points Sanli (St 36), Juxu Shanglian (St 37) and Juxu Xialian (St 39) are the he (gathering) points of the Hand Yangming (LI) and Foot Yangming (St). Therefore, needling Sanli (St 36) is done with the leg dropped because this channel occurs at the lower part of the body. Needling the Juxu (St 37 and 39) is made with the foot lifted in order to relax the muscles of this area. weiyang (Bl 39), belonging to the Foot Taiyang (Bl), is the he (gathering) point of sanjiao (SJ). Needling this point is performed with the movements of flexion and extension to activate the circulation of energy of the sanjiao into this part of the body. 141. The bladder governs water which is why needling weizhong (Bl 40) is performed with the knee bent. shaoyang (GB) belongs to wood. This is why to needle Yanglingquan (GB 34) one must ask to

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bend the 2 knees to the same height so that the “wood” energy is well equilibrated (slack). The gallbladder (GB) and sanjiao (SJ) are the same energy: shaoyang. In conclusion, the jingmai (principal channels) divide into the channels of the hand and foot. But when one speaks of the energy of the 3 yin and 3 yang, this division no longer enters into play. “To needle the points outside the channels” implies that these points are none other than the ying (gushing) and shu (transport) points of the 5 organs and 6 bowels. At the moment of needling, one must ask to relax the arms and legs to facilitate the circulation of the channels. Huangdi’s question concerns the ying, shu and he points of the 5 organs and 6 bowels. Qi Bo’s response only furnishes the he point of the 6 bowels. This question and response are for the goal of applying the entering/exiting movements of yin and yang, blood and energy and the external-internal communications of the jingmai.”

PARAGRAPH 16 Huangdi: “Would you teach me about the diseases of the 6 bowels?” Qi Bo: Foot

“The sensation of heat of the face is the indicator of disease of the Yangming (St).

The abundance of blood in Yu luo (fish-vessel: longitudinal luo of lung) is the sign of attack of the Hand Yangming (LI). The hard and excavated pulse of the top of the foot (pedal pulse) is the sign revealing disease of the Foot Yangming (St). This pulse is specific in the determination of the energetic state of the stomach.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph defines the blood and energy circulating outside the channels. They come from the hand and Foot Yangming (LI and St). 142. 1 - wei (defensive) energy is han qi (“cold” energy) (6) of yangming. On the one hand, it reaches the cephalic region passing by the external canthus of the eye and the front of the ear to spread into the regions of the 3 yang; on the other hand, it descends and encircles the gums, following the yangming, arrives at renying (St 9) and descends to the top of the foot. In this way, to speak of the “sensation of heat of the face” is to determine the disease of the yangming with overheating (same in the event of irascibility) of the wei energy which flows toward the face.

2 - At the exterior, the jingmai of the 5 organs and 6 bowels answer to the 6 energies: taiyang, shaoyang, yangming, taiyin..., and in the interior they unite with the organs and bowels to constitute the pulsologic system: stomach pulse, heart pulse, kidney pulse... . In other words, in the interior, the energy of the 5 organs and 6 bowels unites with the “5 movements”: “wood” movement, “fire” movement, “metal” movement..., and at the exterior, with the 6 energies: wind, Cold, heat... .

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The energy and blood coming from the stomach-bowel are conducted outside the channels (principal) towards the Great luos; and, upon leaving these luos, they infiltrate into the sunluo 6. here, han qi designates “water”. In other words, wei (fire) energy comes from water (water produces fire).

(small luos or energetic capillaries) and into the skin. Then, they follow the Shou yangming (LI) channel to gather above at Yu luo, which is to say Chi Fu (cutaneous area associated with the “foot” pulse), all as the blood and energy circulating within the vessels and gathering into Chi Cun (“foot” pulse and “inch” pulse: radial pulse) of Hand Taiyin (Lu). This is why the text states: “The abundance of blood at the level of Yu luo is the sign revealing the attack the Hand Yangming (LI)”. This is aimed at demonstrating that the energy and blood circulating outside the vessels gather at the Hand Yangming (LI). This is the reason why, in order to answer Huangdi’s question on the diseases of the bowels, Qi Bo addresses those of the yangming first. We note, finally, that this classic often grasps the occasion of the appearance of the diseases in order to explain the notions concerning birth and beginning, entering and exiting of yin and yang, blood and energy and particularly the notion of the interior-exterior system of the jingmai of the 5 organs and 6 bowels. Our readers have certainly observed it.”

PARAGRAPH 17 diseases of the large intestine are characterized by sharp intestinal pains and boborygmi.

143.

In winter, the offensive of “cold” energy triggers diarrhea with umbilical pain preventing the prolonged standing position. diseases of the stomach present the same symptoms. One must needle Juxu Shanglian (ST 37). EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: 1 - The large intestine is an organ of transit and governs peristaltic movements. This is why, in the event of disturbances, signs of spasmodic colitis and boborygmi appear. 2 - yangming controls “metal-Purity”. In winter, attack on the large intestine by cold instantaneously triggers diarrhea with peri-umbilical pain. The large intestine controls the organic liquid. These permeate the osseous system. This is why, in the event of disturbances, the subject cannot maintain the prolonged standing position. 3 - The large intestine and stomach constitute the yangming system. This is the reason why, in case of disturbances, the stomach presents these same symptoms as the large intestine. 4 - Juxu Shanglian (St 37) belonging to the stomach channel is the he point of the large intestine”.

PARAGRAPH 18 diseases of the stomach are characterized by abdominal bloating and gastralgia with energetic obstruction at the level of the upper limbs, hypochondria, diaphragm and esophagus; foods do not descend.

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One must needle Sanli (St 36).

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The abdomen is the rampart of the stomach and intestines. The cardia is found behind Jiu wei (xiphoid appendage: CV 15), just below the heart. In the event of stomach problems, the clinical manifestations are essentially abdominal bloating and pain of the cardia (cardialgia, gastralgia). The upper limbs are dependent on the heart and lungs. The hypochondria are associated with the liver. 144. Once arriving in the stomach, foods are transformed into pure cereal energy (sheng qi) which spreads to the liver, and into impure cereal energy (Zhou qi) which goes to the heart and, from there, to the lungs. In the event of stomach problems, this energy circulates in the wrong way and its physiologic function is stopped, hence circulatory obstruction at the level of the upper limbs, hypochondria, diaphragm, esophagus. It is advised to needle Sanli (St 36).”

II - Ma Shi comments: “These 3 paragraphs (16, 17 and 18) study the diseases of hand and Foot Yangming (LI and St) and their treatment by acupuncture.

1 - Foot Yangming designates the energy of the stomach. Its vessels reach the face. This is why “warm face” is a sign of disturbance of the Foot Yangming (St). 2 - Hand Yangming designates the energy of the large intestine. Yu luo (Fish-luo: longitudinal vessel of lung) is the vessel which goes around the base of the thenar eminence between yangxi (LI 5) and Lieque (Lu 7). Yu luo is in relationship with the large intestine; this is why congestion of Yu luo is a pathognomonic sign of the large intestine. 3 - The raised (hard) or sinking (soft) pulse of the top of the foot is located at the level of Chongyang (St 42) and Jiexi (St 41). This pulse is specific in determination of diseases of the Foot Yangming (St). 4 - diseases of the large intestine manifest as sharp abdominal pains and boborygmi. Boborygmi results from the outflowing of water into the intestinal surface from the ascent of the energy. In winter, the aggression of cold immediately transforms them into diarrhea. Peri-umbilical pains with inability to hold a standing posture are presented because the large intestine is precisely located in this region. As Juxu Shanglian (St 37), belonging to the stomach channel, is the he point of the large intestine and as the large intestine and stomach make up part of the same system of yangming, the text has chosen this point in the treatment of ailments of this bowel (LI). 5 - In diseases of the stomach, the abdomen is swollen with pain of the cardia located below the heart (cardialgia or gastralgia). The circulation of the energy at the level of the upper limbs and hypochondria, diaphragm and esophagus is obstruct. One must needle Sanli (St 36) of the stomach channel.”

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PARAGRAPH 19 diseases of the small intestine are characterized by pains in the lower abdomen with radiation to the lumbar region and spine to the testicles. Sometimes the pains are sharp and followed by tenesmus. 145.

The sensation of heat in front of the ears, the sensation of cold or of heat at the shoulders and between the little and ring fingers and the weakening of the channel-vessel are the symptoms associated with diseases of the Hand Taiyang (SI). One must needle Juxu Xianlian (St 39). EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: 1 - diseases of the small intestine are due to disorders of the energy of this bowel. The small intestine also has the name “Chi Chang” (red intestine). It has the role of separating “pure” and “impure” (decantation). Therefore, its function basically consists of controlling the formation of liquids and bringing “purified water” toward the bladder. Consequently, the energy of the small intestine is closely linked to that of the bladder. Therefore, pains in the lower abdomen always bring with it pain in the lumbar area, spine and testicles. 2 - These symptoms denote that the disease of the Hand Taiyang (SI) channel is the result of that of the bowel. One must needle Juxu Xialian (St 39), he point of the small intestine. II - Ma Shi comments: “This paragraph studies disease of the Hand Taiyang (SI) and its treatment. 1 - The small intestine is located in the lower abdomen and is bounded behind by the lumbar area/spine; its energy is linked to that of the testicles. Also, in the event of disturbances, intestinal pains radiate toward these regions. Sometimes, these pains present with a burning sensation and desire to move the bowels. 2 - The small intestine channel starts at the external ungual angle of the little finger, ascends to the wrist, passes through the forearm, reaches the elbow, runs along the posterior side of the arm, goes up to the neck, reaches the cheek where it divides into 2 branches: one arrives in front of the ear and the other at the internal canthus of the eye. In this manner therefore, the sensation of heat in front of the ear, the sensation of cold or heat of the shoulders, the sensation of heat at the 4th metacarpal space and the weakening of certain spots on the trajectory of the small intestine channel are the signs of attack of the Hand Taiyang (SI). On the stomach channel, one finds Juxu Xialian (St 39), he point of the small intestine. This is the specific point in the treatment of diseases of this bowel.”

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PARAGRAPH 20

146.

In diseases of the sanjiao (SJ), the abdomen is bloated, the lower belly is tense and urination is difficult. In serious cases, water overflows and transforms into dropsy ( e d e m a ) or ascites. At the exterior, this syndrome has an influence on the Da luo (great luo) of the Foot Taiyang (Bl); the Da luo of the sanjiao (SJ) is located between taiyang (Bl) and shaoyang (GB). One must needle weiyang (Bl 39).

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: 1 - The sanjiao (SJ) adheres down below to the bladder. In the event of problems, the energetic system is immobilized and loses its transformative functions, hence abdominal bloating and oligo-anuria. water overflows and stagnates within the peritoneum, hence ascites.

2 - At the exterior, this syndrome can be detected by the visibility of Da luo (great luo) of Foot Taiyang (Bl) and Da luo of Hand Shaoyang (SJ) located on the leg between the taiyang (Bl) and shaoyang (GB). Treatment consists of needling weiyang (Bl 39).

II - Ma Shi comments: “This paragraph concerns diseases of the sanjiao (SJ) and their acupuncture treatment. 1 - The Hand Shaoyang channel (SJ) penetrates into Quepen (St 12), spreads to Tanzhong (CV 17), connects to the xinbao (XB), descends to the diaphragm and unites with the “3 exits/ outlets” (sources: cores/nucleus) of the sanjiao (SJ): shangjiao (Upper Jiao), zhongjiao (middle jiao) and xiajiao (Lower Jiao). In the event of problems, the abdomen is filled up with air and the lower belly is tense and hard. The sanjiao (SJ) is a unique apparatus responsible for the energetic metabolism of the entire organism. In the event of disturbances, oligo-anuria is the rule. water stagnates in the interior of the abdomen, hence ascites. weiyang (Bl 39), located at the external border of the the popliteal crease between the 2 tendons, is the he point of the sanjiao (SJ). When the sanjiao (SJ) is affected, the vessel located at this level is weakened.”

PARAGRAPH 21 In diseases of the bladder, the lower abdomen is inflamed and painful; palpation causes a false desire to urinate. 147.

The top of the shoulder is warm, and the vessel there is weakened.

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Furthermore, the subject feels a heat sensation at the external part of the little toe and behind the external malleolus; if the vessel there is weakened, one must needle weizhong (Bl 40). EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The bladder is the “palace” of organic liquid. It is the last relay of energetic transformation. When the palace is affected, the lower abdomen is tense and painful with inability to urinate. The top of the shoulder, external part of the little toe and posterior area of the external malleolus are the sites of passage of the Foot Taiyang (Bl). A sensation of heat in these regions is the sign revealing contamination of the channel (Bl) by disease of the bowel (Bl). Its treatment consists of needling weizhong (Bl 40).”

II - Ma Shi comments: “This paragraph concerns diseases of the bladder and their acupuncture treatment. Inflammation and pain of the lower abdomen and desire to urinate when the abdomen is palpated in this region are the signs revealing disease of the bladder. The top of the shoulder is warm, and the channel-vessel which is found there is weakened because this region is the site of passage of the dorsal trunk of the bladder channel on which is found the following points: Dazhu (Bl 11), Fengmen (Bl 12). The external edge of the little toe and region posterior to the external malleolus are warm, and the channel which is found there is weakened because these regions belong to the Foot Taiyang (Bl) on which the points zhiyin (Bl 67), Tongqu (Bl 66), shugu (Bl 65), jinggu (Bl 64), jinmen (Bl 63), shenmai (Bl 62), Pushen (Bl 61), Kunlun (Bl 60), Fuyang (Bl 59), Feiyang (Bl 58), etc. are found. weizhong (Bl 40) is the he point of the Foot Taiyang (Bl). For this reason, one uses it to treat diseases of the bladder.”

PARAGRAPH 22 In diseases of the gallbladder, sighs are frequent, the mouth is bitter and vomiting is sour; the subject has fear with the feeling of being confined. Furthermore, laryngeal sounds and frequent expectoration are often observed. The “root” (Ben) and “summit” (Jiao) of the Foot Shaoyang (GB) are simultaneously affected. One must observe the sites of weakening of the channel-vessel in order to apply moxabustion there. In the event of “Cold-heat” (fever-chills), one must needle Yanglingquan (GB 34). EXPLANATIONS AND COMMENTARIES

148.

I - Zhang Shi explains: 1 - “The gallbladder being affected, its energy cannot be directed toward the top, and the individual has need to attract it toward the lungs, hence frequent sighs. Bitter mouth and sour vomiting originate from the bile. Fear and the feeling of being confined indicate emptiness of the energy of the gallbladder.

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Laryngeal sounds and frequent expectoration reveal that the channel-vessel (Foot Shaoyang-GB) is affected. 2 - The “root” designates the lower part and “summit”, the cervico-dorsal region. Moxabustion is applied to rectify the weakened parts (to tonify the emptiness). The illness “Cold-heat” is associated with the “intermediary” (hinge) channel (midexternal, mid-internal). This means to say that the energy of the gallbladder is sometimes directed toward the exterior (taiyang), sometimes toward the interior (yangming). Yanglingquan (GB 34) is the he point of the Foot Shaoyang (GB).” II - Ma Shi comments: “This paragraph concerns diseases of the gallbladder and their acupuncture treatment. Frequent sighs, bitter mouth, sour vomiting, fear and the impression of being confined are the signs of emptiness of the gallbladder energy. Laryngeal sounds and frequent expectoration are due to the presence of perverse energy in the gallbladder. In practice, one must observe well the “root” and “summit” of Foot Shaoyang (GB). The points and the beginning of the jingmai are the “root”, and the points and the end of the jingmai are the “summit”. Apply moxabustion to the weakened sites of the channel. In contrast, in the case of “Cold-heat” illness (fever-chills), one must needle Yanglingquan (GB 34).”

PARAGRAPH 23

149.

Huangdi: “What is the Dao (rule, law) of needling?” Qi Bo:

“Needling must access the energy of the point of impact without injuring the flesh. In reaching the energy of the point, the needle slips into the opening without encountering any obstacle; reaching the flesh, it provokes pain at the level of the skin. Tonification and dispersion are utilized in spite of the rule worsening the disease. If the needle injures the muscles, it provokes laxity. Not being expelled, the perverse energy enters into conflict with the Zhen qi (source energy); it works its way in and settles in the interior. Needling

without

judgment

carries

with

it

opposite

reactions.”

EXPLANATIONS AND COMMENTARIES I- Zhang Shi explains: “The energy of the point of impact (qi Xue) originates from the bowels via the jingmai. When the needle succeeds in contacting it, the point is penetrated with ease as if it slips into a crack. Also, Chapter 37 of the Suwen (“Dissertation on the energy and blood”: qi Xue lun) has stated: “When the needle falls exactly into the crack, it does not encounter any obstacle.” Perverse energy of the bowel reaches the exterior via the jingmai and manifests at the level of the points of impact. This process of propagation of the disease confirms the reactive effects cited in the previous paragraphs:

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_“Warm face is the indicator of disease of the Foot Yangming (St)” (Paragraph 16), _ “Congestion of Yu luo indicates disease of Hand Yangming (LI)” (Paragraph 16), etc. These explanations demonstrate that the energy of the bowels exteriorizes at the skin via the jingmai system. The skin, flesh, muscles and bones... are the sites of distribution of the energy (precisely, the jing: essence) located outside the channels. If the needle reaches the flesh (sites devoid of points), it provokes pain in the skin; if it reaches the muscles, these become lax. In these two cases, the perverse energy has not been excreted; to the contrary, it provokes disturbance of the Zhen qi (source energy, vital or essential energy) and drives it into the organism. In other words, an erroneous needling does not remove the perverse energy; it causes serious perturbations at the level of the Zhen qi because the energy and blood circulating outside the jingmai reveals itself to the channels without penetrating into the bowels, as has already been stated in Paragraph 16: “The firm and excavated pulse of the top of the foot (pedal pulse) heralds disease of the Foot Yangming (St)” and not that of the stomach bowel. 150. This is the reason why, in the course of commentaries of Paragraph 16, I have attracted the attention of physicians to the notions concerning “the Beginning and Ending, entering and leaving, of yin and yang, of blood and energy”to which we must obey, never opposing it.” II - Ma Shi comments: “This paragraph concerns the rules of needling. Not observing them worsens the disease. When needling, one must attain the point, site of gathering of the energy circulating in the channel, without injuring the connective tissues. Because, when the needle reaches the energy of the point of impact, it becomes freely engaged as if it penetrates into a crevice and unobstructs the energy and the channel. If one injures the flesh, one provokes pain. If one injures the muscles, one provokes laxity. If, at the site of tonification, one disperses or vice versa, one worsens the disease. This is why the non-evacuation of the perverse energy by a technical error is the origin of perturbation of the Zhen qi (source energy).”

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151.

CHAPTER V Origin and Gathering (Gen Jie)

Chapter 5 of the Lingshu is devoted to the therapeutic effects of the “origin points” and “gathering points”. The origin points are the sites of departure of the energy of the channels, and the “gathering points” are the sites of regrouping of this energy. The yin and yang channels are endowed with the function of opening (Gai), closing (Za) and hinge (Zhu) permitting the establishment of the system of connection of the interior and exterior. Disturbance of these functions are the origin of diseases. The localization and naming of the origin points and gathering points are well defined in this chapter. The “origin points”, “gathering points” and “departure points” of the 3 yang channels of the foot and hand are also made the object of detailed study. The excessive or insufficient number of beats of the pulse studied according to the cyclic circulation of the channels of the human body (50 turns in 24 h) is also presented with the aim of determining the state of energy in order to adopt therapeutic rules: “According to the constitution of the patient, needling is rapid or slow, superficial or deep, and the sessions repeated or spaced out.” Briefly, this chapter concerns the study of the Beginning and Ending of the jingmai with therapeutic aim, hence the title “Origin and Gathering (Gen Jie)”. This chapter comprises 7 paragraphs.

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PARAGRAPH 1

152.

Qi Bo says: “heaven and earth enter into symbiosis, the cold and the heat t u r n . How does the Dao of yin and yang come to pass, and how are their excess and insufficiency? The Dao of yin responds to even numbers and that of yang to odd numbers. In spring and summer, yin is weak and yang is excessive; the branches and leaves wither and dry out; the rain and humidity return; yin and yang follow these movements and enter into disequilibrium. How then does one tonify or disperse? When the curious perverse energy (qi Xie) leaves the channel, one can longer count the diseases. If one breaks open the “door” (guan), ignorant of the “origin points” (Gen points) and “gathering points” (Jie points) of the 5 organs and 6 bowels, the hinge (Zhu) deteriorates, the movements of opening (Gai) and closing (Za) no longer function; yin and yang become totally disordered and irretrievable. The profound meaning of the 9 Needles has its “nodes” and its “hinges” in the chapter entitled “Beginning and Ending” (Chapter 9). This is why ignoring the Beginning and Ending is to expose the Dao of needling to errors.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph defines the movements of “opening”, “closing” and “hinge” of the 3 yin and 3 yang energies. These movements are indiscernible; because of these movements, the energy enters and exits within the entire body to unite with the channels which are discernible. a - In man, yin and yang respond to the 6 energies of heaven; these unite with the 4 seasons. Spring and summer are yang. In the course of these 2 seasons, yang energy is born and grows while yin weakens and declines. Autumn and winter are yin. In the course of these 2 seasons, yin energy is born and grows while yang weakens and declines. In man, the opening and closing movements of yin and yang function following the rhythm of the 4 seasons. For this reason, in spring and summer, the renying pulse (left radial pulse) is slightly changing (Da), and in autumn and winter the Cun Kou pulse (right radial pulse) is also changing (Da). These pulses denote the good health of the individual.

b - The disordered perverse energy leaves the channel implies that, once in the channel, it reaches the Dai luo (great secondary vessels) to trigger a significant number of individual diseases. 153. The origin and gathering designates the places called “roots” and “summits” where the energy of the jingmai begin and end.

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Opening, closing and hinge define the movements of the 6 energies belonging to the organs and bowels, to yin and yang. Beginning and Ending implies the departure and termination of the circulation of the jingmai, of the blood and energy. II - Ma Shi comments: “This paragraph places emphasis on the significance of the “9 Needles” (Ch. 1 of this classic) whose “node” and “root” are found in Chapter 9. 1 - Symbiotically, heaven and earth create yin and yang. The Dao of yin and that of yang basically reside in the alternation of their excess and their insufficiency. The Dao of yin is the even number and that of yang the odd number. Via the intermediary of this yin and yang, man becomes united to heaven and earth.

2 - In diseases during the course of the 2 seasons of spring and summer, the yin energy is insufficient and yang energy is excessive. yin and yang are then in disequilibrium, hence the question: “At the level of which channel must one tonify or disperse?” 3 - The curious perverse energy is a type of disordered perverse energy. “Perverse energy leaves the channel” implies that the perverse energy localized in a channel passes to another channel. The site of departure of the energy of the channel bears the name “origin”, and the site of concentration of this energy, “gathering”. Chapter 27 of the Suwen (“Study on the Separation and Gathering of Mental energy and Perverse energy”) states: “taiyang is the opening. yangming is the closing. shaoyang is the hinge. taiyin is the opening. jueyin is the closing. shaoyin is the hinge.” This assertion corresponds to the terms cited in this paragraph, except for “guan” (door) because this word “door” is the necessary component of the movements of “opening, closing and hinge”. 4 - “Beginning and Ending” is the title of Chapter 9 of this classic. “The acupuncturist who ignores the origin points (Gen) and the “gathering points” (Jie) is responsible for phenomena of deterioration of the“hinge” with non-airtight “opening” and “closing”, hence escape without hope of return. 154. In the above-cited chapter (Ch. 1), the marvelous method of the “9 Needles” and the notions of “node points” and “hinge points” are clearly explained. In our time, some practitioners know it and others do not, hence the two categories of physicians, good and less good.”

III - N.V.N.: The words “origin” and “gathering” designate the “roots” and “nodes”. In practice, among the points utilized, some are considered “root points”, which is to say the points of departure of the energy, and the others “ligature points” or “node points” or also points of attachment of the energy, which is to say particularly sensitive and important points or points of concentration of perverse energy. a - “guan” mean: door. “shu”: hinge

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“Gai”: opening “Za”: closing b - “Door broken, hinge worn out... escape of the energy”, illustrates the movements of the energy of the 3 yin and 3 yang from an erroneous application of needling. c - The exact sense of these aphorisms: “taiyang is the opening; yangming is the closing; the shaoyang is the hinge” is the following: _ taiyang is outside as in front of an open door. _ yangming is inside as behind a closed door. _ shaoyang is on the doorstep as the hinge turns towards the outside or towards the inside. These imaged terms symbolize the complete or incomplete movements of entering and exiting of the energy of the 3 yang channels. d - In Chapter 9 of this classic, Qi Bo examines the diseases of the 6 yang channels at the level of the renying pulse (left radial pulse) and the diseases of the 6 yin channels at the level of the Cun Kou (right radial pulse). In the case of fullness of yang and emptiness of yin, one must tonify yin and disperse yang, and, in the opposite case, one must disperse yin and tonify yang. This method is considered prodigious. e - In 1969, Chamfrault and ourselves, introduced for the first time in the Western world this important study based on the movements of the 3 yin and 3 yang, impeccable study of this classic. (1)

PARAGRAPH 2

155.

“ T h e origin of the taiyang channel is found at zhiyin (Bl 67) and its g a t h e r i n g , at Mingmen. Mingmen is located at the eyes (jingmen- Bl 1). The origin of the yangming channel is found at Lidui (St 45) and its g a t h e r i n g, at Zang Da. Zang Da is located above and in front of the ear. (Touwei- St 8). The origin of the shaoyang channel is found at qiaoyin (GB 44) at its g a t h e r i n g, at Chuang Long. Chuang Long communicates with the interior of the ear. (Tinggong- SI 19 whose branch deeply penetrates into the ear). • taiyang is the o p e n i n g ; yangming is the c l o s i n g and shaoyang is the h i n g e . When the “opening” is broken, the muscular fibers are crushed and dilated and the illness spontaneously arises. It is why, in the individual affected by this illness, one must needle the taiyang channel and observe for the state of fullness or emptiness in order to disperse or tonify. This sudden illness is characterized by skin desquamation and general weakness. When the “closing” is forced, the energy no longer has a place to stop and the illness manifests as atrophic impotence (wei). One must needle the yangming and observe for the state of fullness or emptiness in order to disperse or tonify. The phrase “the energy no longer has a place to stop” implies that the Zhen qi (energy source) is impeded resulting in a concentration of perverse energy.

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1. See “Human energy” and “Energetic Pathology and Pathogenesis in Traditional Chinese Medicine”, NVN Edition, 19691971.

When the “hinge” is deteriorated, the bones are not maintained and the feet can no longer be placed on the earth. One must needle the shaoyang and observe for the state of fullness or emptiness in order to disperse or tonify. Non-maintenance of the bones denotes joint laxity with lack of flexion and extension. To treat this illness, one must carefully examine its “root”. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “1 - taiyang and taiyin constitute the system of opening; yangming and jueyin, the system of closing, and shaoyin and shaoyang, the hinge system. Such are the characteristics of the energy of the 3 yin and 3 yang.

2 - The word “Tai” implies the plethoric state of the energy. This is why taiyang and taiyin open to the exterior (opening). yangming designates the union of the 2 yang energies, factor activating the light, and jueyin, the ending of the 2 yin energies. This is why they govern the interior (closing). The word “Shao” designates the start of the activity of the birth energies. This is why shaoyang and shaoyin govern the “hinge”. 156. In the interior, these 6 yin and yang energies (taiyang, taiyin, yangming, jueyin, shaoyang and shaoyin) unite with the organs and bowels, and, at the exterior, with the 6 channels whose circulation is in harmony with the circumduction of the energy of si Tian and Taiquan (celestial energies). Once in man, this cosmic energy evolves according to the route of the 6 channels to trigger, for example, the Shanhan diseases (evolutive diseases of Cold); sometimes, they become united with the channels at the level of the “origin points” and “gathering points”. “Gen” (origin) is the site of departure of the birth energy. “Jie” (gathering) is the site of the union of the energy of the channel at the level of such points as Mingmen, Chuang Long... by which the energy leaves the channel to reach the “orifices”. taiyang designates water and fire, sources of life, and Mingmen (door of life), the eyes, sites of entry and exit of the energy of the channel (It is the point jingming- Bl 1). Zang Da is located in front of the superior auricular angle (It is the point Tou wei- St 8). Chuang Long sends a vessel to the interior of the ear (It is the point Tinggong- SI 19). • The energy of the 3 yang follows the channels and gathers at these 3 points; then from there, it reaches the “cave of energy” (qi Jie) and irrigates the corresponding territories, developing, in this manner, the movements of “opening-closing-hinge” and of “entering-exiting” at the level of the jingmai and of the organs and bowels. “Opening” and “closing” are the words used to compare the movements of the energy to those of the flap of a door, and “hinge”, to compare the movements of the energy to that of a hinge by which the strap hinges turn. Without the “hinge”, the door can neither be opened nor closed. Without the “opening” and “closing”, the hinge does not function. In this manner, because of the movements of the 3 yin and 3 yang, the energy enters and exits at the level of the interior and exterior of the skin, the jingmai and the organs-bowels. • The energy of taiyang governs the cutaneous system. For this reason, when the “opening” and “closing” is fractured, the muscles are damaged.

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Tong qi (a priori or thoracic energy) directs the activity of yangming at the level of the upper part of the body. This energy follows the respiratory route and spreads out at the level of the 4 limbs. This is why, when the “closing” is worn out, “the energy has no place to stop” and the disease is characterized by atrophic impotence (wei). shaoyang manages the tendino-osseous system. This is why, when the “hinge” is damaged, the joints become lax (functional disability). 157.

Chapter 6 (“Study of the Separation and Union of yin and yang”) of the Suwen states: “taiyang, whose origin (root) occurs at zhi yin (Bl 67), is called “yang in yin”. yangming, whose origin (root) occurs at Lidui (St 45), also has the name “yang in yin”. shaoyang, whose origin (root) is qiaoyin (GB 44), is also named “yang in yin.” In summary, the 3 yin energies and that of the 3 yang come entirely from yin and go from below upward. One must carefully examine their root.” Yu Shi states: “The energy of the 3 yang follow the routes of the channels and reach the “caves of energy” (sinus) of the face to penetrate into the “orifices”. The jing yang (yang essence) of the taiyang reaches the eyes to maintain the pupil; Bie qi (distinct energy) of the shaoyang reaches the ears to maintain hearing; Tong qi (a priori or thoracic energy) coming from the yangming reaches the nose to maintain the sense of smell. Tong qi originates from shangjiao (Upper Jiao= cardia). At the top, it gathers in the thorax to control respiration. II - Ma Shi comments:

“This paragraph is devoted to the origin points and gathering points of the 3 yang channels of the foot. 1 - The origin point (root) of Foot Taiyang (Bl) is zhiyin (Bl 67), located at the external edge of the little toe at a “he” leaf’s distance (about 2 mm) from the ungual angle. Needle depth 0.1 cun, left in during 5 expirations and moxa 3 times. The gathering point of this channel is Mingmen. here, the word “Mingmen” designates the eyes, that is to say jingmen (Bl 1) located 0.1 cun outside the internal canthus of the eye. Needle depth 0.1 cun, left in for 6 expirations, moxa forbidden. 2 - The origin point of Foot Yangming (St) is Lidui (St 45), located at the tip of the second toe near the external ungual angle about one “he” leaf width. Needle depth 0.1 cun, moxa 3 times. The gathering point of this channel is Touwei (St 8) located at the angle of the forehead, in the scalp line, 1.5 cm. from Benshen (GB 13) and 4.5 cm. from shenting (GV 24). Needle depth 0.3 cun, moxa forbidden. 3 - The origin point of Foot Shaoyang (GB) is qiaoyin (GB 44), located at the external ungual angle of the 4th toe. Needle depth 0.1 cun, left in during 1 expiration, moxa 3 times. The gathering point of this channel is Chuang Long, located within the ear, that is to say at Tinggong (SI 19), located in front of the tragus in a crease which is formed when one opens the mouth. Needle depth 0.3 cun.

III - N.V.N.: 158. 1 - In relation to Tinggong (SI 19), gathering point of Foot Shaoyang (GB), a number of objections have been issued over the centuries. According to us, Tinggong (SI 19) is indeed the gathering point of the energy of Foot Shaoyang (GB). In effect, it is stated in Paragraph 3 (see below): “The gathering point of Foot Shaoyin (Ki) is Lingquan (CV 23) and that of Foot Jueyin (Li)

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is Yuying (other name Yutang- CV 18). Therefore, we can conclude that the energy of a channel is not forced to gather at the end of the same channel. According to the characteristics of each channel, the energy can gather at the level of another channel following the processes of “opening-closing-hinge” that is specific to it. 2 - The “opening-closing-hinge” movements of the 3 yin and 3 yang are of prime importance in therapy. In effect, _ taiyang is the 3rd yang. It occurs at the most superficial level of the 3 yang. It therefore governs the “opening”. _ yangming is the 2nd yang. It occurs in the medial zone of the 3 yang and, therefore, governs the “closing”. _ shaoyang is the 1st yang. It is found in the deepest zone of the 3 yang and plays the role of “hinge”. (Figure. 11) In this way, when the “opening” is worn out, the muscles are squashed. One must needle the taiyang (Bl) and evaluate for the excessive or insufficient state to disperse or tonify. When the “closing” is broken open,”the energy has no place to stop”, hence, atrophic impotence (wei). One must needle the Foot Yangming (St) and observe for the excessive or insufficient state in order to disperse or tonify. When the “hinge” is demolished, the bones are not maintained; one must needle the Foot Shaoyang (GB) and observe for the excessive or insufficient state in order to disperse or tonify. 3 - The terms “muscles are squashed, bones not maintained and absence of a place to stop” illustrate the clinical aspects resulting from these phenomena of “door broken open, hinge damaged, opening and closing without function”. This is why, therapeutically, one must always examine the “root” and “summit” of the disease. 4 - Do not confuse these movements with the superficial and deep circulation of the 3 yin and 3 yang (notions we had presented in 1969 in our works). 159.

Figure 11

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“Opening-closing-hinge” movements of the 3 yang.

Figure 12 “Gathering points” of the 3 yang of the foot.

PARAGRAPH 3 The “origin” of taiyin occurs at Yinbai (Sp 1) and its “gathering” at Taishang (other name Zhongwan) (CV 12). 160. The “origin” of shaoyin (Ki) occurs at Yongquan (Ki 1) and its “gathering” at Lingquan (CV 23). The “origin” of the jueyin (Li) occurs at Dadun (Li 1); its “gathering” at Yuying (other name Yutang- CV 18) and its “luo” at Tanchong (CV 17). • taiyin is the “opening”, jueyin is the “closing” and shaoyin is the “hinge”. This is why, _ when the opening is broken open, food metabolism is damaged and the diaphragm is closed. In obstruction of the diaphragm, one must needle the taiyin (Sp) and carefully observe for the excessive or insufficient state in order to practice dispersion or tonification. _ when the closing is worn out, the energy and blood are annihilated, and the individual is open to illness. To treat the affliction, one must needle the jueyin (Li) and observe for the excessive or insufficient state in order to carry out dispersion or tonification. _ when the hinge is demolished, certain places on the vessel are obstructed. This is why in stases (obstructions), it is advised to needle

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the shaoyin (Ki) and carefully observe for the excessive or insufficient state in order to carry out dispersion or tonification. recall that all of these obstructions or stases come from insufficiency.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “1- Tai Shang (Taicang) designates the base of the tongue. The spleen is a metabolizing organ of nutritive substances. Its vessel links to the base of the tongue and spreads into the sublingual region because the base of the tongue is the site of gathering of the food bolus (2).

2 - Lianquan (CV 23) belonging to renmai (CV) is located at the middle of the neck above the pharynx. renmai has its source in the kidney; this is why the energy of shaoyin (Ki) gathers at Lingquan (CV 23). Chapter 52 (“Defensive energy”) of this classic states: “The “summit” of jueyin (Li) occurs at the shu point of the back...”. By that, Yuying (or Yutang- CV 18) must be located on the back... .The “luo” (secondary branch) of jueyin occurs at Tanzhong (CV 17) because the vessel of the liver crosses the diaphragm and passes by this point. 3 - The spleen is a food metabolizing organ. This is why when the opening is broken open, the diaphragm is obstructed and the energy becomes insufficient. In Ge Rong (diaphragmatic obstruction), at the top, foods cannot pass, and down below the intestines lose their tone, hence post-prandial diarrhea. 161. 4 - jueyin is the site of termination of the 2 yin. At the culmination of yin is the birth of yang. This is why when the “closing” is broken open, the vital energy becomes exhausted and the individual tends to be distressed. The energy of the “1st yang” comes from the kidney organ. Because zhi (will) is not fulfilled in perfect fashion, the individual is prone to affliction. 5 - shaoyin controls the system of vessels. This is why when the “hinge” is broken open, the vessels present with stases at certain places. In this way, in the case of stasis or obstruction, one must needle shaoyin and observe for the excessive or insufficient state to disperse or tonify. 6 - The previous paragraph emphasized that all syndromes of accumulations or stases must be considered syndromes of insufficiency. This means to say that the excess is due to the accumulation of perverse energy and insufficiency is synonymous with deficiency of the essential energy. To combat this accumulation of perverse energy, one must reinforce the potential of the essential energy.” II - Ma Shi comments: “This paragraph studies the origin and gathering points of the 3 yin of the foot and their techniques of use. 1 - The origin of Foot Taiyin (Sp) is at Yinbai (Sp 1), a “he” leaf width from the internal ungual angle of the great toe. Needle depth 0.1 cun, left in for 3 expirations, moxa 3 times. The gathering point of this channel is Tai Shang (Zhongwan- CV 12), belonging to the renmai (CV), located 4 cun above the umbilicus. Needle depth 0.8 cun, moxa 7 times.

2 - The origin point of Foot Shaoyin (Ki) is Yongquan (Ki 1), located in the plantar crease. Needle depth 0.3 cun, left in during 3 expirations, moxa 3 times.

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2. For Ma Shi and us, Tai Shang is another name for Zhongwan- See “Art and Practice of Acupuncture and Moxabustion”, Vol. III- NVN Edition.

The gathering point of this channel is Lianquan (CV 23- other name Sheben), located on the neck above the pharynx and below the chin. Needle depth 0.2 cun, left in for 7 expirations, moxa 3 times. 3 - The origin point of jueyin (Li) is Dadun (Li 1), located behind the nail of the great toe, 1 cun from a “he” leaf, at the place of reunion of the “three hairs”; according to another argument, at the internal ungual angle is Yinbai (Sp 1) and at the external angle is Dadun (Li 1). Needle depth 0.3 cun, left in during 10 expirations, moxa 3 times. The gathering point of this channel is Yuying (also Yutang- CV 18), belonging to the renmai (CV), located 1.6 cun below Zigong (CV 19). Needle depth 0.3 cun, moxa 3 times. The luo (branching vessel) is linked to Tanzhong (CV 17), located 1.6 cun below Yuying (CV 18) in a crease at the midline joining the two breasts. Needling is forbidden, moxa 5 times. 162.

4 - The taiyin is the “3rd yin”, located within the superficial layer of yin. Therefore, it controls the “opening” of the door. The jueyin is the “1st yin”, located within the deep layer of yin. Therefore, it controls the “closing” of the door. The shaoyin is the “2nd yin”, located within the middle layer of yin. Therefore, it controls the “hinge” of the door. In this way, when the “opening” has deteriorated, the spleen loses its function of food assimilation, and the metabolizing organ function is altered, hence diaphragmatic obstruction and post-prandial diarrhea. In this case, one must needle the Foot Taiyin (Sp) and carefully observe for the excessive or insufficient state in order to perform dispersion or tonification (3). When the “closing” has deteriorated, the liver energy is annihilated, and the subject has the tendency to be afflicted. Also, in cases of destruction of the energy and affliction, one must needle jueyin and carefully observe for emptiness or fullness in order to tonify or disperse. When the “hinge” is torn down, the kidney vessel presents at certain sites the phenomena of stasis with obstruction of xiajiao (Lower Jiao). In this manner, in the individual suffering from signs of engorgement of xiajiao, it is strongly advised to needle Foot Shaoyin (Ki) and carefully observe for the excessive or insufficient state in order to tonify or disperse. In the reasoning of the mechanism of stasis or obstruction, one must not consider them, thoughtlessly, as syndromes of fullness, but always as syndromes of insufficiency.”

III - N.V.N.: a - According to Yu Shi, “_ Hand Taiyin (Lu) and Hand Jueyin (XB) are controlled by Tong qi (ancestral, a priori or thoracic energy). _ shaoyin (Ki) and jueyin (Li) reach the skull and brain under the action of renmai (CV) and Dumai (GV). _ Lianquan (CV 23) and Yutang (CV 18) are points of liquid conduction toward the sublingual region. _ “jing-liquid” of the kidney organ follows, on the one hand, the route of the renmai (CV) to reach Lingquan (CV 23) and the sublingual region, and, on the other hand, the spinal route to penetrate into the brain. _ jueyin (Li) and Dumai (GV) gather together at the top of the skull, then descend into the sublingual region where the 2 curious points, “Jixin-Yuye” (PC 20), are found. b - The gathering points of the 3 yin are diagrammed in Figure 13 below:

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3. These illnesses originate from the insufficiency of the energy of the spleen 163.

Figure 13 Gathering points of the 3 yin of the foot.

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PARAGRAPH 4 The Foot Taiyang (Bl), whose origin occurs at zhi yin (BL 67), flows out towards jinggu (Bl 64), arrives at Kunlun (Bl 60) and gathers at Tianzhu (Bl 10) and Feiyang (Bl 58). The Foot Shaoyang (GB), whose origin occurs at qiaoyin (GB 44), flows out towards qiuxu (GB 40), arrives at yangfu (GB 38) and gathers at Tianrong (SI 17) and guanming (GB 37). The Foot Yangming (St), whose origin occurs at L i d u i (St 45), flows out towards Chongyang (St 42), arrives at Xialing (Jiexi-St 41) and gathers at renying (St 9) and Fenglong (St 40). The Hand Taiyang (SI), whose origin occurs at Shaoze (SI 1), flows toward Wangu (SI 4), arrives at yanggu (SI 5) and gathers at Tianchuang (SI 16) and zhizheng (SI 7). The Hand Shaoyang (SJ), whose origin occurs at flows out towards yangchi (SJ 4), arrives at zhigou (SJ Tianyou (SJ 16) and Waiguan (SJ 5). The Hand Yangming (LI), whose origin is found flows out towards hegu (LI 4), arrives at yangxi (LI 5) (LI 18) and Pianli (LI 6).

guanchong (SJ 1), 6) and gathers at at S h a n g y a n g (LI 1), and gathers at Futu 164.

These movements are the origin of fullness of the luo of the 12 channels; one must needle them.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: 1 - “The 3 yin and 3 yang, associated with the 6 channels and with the origin and gathering points, are briefly studied in the two previous paragraphs. Paragraph 4 concerns the penetration of the energy of the 3 yang into the different channels of the foot and hand which all go to the cervico-nuchal region. This is why it is said: “These movements bring with them the fullness of the luomai; one must needle them”. In effect, when the energy arrives at the luo (system of luos), these go into fullness. One must disperse them to aid the circulation of the energy of the 3 yang to pursue its normal path toward the top and the exterior. Feiyang (Bl 58), guanming (GB 37), Fenglong (St 40), zhizheng (SI 7), Waiguan (SJ 5) and Pianli (LI 6) are the luo of the 6 channels of the foot and hand, all located between the jing-river and he points. “Gathering at the he point” implies that the blood and energy from the exterior (epidermodermal layer) penetrate into the jing-well point and reach the elbow and the knee to unite with the energy and blood of the channel. In this way, the energy of the 3 yang gather within the channels at the jing-well point in order to be directed toward the top, up to the points: Tianzhu (BL 10), Tianrong (SI 17), renying (St 9), Tianchuang (SI 16), Tianyou (SJ 16) and Futu (LI 18), located in the cercvico-nuchal region; then from there it reaches the face and cranium (4). This circulation of blood and energy differs from that which flows out towards the jing-

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4. This permits understanding why these points are called “windows of heaven”.

well point, arrives at the shu point, passes to the jing-river point and gathers at the luo point. This is why the text cites the points Feiyang (BL 58), guanming (GB 37), Fenglong (St 40), etc. in order to differentiate the circulation of the energy of the 3 yang from that of ying-Xue (nutritive energy and blood). The first circulates from the exterior (epidermis and dermis) toward the interior and the second from the interior (jingmai) toward the exterior (cephalic region). 2 - This paragraph describes the circulation of the energy of the 3 yang within the channel (jingmai) and outside the channel (Luomai). Chapter 52 speaks on the Ying Qi (nutritive energy) and Chapter 57 of this classic on the Tong qi (ancestral or innate energy). The energy of the 3 yang and 3 yin, the nutritive energy (Ying Qi) and ancestral energy (Tong qi) circulate together within the channels and throughout the entire body, at the exterior as in the interior, following a circle without end. As a result, one often encounters similar explanations, but their content is entirely different. A synthetic study of these chapters proves to be necessary to better understand the reactive phenomena of yin and yang, of energy and blood of the human being, being material or immaterial, answering to the “5 movements” and “6 energies” of heaven and earth, to the cold and heat, like the shadow and the body, echo and sound.”

II - Ma Shi comments: “This paragraph defines the circulation of the 6 channels of the foot and hand beginning at the jing point and gathering at the he point. In effect, _ the Foot Taiyang (Bl) starts at the jing-well (origin point) which is zhi yin (Bl 67), flows out towards the yuan point which is jingqu (Bl 64), arrives at the jing-river point which is Kunlun (Bl 60) and gathers at the nucha region at the point Tianzhu (Bl 10) located at the neck and at the luo point which is Feiyang (Bl 58), located on the leg.

_ the Foot Shaoyang (GB) begins at the jing-well point which is qiao yin (GB 44), flows out toward the yuan point which is qiuxu (GB 40), arrives at the jing-river point which is yangfu (GB 38) and gathers at the nuchal region at the point Tianrong (SI 17) and on the leg at the luo point which is guanming (GB 37). _ the Foot Yangming (St) starts at the jing-well point which is Lidui (St 45), flows out toward the yuan point which is Chongyang (St 42), arrives at the jing-river point which is Jiexi (St 41) and gathers at renying (St 9) located at the neck and at Fenglong (St 40) on the leg. _ the Hand Taiyang (SI) starts at the origin point called jing-well which is Shaoze (SI 1), flows out toward the yuan point which is Wangu (SI 4), arrives at the jing-river point which is yanggu (SI 5) and gathers at Tianchuang (SI 16) located on the neck and at the luo point which is zhizheng (SI 7) located on the forearm. _ the Hand Shaoyang (SJ) starts at the origin point called jing-well which is guanchong (SJ 1), flows out toward the yuan point which is yangchi (SJ 4), arrives at the jing-river point which is zhigou (SJ 6) and gathers at Tianyou (SJ 16) located on the neck and on the forearm at the luo point Waiguan (SJ 5). _ the Hand Yangming (LI) starts at the origin point called jing-well which is Shangyang (LI 1), flows out to the yuan point which is hegu (LI 4), arrives at the jing-river point which is yangxi (LI 5) and penetrates into Futu (LI 18) located on the neck and into the luo point Pianli (LI 6) located on the forearm.

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This circulation causes fullness of the luo; one must needle them.” III - N.V.N.: The explanation and commentary of Zhang and Ma clarify the process of penetration of the yang energy (here, yang = external), that is to say of the energy and blood, at the epidermo-dermal layer into the jingluo system (principal channels and luo vessels) and the formation of the points called “windows of heaven” 166. In effect, this yang energy penetrates into the channel by the jing-well point located at the tips of the fingers and toes, flows towards the yuan point and arrives at the jing-river point; above, it penetrates into the “window of heaven” point located at the neck, and below into the luo point of the leg and forearm. Table

Name of Channel

of

“Origin-Passage”

Origin point (JIng)

Passage point (yuan)

and

“Arrival-Penetration”

Arrival point (jing)

points

points of Penetration windowof heaven

luo points

Tianzu (Bl 10) Tianrong (SI 17)*

Feiyang (Bl 58) guanming (GB37)

Chongyang (St42) Jiexe (St 41)

renying (St 9)

Fenglong (ST 40)

Wangu (SI 4) yangchi (SJ 4)

yanggu (SI 5) zhigou (SJ 6)

Tianchuang(SI 16 zhizheng (SI 7) Tianyou (SJ 16) Waiguan (SJ 5)

hegu (LI 4)

yangxi (LI 5)

Futu (LI 18)

Zu taiyang (Bl) zhiyin (Bl 67) Zu shaoyang (GB) qiaoyin (GB 44) Zu yangming (St) Lidui (St 45) Shoutaiying (SI) Shoushaoyang Shaoze (SI 1) (SJ) guanchong (SJ 1) Shou yangming (LI) Shangyang (LI 1)

jinggu (Bl 64) Quiuxi (GB 40)

Kunlun (Bl 60) yangfu (GB 38)

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Pianli (LI 6)

Figure 14 Process of penetration of the energy and blood from the exterior into the yang channel and formation of the “window of heaven” points.

PARAGRAPH 5

167.

In one day and one night (24 h), the energy of the jingmai (channel vessels) carries out 50 ying (cycles) around the body in order to activate the circulation of the jing (essence) energy of the 5 organs. The number of lower cycles of this fixed number bears the name of Kuang sheng (restless, degraded cycle). In this way, to speak of “50 ying” (cycles) is to evaluate the energy perceived by the 5 organs. This appreciation can be verified at Mai Kou (radial pulse) by exact count of the number of pulsations. In this manner, _ At the end of 50 beats, the absence of “Da” (changing pulse, pulse which stops at regular intervals) is the indicator of the perfect state of the 5 organs. _ At the end of 40 beats, the presence of “Da” predicts the insufficiency of the energy of one of the 5 organs. _ At the end of 30 beats, the presence of “Da” indicates the insufficiency of the energy of two of the 5 organs. _ At the end of 20 beats, the presence of “Da” indicates the insufficiency of the energy of three of the 5 organs. _ At the end of 10 beats, the presence of “Da” denotes the insufficiency of the energy of four of the 5 organs. _ At less than 10 beats, the presence of “Da” predicts the insufficiency of 5 organs. B a s e d on the moment of stoppage of the pulse, one can define the “short cycle” of the energy whose node and ankle are explained in the chapter “Beginning and Ending” (Chap. 9). In total, to speak of the absence of stopping at the end of 50 beats is to define the pulse in the healthy subject, therefore the cyclic periods of the 5 organs. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph describes the energy of the 3 yin and 3 yang. At the exterior, it circulates following the system of jingmai, and in the interior, it maintains the 5 organs.

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The organs have a double function: receiving and distributing the jing (essence). The 5 organs generate the 5 movements whose energy is divided into the 10 Celestial Trunks possessing the property of uniting them and transforming them. In the healthy individual, the energetic transformation is characterized by a regular rhythm of 50 beats. The word “one Da” means a stoppage before 50 beats. The “Da” pulse is a changing pulse with stoppage not designating a large pulse. A pulse now less frequent, now rapid is a fatal pulse. 168. The “knot” and “ankle” of Chapter 9 (“Beginning and Ending”) of this classic can be epitomized with this aphorism: “To live by the 6 energies and die by the 5 channels.”

II - Ma Shi comments: 1 - “This paragraph concerns the 50 beats of the radial pulse (Mai Kou). In the healthy individual, its decrease in number is a sign of disease. Chapter 15 (“The 50 Cycles” - Wu Shi Yu) of this classic was also mentioned. The total length of the jingmai of the body is 12 sheng (5) and 2 Chinese meters, that is to say 12 x 4 = 48 +2 = 50 Chinese meters (or 50 x 0.4 = 20 European meters). Tong qi (a priori energy) located in the thorax controls respiration and the circulation of the channels. With each expiration, the energy advances 3 cun , and with each inspiration, it advances also 3 cun, that is to say 6 cun with each respiration. During one day and one night, the energy accomplishes 50 cycles around the body and 13, 500 respirations, traveling therefore 810 sheng or 810 x 4 = 3,240 Chinese meters (or 3,240 x 0.4 = 1,296 European meters) in order to conduct the jing (essence) of the 5 organs.

2 - If the number attained is less than the fixed number, the phenomena has the name Degraded Cycle (Kuang sheng). That infers that, with a lower number, survival is rare. 3 - The “50 cycles” are the movements of attraction of the jing (essence) of the 5 organs being able to be observed at Mai Kou (mouth of the vessels = radial pulse). As this is the site of reunion of the energy of the 5 organs, one also gives it the name qi Kou (mouth of the energy). As a matter of fact, because Taiyuan (Lu 9) is located 1 cun from Yuji (Lu 8), the Mai Kou also carries the name Cun Kou (mouth of the “inch”). 4 - As for the pulsations, if, at the end of 50 beats, there is absence of stoppage (Da), this indicates that the energy of the 5 organs is sufficient. The individual is in good health. Chapter 17 of the Suwen (“Study of the Subtleties of the Pulses”; Mai Yao jing wei lun) states: “The changing pulse (Da) is the indicator of the insufficiency of the energy because there is a stoppage after beating like a need to recover...”. Therefore, the absence of stoppage after 50 beats allows assurance that the 5 organs are sufficiently provided with energy. 169. On the other hand, _ at less than 50 beats, the presence of a stoppage indicates the absence of energy of 1 of the 5 organs _ at less than 40 beats, the presence of a stoppage indicates the absence of energy of 2 of the 5 organs, _ at less than 30 beats, the presence of a stoppage indicates the absence of energy of 3 of the 5 organs, _ at less than 20 beats, the presence of a stoppage indicates the absence of energy of 4 of the 5 organs, _ at less than 10 beats, the presence of a stoppage indicates the absence of energy of all 5 organs. In this way, one can define the “short cycle” of energy whose explanation is found in

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Chapter 9 (“Beginning and Ending”) of this classic. In the same chapter, we note: 5. 1 sheng = 4 Chinese meters; 1 Chinese meter = 0.4 European meters.

“The study of the Beginning and Ending is based on that of the Beginning and Ending of the jingmai. _ Palpation of Mai Kou (right radial pulse) and renying (left radial pulse) permits specifying the excessive or insufficient state, harmonious or discordant state, of yin and yang. _ In the healthy individual, Mai Kou and renying are concordant; the top and bottom respond to and follow one another. _ The pulses of the 6 channels are not fixed, etc.” All of this is perfectly explained. In total, the absence of stoppage at the end of 50 pulsations denotes good health, and the pulse whose beats are either spaced out or rapid is a “changing” (Da) pulse.” III - N.V.N.: This paragraph, therefore, gives the definition of the short energetic cycle as a function of the appearance of the “Da” pulse. In this manner, the “Da” pulse that was translated as “large” pulse absolutely does not conform to the text. here, “Da” means stopping movement of the pulse, the result of a perturbation. The “Da” pulse is, therefore, a changing pulse with stoppage. The “Short Cycle” or “shortening” of the energy translates as a shortage of energy; the shorter it is, the more the prognosis is unfortunate.

PARAGRAPH 6 Huangdi: “To speak of the normal and abnormal “5 morphological types” is to analyze: _ the size of the bones and joints _ the firmness or flaccidity of the muscles _ the thickness or thinness of the skin and flesh _ the purity or impurity of the blood _ the slippery or rough state of the energy _ the long or short pulse _ the abundance or shortage of energy 170. _ and, finally, the number of the jing (principal channels) and luo (secondary channels). One knows them. But it concerns the common people and not princes and dukes, the favored or rich, whose skin is supple, blood and energy abundant... . In these 2 categories of people, the method of needling, slow or rapid, deep or superficial, repeated or spaced out, is it identical?” Qi Bo:

“One eats choice foods, and the other vegetable products. As a result, the treatment is different. Because, _ when the energy is s l i p p e r y , removal of the needle must be rapid, _ when the energy is r o u g h , removal of the needle must be slow,

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_ needle _ needle _ _

when the energy is s l i p p e r y , one must use the little needles and superficially, when the energy is r o u g h , one must use the little needles and deeply, when the needling is deep, the needle must be left in place, when needling is superficial, insertion of the needle is rapid.

Following these recommendations, needling of the common people is necessarily deep and the needle must remain in place, and the needling of nobility and favored ones, with the help of the little needles, must be superficial and slow. Such are the different techniques of needling according to the weak, slippery, rough... states of the energy.” EXPLANATIONS ANS COMMENTARIES I - Zhang Shi explains: “This paragraph defines the 3 yin and 3 yang originating from the 5 organs, the 5 animal kingdoms, the 5 vegetable kingdoms and the 5 ranges of sapors like producer-agents of the “contrary and favorable” movements and the “5 morphological types”. The 3 yin and 3 yang energies carry out the entering and exiting movements in relation to the superficial and deep of the skin and to the interior and exterior of the jingmai. These movements are animated by the direct or contrary impulses. At the exterior of the vessel, if the skin is thin and pliable, these movements are rapid. In contrast, if the skin is thick and rough, they are slow. In the interior of the vessels, if the blood is clear and the vessels are short; these movements are accelerated. In contrast, if the blood is disordered and the vessels are long, they are slowed down. 171. In this manner, the rapid and slow movements are studies according to the morphology of the skin and blood vessels, which explains the “slippery” and “rough” nature of the energy. Princes and the wealthy consume too much choice food; their bones and muscles are soft and weak and their energy and blood are fluid and flow out rapidly. On the other hand, in peasants and workers, who have only available thick and solid foods, their energy and blood are different and flow out slowly. Therefore, because rich and poor do not eat in the same fashion, their energy is different. In acupuncture, one must take this into account. Huangdi concludes: “Subjects having a fine skin, supple muscles and well balanced energy have appreciable longevity”.

II - Ma Shi comments: “since there exists the rich and the poor, needling must be different. The “5 morphological types” cited in Chapter 64 of this classic (“yin and yang and the 25 Types of Humans”- yin yang Er Shi Wu ren) are defined by the physiognomy and appearance of men classed into the 5 biotypes. In ordinary and simple people, the bones and joints are large or small, the muscles are hard or supple, the skin is thick or thin, the blood is clear or disordered, the energy slippery or rough, the vessels long or short, the blood is in abundance or in shortage, etc. They possess the configuration type of jingluo which are allocated in the same fashion. In princes and nobleman, the body constitution and musculature are weak, the blood and

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energy are “overflowing, rising, muddled...”. The comparison of these 2 categories of men permit deduction of the rules of needling in accordance with the slowness or rapidity, superficiality or deepness, of insertion. Such is the object of the question posed by Huangdi.” here is Qi Bo’s reply: “In those who live on refined dishes and in those who eat vegetable products, the needling is different. In effect, _ removal of the needle is rapid in subjects with “slippery” energy. _ removal of the needle is slow in subjects with “rough” energy. _ the little needle is utilized in subject with “slippery” energy and needling must be superficial. _ the large needle is utilized in subjects with “rough” energy and needling must be deep. _ the needle remains in place when the needling is deep. _ removal of the needle is rapid when the needling is superficial.” As a result, in ordinary and simple subjects whose energy is rough, one must use the large needles; needling must be deep and the duration of insertion must be long. In noblemen and the rich, the energy is slippery; one must employ the little needles; needling must be superficial and slow. Such are the rules of needling in subjects with different energy.”

PARAGRAPH 7

172.

Huangdi: “How are xing (form) and qi (energy) when they are associated with the “contrary” (ni) phenomena?” Qi Bo:

“In the insufficiency of xing and qi, if the illness is that of qi in excess, that is to say if the perverse energy is “victorious”, one must disperse urgently. On the other hand, in the insufficiency of xing and of qi, if the illness is that of qi in insufficiency, one must tonify urgently. In the insufficiency of xing and qi and the illness of insufficiency of qi, yin and yang are also insufficient. Needling is then advised against at the risk of worsening the insufficiency. The accentuation of the insufficiency is the origin of the depletion of yin and yang and the exhaustion of blood and energy responsible for the emptiness of the 5 organs characterized by a drying up of the muscles and thinning of the marrow. In that case, the very old die and the young are restored with difficulty. In the excess of xing and qi causing the illness of excess of qi, yin and yang are in excess; one must disperse the perverse energy to balance the emptiness and fullness. This is why it is said: “Disperse excess and tonify insufficiency.” To needle without discerning what is “contrary” and what is “favorable” is to provoke the confrontation of essential energy and

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perverse

energy.

To tonify the too full causes overflowing of yin and yang at the 4 s i d e s with gastrointestinal swelling, hepato-pulmonary hypertrophy and fusion of yin and yang. To disperse the empty worsens the insufficiency of the jingmai with gastrointestinal contracting, thinning of the skin and withering of the body hair heralding the fatal period. This is why it is said: “The node and ankle of needling consists of balancing yin and yang. After regulation, the jing energy (essence) becomes luminous, the shen (mental) unites with qi (energy) and gathers in the interior.” It is also said: “The great worker balances the energy, the average worker perturbs the pulse and the little worker drains the energy and puts life in danger.” Therefore, the poor physician must be very attentive during the observation of and alterations in the energy of the 5 organs. he must carefully examine the response of the 5 pulses, the emptiness or fullness of the jing and luo, before determining the points to needle.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: 173. 1 - “xing (form) and qi (energy) designate the configuration of the energy of the skin, muscles and bones. “The illness of excess and insufficiency of qi” implies affliction of the 3 yin and 3 yang caused by the aggression of perverse energy, hence affliction caused by the emptiness and fullness of yin and of yang, blood and energy. “The perverse energy being victorious, one must urgently disperse; the blood and energy being in insufficiency, one must urgently tonify.” These are the acupuncture techniques consistenting of regularizing the yin and yang energies. In the case of depletion of the energy, needling is strictly prohibited. “The blood and energy being exhausted at the exterior, the 5 organs are not necessarily in a state of emptiness in the interior”. This assertion stresses the importance of the notion of “interior-exterior”. Clinically, one must carefully determine them by a precise examination of the pulses. “Draining the muscles and depletion of the marrow”, implies that the presence of perverse energy necessarily causes signs of fullness. One must disperse it to correct the emptiness of the essential energy and fullness of perverse energy because the perverse energy can infiltrate into the organism due always to the emptiness of the essential energy. It is, therefore, imperative to eliminate the perverse energy and harmonize the essential energy. “To tonify the too full is to provoke overflowing of yin and yang: gastrointestinal swelling and hepato-pulmonary hypertrophy...”, means: the overflowing manifests itself first in the interior. On the other hand, when the overflowing is takes place in the interior as well as at the exterior, yin and yang become intermingled.

2 - When blood and energy are in abundance, the skin is smooth and the flesh is firm and well-warmed. When only blood is in abundance, it permeates the skin and embellishes the

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dermoskeleton. When the jingmai are in emptiness following an exhaustion of the blood and energy, the stomach and intestines retract, the skin is flaccid... . The prognosis is gloomy. 3 - The regulation of yin and yang returns the vitality to the jing qi (pure energy: energetic quintessential) and reestablishes the concordance of yin and yang with the energy circulating in the channels. At the time of the separation of xing (form) and qi (energy), the shen (mental) escapes to the exterior. This is why the regulation of yin and yang is an excellent technique for consolidation of the jing-shen (Mental essence) of the interior and improvement of the xing (form) of the exterior. 4 - In summary, the appearance of the po (sensitive soul) at the pulse is the consequence of disorder of the jing qi, caused either by cosmic external energy or by the ailments of the organs. In order to treat it, the grand master meticulously observes the interior and exterior, the emptiness and fullness, before applying adequate treatment. 174.

II - Ma Shi comments:

“This paragraph defines tonification and dispersion and the necessity of recognizing what is “contrary” and what is “favorable”. For that, one must understand the “node” and the “ankle” in employing the needles. 1 - In the case of the person whose xing and qi are together insufficient, the clinical signs are that of fullness because the perverse energy is “victorious”; one must disperse urgently. 2 - In the case of the person whose xing and qi are together in excess, the clinical manifestations are those of insufficiency because the essential energy is weak; one must urgently tonify. 3 - If the illness of qi and xing-qi (form and energy) are associated with insufficiency, it is because the energy of the yin channels and yang channels are simultaneously insufficient. In this case, needling is advised against at the risk of augmenting the insufficiency with depletion of both the yin and yang energy, weakening the blood and energy of the 5 organs, drying out the bones and marrow. Aged persons will die and young ones will be hard to restore. 4 - If the xing-qi and illness of the qi are associated with excess, it is because the energy of the channels is in excess. In that case, one must, in the first place, urgently disperse in order to evacuate the perverse energy; next, balance the emptiness or fullness of the essential energy. These are the “favorable” techniques of dispersion in the event of excess and of tonification in the event of insufficiency. In contrast, tonification applied to excess and dispersion to insufficiency are “unfavorable” or “contrary” techniques. Consequently, to ignore the “contrary” and “favorable” is to expose the energy of the body and the perverse energy to confrontation. 5 - In the case of fullness, tonification utilized in place of dispersion is causes accentuation of the excess of perverse energy and the overflowing of the yin and yang energy with dilation of the stomach and intestines and hypertrophy of the liver and lung. 6 - In the case of emptiness, dispersion utilized in place of tonification causes accentuation of the insufficiency of the essential energy and of the jingmai with depletion of the blood and energy, shrinkage of the stomach and intestines, falling out of the hair, wrinkles, etc. The prognosis is fatal.

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7 - The “node” and “ankle” of needling reside in the regulation of yin and yang toward the goal of “polishing” the energy, uniting xing and qi and maintaining the jing-shen in the interior. Such is the method of balancing utilized by the good worker; the poor worker can only complicate the pulse and dry up the energy. Briefly, the physician must perfectly appreciate the evolutive state of the diseases of the 5 organs, the differentiation of the 5 types of pulses, the emptiness and fullness of the jingmai, the fineness and firmness of the skin... in order to determine the points to needle.”

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175.

CHAPTER VI Longevity and Brevity Hard and Soft (Tu Yao Gang Ru)

Chapter 6 of the Lingshu is devoted to the differentiation of the yin and yang, Hard and Soft, xing (bodily form) and qi (energy) of the human being which is dependent upon _ _ _ _ _

the the the the the

speed of growth of bodily development potential of yuan qi (source energy) consistency of the skin length of the bones nature of pulsologic beats (strong and large, weak and small...).

The concordance and discordance of xing and qi, blood and energy, jing (principal channels) and luo (secondary channels) are the two pathophysiologic aspects from which are posed the problem of longevity and brevity of life and, in particular, the therapeutic problem. The objective of this chapter is to discuss the duration of life, its longevity and brevity, hence its title: “Longevity and Brevity - Hard and Soft” (Tu Yao Gang Ru). This chapter consists of 6 paragraphs.

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PARAGRAPH 1 Huangdi

questions

Shao

Yu:

“I have heard it said that man is born “hard” or “soft”, “strong” or “weak”, “short” or “long”, “yin” or “yang”. In relation to this, I would like to know the therapeutic implications.”

EXPLANATIONS AND COMMENTARIES

176.

I - Zhang Shi explains: “At birth, man receives the yin and yang of heaven and earth. Within heaven is qi (energy) and within earth, xing (bodily form). From the concordance of xing and qi result longevity, and from their discordance, brevity.

The Hard and the Soft are the Dao of yin and yang. The yin and the yang are the Dao of heaven. The Hard and the Soft are the Dao of earth. This is why: _ in yin, there is yang _ in yang, there is yin _ in the interior, there is yin and yang _ at the exterior, there is also yin and yang. Yu Xu has said: “Strong and weak, short and long” are like the cold and heat of the 4 seasons, or like day and night being able to be long or short... . This variation comes from xing and from qi answering to yin and to yang and to the 4 seasons, hence the existence of the phenomena of the Hard and Soft.” II - N.V.N: Each individual acquires at birth natures that for him are appropriate: _ “hard” and “soft” natures and feelings _ strong or weak constitution _ tall or short size, all dependent on the anatomic and energetic evolution of the individual, that is to say on yin and yang. By these words, Huangdi contemplates a therapeutic by acupuncture and asks Shao Yu to submit a report on this subject to him.

PARAGRAPH 2 Shao

Yu

replies:

“In yin, there is yang; in yang, there is yin. According to the

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rules, one must carefully examine the yin and yang before needling. Needling must be in agreement with the evolutive phase of the disease and performed as a function of the etiology and climatic variation of the 4 seasons. In the interior, the disease answers to the 5 organs and 6 bowels, and at the exterior, to the pilocutaneous and musculo-skeletal systems. For this reason, at the exterior, there is the yin and the yang, and in the interior, there is also the yin and the yang. 177.

In the interior, organs are yin and bowels are yang. At the exterior, muscles and bones are yin and hair and skin are yang. This is why it is said: 1. In the disease located in the yin part belonging to the yin channels, one must needle the ying and shu points of the yin channels. In the disease located in the yang part belonging to the yang channels, one must needle the he point of the yang channels. In the disease located in the yin part belonging to the yang channels, one must needle the jing-river point of the yin channels. In the disease located in the yang part belonging to the yin channels, one must needle the luo points of the yang channels. 2. The disease localized in the yang part is called Feng (wind), and that localized in the yin part, called Bi ( o b s t r u c t i o n ) : When yin and yang are jointly affected, the disease bears the name Feng Bi (obstruction caused by wind: painful paresthesias). The disease manifesting only in xing (bodily form) without pain belongs to the yang channels, and that not manifesting in xing with pain belongs to the yin channels. In the disease without form (xing) with pain, yang is intact and yin is damaged. One must urgently treat yin without attacking yang. In the disease having a form (xing) without pain, yin is intact and yang is damaged. One must urgently treat the yang without attacking on the yin. When yin and yang are simultaneously affected, the disease presents sometimes with a form (xing), sometimes without a form with anxiety. This phenomenon is called “Victory of yin over yang”, manifesting neither at the exterior nor in the interior; xing (form) cannot remain a long time without changing.”

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EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: 1 - “yang is the energy of heaven; it controls the exterior. yin is the energy of earth; it controls the interior.

178.

But the yin energy and yang energy of heaven and earth ascend and descend, enter and exit, according to the principles “Top-Bottom, interior-exterior”... . This is why in the interior, there is yin and yang; at the exterior, there is also yin and yang. The skin and flesh, the 5 organs and 6 bowels, the interior and exterior unite and respond to the 4 seasons; the 5 organs are yin and the 6 bowels are yang. yin and yang cited in this paragraph applies to the exterior toward a therapeutic goal. 2 - “Disease localized in the yin part belonging to the yin channels” means: the disease coming from the interior (5 organs) manifests in the yin part of the exterior. This is why one must needle the ying (fire) and shu (earth) points of the yin channels of the organs. 3 - “Disease localized in the yang part belonging to the yang channels” implies: the disease coming from the interior (6 bowels) manifests in the yang part of the exterior. This is why one must needle the he (earth) point of the yang channels of the bowels. 4 - “Disease localized in the yin part belonging to the yang channels” means to say that the disease occurs in the muscles and bones. This is why one must needle the channels belonging to yin because the energy of the 5 organs unites at the exterior, with the musculo-skeletal system. The treatment consists, therefore. of needling the jing (metal) point of the yin channels. 5 - “Disease localized in the yang part belonging the yin channels” means: the disease occurs in the organs and manifests in the pilocutaneous system.One must needle the luo point of the yang channels. 6 - “Disease of the yang part is called Feng and that of the yin part, Bi” because: Feng (wind) is the yang energy belonging to heaven, and Bi (obstruction) is perverse yin also belonging to heaven. When yin and yang are simultaneously affected, the disease then has the name “FengBi”. This is one of the reasons for the union of the interior and exterior. 7 - “To speak of disease having xing (form)” is to speak of disease of the skin, flesh, muscles and bones... . “To speak of disease devoid of xing”, designates disease of the energy of the 5 organs and 6 bowels. 8 - “Disease having form with absence of pain” is that localized in the yang part, at the level of the exterior. “Disease having no form with pain” is that caused by an attack of the energy. 9 - “yin is intact... yang is intact” means that yin and yang are not subject to alteration. 10 - heaven and earth are above and below the thousand beings. Movement and rest are the rhythm of change as a function of time belonging to heaven and to earth. water and fire are the symbols representing yin and yang. The energy of heaven descends and floats on the surface of the earth; that of the earth rises and ascends toward heaven. It is in this manner that the energy of heaven and that of earth intersect. Within Li ( ), there is emptiness, and within Ken ( ) there is fullness. Such

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is the reason for water and fire. yin and yang are disordered together and sometimes present a form, sometimes not, when they are located neither in the interior nor at the exterior. 179. The heart is yang; it controls fire. water is yin and is located down below. If the heart is disordered, it is because “yin has triumphed over yang”. yin and yang of the interior and of the exterior then lose their connection, and water and fire from the top and bottom oppose one another. Such is the disharmony of the yin energy and yang energy of heaven and earth. In this case, the bodily form cannot remain a long time without changing. 11 - Briefly, the techniques of needling essentially consist of balancing this disharmony. The true meaning of the text of this classic must be explored from natural phenomena to better understand the principles of acupuncture.

II - Ma Shi comments: 1 - “This paragraph emphasizes the yin nature and yang nature of the illness. Needling must be also differentiated into yin and yang, hence Huangdi’s question. “Man is classed as “hard” and “soft”, “strong” and “weak”, “long” and “short”... into yin and yang. What then are the therapeutic methods which follow?”

2 - Shao Yu replies: a) “yin and yang have one global meaning. But in yin, there is yin; and in yang there is yang. Comprehension of this meaning permits the discovery of the therapeutic principles. Because, at the starting phase of the illness, one must search for the cause in order to explain the reason for the needling. After having found the cause, the needling must be performed in accord with the 4 seasons. b) The interior responds to the 5 organs and 6 bowels, themselves also classified into yin and yang; the 5 organs are yin and 6 bowels are yang. The exterior responds to the muscles and bones, to the skin and flesh, also classified into yin and yang; the muscles and bones are yin compared to the skin and flesh which are yang. For this reason, therapeutically: _ In illness localized in the yin part belonging to the yin channels, that is to say in ailments of the organs manifesting at the level of the muscles and bones, one must needle the ying (Summer, fire) and shu (End of Summer, earth) points of the yin channels. Ex: Yuji (Lu 10) and Taiyuang (Lu 9) of the Hand Taiyin (Lu). _ Sometimes, in the illness localized in the yang part belonging to the yang channels, that is to say in ailments of the bowels manifesting at the level of the skin and the flesh, one must needle the he (earth, End of Summer) points of the yang channels. Ex: Quchi (LI 11) of the Hand Yangming (LI). _ Sometimes, in the illness localized in the yin part belonging to the yang channels, that is to say the ailments of the bowels manifesting at the level of the muscles and bones, one must needle the jing (Autumn, metal) of the yin channels. Ex: jinggu (Lu 8) of the Hand Taiyin (Lu). _ Sometimes, in the illness localized in the yang part belonging to the yin channels, that is to say in the ailments of the organs manifesting at the level of the skin and hair, one must needle the luo point of the yang channels. Ex: Pianli (LI 6) of the Hand Yangming (LI). 180.

c) The illness localizing in the yang channels is called Feng (wind) and that localizing in the yin channels, Bi (obstruction: pain and paresthesias). When yin and yang channels are simultaneously affected, the illness bears the name

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“Feng-Bi” (pain and paresthesias caused by wind). d) Illness having form (xing), without pain on pressure, belongs to the yang channels. Illness without form (xing), with pain on pressure, belongs to the yin channels. They are this way because: _ in illness devoid of form with pain, the yang channels maintain their integrity and the yin channels are damaged. One must urgently treat the yin without taking on the yang channels. _ in the illness having form without pain, the yin channels maintain their integrity and the yang channels are affected. One must urgently needle the yang without taking on the yin channels. _ in the simultaneous attack of the yin and yang channels, the illness is now without form, now with form accompanied by the signs of anxiety (literally: anxiety of the heart). In this case, attack of the yin channels is a great deal more serious; if one wishes to treat the yang, one abandons/relinquishes the yin and vice versa. Treatment of this type of illness is therefore difficult.”

III - N.V.N.: The explanation of Zhang and Ma is clear. Nevertheless, we emphasize the treatment of the different layers of the body (skin, flesh, muscles and bones). a) Skin and flesh (yang of yang) The illness can be localized: _ either in the yang part belonging to the yang channels. The he (End of Summer, earth) points of the yang channels are specific. Ex: Quchi (LI 11) of the Hand Yangming (LI), _ or in the yang part belonging to the yin channels. The luo points of the yang channels are specific. Ex: Pianli (LI 6) of the Hand Yangming (LI). b) Muscles and bones (yin of yang) The illness can be localized: _ either in the yin parts belonging to the yin channels. The ying (Summer, fire) points and shu (End of Summer, earth) are specific. Ex: Yuji (Lu 10) and Taiyuan (Lu 9) of the Hand Taiyin (Lu), _ or in the yin part belonging to the yang channels, The jing (Autumn, metal) points are specific. Ex: JInggu (Lu 8) of the Hand Taiyin (Lu). 181.

Localization and therapy of the different layers Layer of the Body

Skin and flesh (yang of yang)

Muscles and bones (yin of yang)

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Disease (localization)

Therapy (specific points)

yang Part yang Channels

he points of the yang channels

yang Part yin Channels

luo points of the yang channels

yin Part yin Channels

ying-spring and shu points of the yin channels

yin Part yang Channels

jing-river points of the yin channels

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PARAGRAPH 3 Huangdi questions Bai Gao: “I have heard something about the state of xing (bodily form) and of qi (energy) before and after the illness. What are the connections then between the interior and exterior? Bai Gao: “wind-Cold injures xing; worries, fear, anger... injure qi. Perturbed qi injures the organ; the illness is that of the organ. Cold injures xing; the illness is that of xing. wind injures the muscles and Mai (channel vessels); the illness is that of the vessels and muscles. In this way, xing and qi, interior and exterior communicate.” Huangdi: “How do you needle?” Bai Gao: “If the illness lasts 9 days, one must needle 3 times (sessions). If it lasts 1 month, one must practice 10 sessions. The number of sessions depends, therefore, on the chronicity of the illness. make

In chronic Bi, one must examine Xue luo (blood them bleed.”.

capillaries) and

Huangdi: “What are the difficulties of treating the illnesses located at the exterior and in the interior?” Bai Gao: 182. “In the illness of xing (form) not yet having reached the organs, the number of days (sessions) of needling is diminished by half. If the organ is affected before the xing, the number of sessions must be doubled. Such are the difficulties and ease of treatment of the illness whose evolution does not exceed one month.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: 1. “This paragraph studies the illnesses of exogenous origin, that is to say illness caused by an infiltration of external cosmic energy, and the illnesses of endogenous origin, that is to say illness caused by an internal perturbation. The causal factors are therefore from triggering phenomena of the interactions of the xing (bodily form) and qi (energy), of the exterior and interior. 2. wind-cold is an energy from the exterior which infiltrates into the organism and injures the xing, while worries and fear, irritability and anger are the energies of the interior that injure the organs.

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3. exterior is yang; interior is yin. Illness which lasts 9 days is an ailment which manifests at yang. This is why one uses the odd number (3) as the number of sessions of needling. The illness which lasts 1 month (Lunar) is a ailment which manifests at yin. This is why one uses the even number (10) as the number of sessions of needling. In this manner, in acupuncture, the even number and odd number are utilized in order to respond to yin and yang. 4. One practices the bleeding of the Xue luo (blood capillaries) in the goal of ventilating the vessels. 5. “xing is affected in the first place and the illness has not yet reached the interior”, means: The illness is at yang without reaching yin. In this case, 3 sessions of acupuncture suffice to cure the illness”. 6. “The organ is affected in the first place, then goes to xing”, implies: The illness of the interior has reached the exterior. In that case, the number of sessions must be doubled. 7. The illness of yin with external evolution is easy to treat. If it lingers longer in the interior, the illness is difficult to treat. This is why sometimes 10 sessions of acupuncture or even double that, sometimes 2 sessions suffice... . Such are the difficulties of needling the illnesses of less than one month.”

II - Ma Shi comments: “This paragraph is devoted to the study of the reactive phenomena of the xing (bodily form), of the qi (energy) and of illnesses whose therapy is sometimes easy, sometimes difficult. 1. “Cold-wind injures xing” This means to say when “cold” energy penetrates into the xing, the reactive phenomena are external. “Worries and fear, discontent and anger injure qi”. Perturbed, the qi injures the organs and manifests at the level of the organs and bowels. The reactive phenomena are therefore internal. When wind injures the muscles and vessels, the reactive phenomena manifest just as easily in the interior as at the exterior. Such are the reciprocal reactions of xing and qi, of the illness located in the interior and of the illness located at the exterior.

2. As for the methods of needling, the illness of 9 days is cured with 3 sessions of acupuncture, or that of one month is cured at the end of 10 sessions. In this manner one takes into account the seriousness and chronicity of the illness in order to deduce the number of sessions: _ 1 session for an illness of 3 days _ 2 sessions for an illness of 6 days _ 10 sessions for an illness of one month _ etc. 3. In chronic Bi (chronic painful paresthesias), if the individual cannot shift, one must examine the Xue luo (blood capillaries) and make bleed without concern for the method called “3 days”. 4. The illness localized in the interior or at the exterior is sometimes easy, sometimes difficult to cure. Because: a) In the illness of xing caused by wind-cold, if it has still not reached the organs, the ailment is external, therefore slight. In this case, the number of sessions of acupuncture can be reduced by half. So, for example: _ in the illness dating 6 days, perform one session instead of two _ in the illness dating 1 month, perform 5 sessions instead of 10 _ etc.

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b) In the illness of qi caused by worries and fear, discontent and anger... the organs are affected with external perturbation; therefore, the exterior and interior are affected together. In that case, the illness is deep and the number of sessions of acupuncture must be doubled: _ 6 (3 x 2) sessions in the illness of 9 days _ 20 (10 x 2) sessions in the illness of one month _ etc. Such is the case of illnesses of variable seriousness evolving over 1 month whose therapy is more or less difficult.”

III - N.V.N.: 184. The acupuncture technique called “one session every 3 days ” is clearly explained and commented on by Zhang and Ma. We will particularly retain the ideas “xing” and “qi” and take into account the number of sessions in the treatment of illnesses of exogenous origin (like “Bi”: painful paresthesias) and illnesses of endogenous origin (like psycho-affective ailments).

PARAGRAPH 4 Huangdi questions Bai Gao: “I have understood it said _ that the xing (bodily form) may be slowed down or speeded up _ that the qi (energy) may be excessive or insufficient _ that the bones may be large or small _ that the muscles may be firm or soft _ and that the skin may be thin or thick. How can one determine longevity or brevity?” Bai Gao: “In harmony, xing and qi assure longevity. Their disharmony brings about brevity. In concordance, the muscles and bones assure longevity. Their discordance brings about brevity. Prevailing over xing, the blood and energy, jing (principal channels) and luo (secondary channels) guarantee longevity. Their defeat by xing leads to brevity.” Huangdi: “What does a “slowed down” or “accelerated” xing mean?” Bai Gao: “A supple and well developed xing with very firm and blossoming skin predicts longevity. On the other hand, a supple and well developed xing with sometimes wrinkled, sometimes lax skin indicates brevity. A supple and well developed xing with strong and changing pulse (Da) is favorable. On the other hand, a supple and well developed xing with a small and weak pulse indicates an insufficiency of qi whose prognosis is fatal. A supple and well developed xing with slight protrusion of the cheekbone indicates a small skeletal frame, therefore brevity.

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A supple and well developed xing with firm and well demarcated musculature indicates longevity. On the other hand, a supple and well developed xing with flaccid musculature without demarcation predicts brevity. 185. Such is the destiny of man founded on the principles of “ t h e creation of xing and determination of qi”, factors of longevity and brevity. One must, therefore, know these principles to be able to treat illnesses and predict the duration of existence.” Huangdi: “On what basis does one evaluate longevity and brevity?” Bai Gao: “The orbital contour” (Shang go) less raised than that of Di (chin) indicates death before 30 years of age. If the individual presents with another illness, he dies before 20 years.” Huangdi: “In the event of victory of xing or qi, is there longevity or brevity?” Bai Gao: “In the normal individual, victory of qi over xing is the sign of longevity; and in the individual whose xing is indicated by muscular escape (cachexia, emaciation), the victory of qi over xing or the victory of xing over qi is the sign predicting death.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: 1. “Man receives yin and yang from heaven and earth in order to produce qi (energy), and this occurs in the face of the problem of longevity and brevity. The life of the human being is represented by xing (bodily form, matter) and qi (energy). This is why the concordance of xing and qi is life, and their discordance, death. In man, skin and flesh respond to heaven (yang) and the muscles and bones, to earth (yin). Their concordance and reciprocity are signs of longevity and their opposite is the sign of brevity. 2. xing encompasses together the skin and flesh, muscles and bones, blood and energy, the jing (principal channels) and luo (secondary channels). It also responds to the jing shui (liquid routes) and to the qi Mai (energy of the pulses) traveling the entire body. This is why, “Victory of qi over xing” is synonymous with longevity, and “Defeat of qi by xing”, synonymous with brevity. 3. xing and qi are created from the yin and yang of heaven and earth. “The skin and hair are “supple” and “radiant” (literally, slowed down).”“This means to say that they possess the “source character” (yuan xing) of the Celestial Dao. For this reason, the suppleness and blossoming of the skin and hair are the marks of longevity, and their “retraction” and “laxity” (literally, “acceleration”), the marks of brevity. 186. 4. Mai (pulse) designates the force of circulatory movements of jing Xue (blood routes). The large and well developed xing with a strong and changing (Da) pulse is favorable. If the pulse is small and weak, it indicates concomitant insufficiency of ying (nutritive energy), wei (defensive energy) and Tong qi (a priori, innate or thoracic energy). The prognosis is fatal. 5. The kidney receives the yin and yang energy of the parents, called “innate, a priori energy”, and controls the osseous system.

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The bone of the cheekbone constitutes the “postero-external” part of the kidney energy. This is why slight protrusion of the cheekbones indicates a small skeletal frame, indicator of brevity. This state is due to the insufficiency of the a priori energy. 6. The spleen corresponds to earth; it controls the flesh whose firmness assures longevity and flaccidity, brevity. This state depends on the quality of “the foundation of the wall”, able to be innately “thin” or “thick”. 7. In this way, human life can only exist thanks to “the creation of xing” and to the “determination of qi” on which longevity or brevity depends. The physician must know the reason to study the xing and qi before examing the patient in order to predict life or death. 8. It is stated in Chapter 54 (“Celestial Age”- Tian nian) of this classic: “The mother is the “foundation”, and the father, the “shield”. If man can live to 100 years, it is thanks to the bone of his nose which is long and straight and to Shang go (orbital contour) which is raised and square.” “Shang go is low, less high than Di (designating the chin)” implies: the orbital bone sags and is flat following an insufficient reception of qi from the mother because xing (bodily form) depends on principle of Kun ( ) (1). 9. It is also stated in this same chapter: “If man has lived to 30 years, it is because his 5 organs are in perfect ease. If he dies before 30 years, it is because his 5 organs have not able to respond to the 5 movements of earth. Sometimes, because of illnesses, he dies before 20 years, when he was not able to accomplish the “numbers of production” of earth.” 10. “In normal man, the victory of qi over xing is the mark of longevity”. This means to say that his orbital contour is large and thick. qi must prevail over xing because the thousand beings coming from heaven and earth envelop the earth. In ill man with emaciated body, qi dominates xing. (here, “qi” designates perverse energy). In the opposite case, when xing dominates qi, the essential energy escapes; it is death.” II - Ma Shi comments: 187. 1. “This paragraph develops the theory called “creation of xing and determination of qi” from which one can evaluate the duration of longevity. • Emperor Huangdi asks: “The xing (bodily form) is “slowed” (supple and well developed) or “accelerated” (emaciated and retracted). The qi is in abundance or insufficiency. The bones are large or small. The flesh and muscles are firm or flaccid. The skin is thick or thin, etc. Based on these 5 criteria, can one determine longevity or brevity?” • Bai Gao replies: “Man has his xing and his qi. The development and suppleness of xing depends on the state of the qi. A supple and well developed xing in concordance with a plethoric qi indicates longevity. A supple and well developed xing with a qi in shortage, or else, an emaciated and retracted xing with insufficient qi, etc. are phenomena of discordance, signs of brevity.” 2. In effect, a thick skin with firm and hard muscles indicates the achievement of bodily transformation, indicator of longevity. A thick skin with flaccid muscles, or else a thin skin with firm muscles, or even a thin skin with flaccid muscles, indicates the lack of achievement of bodily transformation, indicator of brevity. 3. Supplied with blood, the human body must have qi; and supplied with jing (principal channels), it must have luo (secondary channels).

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1. This phrase indicates that It is “earth” (spleen) energy which creates xing (form). here, “Kun” = earth-spleen.

If these 4 factors (blood, qi, jing and luo) prevail over xing, the xing is “slowed” because the energy and blood, the jing (principal channels) and luo (secondary channels) are in abundance, essential to longevity. 188. If these 4 factors cannot prevail over the xing, xing is also “slowed”, but the energy and blood, jing and luo are in insufficiency, which causes brevity. 4. “Accelerated” xing and “slowed” xing”: A well developed xing with thick and “slowed” skin indicates longevity. In contrast, if the skin is thin and “accelerated”, it indicates brevity. 5. “Excess and insufficient”: A well developed xing with a strong and changing (Da) pulse is favorable. The opposite, with a small and weak pulse, is unfavorable. 6. “Large bones and small bones”: A well developed xing with protruding cheekbones must have large bones because the zygomatic bone is the sentinel of the entire skeletal system of the human being. In other words, raised cheekbones with large bones indicates longevity and protruding cheekbones with little bones are the indicators of brevity. 7. “Firm muscles and flaccid muscles”: In tall individuals with large, very muscular buttocks, the musculature of the entire body if firm because the gluteal muscles are the sentinels of the muscles whose firmness indicates longevity and whose flaccidity indicates brevity. 8. “xing and qi” From birth, man possess xing and qi thanks to which one can evaluate longevity and brevity. Chapter 49 (“The Five Complexions”) of this classic has related some principles of evaluation of longevity and brevity: a) Mingtang designates the nose Jue, the space between the eyebrows Ding, all the parts of the face Fian, the 2 sides of the cheek Ti, the 2 auricular holes . b) The bones of Mingtang are raised and protruding, smooth and straight. The 5 organs respond to the center (nose) and the 6 bowels to the 2 sides (of the nose). The head and face allow determination of the pathophysiologic status of the 5 organs and 6 bowels. c) At the level of the eyes, the circumference designates the “walls” whose foundation is low. If it is lower than that of Mingtang, the individual will not live beyond 30 years. If he is affected additionally by a disease, whether exogenous or endogenous, he will not live more than 20 years”. 9. In the interrelationship between xing and qi, how do you determine longevity and brevity? since healthy individuals have xing and qi, they necessarily have their source energy (yuan qi). Their longevity is due to the victory of qi over xing. When they are sick and when their xing is found emaciated and they can no longer recover, their qi dominates their xing; it is death. similarly, in patients whose xing is not yet completely exhausted, when the source energy is found in a state of great insufficiency, xing dominates qi. This case is also fatal. 189.

III - N.V.N.: We rediscover in this paragraph the dualism of xing and qi, first concepts of traditional Chinese medicine. Yet, this dualism occurs suprisingly in modern physical science in the “Matter-energy” interaction”.

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PARAGRAPH 5 Huangdi: “I have heard it said that the energy has “3 modifications”. What does that mean?” Bai Gao: “Sometimes one needles the ying (nutritive energy), sometimes the wei (defensive energy) and sometimes the han Bi (obstruction caused by cold at the level of the channels).” Huangdi: “The needling therefore has “3 modifications”. How is that?” Bai Gao: “One needles the ying to make the blood leave, the wei to make the energy leave and the han Bi to make the heat enter.” Huangdi: “What are the symptoms of the diseases of ying, wei and han Bi? Bai Gao: “ ying illness is characterized by signs of alternating cold and heat (fever and chills) with weak ascent or weak descent of the blood and energy. wei illnesses are characterized by intermittent pains of energetic origin. Cold-wind “guest” (Ke) can bring about a gastrointestinal syndrome, while han Bi illnesses are characterized by pain of fixed localization with cutaneous paresthesias.”

EXPLANATIONS AND COMMENTARIES: I - Zhang Shi explains: 190. “1. The xing is the site of residence of the qi. This is why qi returns to the xing as if it goes back home. The “jing shui” (essence of water) contained within Xiaojiao (Lower Jiao) and the ying and wei originating from zhongjiao (middle jiao) have the property of heating up the “flesh” system, disseminating to the skin “system”, permeating the musculo-skeletal system and facilitating secretion. water follows the energy performing unceasing cyclic movements towards the exterior. If the circulation of ying and wei is hindered, the water no longer circulates and xing and qi become exhausted. In this way, when one speaks of the ”3 modifications”, one means the transformations of energetic movements.

2. “ying-blood” and “wei-energy” form from the routes of exit toward the exterior. This is why, in the case of cold with pain (that is to say, in the case of “Bi” = algoparesthesias), one must disseminate the “heat” energy located in the interior.

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Because, ying and wei, energy and blood control the movements of entering and exiting. If they are disordered, these movements are worn out and provoke painful syndromes caused by the cold and heat. 3. This paragraph distinguishes illnesses of ying, wei and han Bi which have their internal, non-external origins. The word “Bi” indicates obstruction. han Bi is an affliction caused by Cold-water. The kidney controls the osseous system. Superficially, skin and hair respond to yang, and deeply, the muscles and bones to yin. The ailments associated with yin are called Bi whose fixed and intermittent pain is always accompanied by cutaneous paresthesias. Such is the Bi Syndrome caused by Cold-water of the kidney. This illness is, therefore, of internal etiology. 4. Yu Xu teaches: “This paragraph studies, in the first place, the problem of determination of longevity and brevity, then, in the second place, that of xing and qi, determining factors of longevity and brevity. But the illnesses of qi are classified into 2 categories: a) illnesses of qi caused by wind-Cold, a type of illness of qi prevailing over xing. b) and illnesses caused by an obstruction of ying and wei. In this case, the liquid route is stagnated. This is the type of illness of xing prevailing over qi.”

II - Ma Shi comments: “The technique of needling essentially comprises 3 different modalities: 191. 1. Needling ying must be performed according to the technique of bleeding because the blood comes from the ying energy. In effect, in the excess of ying energy, yang cannot triumph over yin, and in the insufficiency of ying energy, yin cannot triumph over yang, which provokes an alternation of cold and heat and a great insufficiency of qi. The blood is then expelled by the yang energy and floods the top (superficial) as well as the bottom (deep), The illness is, therefore, that of the blood which one must treat by bleeding.

2. Needling wei must be done according to the technique of evacuation of the energy. After Chapter 43 (“Discourse on Obstructions”- Bi lun) of the Suwen: “wei energy circulates in the skin and flesh. It rises up towards Huang Ma (yellow membrane: peritoneum) and spreads into the thorax and abdomen. When the wei is disturbed, the illness is intermittent and becomes localized either in the interior or exterior.” 3. “wind-Cold guest” (Ke) localized in the stomach and intestines is an internal ailment of energetic origin. Therefore, in these illnesses, one must evacuate the qi (perverse). similarly, the han Bi diseases become localized in the channels; the needling must be associated with the technique of revulsion (application of poultice or plaster patch) (2)in the goal of heating up the deep layer because the pains are of fixed localization and are always accompanied by cutaneous paresthesias.” III - N.V.N.: This paragraph describes 3 types of energetic illnesses: _ illnesses of ying (Rong) _ illnesses of wei _ and illnesses of han Bi whose pathophysiologic process and treatment are clearly explained by Zhang and Ma.

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2. See Paragraph 6 below.

PARAGRAPH 6 Huangdi: “In the case of han Bi (painful paresthesias), how do you practice the method called “intromission of heat” ? ” Bai Gao: “In the common people, one uses heated needles, and in people of high society, medicinal poultices after the needling.” Huangdi: “What

are

these

poultices?”

192.

Bai Gao: “These poultices are composed of the 4 following ingredients: Alcohol of prime quality 20 jin (1/2 kilo) Frutus Zanthoxyli (Huajiao) 1 jin Rhizoma Zingiberis (Ganjiang) 1 jin Ramulus Cinnamomi (Guizhi) 1 jin These 4 ingredients are finely ground and macerated in alcohol. Next, one uses: Cotton 1 jin silk cloth 4 sheng soaked in the same alcohol. The mixture is closed in a jar very tightly to prevent evaporation. Then, one buries the jar in the middle of very hot ashes of horse manure. After 5 days and 5 nights, one removes the cloth and the cotton that one dries in the sun. The drying ended, one macerates them again in the same alcohol. One repeats the same process once a day until complete exhaustion of juice of the alcohol (contained in the jar). At the end of the process, one uses the medicinal residue from the cotton and the silk cloth. With the cloth, one produces several sacks of 6 or 7 Chinese meters (3) in length in which one introduces the cotton and the medicinal residue. At the time of use, one heats up the sack of cloth above the ashes of a blackberry bush, then one applies it to the area affected by han Bi, after needling. This process allows the introduction of heat into the painful area. When the sack cools down, one uses another one warmed up and repeats about thirty times the same actions. Each procedure provokes sweating. It is necessary to carefully wipe the body very clean before performing the next procedure. After the session, the patient must stand up and do an exercise walk around his entire room, avoiding becoming exposed to wind. In this manner, after each needling, the application of medicinal poultices permits activation of the cure of the han Bi illnesses.

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3. 1 Chinese meter = 0.40 European meters.

Such is the method of “intromission of heat”. ”

EXPLANATIONS AND COMMENTARIES

193.

I - Zhang Shi explains: “1. Bi is a painful syndrome of fixed localization without radiation toward the neighboring areas. xing Bi (erratic pains) is an ailment caused by cold coming from kidney-water.

2. Man receives the “water” energy and “fire” energy from the natural world and transforms them into the 5 movements. The kidney receives the a priorijing qi (energetic essence) to transmit it to the 5 organs. If water and fire are not in a synergistic state, the 5 organs lose their connection and the han Bi syndromes lives on This is why one uses fire to aid water. 3. The lung is the master of the pilocutaneous system. The alcohol is directed first toward the skin, then toward the luomai (secondary vessels). The medicinal formula cited in the previous paragraph is, therefore, alcohol-based with the aim of restoring the relationship of the “lungkidney” system. 4. Frutus Zanthoxyli (Huajiao) is used to reinforce the communication of heart and kidney. The spleen makes up part of zhi yin in yin. Rhizoma Zingiberis (Ganjiang) has the property of treating ailments of the “center” (abdomen). The magistral formula cited in this paragraph uses Ganjiang to reinforce the relation of spleen and kidney. Cinnamomi (Guizhi) is a type of wood classified among the most precious. The magistral formula cited in this paragraph uses Guizhi to consolidate the relationship of liver and kidney. silkworms feed on the leaves of the blackberry bush to produce silk fibers. Gui Xin, the blackberry bush and silk fibers, are therefore specific products to treat illnesses of the lung. 5. “1 jin of cotton, 1 jin of silk fibers, 4 sheng of cloth... 30 applications, etc.” implies: the therapeutic action of the poultices permits the evacuation of perverse yin by the cutaneous route. In other words, the heating action of the poultice favors the elimination of perverse energy towards the exterior. 6. In this paragraph, Bai Gao has demonstrated the existence of the relationships of the organs and bowels, of yin and yang, in the categories of man (rich and poor). The treatment is based on the method of liberation of the exterior. Practitioners must delve deeply into the subtleties of the specific therapeutic application in each case.” II - Ma Shi comments: “This paragraph explains the treatment of han Bi (painful paresthesias) by acupuncture and by the method of “intromission of heat” with the aid of poultices. 194. In the common people, the energy and blood are compact and impure. After needling, one must use fire (moxabustion). In contrast, in the rich and noblemen, the energy and blood is “pure” and “slippery”; after needling them, one must use poultices according to the method of “intromission of heat”.”

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195.

CHAPTER VII Use of the Needles (guan Zhen)

Chapter 7 of the Lingshu defines the use of the “9 Needles” responding, not only to the 9 methods of needling, but also to 12 other procedures based on the localization and natures of the illness: 1 - Method of Ou Ci (double needling) 2 - Method of Bao Ci (needling painful points) 3 - Method of Hui Ci (needling-drilling) 4 - Method of Ti Ci (grouped needling) 5 - Method of yang Ci (light and superficial needling) 6 - Method of zhi Zhen Ci (subcutaneous needling) 7 - Method of shu Ci (needling energetic points) 8 - Method of Duan Ci (“short” needling) 9 - Method of Fu Ci (cutaneous needling) 10-Method of yin Ci (needling the yin part of the leg) 11-Method of Bang Ci (dispersive needling) 12-Method of Zan Ci (complementary needling). Other methods are also cited to treat specific illnesses of the 5 organs localizing in the interior and responding to the 5 energetic levels: 1 - Method of Ban Ci (semi-needling) 2 - Method of Bao Wen Ci (Leopard needling) 3 - Method of guan Ci (articular needling) 4 - Method of hegu Ci (needling evoking the image of hegu) 5 - Method of shu Ci (needling of the shu). The object of this chapter is to determine the functions of the “9 Needles” and the different methods of needling in the goal of justifying the use of needles of different size and length based on the localization and natures of the illness, hence the title “Use of the Needles” (guan Zhen). Ma Shi, in introducing this chapter, declares: “The word guan means: Use. The use of needles implies the study of the

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196.

different methods of employing needles. This chapter does not mention the name of the speakers. But according to the style, the dissertation would come from Qi Bo.” This chapter consists of 7 paragraphs.

PARAGRAPH 1 The “knot and ankle” of needling reside in the choice of needles. The “9 Needles” each have their specific indication; long and short, large and small, are utilized as a function of the location and natures of the illness. Ignorance of these indications leads inescapably to therapeutic failure. Because, _ in superficial illnesses, deep needling injures not only the muscles, but causes cutaneous inflammation as well. _ in deep illnesses, superficial needling does not expulse the perverse energy, but also favors pyogenic formation. _ in benign illnesses, large needles destroy not only the essential energy, but puts the individual in danger. _ in serious illnesses, little needles cannot expulse the perverse energy, and can even worsen the illness. Thus, by ignorance of the rules, large needles used in place of little needles injures the essential energy, and little needles used in the place of large needles are incapable of eliminating the perverse energy. Such are the risks of using the needles erroneously. The modes of choice of needles according to the natures and localization of the illness are the following: 1 - In superficial illnesses (skin), on must use needles of the Chai (1) type to puncture the effected sites. Nevertheless, if the skin of these sites is too white, needling is prohibited. 2 - In illnesses of the flesh, it is necessary to use needles of the yuan type in order to massage the painful points so to activate the circulation of blood and energy. 197.

3 - In illness of the jingluo caused by chronic obstruction (Gu Bi), one must use the needles of the Feng type in order to bleed the luo vessels. 4 - In the insufficiencies of the energy of the vessels, one must carry out the tonification method with the Ti type of needles to puncture

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the jing, ying, shu points... in the goal of tonifying and activating the circulation of the blood and energy. 5 - In pyogenic illnesses, one must use the Fi type of needle to incise the abscess and evacuate the pus. 6 - In sudden obstruction of the energy (Bi qi Lao Fa), one must use the yuan Li type needle to treat enervating pains. 7 - In chronic obstructions (Chronic Bi), one must use the Hao type of needles to treat the painful paresthesias. 8 - In deep illnesses, one must use the Chang type of needles to expulse the perverse energy located deeply. 9 - In edemas not reaching the joint, one must use the Dai type of needles to dissolve the liquid stasis. 10 - In illnesses of the 5 organs that are well localized, one must also use the Feng type of needles to disperse the jing, ying, shu... points according to the 4 seasons.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The word guan signifies process, method. Consequently, the procedures of acupuncture are based on: _ the diameter and length of the needle _ the manipulation of the needle in view of tonification or dispersion _ the depth of implantation _ and, finally, the number (3, 5, 9, 10, etc.) of needles needed for a treatment. These processes rigorously obey the rule according to which “all needling must be performed according to the nature and localization of the illness”. II - Ma Shi comments: “This paragraph demonstrates the choice of use of the “9 Needles”. 1 - Superficial illnesses are needled superficially because deep needling injures the muscles and provokes cutaneous abscess formation. 198. Deep illnesses are needled deeply because superficial needling cannot disperse the perverse energy deeply located, responsible for pyogenic formation. Large needles used in the treatment of benign illnesses bring about too abundant a depletion of essential energy. Little needles used in the treatment of serious illnesses cannot eliminate perverse energy. These needling processes are contrary to the rule and introduce technical errors.

2 - In skin ailments, one must use the Chan (Sam) type of needle to needle the places affected, except in the case where the skin there is too white because the essential energy is not very abundant. In the ailments of the flesh (dermis), the painful sites are needled with Xiao (little) type needles. In the illnesses of the jingluo caused by Gu Bi (chronic painful paresthesias), one must

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use the Feng type of needles. In insufficiency of the energy of the channel, Ti (De) type of needles are utilized to tonify the jing, ying, shu, jing and he points. In sudden obstructions of the energy (Bi qi Lao Fa), one must use yuan Li type needles. In chronic obstructions with pain of fixed localization, one must use Hao type needles. In illnesses of the middle layer (between muscle and flesh), one must use Chang type needles. In edemas, needling must not reach the joints. In this case, it is necessary to use the Da (large) type of needle. In obstructions of the 5 organs, needles of the “Feng” type are used to disperse the jing, ying, shu... according to the principle of the 4 seasons.”

III - N.V.N.: This paragraph emphasizes the use of the 9 types of needles (see Chapter 1) according to the natures and localization of the illness, and more particularly in the case “Bi” (obstruction). Because, when perverse energy infiltrates into the sunluo and luo located in the epidermodermal layer, it is the origin of pain (dermalgia) on the one hand, and on the other hand, obstruction of the circulation at the level of the jing (principal channel) characterized by paresthesias. We witness then a phenomenon called painful paresthesias that can be diagrammed in the following fashion: 199.

Figure 15: Superficial Layer: yang (sunluo and luo). Deep Layer: yin (jing) Infiltration of wind-cold into the superficial (yang) layer and obstruction of the jing: phenomenon called algoparesthesias.

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Therefore, two types of needles are used: a -“Chai” (Sam) type of needle: to superficially needle A Shi (painful) points according to the technique of dispersion to evacuate the perverse energy. b - “Hao” type of needle: to needle the corresponding principal channel points according to the technique of tonification in the goal of ventilating the jing. This process rigorously obeys the law known as “yin-yang”, Emptiness-Fullness”.

PARAGRAPH 2 forms

There exists 9 methods of needling responding to the 9 evolutive of illness.

1 - Method of shu Ci: needling specific shu points: jing, ying, shu and the back shu points of the 5 organs. 2 - Method of yuan Dao Ci: needling points located at the lower part of the body in cases of illness located above. here, it is also a matter of needling the shu points of the 6 yang channels belonging to the bowels. 200.

3 - Method of jing Ci: needling the luo points of the channels where the Great luos leave from. (Little

4 - Method of luo Ci: needling the little vessels located at the sunluo luos). 5 - Method of Fen Ci: needling the “spaces of distribution of flesh”.

6 - Method of Da Xie Ci: needling with the aid of Fi type of needles to evacuate pus. 7 - Method of Mao Ci: needling cutaneous pains. 8 - Method of Ju Ci: needling on the opposite side. Needling performed at the left when the illness is located on the right and vice versa. 9 - Method of Cui Ci: needling with the aid of heated needles to treat painful Bi (painful paresthesias).

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The preceding paragraph defined needling performed according to the natures and localization of the illness, while this one determines needling as a function of the evolutive forms of the illness. 1 - The Method of shu Ci is used to treat illnesses located outside the channels by the shu points of the 5 organs such as the jing, ying, shu, etc. 2 - The Method of yuan Dao Ci treats illnesses located above by the lower he points

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because the channels of the 3 yang of the foot and hand begin at the feet then arrive at the neck and nucha. 3 - The Method of jing Ci permits the ventilation of the Dai luo (great secondary vessels). Because, perverse energy first infiltrates into the sunluo (little secondary vessels), then it stagnates in the inter-channel spaces in order to trigger illnesses called singular. Needling the luo points of the principal channels has the power to dissolve this stasis, therefore, to ventilate the Great luos. 4 - The Method of luo Ci consists of needling the Xiao luo (little luos) located in the skin. 5 - The Method of Fen Ci consists of needling the “spaces of distribution of the flesh” (1), that is to say the sites where the “365 reunion points” occur, at the time of the fixation of the perverse energy in the flesh-muscle system. 6 - The Method of Da Xie Ci is utilized at the time of an obstruction caused by perverse energy at the level of the pilocutaneous system. This is to say that the needling is very superficial conforming to the saying “Needling the body hairs must not injure the skin, and needling the skin must not injure the flesh” (2). 8 - The Method of Ju Ci is used when the perverse energy occurs at the level of the distinct channels (Jing Bie). The illness being at the left, needling is performed at the right and vice versa. 9 - The Method of Cui Ci consists of utilizing heated needles to treat Gan Bi (painful paresthesias of the muscles and tendons: myalgias)”.

II - Ma Shi comments: “This paragraph defines the 9 methods of needling. 1 - The Method of shu Ci consists of needling the jing, ying, shu... and the back shu points such as Xinshu (Bl 15), Feishu (Bl 13), shenshu (Bl 23), Pishu (Bl 20), Ganshu (Bl 18), etc. 2 - The Method of yuan Dao Ci consists of needling the bottom while the illness is situated above. Ex: needling points of the 3 yang channels of the foot. 3 - The Method of jing Ci consists of needling the luo points belonging to the principal channels, points located between the jing and he points. 4 - The Method of luo Ci consists of needling the Little luos. 5 - The Method of Fen Ci consists of needling the Xi and Gu points (little valleys and valleys) situated in the inter-channel spaces. 6 - The Method of Da Xie Ci consists of using the Fi type of needles to evacuate pus. 7 - The Method of Mao Ci consists of needling edemas and Bi (cutaneous pain). 8 - The Method of Ju Ci consists of needling the left side while the illness is localized at the right and vice versa. 1. These “spaces of distribution of the flesh” have the names Xi (small valleys) and Gu (valleys) and are located in the dermis.

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2. Translators’ note: #7 (The Method of Mao Ci) does not appear.

9 - The method of Cui Ci consists of using heated needles to treat Gan Bi (algoparesthesias of the muscles and tendons).”

III - N.V.N.: Needling according to the 4 seasons is represented by needling the Wu shu points (5 shuAntique points) based on the seasonal movements described in Chapter 2 of this classic. In this manner, for example: _ in spring, needle the luo points _ in summer, the shu points _ in autumn, the he points _ in winter, the jing-well points. It is, therefore, a question of one of the methods of dispersion to evacuate perverse energy. • The 9 methods of needling cited in this paragraph are widely distributed in our time. They make up part of the teaching programs of acupuncture in the West. 202.

PARAGRAPH 3 One distinguishes 12 methods of needling responding to the 12 channels. 1 - Method of Ou qi (double needling) to treat Xin Bi (obstruction of heart energy; cardialgia): _ A hand placed on the heart and another on the opposite (dorsal) region to determine the region affected. _ Implant 2 needles, one in front and the other behind on the painful area. _ Oblique needlings. the

fixed

2 - Method of Bao Ci (needling painful points) to treat pains without location: _ Needle painful points without removing the needle, _ With the left finger apply pressure near the point of impact, _ Push the needle in again before removing it.

3 - Method paresthesias of _ Needle _ Lift the retreating.

of Hui Ci (needling-drilling) to treat Gan Bi (painful muscles and tendons): vertically, needle and execute movements of advancing and

4 - Method of Ti Ci (grouped needling) to treat han Bi (obstruction caused by cold): _ One needle placed vertically at the point of impact, _ Two others implanted on the sides. This method also has the name San Ci (3 punctures).

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5 - Method of yang Ci (yang needling) to treat syndromes of fixation of “cold” energy in a sufficiently extended but superficial zone: _ One needle at the center of the point of impact, _ and 4 others around this center slightly raised up superficially. 6 - Method of zhi Zhen Ci (vertical, subcutaneous needling) to treat superficial syndromes of cold: _ Raise the skin up at the point of impact _ and perform a perpendicular stick on the cutaneous plane without injuring the dermis. 7 - Method of shu Ci (needling the shu points) to treat the fullness of energy with fever: _ Deeply implant the needle and raise it up slightly toward the superficial, _ Implantation and removal of the needle are vertical and relatively rapid. 203. the

8 _ _ depth,

- Method of Duan Ci (“short” needling to treat Gu Bi (ostealgias): Needle deeply up to the bone. Transmit movements to the needle of advancement towards the followed by movements of rotation.

9 - Method of Fu Ci (cutaneous needling) to treat muscular cramps due to cold: _ Oblique needling with lifting up of the point of the needle. 10 - Method of yin Ci (yin needling) to treat syndromes of afflux of cold (han Jue) and Zhonghan syndromes (direct attack by cold) with afflux: _ In the first case, needling is bilateral. _ In the second, it is done behind the internal malleolus (belonging to the shaoyin channel). 11 - Method of Bang Ci (lateral needling) to treat chronic Bi (painful paresthesias): _ A vertical needling applied to the center of the point of impact. _ Another at the side of this point. 12 - Method of Zan Ci (dispersive needling) to reduce inflammation or abscesses: _ Needle vertically _ remove vertically _ During the process, perform several movements of retreat to make it bleed.

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EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “Needling has its 12 methods corresponding to the 12 channels: 1 - Double needling (Ou Ci): _ A needling done on the thorax and another on the back, that is to say in front of and behind, at yin and at yang. _ The needling must be oblique to not injure the energy of the heart. 2 - Needling painful points (Bao Ci): _ Needling painful points without fixed localization. _ After removal of the needle, a new needling is done again at the same point. 3 - Needling-Drilling (Hui Ci): _ Transmit to the needles advancing and retreating movements to widen the point of

impact. _ This procedure is used in treatment of Gan Bi (painful paresthesias of the muscles and tendons). 204.

4 - Grouped Needling (Ti Ci): _ First needle vertically at the center of the point of impact, then needle obliquely at the two sides to reinforce that of the center. _ This process treats the deep syndrome of cold. 5 - yang Needling (yang Ci): _ Plant a needle at the center of the point of impact and transmit to it rotatory movements around this center. _ This process treats the superficial syndrome of cold. 6 - Vertical subcutaneous Needling (zhi Zhen Ci): _ The needling is only realized under the skin without touching the dermis (flesh). At the arrival of the energy, the needle is straightened vertically. _ This procedure treats the relatively superficial Bi caused by “cold” energy. 7 - Needling the shu points (shu Ci): _ Needling vertically and withdraw vertically. _ This procedure treats the syndrome of excess energy with hyperthermia. 8 - “Short” Needling (Duan Ci): _ Use short needles and needle right up to the bone. _ Perform advancing and retreating movements scraping the periosteum to treat Gu Bi (bone pains). 9 - Cutaneous Needling (Fu Ci): _ Oblique needling leaving the needle in place to treat muscular spasms due to cold. 10 - yin Needling (yin Ci): _ Method used to treat the han Jue syndrome (afflux of cold) at the level of the shaoyin. 11 - Lateral Needling (Bang Ci): _ First a vertical needling, then a lateral needling to treat chronic Bi.

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12 - Dispersive Needling (Zan Ci): _ After implantation of the needle, perform several retreating movements to make the blood leave in the treatment of inflammations and abscesses.”

II - Ma Shi comments: “This paragraph defines the 12 methods of needling responding to the 12 channels: 1 - Double Needling (Ou Ci): _ After having determined the symmetry of the cardiac and dorsal zones, needling is done at the anterior zone and another at the posterior zone to treat Xin Bi (obstruction of the energy of the heart; cardialgia) _ Note, however, that the needling must be oblique at the risk of touching the heart able to cause immediate death. 205. 2 - Needling painful points (Bao Ci): _ This procedure treats pains without fixed location, being seated either at the top or at the bottom of the body. _ Needle vertically and leave it in place. _ Massage the area near the point of impact before removing the needle. _ After its removal, immediately repeat a needling at the same painful spot. 3 _ _ (probing

- Needling-Drilling (Hui Ci): Vertical needling done on the side of the point of impact. Transmit rotatory movements to the needle with those of advancing and retreating motions) to treat Gan Bi (painful tendino-muscular paresthesias: myalgias).

4 - Grouped Needling (Ti Ci): _ Vertical needling done at the center of the point of impact, then 2 others at the 2 sides to treat han Bi (obstructions caused by the cold) located in the deep regions. _ Because of the number of needles, this process bears the name “3 punctures”. 5 - yang Needling (yang Ci): _ Vertical needling done at the center of point of impact and 4 others around this center. _ Slightly lift the needles without removing them and execute movements of going and coming to treat han Bi (afflux of cold) located in the superficial regions. 6 _ touching _

- Superficial and Subcutaneous Needling (Zi Zhen Ci): With one hand lift the skin, and with the other implant the needle into the skin without the dermis. This procedure treats cold syndromes localized in the superficial zones.

7 - Needling of the shu (shu Ci): _ Needle and remove vertically. _ During needling, advancing movements are rapid and deep and the movements of slight retreating to treat syndromes of excess of energy with fever. 8 - “Short” Needling (Duan Ci): _ During needling, rotatory movements transmitted to the needle are associated with those of advancing and retreating. _ The needling is done very close to the bone to treat Gu Bi (ostealgias).

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9 - Superficial Needling (Fu Ci): _ Oblique needling with the point of the needle oriented towards the point of impact and slightly elevated towards the skin (superficial) to treat spasms caused by cold. 10 - yin Needling (yin Ci): _ Bilateral needling to treat syndromes of han Jue (afflux of cold). _ But in the case of Zhonghan (direct attack by cold) accompanied by afflux, one must always needle the channels below (foot) because Jue (afflux) always starts at the bottom before reaching the top. _ This is why the choice of points to needle is that of the shaoyin (Ki), that is to say Taixi (Ki 3) located behind the internal malleolus. 206.

11 - Lateral Needling (Bang Ci): _ It concerns a vertical needling associated with lateral needling. _ This procedure treats chronic Bi (chronic algoparesthesias). 12 - Dispersive Needling (Zan Ci): _ Superficial implantation and removal of the needle relatively rapidly. _ The goal of this needling is to bleed some drops of blood to treat inflammations and abscesses.

III - N.V.N.: This paragraph constitutes a study of great valor in the practice of acupuncture and merits more detailed explanation as therapeutic success depends on it because the 12 procedures of needling noted in this paragraph are done according to the nature and localization of the disease. 1 - Ou Ci: Ou: double, two Ci: needling hence, Ou Ci: double needling. Methodology: _ Two needles, one is implanted into the anterior, and the other into the posterior part of the body. _ It is a matter of the technique called “yin-yang” or “shu-Mu”. _ The needling is necessarily oblique at the risk of injuring the organs. Therapeutic effect: This procedure treats ailments of the organs and bowels. Thus, for example, in gastralgia, one chooses Zhongwen (CV 12) of the supra-abdominal region and weishu (Bl 21) of the dorsal region. 2 - Bao Ci: Bao means: reaction Ci: needling hence Bao Ci: needling the reactive or A Shi (painful) points. Methodology: _ Vertical, direct needling into the painful (A Shi) point without immediate removal of the needle. _ With the finger of the left hand, press slightly on the painful spot. _ Before removing the needle, transmit to the needle some advancing movements. Therapeutic effect: 207. This procedure treats xing Bi (erratic pains).

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3 - Hui Ci: Hui means: drilling, probing; to expand, to enlarge Ci: needling hence Hui Ci: needling-drilling (or “large” needling). Methodology: _ Needling performed at the side of a muscle or tendon, executing advancing and regressive movements associated with rotation to enlarge the point of impact in the goal of making the muscles dilate in the event of retraction. Therapeutic effect: This procedure treats muscular spasms. 4. Ti Ci: Ti means: well ordered, well grouped Ci: needling hence Ti Ci: grouped needling.

Methodology: _ Three punctures, one needle implanted at the center of the point of impact and two others by the edges. Therapeutic effect: This technique treats Bi syndromes caused by cold localized in a relatively restricted area, but deep. 5. yang Ci: yang means: suppleness, lightness; superficial. Ci: needling hence yang Ci: light and superficial needling. Methodology: _ Superficially implant one needle at the center of the point of impact and 4 others at the sides. Therapeutic effect: This technique treats Bi syndromes caused by cold localized in a relatively extended zone, but superficial. 6 - zhi Zhen Ci: zhi means: straight, direct; subcutaneous Zhen: needle Ci: needling hence zhi Zhen Ci: vertical and subcutaneous needling. Methodology: _ First lift the skin at the point of impact, then insert the needle under the skin without injuring the dermis. Therapeutic effect: 208. This process treats Bi (pains) caused by “cold” energy localized in superficial areas. 7 - shu Ci: shu means: movement, displacement; ever-changing Ci: needling hence shu Ci: needling energetic (shu) points, implying the dispersion of perverse heat. Methodology: _ Advancing and retreating movements transmitted to the needle rapidly _ Needling is deep.

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Therapeutic effect: In a general way, this procedure treats febrile syndromes whose perverse heat is in an evolutive phase. 8 - Duan Ci: Duan means: short Ci: needling hence Duan Ci: “short” needling, implying the sense of slow needling and not using short needles or needling deeply. Methodology: _ Slow, advancing and retreating movements with movements of agitation of the needle. _ The point of the needle arrives right up to the bone. Therapeutic effects: This procedure treats joint inflammations. 9 - Fu Ci: Fu means: superficial Ci: needling hence Fu Ci: superficial or cutaneous needling. Methodology: _ Oblique needling _ The point of the needle is oriented towards the top (superficial) to not injure the dermis. _ Same group of needling as Mao Ci and yang Ci. Therapeutic effect: This procedure treats muscular spasms of “cold” origin. 10 - yin Ci: yin means: internal Ci: needling hence yin Ci: needling the internal surface of the leg. Methodology: 209. _ Bilateral needling _ Needle the shaoyin (Ki) located at the internal side of the leg. Therapeutic effect: yin needling is a specific method of treatment of afflux of cold (han Jue). han Jue always has a relationship with the Foot Shaoyin (Ki). This is why Taixi (Ki 3) is the specific point of treatment of the syndromes of afflux of cold. 11 - Bang Zhen Ci: Bang means: to the side, neighboring; lateral. Zhen: needle Ci: needling hence Bang Zhen Ci: lateral needling. Methodology: _ Bilateral needling close to vertical needling. Therapeutic effect: This procedure treats chronic Bi. 12 - Zan Ci: Zan means: to disperse, evacuate Ci: needling hence Zan Ci: dispersive needling.

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Methodology: _ relatively rapid implantation and removal of the needle in the goal of making the blood well up. Therapeutic effect: This procedure combats inflammation and dissolves abscesses.

PARAGRAPH 4 During needling of deep vessels, therefore imperceptible, the needles are left in place permanently to await the arrival of the energy. During needling of superficial vessels, one must first massage them before needling them to prevent the jing (essence) from escaping because the objective of the needling is to expel the perverse energy. EXPLANATIONS AND COMMENTARIES

210.

I - Zhang Shi explains: “The jingmai (system of principal channels) are linked to the “5 movements” of transformation, of the interior and to the “6 energies” of heaven, of the exterior. Practitioners who utilize the needles nust understand these relationships. Because, in the interior, the jingmai are linked to the organs and bowels, and at the exterior to the 6 celestial energies. a - In the interior, the 5 organs unite with the “5 movements” responding to the “5 Transformations” and control the entering and exiting movements of the energy; this is why one names them “5 organ-motors”. At the exterior, the energy circulates following the movements of ascent and descent, which is why one call it “creative-energy”. The 6 energies of heaven respond to the jing shui (liquid routes). These follow the energy in order to circulate towards the exterior, that is to say towards the skin.

b - The deep vessels of the energy are not perceptible because they are linked to the 5 organs. In this case, one must leave the needles in place permanently in the goal of awaiting the arrival of the energy (daqi). The jing shui follow the energy in order to exteriorize, and the vessels located at the skin are superficial; therefore, one must not hasten to needle them. First, one must stroke (lightly massage) them in order to push away the essence (jing) located at the level of the point of impact. For this reason, during needling, one does not injure the jing because this process is one of expelling the perverse energy and not the jing (essence).” II - Ma Shi comments: “This paragraph defines the 2 groups of energetic vessels (jingmai and luomai), one deep and the other superficial. As a consequence, their treatment is done entirely differently. For the deep vessels, implantation of the needle must be soft and light and placed permanently, much longer. here, it is necessary to know how await the arrival of the energy. In contrast, for the superficial vessels located at the level of the skin, it is necessary, before needling, to massage them lightly to push aside the jing shui (essence of water) because the objective of this type of needling is to excrete only the perverse energy”. III - N.V.N.:

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This paragraph defines the needling technique of the jingmai (principal channels) and luomai (secondary channels). The commentaries and explanations of Zhang and Ma permit clarification of the following notions: _ the notion of the “jing shui” (river routes) _ the notion of the “5 movements” responding to the “5 Transformations” _ and the notion of “ascent-descent” of the energy.

211.

Figure 15: “Movements” responding to the 5 Transformations and movements of ascent and descent of the energy.

PARAGRAPH 5 As for the method called “3 Punctures” (San Ci), it consists of _ first pricking across the skin to expel the perverse energy. _ then pushing the needle in deeper to excrete the perverse yin _ finally driving the needle in well, still more deeply, up to the muscles without penetrating them, to make the cereal energy return. This is why it is said in the “Methods of Needling”: To needle first the skin to gather the perverse energy in order to eliminate it in the goal of facilitating the arrival of energy and blood; next, to slightly advance the needle deeper to make the perverse yin come back out, and finally to make the needle advance still deeper to attract the cereal energy.” Such is the meaning of the method called “3 Punctures” (San Ci).

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EXPLANATIONS AND COMMENTARIES

212.

I - Zhang Shi explains: “This paragraph describes the 3 phases of needle implantation. According to Chapter 9 (“Beginning and Ending”) of this classic: “Needling must successively touch the layers of the body to reach the cereal energy: _ at the 1st layer, perverse yang exteriorizes _ at the 2nd layer, perverse yin exteriorizes _ at the 3rd layer, the cereal energy arrives”. The arrival of the cereal energy is determined by the process of tonification, which causes it to be in a state of fullness, or by the process of dispersion, which conducts it into a state of emptiness.”

II - Ma Shi comments: “This paragraph has the same theme as the preceding one. _ First, needling is cutaneous, superficial, to excrete perverse energy located in the wei (defensive) layer. _ Then, needling is slightly deeper, going past the skin, to expel the perverse energy located in the ying (nutritive) layer. _ Finally, at the 3rd stage, the needle enters into the flesh (dermis), that is to say into “the spaces of distribution of flesh” where Xi (small valleys) and Gu (valleys) are found to attract the cereal energy.”

III - N.V.N.: `In our era, the method of acupuncture called “heaven-Man-earth” is only a reflection of that of the “3 Punctures” (3 movements transmitted to the needle) mentioned in this paragraph: Let us note, however, that: a - Perverse yang designates the perverse energy localized in the wei (yang) layer. b - Perverse yin, the perverse energy fixed in the ying (yin) layer. c - The Cereal energy, the energy originating from the stomach after food metabolism. here, these words imply reactive phenomena perceived during manipulation of the needle (Da qi).

Figure 16: Techniques of the “3 Punctures”

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PARAGRAPH 6

213.

The use of needles without knowledge of the “great reunions” of the year, the excess or insufficiency of the energy of the 5 movements, and the causes of emptiness and fullness...is not worthy of the name “grand master”. EXPLANATIONS AND COMMENTARIES I - The explanation of Zhang Shi concerns not only this paragraph but also the previous one: “This paragraph describes the circulation of the 3 yin and 3 yang at the level of the 3 external layers of the body. _ “Cereal energy” is a source energy originating from spleen-stomach. It controls the sweat gland system. _ “Perverse yin and Perverse yang” are perverse energies localized in the yin layer and yang layer of the body. _ “To advance the needle still more deeply, etc.” implies: in crossing the skin, the needle is found in the flesh without touching the bones. _ The energy of the 3 yin and 3 yang circulate from the interior towards the exterior (to the skin) in order to respond to the 6 energies of heaven. This is why one must know the “annual movements” (3) of the energy during implantation of the needle to determine the emptiness or fullness of the disease; the great workers practice in this manner.” II - Ma Shi explains: “Treatment by acupuncture essentially consists of being based: _ on the annual movements of the “Great reunions’ of the energy, _ on the fullness and emptiness of the energy of the “5 movements” _ and especially on the causes of this fullness or emptiness.

In effect, it is again said in Chapter 71 (“Great Study on the Preparation and Cyclic recording of the 6 Energetic Sources”) of the Suwen: “Each year consists of its excessive movements and insufficient movements. The 1st energy... and “center” energy have their “host” and their “guest”, their movements of victory and their movements of counter-attack, etc. (3) All this is perfectly known by the grand masters.” III - N.V.N.:

214.

“The great annual reunions” of the energy constitute the principal rules of modification of the 6 energies (wind, cold, heat, humidity, dryness and fire). These periods of modification of the 6 energies are clearly explained in Chapter 66 (“Great Essay on the Origin of the 60 Year Cycle”) of the Suwen and in the chapters concerning the “5 movements and 6 energies” of our work, “Medecine Traditionelle Chinoise”.

3. See the detailed study in “Traditionelle Medicine Chinoise”. NVN Edition, 1984.

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PARAGRAPH 7 There exists 5 types of needling responding to the 5 organs: 1 - Ban Ci (semi-puncture) _ Needle superficially and withdraw rapidly without injuring the flesh, recalling pulling out of a hair. _ This process expels perverse energy localized in the skin. It responds to the lung. 2 - Bao Wen Ci (needling recalling the image of spots on the skin of leopard): _ Needling done indifferently at the left or right, in front or behind, but falling right on the blood capillaries to make the jingluo bleed. _ This process responds to the heart. the

3 - guan Ci (joint needling): _ Needling performed to the left or right, in front of or behind the joint, particularly at the level of the tendons, to treat jin Bi (pains of the muscles; myalgias) _ The method of bleeding is strictly contra-indicated here because this process responds to the liver. 4 - hegu Ci (needlings recalling the image of the angle where heguLI 4 occurs): _ 3 or 4 needles oriented toward the point of impact evoking the image of the claw of a chicken. This type of needling must touch the “spaces of distribution of flesh” (Xi and Gu: small valleys and valleys). _ This process treats Gu Bi (pains of the flesh; dermalgias). It responds to the spleen. 5 - shu Ci (needling the shu points): _ Vertical needling to the bone and also vertical removal of the needle to treat Gu Bi (pains of the bones; ostealgias). _ This process responds to the kidney.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

215.

1 - This paragraph defines the energy of the 5 organs. At the exterior, it unites with the skin, flesh, muscles and bones; in the interior, it controls the internal parts of the body. For this reason, one needles the places called “he” (reunion) located at the exterior in order to respond to the 5 organs. 2 - The blood makes up part of the “shen qi” (mental energy) group. This why the shen of the 5 organs circulates in the blood vessels to respond to the transformations of the 5 movements. 3 - The energy of the 5 organs unites at the exterior, at the level of the skin, flesh, muscles and bones in order to respond to the 4 seasons.”

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II - Ma Shi explains: 1 - Ban Ci or “semi-puncture”: _ Superficial needling with immediate removal of the needle is not a perfect method, hence the name “semi-puncture”. _ Deep needling risks injuring the flesh. This is why it must be superficial, as if one has extracted a hair. The goal of this needling is to only touch the energy of the cutaneous zone. _ As the skin unites with the energy of the lung, cutaneous needling (semi-puncture) responds to the lung organ. 2 - Bao Wen Ci or “Leopard Needling”: _ Numerous needlings done to the right and left, in front and behind. It is a matter of lightly touching the blood capillaries to make the jingluo bleed. _ As the energy of the heart controls the blood, this process responds to the heart organ. 3 - guan Ci or “Articular Needling”: _ Vertical and bilateral needling of the 4 limbs done especially at the level of the tendons and muscles, without bleeding, to treat jin Bi (myalgias, tendinitis). _ As the energy of the liver controls the muscles and tendons, this process responds to the liver organ. 4 - he Ci or “reunion Needling”: _ To the left as to the right, needling made up of several needles directed so as to form a claw of a chicken, to a depth not going past the “spaces of distribution of flesh”. _ As the energy of the spleen controls the dermis (flesh), this process responds to the spleen organ. 5 - shu Ci or “shu Needling”: _ Vertical and deep needling right to the bone to treat Gu Bi (ostealgias). _ As the kidney energy controls the bones, this process responds to the kidney organ.

III - N.V.N.: The 5 types of needling cited in this paragraph concern the disturbances of the 5 organs at the level of the exterior, that is to say at the level of the: _ skin (responding to the lung) _ little blood capillaries (responding to the heart) 216. _ muscles and tendons (responding to the liver) _ flesh (responding to the spleen) _ bones (responding to the kidney). 1 - First type of needling: Ban Ci. _ Needling only the epidermis, therefore not touching the dermis, hence “semi-puncture”. _ Superficial implantation and immediate removal of the needle like plucking out a hair. _ Technique of expulsion of perverse energy at the skin to treat cutaneous pain. _ Technique provoking reactive phenomena of the lung energy because the lung organ controls the pilocutaneous system. 2 - Second type of needling: Bao Wen Ci _ Needling evoking the image of the spots of the leopard’s skin. _ Numerous punctures at the sites of appearance of little blood capillaries, hence the name “leopard needling”. _ Technique of bleeding to evacuate blood stasis in order to ventilate the jingluo.

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_ Technique provoking reactive phenomena of the energy of the heart because the heart organ controls the vascular system. 3 - Third type of needling: guan Ci _ Needling close to the joint at the level of the muscles and tendons, hence the name “articular needling”. _ Needling without bleeding. _ Specific technique in the treatment of jin Bi (myalgias and tendinitis). _ Technique provoking reactive phenomena of the energy of the liver, because the liver organ controls the musculo-tendinous system. 4 - Fourth type of needling: hegu Ci _ “hegu Ci” does not designate the needling technique of the point hegu-LI 4. _ After having implanted the needle to a determined depth, lift it up slightly and place the needle into the dermis. With 3 needles, form the ideogram “ “ (fish) evoking the claw of a chicken. _ Specific technique for treatment of Bi of the flesh (dermalgias). _ Technique provoking reactive phenomena of the energy of the spleen, because the spleen organ controls the system of connective tissue (flesh). 5 - Fifth type of needling: shu Ci _ “shu” implies the sense of harmonious movements of aeration and circulation. All needlings are of the “shu” type. here, the needling must be deep in order to disperse the perverse energy localized at the level of the articulation. _ Rapid movements of advance and retreat transmitted to the needle. _ Deep needling right to the bone to treat Gu Bi (ostealgias). _ Technique provoking reactive phenomena of the energy of the kidney, because the kidney organ controls the osteo-medullary system. • In conclusion, Chapter 7 of the Lingshu concerns the daily practice of acupuncture. Failure to appreciate acupuncture techniques and imperfect manipulation of the needles are the principal causes of therapeutic failure.

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217.

Book II Book II comprises 3 chapters:

Chapter 8: Origin of the Mental (Ben shen) Chapter 9: Beginning and Ending (Zhang shui) Chapter 10: Vessels-Channels (jing Mai)

no 218 /219.

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CHAPTER VIII Origin of the Mental (Ben shen)

Chapter 8 of the Lingshu is devoted to the study of the origin of the mental activities, such as jing (essence), shen (mental), po (sensitive soul), si (reflection), zhi (intelligence) and lu (preoccupation). These activities have an intimate relationship with eugenics and are necessary for the maintenance of good health. The 7 feelings (sadness, joy, fear, anger, fright, worry, anxiety) can modify the mental activities and transform them into pathological factors. Also, during the use of acupuncture and moxabustion, the mental state of the patient must be evaluated, hence the title: “Origin of the Mental” (Ben shen). This chapter comprises 9 paragraphs.

PARAGRAPH 1

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Huangdi questions Qi Bo: “All acts of needling must be based on the shen (mental), Xue (blood), Mai (vessels), ying (nutritive energy), qi (energy) and jing (mental essence) stored in the 5 organs. When debauchery divides from the organ, _ jing is lost _ hun and po (vegetative and sensitive souls) rise up _ zhi and lu (intelligence and preoccupation) are missing. What does that mean? Is it the punishment of heaven or the of man? How do De (virtue) and qi (energy) produce jing (essence), (mental), hun (vegetative soul), po (sensitive soul), Chi (will), si (reflection, contemplation) and lu (preoccupation, worry)? I would like to understand this process.

shen them

fault shen

220.

Qi Bo replies: “In man, virtue (De) is created by heaven, and energy ( q i ) , by earth. In this way, man is born with De and q i . At birth, jing (essence; innate essence) occurs. The reunion of the two jing bears the name shen (mental); the reason to s e r v e /make use of things is called Xin (heart); that which records and memorizes the heart is called yi (thought); that which retains thought is called Chi (will); that which follows from will by the judgment of exterior manifestations is called lu (preoccupation); the arrangement of things after preoccupation is called zhi ( i n t e l l i g e n c e ) . This is why zhi (intelligence) maintains life, and life must necessarily be in accord with the 4 seasons and adapt to heat and cold, harmonize joy and anger, conserve yin and yang and balance Hard and Soft... . In this way, disequilibrium of the energy cannot ensue and one can live a long time.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “ 1 - This paragraph defines De (virtue) and qi (energy) of man, two innate elements that originate from heaven and earth, origins of the production of jing (essence, vital essence), qi (energy), hun (vegetative soul), po (sensitive soul), Chi (volition), yi (thought), zhi (intelligence) and lu (preoccupation). This is why the man of will can maintains his “shen-Chi” (mental-will) in perfect harmony with the jing of heaven and earth conforming to the Dao of eugenics.

2 - De (virtue) depends in part on heaven; it is sacred and clear-sighted, never confused, always full of reason in order to respond to all problems and adapt to all circumstances. 3 - The eyes and vision, ears and hearing, nose and smell, mouth and taste, limbs and gestures are none other than the xing (bodily form) and qi (energy) created by the earth. 4 - All must start by the beginning and wise building and development for the future. It is the union of De and qi which creates the beginning. In Chapter 30 (“Fundamental Characteristics of the energy”) of the Lingshu, it is said: “That which creates before form is called “jing”. That means that the creation of form is the result of the impregnation of celestial jing. For this reason,

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it is said: “The origin of life is jing”. It is also stated in Chapter 32 (“Normal Man Faced With a Shortage of Cereals”) of the same classic: “shen comes from the union of celestial (innate) jing and cereal (acquired) jing.” The text therefore states: “The union of the 2 jing forms the shen”. 221.

5 - The jing of fire is shen (mental) and the jing of water is jing (essence, vital essence). The liver is a yang organ receiving the hun (vegetative soul); the lung is a yin organ conserving the po (sensitive soul). This is why the hun follows the shen (mental) in order to go and come, and the po (sensitive soul) follows the jing in order to enter and leave. The heart is a sovereign organ, site of manifestation of shen Ming (mental, clarity, genius). All beings and all things of the universe are harnessed and controlled by the heart (Xin). That which the heart records and memorizes is called “yi” (thought); that which the will brings about is called “si” (reflection); that which reflection permits or regrets is called “lu” (preoccupation); that which preoccupation organizes is called “zhi” (intelligence)... . All these activities originate from “Xin-shen” (heart-mental: Morals). This is why the man of will obeys the “nature” of heaven and earth and knows eugenics.”

II - Ma Shi comments: “This paragraph studies the meaning of De (virtue) and qi (energy). After profound analysis of these words, Qi Bo certifies that only the man of will knows the method of eugenics.

1 - heaven is not without energy (si) if one takes reasoning as “basic element”. This is why the virtue (De) of man is that of heaven. earth is not without virtue (De) if one takes energy as “motor-component/driving force”. This is why the energy (qi) of man is that of earth. In this way, man is created thanks to the fusion of De (Virtue) and qi (energy). 2 - At birth, man has yin, that is to say ying (nutritive energy), and yang, that is to say wei (defensive energy). When ying and wei fuse, shen appears. hun (vegetative soul), although yang, must follow the shen in order to go and come. po (sensitive, etheric soul), although yin, must follow the jing (essence, vital essence) in order to enter and leave. If one compares jing with shen, jing is yin and shen is yang. For this reason, the hun belongs to shen, and the po, to jing. The heart (“mental” heart), yi (thought), Chi (will), si (reflection), zhi (intelligence) and lu (preoccupation) uniquely originate from the heart (organ). Therefore, the answer or reason for using these things is dependent exclusively on the heart. What the heart records and memorizes is called yi (thought),... etc. Without the 13 resolutions cited above, the ignorant will never succeed; only the wise know the principles of eugenics: above, it will conform to celestial time (4 seasons); below, it will be in accord with human affairs; it will conserve yin and yang, will harmonize the Hard and the Soft and will avoid “deviations of the heart”. In this way, he will be able to live and see long times.” III - N.V.N.: 222. 1 - This paragraph is fundamental to the practice of acupuncture and moxabustion because it emphasizes the importance of studying the psycho-affective terrain, the basis of all therapy, modern or ancient. 2 - heaven bequeaths to us De (virtue) and earth, qi (energy). The energy of heaven and earth, of yin and yang, of top and bottom, intersects and fuses to create the succession of life and death in all beings and things. This is why the origin of life is immaterial; it is the result of the principles of crossbreeding of two energies, yin and yang. This

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immaterial substance is called “jing”. The reunion of the 2 jing produces the vital force called “shen” (mental). The force of activity concerning the “going and coming” movements which follow the shen qi (mental energy) and represents the jing shen (mental essence: morals), and yi Cheng (thoughtknowledge: consciousness) is called “hun” (vegetative soul). The force of activity concerning the “entering and exiting” movements which is close to the jing energy and maintains qi guan (energetic barriers; the points) is called “po” (sensitive soul). The force of activity responsible for the realization of vital manifestations is called “Xin” (heart). The force of preparation of work at the level of the heart is called “yi” (thought). The mental disposition, which tends toward being expressed by an effective decision matched with intention, is called “Chi” (will). The state of the mind which is absorbed by an object as far as moral suffering is called “lu” (preoccupation). The ability of a individual to adapt to new situations (between reflection and preoccupation) is called “zhi” (intelligence). 3 - These mental forces are developed according to the laws of the 5 movements (Fig. 17).

Figure 17 The mental forces and the laws of the “5 movements”

223.

4- Eugenics practiced by man basically consists of following the movements of the 4 seasons, responding to cold and heat, not excessively letting go to joy or anger, limiting the ascending force of yin and yang and, at the same time, harmonizing the Hard and Soft (see Ch. 6) in the goal of attaining the equilibrium of the exact milieu. In summary, Eugenics is a method capable of safeguarding health, therefore maintaining life, in order to avoid infiltrations of perverse energy, causal factors of disease.

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PARAGRAPH 2 This is why, _ fear, reflection and preoccupation injure the shen (mental) and perturbed s h e n creates a permanent state of panic. _ sadness and grief disturb the interior and causes loss of the joy of life. _ excessive joy disperses the shen which is no longer conserved. _ worries and affection block the circulation of the energy. _ excessive anger causes blind, embarrassing and uncontrollable gestures. _ fright brings the s h e n to a state of wandering without possibility of retaining it.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph completes the preceding one. si (meditation, reflection), lu (preoccupation, obsession), Chi (will) and yi (thought) are directly controlled by the shen (mental). This is why mental activities such as reflection, preoccupation, sadness, joy, anger, anxiety, fear, fright... injure the shen.” II - The explanations of Ma Shi are found in Paragraph 8 (see pg. 230-31). III - N.V.N.: This paragraph explains the consequences of excess of disturbance of the psyche. Because, _ fright and worries injures the shen. The shen being injured, daily life is in a permanent state of fear, _ intense compassion injures the organs. The blood and energy are then in a state of exhaustion and their depletion is synonymous with death, _ extreme joy makes the shen qi (mental energy) ramble which can no longer return. _ immoderate sadness injures the lung, and the energetic system of shangjiao (upper jiao) is obstructed, _ unbridled anger also injures the shen (mental) rendering it dazed and terrified without possibility of mastering oneself, _ exaggerated worries also disperse the shen qi without possibility of retaining it.

PARAGRAPH 3 Fear, reflection and preoccupation injure the s h e n . The injured shen causes panic and loss of the notion of “I”; the muscles grow weak and complexion and form (xing) wither. Death occurs in winter. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

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“This paragraph and the following ones concern the study of the “7 feelings” susceptible to injuring the “shen-Chi”(mental-will) of the 5 organs. Fear, reflection and preoccupation injure the shen of the heart organ. The shen being injured, self-mastery is absent, hence panic and disappearance of the notion of “self”. The spleen answers to earth and controls the “flesh” system, and the lung answers to the energy and controls the pilocutaneous system. The muscles originate from the xing (bodily form, material) of earth; body hair, skin and complexion originate from the qi (energy) of heaven. If the muscles become lax and if the complexion fades, the“source of life” obtained from heaven and earth dry up and death follows in winter. This death is due to the energy of the 5 movements according to “victory-inhibition of the 4 seasons”. II - The commentaries of Ma Shi can be found in Paragraph 8 (see pg. 230-31) III - N.V.N.: 225. The heart receives the shen. Fear and excessive worries injure the shen. Because the shen is injured, a state of panic appears and self-mastery disappears. In the chronic state, the muscles and tendons of the neck become swollen and those of the knee and buttock collapse; the muscles of the body atrophy; the body hair and head hair fall out, the skin dries up and complexion tarnishes. One says that death follows in winter because the heart-shen answers to fire and winter to water. water invades fire, therefore death takes place in winter (Figure 18).

Figure 18 Invasive action of water on fire in disease of the shen.

PARAGRAPH 4 Sadness and unreleased grief act on the spleen and injure the yi (thought). Perturbed thought brings with it disorder, the limbs are

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heavy and blocked, the xing (bodily Death occurs in spring.

form)

and

complexion

wither.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “Anguish and grief are the feelings of the spleen. If anguish and grief are not released, they injure the yi (thought). The injured yi creates disturbance and the limbs cannot be lifted because anguish and chagrin, originating from the heart and spleen, control the 4 limbs.” II - See the explanation of Ma Shi in Paragraph 8 (pg. 231). 226.

III -N.V.N.: The spleen receives yi (thought). Excessive, prolonged and unresolved sadness injure yi. The disturbed yi causes thoracic oppression coupled with anguish and grief; the limbs are weak. In serious cases one notes falling out of hair, dryness of skin and tarnished complexion. Death follows in spring because “spleen-thought” responds to earth and spring, to wood. wood invades earth, therefore death takes place in spring (Figure 19).

Figure 19

PARAGRAPH 5

Invasive action of wood on earth in disease of thought.

Sadness and lamentations act on the liver and perturb the hun (vegetative soul).

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The injured hun causes amnesia and a loss of jing (essence). The loss of jing is the origin of manic-depressive psychosis. The illness presents other signs such as retraction of the genitals, muscular spasms and hypochondralgia preventing movement of the body. The xing (bodily form) and complexion wither, and death occurs in autumn.

EXPLANATIONS AND COMMENTARIES

227.

I - Zhang Shi explains: “Sadness and lamentations are the feelings of the lung. In the interior, they injure the liver and perturb the hun (vegetative soul). The disordered hun provokes forgetfulness and loss of jing. The liver is an organ which fills the function of “general”; all strategies follow from it. The liver being damaged, commands become hesitant and judgment is not clear. The gallbladder is a “loyal and honest” bowel. It is has the power to make decisions. When the liver energy is disturbed, the bowel (gallbladder) is hindered during its decisions.

The liver controls the muscles, and its channel-vessel becomes attached to the energy of the genital organs. This is why disturbance of the liver energy is the origin of penile retraction and muscular contraction with hypochondralgia... . Such are the repercussions of the disorder of feelings on xing (bodily form).

II - See the explanation of Ma Shi in Paragraph 8 (pg. 195).

III - N.V.N.: The liver receives the hun (vegetative soul). An excess of sadness and lamentation acts upon the internal organs and injures the hun. The injured hun brings with it madness (yin and yang), delirium and mental confusion. One notes in addition penile retraction, muscular contraction with hypochondralgia, and, in serious cases, loss of hair, dryness of skin and faded complexion. Death occurs in autumn because: _ “liver = hun” responds to wood _ and in autumn, to metal. (Figure 20)

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Figure 20 Invasive action of metal on wood during disease of the hun.

PARAGRAPH 6

228.

The excess of joy acts on the lung and injures po (sensitive

soul).

The injured po causes Kuang (yang madness) and, in the presence of K u a n g , yi (thought) disappears; the skin dries out and desquamates. Death occurs in summer. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “Joy is the feeling of the heart. In the interior, it injures the lung and disturbs the po. The injured po causes Kuang. Kuang drives the yi out and the yi becomes manifest thanks to the Xin (heart). This is why excessive joy disintegrates the shen. From the fact that the lung controls the pilocutaneous system; the skin becomes dry and desquamates. II - See the commentary of Ma Shi in Paragraph 8 (p.230-31). III - N.V.N.: The lung receives the po. An excess of joy injures the po, and the injured po provokes yin madness and yang madness (Dian Kuang) with loss of the notion of others and withering of the skin; and in serious cases, falling out of the hair and faded complexion. Death follows in summer because: _ “lung-po” responds to metal _ and summer, to fire (Figure 21).

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Figure 21: Invasive action of fire on metal during the illness of po.

PARAGRAPH 7

229.

Excess anger acts on the kidney and injures the Chi ( w i l l ) . T h e injured C h i causes forgetfulness and lumbar and spinal pains with inability to flex and stand. The xing (bodily form) and complexion wither. Death follows at the end of summer. EXPLANATIONS AND COMMENTARIES I. Zhang Shi comments: “Anger if the feeling of the liver. Excess anger injures the Chi (will) of the kidney organ and the injured Chi brings with it loss of memory, the limbs and spine are painful preventing flexion and extension movements. The energy of the spleen gathers at the heart; that of the lung, at the spleen; that of the liver, at the kidney... . They are the gathering phenomena of the energy of “son” at the level of “mother”. The energy of the lung gathers at the liver; that of the heart, at the lung. These gatherings are the inhibitory phenomena carried out on the organs inhibited. The Bing Mai states: “The encroachment of water on fire and that of metal on wood are phenomena of submission (subjection). In contrast, the encroachment of water on metal and that of fire on wood are phenomena of constraint (antimonarchic). This means: the encroachment of “mother” on “son” is favorable, and that of “son” on “mother” is contrary. In other words, the reciprocity of stimulation is beneficial and that of inhibition is harmful.” II - See explanation of Ma Shi in Paragraph 8 (see pg. 230-31).

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III - N.V.N.: The kidney receives the Chi (will). Excess anger injures the Chi and perturbation of the Chi is the origin of the diminution of the ability to preserve and recall states of past consciousness, in particular, expressed language; it also is the cause of lumbalgia with radiation to the spine. In serious cases, one notes in addition loss of hair, dryness of skin and faded complexion. Death occurs at the end of summer because: _ liver-anger responds to wood _ wood in fullness revolts against its “mother” _ the kidney being in insufficiency, the disease is worsened and death follows at the end of summer, under the action of spleen-earth (Figure 22).

230.

Figure 22 Invading action of earth on water in disease of the Chi.

PARAGRAPH 8 Unreleased fright damages the jing (essence) and the perturbation of jing is the origin of ostealgias, atrophic impotence (wei Jue) and intermittent spermatorrhea.

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The 5 organs receive the j i n g . One must never injure the jing because this lesion spontaneously causes the emptiness of yin expressed as a deprivation of energy; the prognosis is fatal. As a result, those who utilize needles must carefully study the state of the patient to determine the presence or absence of j i n g , s h e n , h u n , p o , y i . If these 5 components are absent, treatment by acupuncture is advised against. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “ 1 - Fright injures the kidney. Untreated, fright and fear disturb the jing of the kidney organ. The kidney controls the bones. This is why injured jing brings with it latent pains in the bones which, in a chronic state, ends up in the syndrome called “atrophic impotence” (wei Jue) with intermittent spermatorrhea which is difficult to treat because: _ the jing of fire is the shen _ and the jing of water is the Chi. 231. 2 - While the previous paragraph explains the treatment of Chi (will) of the kidney, this one defines the treatment of the jing of the same organ. The hun, po and Chi originate from heart-kidney and from the jing-shen (jing-Mental); this is why Paragraph 2 of this chapter states: “Fear, reflection (si) and preoccupation (Lu) injure the shen.” The shen is produced by the jing, and the jing returns to the shen. 3 - When the cereals penetrate into the stomach, they are transformed into liquid substances and into the 5 sapors circulating according to the appropriate direction: _ sour sapor goes to the liver _ bitter sapor, to the heart _ sweet sapor, to the spleen _ spicy sapor, to the lung _ salty sapor, to the kidney. It is in this way that the 5 organs receive the jing of the cereals.

4 - The shen energy is created by the jing. For this reason, the jing of the 5 organs must not be injured at the risk of causing a syndrome of Emptiness of yin (yin Xie) responsible for the exhaustion of the shen whose prognosis is extremely serious. In this way, “Those who utilize the needles must study the state of the patient to determine the presence of jing, shen, hun, po, yi...” because acupuncture is strictly prohibited in their absence. `5 - Wu Shi declared: “Uncontrolled fright injures jing”. here, the word “jing” designates the innate, a priori jing. In contrast, the jing conserved in the 5 organs is the jing coming from the cereals (acquired). shen comes from jing. This is why the text specifies: “Emptiness of yin is synonymous with the absence of shen energy.”

II - Ma Shi comments: “ 1 - This paragraph concerns the Wu shen (5 mental energies): _ jing-shen (essence/Mental) _ hun (vegetative soul) _ po (sensitive soul) _ yi (thought)

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_ Chi (will). Disturbance of the Wu shen causes that of the 5 organs; the disease is extremely serious, and the prognosis is fatal.

The Wu shen of the 5 organs are: _ the mental (shen) received by the heart _ thought (yi), by the spleen _ the vegetative soul (hun), by the liver _ the sensitive soul (po), by the lung _ jing and will (jing Chi), by the kidney. This is why the text states: “Fear, reflection and worry (Zhu yi si lu) injure the shen of the heart organ. The injured shen causes emptiness of the heart. The heart being in emptiness, the kidney invades it and oppresses it.” (Figure 23)

232.

Figure 23 Wu shen (5 mental energies) and Wu xing (5 movements).

Disorders of the Chi of the kidney provoke fright and increasing growth of fright is the origin of muscular melting (hypotony and laxity), hence the change in xing (bodily form) and complexion. By what manner? By the action of the kidney (water) which destroys fire (shen). 2 - Unchecked anxiety and grief blocks the circulation of the spleen and injures the yi (thought) and injured yi is the origin of disorders of movement of the limbs (inability to lift them). In the chronic state, the xing (bodily form) and complexion become altered. Death occurs in the spring. By what manner? By the destructive action of wood on earth. 3 - Sadness and lamentations injure the hun (vegetative soul) of the liver organ. Perturbed

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hun is the origin of insanity, easy forgetfulness and spermatorrhea; spatial orientation is incorrect (vertigo) and the patient presents moreover with retraction of the genitals, muscular spasms and bilateral hypochondralgia preventing the movement of the body, and, if long enough, a total loss of the “vital source” with alteration of xing (bodily form) and complexion. Death occurs in autumn. By what manner? By the destructive action of metal on wood.

4 - Excess joy injures the po (sensitive soul) of the lung organ. When po is injured, the shen disintegrates without recourse, inducing the appearance of Kuang (yang madness) and, as a result of the latter, yi (thought) becomes lost. The loss of yi comes, therefore, from the insufficient energy of the “mother” (heart-shen); the skin becomes dried out and desquamates with change in xing (bodily form) and complexion. Death occurs in summer. By what manner? By the destructive action of fire on metal. 233. 5 - Excessive and repeated anger injures the Chi (will) of the kidney organ. When Chi is injured, the subject is in a dazed state with mental apathy and aphasia (1) and complains moreover of lumbalgia and spinal pain preventing flexion and extension. Likewise, uncontrolled fright dislocates the shen and injures the jing. Injured jing is the origin of bone pain or atrophic impotence (wei Jue) or spermatorrhea. In the long run, the xing (bodily form) and complexion become altered. Death occurs at the end of summer. By what manner? By the destructive action of earth on water. 6 - The 5 organs have their own energy and their own jing (essence), and all are equipped with the ability to store their jing. If they are injured, the yin energy is found in a state of emptiness because the 5 organs being yin and in emptiness are devoid of energy. This is why the acupuncturist must carefully examine the state of the patient to determine the energetic potential of the jing and shen, hun and po, and Chi and yi. If disturbance of the Chi (will) of the 5 organs becomes expressed by an alteration of xing (bodily form) and complexion, death is near and acupuncture is ineffective. It is stated in Chapter 11 (“Special Study on the 5 Organs“) of the Suwen: “Do not treat incurable diseases since the treatment is ineffective.” For our part, we think that when acupuncture is inadvisable, phytotherapy must be wisely employed.” III - N.V.N.: 1 - In the chronic state, fright injures the jing (essence). The injured jing is the origin of latent arthralgias with weakness of the limbs and spermatorrhea. The 5 organs receive jing qi (energy of the vital essence). Their function must not be disturbed. jing is yin. It is the material basis of the yang energy originating from the activities of the 5 organs. In the event of disturbances, the “jing” energy becomes lost and can no longer 1. According to the original text: forgetfulness of language.

defend the interior, hence the emptiness of yin. Loss of jing and emptiness of yin are two provocative factors of deficiency of nutritive matter, that is to say of the degradation of energetic metabolism. This is while the problem of the change in xing (bodily form) and complexion comes up, ending in death. 2 - This paragraph underscores the importance of the notion: “The 5 organs are the 5 receivers of the jing”, namely:

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_ the liver receives Xue (blood) _ the heart, Mai (vessels) _ the spleen, ying (nutritive energy) _ the lung, qi (energy) 234. _ the kidney, jing (essences). The jing (essence) of the 5 organs creates the shen (mental), and the shen of the 5 organs are: _ shen (mental) _ hun (vegetative soul) _ po (sensitive soul) _ yi (thought) _ Chi (will) which include all mental activities of energetic mutation (metabolism). In all, jing (essence) is a material, nutritive substance. Man has need of this “substance” for his physical and mental activities. Such is the theory according to which: “The posterior (acquired) data maintain the anterior (innate) data”. But the nutritive substance (jing) requires the support of the energetic metabolism to subsist; this is the theory according to which “The anterior (innate) data maintain the posterior (acquired) data.” These theories are fundamental to the complete comprehension of the mechanism of human physiology in Oriental medicine. In this paragraph, Qi Bo emphasizes the protection of the jing because “its loss is the origin of emptiness of yin” , meaning the disappearance of the energy, and the disappearance of the energy is death. This phrase stresses the importance of the reciprocal relationship of the jing (essence) and qi (energy). 3 - As a consequence, the acupuncturist must carefully examine and analyze the mental activities of the patient, that is to say, the jing-shen (essence and mental) and hun-po (vegetative and sensitive souls), in the goal of evaluating the manifestations of the 5 organs in relation to the psycho-affective states. When these states are jointly perturbed, the disease is extremely serious.

PARAGRAPH 9 The liver receives Xue (blood). The blood is the dwelling place of the hun (vegetative soul). Emptiness of the energy of the liver expresses a s fear, and fullness, as anger. The spleen receives ying (nutritive energy). ying is the abode of the yi (thought). Emptiness of the energy of the spleen causes disorders of movement of the 4 limbs and perturbs the 5 organs, and fullness causes abdominal bloating and hinders the urinary routes. The heart receives Mai (vessels). The blood within the blood vessels is the dwelling place of the shen (mental). Emptiness of the heart energy provokes compassion, and fullness, groundless l a u g h i n g . The lung receives qi (energy). qi is the abode of the po (sensitive soul). Emptiness of the lung energy is the origin of nasal obstruction and the insufficiency of energy; fullness causes panting breathing and thoracic discomfort obliging the patient to lift the face up to breathe.

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The kidney receives the jing (essence). jing is the dwelling place of the Chi (will). Emptiness of the kidney energy expresses as ice-cold limbs, and fullness, as abdominal bloating. 235.

In disorders of the 5 organs, one must carefully examine the patient to determine emptiness and fullness in light of applying the method of regulation. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “ 1 - The energy of the 5 organs can be in emptiness or fullness; their symptomatology is, therefore, different. The 5 organs each have a specific energy to store, and the Wu Chi (5 wills) each have a dwelling place which is appropriate to them. When the “5 Chi” are disordered, the disease belongs to the “5 Chi”; and when the energy of the 5 organs is in imbalanced, the clinical signs belong to the disease of the energy of the organs. In this way, a scrupulous examination of the pathological signs of the 5 organs is necessary to determine the emptiness or fullness of the energy.

2 - The liver is an organ whose functions are similar to that of a “general”. For this reason, emptiness of the liver energy causes fear, and fullness, anger. 3 - The spleen controls the 4 limbs. Emptiness of spleen energy becomes expressed as a weakness of the limbs. earth-spleen maintains the other 4 organs. In the event of emptiness of its energy, the 5 organs are affected. The abdomen, fortress of spleen-earth, is bloated, and the urinary routes are blocked when the energy of spleen is full. 4 - Compassion is the Chi (will) of the heart; the emptiness of heart energy augments the compassion, and fullness, incessant and unmotivated laughter. 5 - The lung controls the energy and regulates respiration. As a result, emptiness of the energy of the lung is the origin of nasal obstruction and energetic deficiency. In the event of fullness, respiration is gasping, with thoraco-abdominal discomfort impeding lying on the back. 6 - The kidney is the source organ of the vital energy (sheng qi). In the event of emptiness of the energy of the kidney, the feet and hands are ice-cold. The kidney is also called the “door” to the stomach. In the event of fullness, the “door” (passage) functions poorly, which induces diseases. In total, in the event of disorders of the 5 organs, one must always examine the state of the qi (energy) before treating”. 236.

II - Ma Shi comments: “ 1 - The organs have an emptiness and a fullness which are specific to them. As a result, their diseases are diverse.

2 - The blood received within the liver is the dwelling place of the hun (vegetative soul).

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Fear originates from the emptiness of energy of the liver, and anger, from fullness. 3 - ying (nutritive) energy received within the spleen is the dwelling place of yi (thought). Paralyzed limbs and disorders of the 5 organs are the signs of emptiness of the spleen. In contrast, abdominal bloating and dysuria are caused by fullness. 4 - The Mai (blood vessels) received within the heart are the dwelling places of the shen (mental). Grief and compassion are caused by the emptiness of the heart, and incessant and groundless laughter are the signs are fullness. 5 - qi (energy) received within the lung is the dwelling place of po (sensitive soul). When the energy of the lung is in emptiness, the nose is obstructed and the energy is found in a state of insufficiency. When it is in fullness, respiration is labored and thoraco-abdominal obstruction prevents the supine position. 6 - jing (essences) received in the kidney are the dwelling places of the Chi (will). When the energy of the kidney is in emptiness, the limbs are ice cold, and when in fullness, the belly is bloated because the vessel (channel) of the kidney passes by the lower abdomen. Such are the pathological forms of the 5 organs. One must, therefore, carefully evaluate the state of emptiness and fullness of the qi (energy) before choosing an adequate therapeutic method. Acupuncture and phytotherapy must be used with much discernment.”

III - N.V.N.: The activities of each organ are double, somatic activity and psychological activity, and their energy can be in a state of emptiness or in a state of fullness. Because, 1 - The liver has the power to store the blood and maintain the equilibrium of the blood volume. Its psychological activity, representing the shen (mental), Chi (will) and yi (thought), is the hun (vegetative soul), and the hun dwells within the blood. The emptiness of the energy of the liver causes diminution of the blood volume, factor responsible for fear and anxiety. In contrast, its fullness provokes anger. 2 - The spleen has the function of receiving the ying (Rong, nutritive energy). Its psychological activity is called yi (thought), and yi dwells within the ying. When the energy of the spleen is in emptiness, the circulation of organic liquids and of jing (essence) is impeded and cannot reach the 4 limbs, hence disorder of motility and disharmony of the energy of the 5 organs. In the event of fullness, the energy of the spleen stagnates, provoking abdominal fullness and problems with diuresis. 237. 3 - The heart is the sovereign organ of the liquid blood circulating in the vessels (Mai). Its psychological activity representing thought (yi), and consciousness/awareness (zhi) is called shen (mental); and the shen dwells within the blood of the vessels. Emptiness of the energy of the heart causes sadness and grief; and its fullness, incessant laughter with opened throat (2) (unmotivated). 4 - The lung contains the source energy (3). The movements of “ascent and descent” of the energy-source are controlled by the po (sensitive soul) which is the representative of the qi guan (energetic doors: points) and which dwell in the source energy. Emptiness of the lung energy expresses as nasal obstruction, dyspnea and deficiency of energy, and its fullness as thoracic fullness forcing the patient to throw back his head to breathe.

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5 - The kidney contains the jing qi (“jing” energy) (4) of the 5 organs. Emptiness of energy of the kidney and insufficiency of yuan yang (yang source) (5) is the origin of ice-cold limbs. In diseases of the kidney, perverse energy in fullness is the cause of abdominal bloating. In summary, in practice, it is necessary to study well the syndromes of the 5 organs and to search for the signs of emptiness and fullness of their energy in order to apply an adequate therapy because the results depend on this.

2. Laugh like a hunchback. 3. The source energy (Zhan qi) is also designated by the name “yuan qi” (original energy or essential energy). 4. here, the word “jing” has 2 meanings: jing, pure energy of the 5 organs received by the kidney and “sexual jing” (spermatozoa or ova) 5. kidney yang. no 238/239.

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CHAPTER IX Beginning and Ending (Zhong shui) Chapter 9 of the Lingshu is devoted to the presentation of: _ the 3 yin channels and 3 yang channels _ the pulsology and classification of renying and Cun Kou _ emptiness and fullness, able to be regulated by tonification and dispersion _ the utilization of a small or significant number of points _ and the duration of the interval between acupuncture sessions. The techniques of needling are also noted: _ local needling or needling at a distance, based on the existence of the circulatory pathways of the energy _ the depth of needling as a function of yin and yang nature, the “seasonal” nature of the illness, the constitution of the subject and, above all, the area of implantation of the needle. At the end of this chapter, the 12 contraindications of acupuncture and the different phases of starting and ending of the illness of the energy of the 12 channels are greatly studied. In summary, the key aspect of Chapter 9 is to present the different physiologic, pathologic, diagnostic and therapeutic aspects of the formation and disappearance of the disease. Each form possesses an etiology, specific natures and specific reactions. Knowledge of the mechanism of the evolution of the disease, from its appearance to its end, is, therefore, necessary in order to practice acupuncture methods. For this reason, this chapter is entitled: “Beginning and Ending”. 240.

According to Zhang Shi: “ending and beginning” is the name of a book of antiquity retrieved by Qi Bo. In Chapter 5 (“Origin and Gathering”) of this classic, we note this phrase: “The mystery of the“9 Needles” and their “knot” and “ankle” are found in the chapter “Beginning and Ending. Chapter 9 begins with the same phrase. Therefore, this chapter is clearly taken from a classic book of our masters of long ago.” This chapter comprises 27 paragraphs.

PARAGRAPH 1

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A ll methods of acupuncture are demonstrated in the chapter “Beginning and Ending”. To delve deeply into this chapter is to consider the 5 organs as basic principles, and yin and yang will be, in this manner, determined. yin answers to the organs, and yang, to the bowels. yang receives the energy at the level of the limbs, and yin, the energy at the level of the 5 organs. This is why, during dispersion, one must go in opposition, and during tonification, go in pursuit. In this way, to the know the method “to go in opposition” and the method “to go in pursuit” is to know how to balance the energy. The principle of balancing the energy resides in the ventilation and harmonization of yin and yang. The 5 organs are yin, and the 6 bowels are yang. This notion must be transmitted to posterity by an oath made in blood. In revering it, one becomes skillful; in disdaining it, one becomes clumsy and tactless; in opposition to the Dao and by only one’s personal reasoning, one surely ends up in calamity.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The organs and bowels (Zang and Fu), yin and yang, jing and Mai (channels and vessels), qi and Xue (energy and blood) created by heaven (respiration) and earth (diet) have their “beginning” (shui) and their “ending” (Zhong).

1. wind, cold, heat, humidity, dryness and fire are the “6 energies” of heaven. wood, fire, earth, metal and water are the “5 movements” of earth. heaven maintains living beings with its “6 energies”, and earth with its “5 sapors”. 2. The “6 energies” of heaven transmute and create the “5 sapors”, and the “5 movements” of earth are intended to create the “5 organs”. 241.

3. In the interior, the 5 organs are linked to the 6 bowels in order to respond to the 5 movements of earth. At the exterior, they are linked to the 6 channels in order to respond to the 6 energies of heaven. This is why it is said: “To go very deeply into the chapter “Beginning and Ending” is to grasp the 5 organs as foundational principles.” Therefore, it is stated that the 5 organs originate from the transmutation of the energy of the 5 movements. 4. The meaning of the words “ending” and “beginning” is clearly explained. One must take the jingmai (principal channels) as fundamental rules; their conformity or non-conformity to the celestial Dao permits solution of all physiological and pathological problems. Because, at the ending, _ the taiyang manifests by wide open eyes and curved back _ the taiyin is characterized by abdominal swelling and difficult respiration.

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In this manner, in man, the yin and the yang, the blood and the energy begin via the action of the “5 movements” of earth and of the “6 energies” of heaven and end at the level of the 6 bowels, sites of reunion of yin and yang. 5. “yang receives the energy at the level of the 4 limbs” means: yang absorbs the celestial energy coming from the exterior. “yin receives the energy at the level of the 5 organs” means: yin absorbs the terrestrial energy coming from the interior. This is why, in order to utilize the method of dispersion, “One must go against it (go in opposition to it)”. This means to say that one must go in front of the energy which goes from the interior to the exterior. To utilize the method of tonification, “One must go in pursuit of it (chase after it)”; meaning that one must go in front of the yang energy which goes from the exterior toward the interior. In total, to balance the energy, one must clearly know the meaning of yin and yang.”

II - Ma Shi comments: “All acupuncture methods are based on the idea of the ending and beginning cited in this chapter. Because, _ the organs are yin and the bowels are yang _ yang located at the exterior receives the energy of the 4 limbs and yin located in the interior receives the energy of the 5 organs. This is why: _ when the energy comes to arrive, one must immediately go against it. This process has the name dispersion, _ and when the energy comes to depart, one must immediately go in its pursuit. This process is called tonification. These two methods permit regulating and harmonizing the energy of the 3 yin and 3 yang channels.” 242.

III - N.V.N.: Perfect practice of acupuncture demands knowledge of the ideas of the Beginning and Ending of the 3 yang and 3 yin channels. In effect, _ the 3 yin channels of the foot and hand are linked together to the 5 organs, and the 3 yang channels of the hand and foot, to the 6 bowels. _ the yang channels receive the energy located at the end of the 4 limbs, and the yin channels, the energy at the level of the 5 organs. For this reason, the method of dispersion consists of going against/in opposition to it in order to rob/eliminate. This means to say: To orient and manipulate the needle in the direction opposite to the circulation of the energy. In contrast, in the method of tonification, one must orient and manipulate the needle in the direction of the circulation of the energy. (Figure 24) This method called “to go against” and that called “to go in pursuit” permit the modulation, regulation and, therefore, the harmonizing of the energy and blood. But these 2 methods of regulation of the blood and energy are necessarily linked to the comprehension of the rules of yin and yang: “The organs are yin and the bowels are yang...“. Clinicians must carefully examine and study this argument in also a strong and solemn/formal way that the text declares: “an oath made in blood” because therapeutic successes

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depend on it. Not respecting the rules of “yin-yang” and an entirely personal, whimsical and unpredictable attitude, in fact, leads to specious reasoning and a dangerous practice of acupuncture.

Figure

24

a) Technique of dispersion -

b) Technique of tonification

PARAGRAPH 2

243.

In accordance with the celestial Dao, I would like to address the true meaning of Zhong (ending) and shui ( b e g i n n i n g ) . The ending and beginning have as basic examples the jingmai (principal channels) . Pressure of the fingers at renying (left radial pulse) permits evaluation of the excess or insufficiency of yin and yang, equilibrium or disequilibrium. It is in this manner that one perceives the state of the celestial Dao at this level. One says that “well balanced man” is man without illness. Because, in the non-ill man, Cun Kou (right radial pulse) and renying (left radial pulse) respond to the 4 seasons, top and bottom adapt in their circulation, the pulse of the 6 channels does not stop; the cold and mild heat (Wen) of the root and summit are mutually regulated without error. In other words, form and flesh, blood and energy are in equilibrium in man in good health. If the energy is not very abundant, Cun Kou and renying are weak; the “inch” pulse and “foot” pulse and yin and yang are in insufficiency and treatment consists of prescribing sweet-flavored medicines. Medicines in tablet form are prohibited and moxabustion is also advised against. Inadequate utilization of the method of dispersion

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is responsible for the perturbation of the energy of the 5 organs.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “1. The phrase: “In accordance with the Celestial Dao, I would like to address the true meaning of Zhong (ending) and shui (beginning)” means to say that Huangdi wishes to speak of the 3 yin channels and 3 yang channels responding to the 6 energies of heaven.

2. The blood and vessels are created by the 5 organs and 5 movements. At the exterior, they unite with the 6 energies of yin and yang and exist from birth until death. This is why Huangdi begins his expose with these words: “The ending and beginning have as basic examples the jingmai (principal channels)”. “Pressure of the fingers at Mai Kou (right radial pulse) and at renying (left radial pulse) (1) permit the determination of excess and insufficiency of yin and yang”. This means to say: Examination of the pulses permits the evaluation of the state of circulation of the energy responding to the 4 seasons. In this manner, for example, the energy of spring and of summer circulate from left to right and that of autumn and winter, from right to left (2). This is why, in the course of the 2 seasons, spring and summer, the renying pulse 244. is slightly larger, and in the course of the 2 seasons, autumn and winter, the qi Kou pulse (right radial pulse) is slightly larger. These 2 pulses are normal in the balanced individual. 3. “Top and bottom adapt” means: the energy above and below respond to the 6 energies of heaven and circulate without interruption; the pulsologic movements of the 6 channels (3 yin and 3 yang) are in accord with the circulation of the energy. “Root and summit” designate the entering and exiting movements of the Jiao (branches) and Ben (trunk). “Cold (han) and Mild heat (Wen)” respond to the energy of heaven. When cold begins to leave, warmth arrives. These movements of departure and arrival are immutably carried out. 4. “Form amd flesh, energy and blood” imply the sense of concordance of blood and energy located at the exterior of the vessels and of blood and energy located in the interior of the 6 channels. 5. “Mai Kou (right radial pulse) and renying (left radial pulse)” are intended for exploring the energetic and blood state of the 3 yin and 3 yang. As a result, the insufficiency of the energy brings about an insufficiency of Mai Kou and renying. 1. Right Cun Kou (radial pulse) also has the name Mai Kou (“mouth” of the energetic vessels) and qi Kou (“mouths” of the energy). This pulse is yang (energy, right side) in relation to renying (blood, left side). 2. Spring (liver) and Summer (heart) = blood (whose circulation of blood goes from left to right). Autumn (Lung) and Winter (kidney) = energy (whose circulation of energy goes from right to left). See “Mai jing” (Classic of Pulses of Wang shu he), N.V.N. Edition.

“The “foot” pulse (Chi)” is intended to explore the energetic state of yin, and the “inch” pulse (Cun), to explore the energetic state of yang.

6. The phrase “...non-conforming of “inch” and “foot” pulses” explains the state of emptiness of yin energy and yang energy perceived at the level of the pulse wave of “foot” and “inch”. 7. “Sweet-flavored medicines” make up part of the group of medicines having the power to regulate the functions of the stomach.

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The energy of the 3 yin and that of the 3 yang comes from zhongjiao (middle jiao) of the stomach. For this reason, one must tonify the source of production of the energy and activate the circulation. It is, therefore, prohibited to prescribe them in tablet form, whose sapor (flavor) is very concentrated, at the risk of slowing the therapeutic action. Moxabustion is also advised against because it is a matter of an insufficiency of yin and yang energy at the level of the exterior and not of an accumulation of the energy at the level of the jingmai (principal channels). similarly, the method of dispersion utilized in this case can cause a perturbation of the energy of the 5 organs.” 245.

II - Ma Shi comments: 1. The examination of Cun Kou (mouth of the “inch”, right radial pulse) and of renying (human reception, left radial pulse) allows differentiation of the balanced from ill man.

2 - The true meaning of the chapter “Beginning and Ending” is none other than the consideration of the jingmai as the foundational rules. The “inch” (Cun) pulse of the right wrist is called Mai Kou (pulse of the vessels, also Cun Kou or qi Kou), and that of the left wrist, renying. The examination of the pulse of these two sites allows determining the emptiness or fullness, equilibrium or disequilibrium of yin and yang. 3. “Is called “well balanced man”: the non-ill man whose renying pulse is slightly changing (Da) during spring and summer and Mai Kou pulse also changing in autumn and winter. These pulse respond to the 4 seasons and belong to the “Chi” (foot) and “Cun” (inch) pulse. At the foot and hand, the 6 channels (3 yin and 3 yang) are found. The “knotted pulse” and “restless” pulse are absent there. This is why it is necessary to know well the “root” and “summit” and carefully examine the “cold” (han) and “mild heat” (Wen) of the 4 seasons. 4. “The agreement of form and flesh, of blood and energy” is the essential condition to define the balanced man. 5. The insufficiency of the essential energy causing that of Mai Kou and the “Chi” (foot) pulse is often encountered in individuals whose yin channels are in emptiness. similarly, the insufficiency of the essential energy causing that of renying and the “Cun” (inch) pulse is often encountered in individuals whose yang channels are in emptiness. In these cases, dispersion of the yang channels is the origin of the depletion of the energy of the yin channels, and dispersion of the yin channels is the cause of the escape of the energy of the yang channels. This is why acupuncture is prohibited; only the medicines of sweet flavor aimed at tonifying or dispersing are advised. Moxabustion is also prohibited because it risks worsening disorders of the energy of the 5 organs.” III - N.V.N.: Generally, medical research exactly copies the rules of manifestation of the natural world. 1. In acupuncture, “ending” and “beginning” have a very precise meaning. Because, in the human being, the blood and energy circulate until the end, then they return to their starting point to reform and start the cycle again. This cyclic circulation can be illustrated by that of the 12 jingmai. 246. 2. Mai Kou (right radial pulse) is the site of exploration of the yin part of the 5 organs, and renying (left radial pulse) that of the yang part of the 6 bowels; from them, the state of emptiness or the state of fullness of yin and of yang can be appreciated in the goal of determining their equilibrium or disequilibrium. The evaluation of this state is, therefore, determined by the

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rules of manifestation of the natural world. 3. Balanced man is the non-ill man. In him, _ Mai Kou and renying respond to excess or insufficiency of yin or yang of the 4 seasons. _ the energy of the pulse “ascends” and “descends”, “goes” and “comes back” without discontinuity. _ the pulsations of the 6 channels (3 yin and 3 yang) are undulating, being neither “knotted” nor “rough” or missing. They are neither rapid nor excessive. _ in the interior, these pulsations respond to the “root” (source organ), and at the exterior to the “summit” (skin and flesh). _ their activities are conserved despite cold or heat. These are the conditions generally encountered in the man without illness. (3) 4. In the case of the sick man, the essential energy (yuan qi) is in emptiness, renying and Mai Kou are weak and without force, the “foot” (Chi) and “inch” (Cun) pulses lose their concordance and yin and yang are in insufficiency. In this case, tonification of yang energy rapidly brings about the depletion of the energy of the 5 organs, and dispersion, the emptiness-escape of the energy of the 6 bowels. Faced with these types of illnesses, only the sweet-flavored medicines and well-aimed harmonization are used. In contrast, very stimulating or dispersing medicines are ill-advised. In these illnesses, individuals are extremely weak from the disorders of yin caused by fire, and moxabustion is strictly forbidden. If the patient is not on a road to cure, utilization of the method of dispersion can gravely affect the functions of the 5 organs. This paragraph proves to be fundamental to the practice of acupuncture and moxabustion.

3. Described in the Mai jing de Wang shu he - N.V.N. Edition.

PARAGRAPH 3 • The renying pulse more excessive than Cun Kou indicates illness of the Foot Shaoyang (GB). If it is one time more excessive and agitated, the illness is at the Hand Shaoyang (SJ). 247. The renying pulse 2 times more excessive than Cun Kou indicates illness of the Foot Taiyang (Bl). If it is 2 times more excessive and

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agitated, the illness is at the Hand Taiyang (SI). The renying pulse 3 times more excessive than Cun Kou indicates illness of the Foot Yangming (St). If it is 3 times more excessive and agitated, the illness is at the Hand Yangming (LI). The renying pulse 4 times more excessive than Cun Kou, and at once “changing (Da) and “rough”, is called yi yang (overflowing of yang). yi yang indicates the syndrome Wai Ge (external separation). • The Mai Kou pulse more excessive than renying indicates illness of the Foot Jueyin (Li). If it is one time more excessive and agitated, the illness is at the Hand Jueyin (XB). The Mai Kou pulse 2 times more excessive than renying indicates illness of the Foot Shaoyin (Ki). If it is 2 times more excessive and agitated, the illness is at the Hand Shaoyin (He). The Mai Kou pulse 3 times more excessive than renying indicates illness of the Foot Taiyin (Sp). If it is 3 times more excessive and agitated, the illness is at the Hand Taiyin (Lu). The Mai Kou pulse 4 times more excessive than renying, and at once “changing (Da) and “rough”, is called yi yin (overflowing of yin). yi yin indicates the syndrome of Nei guan (internal barrier). This syndrome is fatal. • renying and Mai Kou of the Hand Taiyin (Lu) 4 times more excessive than normal, or even more, indicates the syndrome of guan Ge (separation of the barrier). This syndrome is also fatal. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The left pulse is renying and the right pulse qi Kou (also: Mai Kou, Cun Kou). These pulses are intended to explore the energy of the 3 yin and 3 yang. 1. The sage looks South. he has in front of him guang Ming (Clarity/Insight) and behind him, Taichong (great energetic elevation); the East is to the left and the West is to the right. The celestial path goes towards the right and the terrestrial path to the left. This is why one takes the left in order to examine the yang (male) and the right to exam the yin (female).

2. “Agitated” designates the state of the energetic movement into yin. Because the 6 energies originate from yin and leave from earth, they only become united with the 6 channels of the foot (Zu). Sometimes, their movements are “agitated” at the level of the hand to unite with the 6 organs/6 bowels and with the 12 jingmai. 248. since the 12 jingmai are intended to respond to the energy of the 3 yin and 3 yang, they are not the 6 energies that divide into the energy of the foot and the energy of the hand. 3. Wai Ge (external separation) is a syndrome of fullness of yang located at the exterior, in a state of disharmony with yin energy. Nei guan (internal barrier) is a syndrome of fullness of yin located in the interior without the presence of yang energy to balance it.

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guan Ge (separation of the “barriers”) is a syndrome of the “yin barrier” located in the interior associated with that of the yang Ge (separation of yang) of the exterior.

4. Ge Shi clarifies: “Mai Kou belongs to taiyin and renying, to yangming. As the energy of the organs cannot reach from itself to the Hand Taiyin (Lu), its displacement can only be effected under the action of the stomach. As a result, the left and right belong to the taiyin and are endowed with the energy of yangming (St). Because the yang energy takes off from left to right, and the yin energy from right to left, the left is intended to explore the 3 yang, and the right to explore the 3 yin. This does not mean to say that the pulse of the left side is yang and that the pulse of the right side is yin. Within yin, there is yang, and within yang, there is yin. These phenomena take place in the balanced individual. If the left is only yang and if the right is only yin, the pulse is called “separation of the barrier” (guan Ge); this is death.”

II - Ma Shi comments: “The comparative study of the excessive state of the energy of Mai Kou and renying permits determination of the illness located at the level of the channels. 1. If the renying pulse is 1 time more excessive than Mai Kou, the illness is at the Foot Shaoyang (GB). If it is more excessive and agitated, it heralds illness associated with the Foot Shaoyang/Hand Shaoyang (GB/SJ). If the renying pulse is 2 times more excessive than Mai Kou, the illness is at the Foot taiyang (Bl). If it is 2 times more excessive and agitated, it heralds illness associated with the Foot Taiyang/Hand Taiyang (Bl/SI). If the renying pulse is 3 times more excessive than Mai Kou, the illness is at the Foot Yangming (St). If it is 3 times more excessive and agitated, it heralds illness associated with the Foot Yangming/Hand Yangming (St/LI). Because renying controls the exterior, illnesses of the 6 yang channels of the foot and hand are detectable at the level of these pulses. If the renying pulse is 4 times more excessive than Mai Kou, and at the same time “changing” (Da) and “rough”, the energy of the 6 yang channels overflows at the exterior and prevents those of the 6 yin channels from exteriorizing, hence the name Wai Ge (separation of the exterior); the illness is fatal.

2. If the Mai Kou pulse is more excessive than renying, the illness is at the Foot Jueyin (Li). If it is 1 time more excessive and agitated, it heralds illness associated with Foot Jueyin/Hand Jueyin (Li/XB). If the Mai Kou pulse is 2 times more excessive than renying, the illness is at the Foot Shaoyin (Ki). If it is 2 times more excessive and agitated, it heralds illness associated with Foot Shaoyin/Hand Shaoyin (Ki/he). 249. If the Mai Kou pulse is 3 times more excessive than renying, the illness is at the Foot Taiyin (Sp). If it is 3 times more excessive and agitated, it heralds illness associated with Foot Taiyin/Hand Taiyin (Sp/lu). If the Mai Kou pulse is 4 times more excessive than renying, and at the same time “changing” (Da) and “rough”, the energy of the 6 yin channels overflows and obstructs the interior, preventing the energy of the 6 yang channels from interiorizing, hence the name Nei guan (internal barrier). The obstruction of Nei guan is fatal. If the Mai Kou pulse is 4 times more excessive than renying, the illness carries the name guan Ge (separation of the barriers), and the prognosis is fatal.” III - N.V.N.: The study of renying and Mai Kou pulses is fundamental in the determination of the

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illnesses of the jingmai. The explanation of Zhang and Ma is unequivocal. Nevertheless, we emphasize certain terminologies of the energetic pathology so as to better understand the pulsology: _ yi yang: overflowing of the energy of the 6 yang channels at the exterior. It is the cause of the syndrome of Wai Ge (external separation). _ yi yin : overflowing of the energy of the 6 yin channels in the interior. It is the cause of the syndrome of Nei guan (internal barrier). When the overflow is maximal, the illness has the name guan Ge (separation of barriers). It is a fatal ailment. Therefore, a gross error has been committed in the last centuries and, more particularly, in our era by translators of classic books who have defined guan Ge as simply “dysphagia” or “difficulty swallowing”.

PARAGRAPH 4 1, When renying is more rapid than Mai Kou, one must disperse Foot Shaoyang (GB) and tonify Foot Jueyin (Li). The dispersion is double, and the tonification is simple. Needling is done daily. It is necessary to control the reaction of the pulses. One stops needling when the blood is not very abundant and when the energy is regulated. 2. When renying is 2 times more rapid than Mai Kou, one must disperse Foot Taiyang (Bl) and tonify Foot Shaoyin (Ki). The dispersion is double, and the tonification is simple. One needles once every 2 days. 250. It is necessary to control the reaction of the pulses. One stops needling when the blood is not very abundant and when the energy is regulated. 3. When renying is 3 times more rapid than Mai Kou, one must disperse Foot Yangming (St) and tonify Foot Taiyin (Sp). The dispersion is double and the tonification simple. One needles 2 times per day. It is necessary to control the reaction of the pulses. One stops needling when the blood is not very abundant and when the energy is regulated. 4. When Mai Kou is more rapid than renying, one must disperse Foot Jueyin (Li) and tonify Foot Shaoyang (GB). The tonification is double and the needling is simple. One needles once a day. It is necessary to control the reaction of the pulses. One stops the needling when the pulse is not very abundant and when the energy is regulated. 5. When Mai Kou is 2 times more rapid than renying, one must disperse Foot Shaoyin (Ki) and tonify Foot Taiyang (Bl). The tonification is double and the needling is simple.

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One It is One when the

needles 2 times per day. necessary to control the reaction of the pulses. stops the needling when the pulse is not very abundant and energy is regulated.

6. When Mai Kou is 3 times more rapid than renying, one must disperse Foot Taiyin (Sp) and tonify Foot Yangming (St). The tonification is double and the needling is simple. One needles 2 times per day. It is necessary to control the reaction of the pulses. One stops the needling when the pulse is not very abundant and the energy is regulated. 7. One needles two times per day because yangming governs the stomach, and the stomach is in great need of the cereal energy. 8. If renying and Mai Kou together are 3 times more rapid (or even more) than normal, the phenomenon carries the name “simultaneous Overflowing of yin and yang” (yin yang gou Jia) . It hinders the circulation and obstructs the blood and vessels; the energy, unable to circulate, floods the interior; the 5 organs are then damaged. In this case, the application of moxabustion results in complications.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “1. Tonification and dispersion are the 2 methods of regulation intended to rebalance the yin and yang energy in cases of disorder. 251. “One disperses the yang 2 times and tonifies the yin one time” because yang is often in excess and yin is often insufficient. “Tonification of yang is double and tonification of yin is simple” because one is interested in stimulating yang and not yin.

2. “One must control the reaction of the pulse” means: One must examine renying and qi Kou in order to evaluate the state of the energy of the 3 yin and 3 yang. yangming governs the stomach which is very rich in cereal energy. This is why one must needle 2 times per day because the energy of the 3 yin and 3 yang originates from the cereal energy of yangming. 3. “renying and Mai Kou are together rapid and the phenomena is called “simultaneous Overflow of yin and yang” because: _ yin is in fullness in the interior _ yang is in fullness at the exterior. For this reason, if one does not use acupuncture to aid the circulation, the blood and energy will be obstructed; these overflow towards the interior and injure the 5 organs. Of course, one disperses in case of fullness, and one tonifies in case of emptiness, and one applies moxas in case of stagnation. But here, the yin energy and yang energy are together victorious and imbalanced. It is, therefore, not a question of the phenomena of stagnation; for this reason, moxabustion is prohibited at the risk of provoking other illnesses.” II - See commentaries of Ma Shi in the following paragraph.

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III - N.V.N.: This paragraph is devoted to the comparative study of the states of renying (left radial pulse) and Mai Kou (right radial pulse) in determining the emptiness and fullness of the3 yin and 3 yang to therapeutic ends, while the preceding paragraph is centered on the comparative study of these 2 pulses in the goal of determining the ailments localizing at the6 yin channels. These studies are then fundamental to the practice of acupuncture. The translation and interpretation of this paragraph are extremely delicate both from the point of view of energetic pathophysiology and the knowledge of the function of the points. In this manner, for example, the phrases: “Tonify 2 and disperse 1” and “Disperse 2 and tonify 1” do not wish to say that each channel has 2 points of tonification or 2 points of dispersion; they simply stress the importance of dispersion performed at the yang channel and the importance of tonification performed at the level of the yin channel. 252.

PARAGRAPH 5 According to the rules, one must stop needling when the regulation of the energy is obtained. Tonification of yin and dispersion of yang permits rendering the voice clearer, hearing and vision finer. In case of contrary actions, the energy and the blood no longer circulate.

EXPLANATIONS AND COMMENTARIES I - Zhang shu explains:

“1. The energy of the 3 yin and that of the 3 yang are created by the 5 organs. “According to the rules, one must stop needling when the regulation of the energy is obtained” implies: during the simultaneous fullness of the yin and yang energy, one must needle up to the point that they are in equilibrium. For that, one must “tonify yin and disperse yang”. “Tonify yin” is to tonify the yin part of the interior belonging to the 5 organs, and “Disperse yang’ is to direct the 6 energies (perverse) located in the interior toward the exterior.

2. After tonification of the organs, the energy of these latter, particularly that of the heart, lung and spleen, are balanced and “the voice is clearer”. The liver energy exteriorizes at the eyes, and that of the kidney, at the ears. When these energies are in a state of plethora, the ears and eyes are keener. After tonification of the organs and after conduction of the energy towards the exterior, the energy of the 3 yin and that of the 3 yang are spontaneously balanced. 3. yin and yang, blood and energy originate from the stomach bowel and the 5 organs. The stomach is the sea of the “water of the Cereals” (shui-Gu) and of blood (Xue) and energy (qi). This energy and blood circulates following the paths of the jing shui; the jing shui are none other than the Great luos (Da luo) belonging to the 5 organs and 6 bowels. This is why, in case of disturbances, if one does not tonify yin and if one does not disperse yang, “the energy and blood no longer circulate”. II - Ma Shi comments:

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“In this paragraph and the previous one, Qi Bo bases his judgment on renying and Mai Kou to define the rules of tonification and dispersion. 253. 1. When renying is one time more rapid than Mai Kou, the illness is at Foot Shaoyang (GB). Because the gallbladder and liver constitute one indissociable “yin-yang, interiorexterior” system, the fullness of the gallbladder automatically causes the emptiness of the liver. One must then disperse Foot Shaoyang (GB) and tonify Foot Jueyin (Li). One ceases the procedure when the energy is regulated. If renying is not only one time more rapid but also more agitated than Mai Kou, the illness is at the Hand Shaoyang (SJ). It is then advised to disperse the Hand Shaoyang (SJ) and tonify the Hand Jueyin (XB). 2. When renying is two times more rapid than Mai Kou, the illness is at Foot Taiyang (Bl). Because the bladder and kidney constitute one inseparable “yin-yang, interior-exterior” energetic system, the fullness of Foot Taiyang (Bl) automatically causes the emptiness of Foot Shaoyin (Ki). Treatment consists then of dispersing Foot Taiyang (Bl) and tonifying Foot Shaoyin (Ki). In contrast, when renying is not only two times more rapid, but also more agitated than Mai Kou, the illness is at the Hand Taiyang (SI). It is advised to disperse the Hand Taiyang (SI) and tonify the Hand Shaoyin (He). 3. When renying is three times more rapid than Mai Kou, the illness is at the Foot Yangming (St). Because the stomach and spleen constitute the inseparable “yin-yang, interior-exterior” energetic system, the fullness of Foot Yangming (St) automatically causes the emptiness of the Foot Taiyin (Sp). Treatment consists then of dispersing Foot Yangming (St) and tonifying Foot Taiyin (Sp). In contrast, when renying is not only three times more rapid, but also more agitated than Mai Kou, the illness is at the Hand Yangming (LI). It is advised to disperse Hand Yangming (LI) and tonify Hand Taiyin (Lu). 4. When Mai Kou is one time more rapid than renying, the illness is at Foot Jueyin (Li). Because the liver and gallbladder constitute one indissociable “yin-yang, interiorexterior” energetic system, the fullness of Foot Jueyin (Li) automatically causes the emptiness of Foot shaoyang (GB). The treatment consists of dispersing Foot Jueyin (Li) and tonifying Foot shaoyang (GB). In contrast, if Mai Kou is not only one time more rapid, but also more agitated than renying, the illness is at the Hand Jueyin (XB). It is advised then to disperse the Hand Jueyin (XB) and tonify the Hand Shaoyang (SJ). 254.

5. When Mai Kou is 2 times more rapid than renying, the illness is at Foot Shaoyin (Ki). Because the kidney and bladder constitute one inseparable “yin-yang, interior-exterior” energetic system, the fullness of Foot Shaoyin (Ki) automatically causes the emptiness of Foot taiyang (Bl). In this case, one must disperse Foot Shaoyin (Ki) and tonify Foot taiyang (Bl). In contrast, if Mai Kou is not only more rapid but also more agitated than renying, the illness is at the Hand Shaoyin (He), It is then advised to disperse Hand Shaoyin (He) and tonify Hand Taiyang (SI). 6. When Mai Kou is 3 times more rapid than renying, the illness is at Foot Taiyin (Sp). Because the spleen and stomach constitute one inseparable “yin-yang, interior-exterior” energetic system, the fullness of Foot Taiyin (Sp) automatically causes the emptiness of Foot Yangming (St). In this case, one must disperse Foot Taiyin (Sp) and tonify Foot Yangming (St). In contrast, is Mai Kou is not only 3 times more rapid but also more agitated than renying,

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the illness is at the Hand Taiyin (Lu). It is then advised to disperse Hand Taiyin (Lu) and tonify Hand Yangming (LI). 7. The text proposes to needle once a day in the case of attack of the “liver-Gallbladder” system, and once every 2 days in the case of attack of the “kidney-Bladder” system, except in the case of attack of the “spleen-stomach” system when one needles it 2 times per day. One needles the yangming 2 times per day because the stomach is very rich in “cereal”. 8. When renying and Mai Kou are 4 or more times more rapid, they bear the name “Overflowing of yin and yang”, responsible for the syndrome called guan Ge (“Separation of the “Barriers”). In this case, if one does not employ acupuncture, the blood and energy will not circulate and obstruction, created in this manner, is the origin of disturbances at the level of the 5 organs. And, if moxabustion is used in place of acupuncture, the illness complicates and becomes incurable. As a result, moxabustion is not as effective as acupuncture. Some physicians wait until the illness becomes serious to apply moxabustion, but it already too late. This is why, in order to use acupuncture, one must know how to examine the state of the illness and know how to await the arrival of the energy which indicates regulation before ceasing the acupuncture act. Therefore, either after having tonified the yin channel in order to disperse the yang channel, or after having dispersed the yin channel in order to tonify the yang channel (according to the general rules of needling), the voice becomes pure and hearing and vision become acute. In the opposite action, the energy and blood does not circulate and the patient slowly rejoins the “world of the dead”.” The same author adds: “This paragraph shows the necessity of examining renying and Mai Kou to determine the emptiness and fullness of the illness in the goal of applying the method of dispersion of yin in order to tonify yang or the method of dispersion of yang in order to tonify yin. Such are the basic therapeutic principles of the application not only of acupuncture but also of phytotherapy.”

III - N.V.N.: 255. The treatment of the syndromes of the 3 yin and 3 yang is specified in Paragraphs 4 and 5 of this chapter. The basic diagnostic and therapeutic principles are: 1. The fullness of yang always causes the emptiness of yin and vice versa. 2. The examination of renying and Mai Kou permit determination of the evolutive state of the illness (retreat or progression). 3. Needling can be performed one time per day, one time every 2 days, or even 2 times per day according to the potential in “ying” (nutritive) energy at the level of the channels concerned. 4. The points of tonification and dispersion are always more or less distant from the diseased area. 5. Awaiting the arrival of the energy (Da qi) is obligatory in the determination of the regulation of the emptiness and fullness. 6. removal of the needles is performed only when the arrival of the energy is assured. 7. In the treatment of the syndromes of the 3 yin and 3 yang, one must observe the fullness and emptiness in order to apply the method of dispersion and tonification according to the rules of yin-yang. In this manner, for example: In the fullness of Foot Yangming (St), Foot Taiyin (Sp) is in emptiness. Asa result, the treatment consists of needling _ St 45 (Lidui), the point of dispersion of the stomach, _ and Sp2 (Dadu), the tonification point of the spleen.

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This therapy, widespread in the West, has been taught in nearly all acupuncture schools for over 2 decades.

PARAGRAPH 6

is

Concerning the technique of the indicator of effectiveness.

needling,

the

arrival

of

the

energy

After dispersion, the pulse must be empty, and in the state of emptiness, the pulse must not be strong. In contrast, if the patient declares that he is relieved in spite of the persistence of a strong pulse, the illness is not yet cured. After tonification, the pulse must be full; and being full, the pulse must be strong. In contrast, if the patient declares that he is relieved despite the absence of a strong pulse, the illness is not yet cured. This is why, after tonification, the pulse must be full, and after dispersion, the pulse must be empty; after removal of the needle, the patient is not immediately cured, but is ameliorated. 256.

Therefore, it is necessary to understand the process of activation of the illness at the level of the 12 channels in order to grasp the meaning of the chapter “ending and beginning”. In this way, there is no error in the distinction of yin and yang; there is no confusion in the appreciation of emptiness and fullness; it is necessary that the needle be right on the channel.”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph completes the preceding one. During tonification and dispersion, one must await “the arrival of the energy”. This arrival of the energy is the indicator of effectiveness because, after dispersion, the appearance of the phenomenon of emptiness is imperative, and, after tonification, the appearance of the phenomenon of fullness is mandatory. In this manner, _ after dispersion, the pulse must be found in a state of emptiness; that is to say, upon the application of the fingers, one feels the weakness of the pulse beats. Therefore, after dispersion, the persistence of a strong and full pulse is indication of the non-amelioration of the illness. _ after tonification, the pulse must be found in a full (plethoric) state, that is to say upon applying the fingers, one perceives the reinforcement of the pulse beats. Therefore, after tonification, persistence of a weak and empty pulse is the sign of non-amelioraton of the illness.

In total, the “strong” or “weak” nature of the pulse represents the aspect of fullness or emptiness of the energy. This is why: _ after tonification, following the appearance of a phenomenon of fullness, the pulse must be strong. _ after dispersion, following the appearance of a phenomenon of emptiness, the pulse must be weak.

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_ and after removal of the needle, the illness is not immediately cured, but strongly ameliorated. In order to disseminate the great meaning of the “ending” and “beginning” of this chapter, acupuncturists must delve deeply into the syndromes of the 12 jingmai (principal channels) in order to scrutinize the signs of emptiness and fullness in the application of the processes of tonification or dispersion. These syndromes, without evolutive nature but fixed at the yin or yang channels, can be treated not only according to their emptiness or fullness, but also according to the weak or strong nature of the pulse.” II - N.V.N.: This paragraph places accent on _ the reactive phenomena of needling, the signs of effectiveness, able to be perceived at the level of the pulses, 257. _ the effect of tonification and dispersion. The first potentiates the essential energy, and the second eliminates the perverse energy _ and the existence of the 12 jingmai and their pathophysiologic processes in order to define the notion of “ending” and “beginning” cited in this chapter. In the preface of the Mai jing (Classic of Pulses), Wang shu he (210-285 A.D.) stated clearly: “ Pulsology is very subtle. The natures and aspects of the pulses are difficult to discern. In this manner, the tense, hurried, superficial, dicrotic characters... define the undulating aspects of the pulse which are mentally accessible but delicate to define when they are under the fingers. If the deep pulse is taken for a hidden pulse, the therapy is definitely wrong; if the late pulse is taken for a slow pulse, danger is not a long time in coming; accordingly, there exist clinical signs appearing simultaneously and different illnesses having the same pulsology.”

PARAGRAPH 7 In order to await the arrival of the “cereal” energy (Gu qi), needling is distinguished into 3 phases. Because the morbid state originates from _ the fusion of perverse energy and essential energy _ the modification of yin and yang _ the consequence of concordance and discordance _ the reversal of the immersing state and emerging state _ and from the failure to adapt to the 4 seasons, creating, in this way, blockage and overflowing of blood and energy. This is why acupuncture is used to eliminate these morbid states, with the following steps: _ the 1st phase eliminates perverse yang _ the 2nd phase secretes perverse yin _ and the 3rd phase is called the cereal energy. Upon the arrival of the cereal energy, one must cease needling. One speaks of the arrival of the cereal energy (deqi) when one is in the presence of fullness after tonification or of emptiness after dispersion. In the case where the perverse energy is only eliminated with persistence of the disharmony of yin and yang, the illness can be cured.

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Also, it has already been stated above that “ tonification brings about fullness (of the bodily energy), and dispersion, emptiness (of perverse energy); if the illness cannot be cured upon removal of the needle, it is certain that it is ameliorated.” EXPLANATIONS AND COMMENTARIES

258.

I - Ma Shi explains: “This paragraph completes the previous one. The amelioration of the illness results from three methods of needling whose goal is to make the “cereal” energy return. At the start of the illness, the perverse energy concentrated in the epidermo-dermal layer infiltrates into the principal channels. The yin and yang channels seem to change role regarding “internal-external”; the direction of the energetic circulation seems reversed; the pulses sometimes seems deep... . This appears anarchical. This state must be pacified by acupuncture. The 1st phase of needling eliminates the perverse energy localized in the yang (superficial) and the 2nd phase evacuates the energy fixed in the yin (deep). In the 3rd phase, the arrival of the cereal energy is perceived at the level of the pulse which becomes full after tonification and empty after dispersion. The perverse energy eliminated in this manner, even if the yin and yang channels are still not in perfect balance, cure is near.”

II - N.V.N.: The 3 techniques of needling according to depth permit the provoking of reactive phenomena at the level of the “cereal” energy in the goal of tonification and dispersion. The presence of perverse energy in the organism causes circulatory disturbances of the blood and energy. The yang energy, instead of remaining at the exterior, reaches the depth, and the yin energy, instead of remaining in the interior, reaches the superficial. The energy of the pulse no longer responds to the movements of ascent and descent. The perverse energy reaches the organs and bowels and provokes illnesses. Acupuncture is then utilized to resolve this morbid problem whose results depend on the 3 phases of the needling: _ the superficial, cutaneous phase can evacuate the perverse energy of the yang part of the body, _ the deep, dermal phase can evacuate the perverse energy from the yin part of the body, _ the still deeper phase of the yin part can provoke reactive phenomena of the part of the cereal energy (see Figure 25). During the course of the last phase, one must wait for the arrival of the energy and leave the needle in place until obtaining the reactive phenomena before removing it. The term “arrival of the energy” (deqi) designates either the use of the method of tonification (the essential energy originally in a state of emptiness returns to the state of fullness, reinforcing its potential) or the use of the method of dispersion (the perverse energy originally in a state of fullness is found in a state of emptiness, attesting to its elimination). During the implantation of the needle, reactive phenomena appear in spontaneous fashion, and the perverse energy immediately regresses, but the energy and blood in the yin-yang space are not yet completely reestablished; this is why it is said: “Cure is near”. 259.

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Figure 25 Different phases of needling to activate the daqi. (reactive phenomena provoked by the essential energy).

PARAGRAPH 8 yin being in fullness and yang being in emptiness, one must first tonify yang, then disperse yin to reestablish balance. tonify

yin being in emptiness and yang being in fullness, one must first yin then disperse yang to reestablish balance.

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph completes the previous ones. The methods of tonification and dispersion of yin and yang channels must be performed following a determined order. In this manner, for example: 1. Mai Kou (right radial pulse) of “rapid” nature following attack of the 6 yin channels: _ The yin channels are in fullness, and yang channels, in emptiness. _ One must first tonify yang, then disperse yin, to reestablish their equilibrium.

2. renying (left radial pulse) of “rapid” nature following attack of the 6 yang channels: _ The yang channels are in fullness, and yin, in emptiness. 260. _ One must first tonify yin, then disperse the yang channels, to reestablish their equilibrium. Why does one act in this manner? Because, if it is necessary to eliminate the perverse energy, it is also necessary to maintain the essential energy.” II - N.V.N.: 1. Mai Kou (right radial pulse) greater than that of renying (left radial pulse) is the indicator of the fullness of perverse energy located in the yin channels and of the emptiness of the essential energy at the level of the yang channels. One must first tonify the essential energy

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of the yang channels, then disperse the perverse energy of the yin channels. In this way, one tends towards the equilibrium of yin-yang by moderation of the excess of yin and the insufficiency of yang. 2. renying (left radial pulse) greater than that of Mai Kou is the sign revealing emptiness of the essential energy at the level of the yin channels and fullness of the perverse energy at the level of the yang channels. One must first tonify the essential energy of the yin channels, then disperse the perverse energy of the yang channels. In this way, parallel to the first case, one tends towards the equilibrium of yin-yang by counterattack, this time with the excess of yang and insufficiency of yin. 3. The comparative study of the two pulses, Mai Kou and renying, is the method of choice for determining the state of emptiness of the essential energy and fullness of the perverse energy (see table below).

Mai Kou (right radial pulse, yang)

renying (left radial pulse, yin)

•Fullness of yin channels Emptiness of yang channels

Emptiness of yin channels •Fullness of yang channels

Notes: a) The pulse is divided into qi Kou (= Mai Kou or Cun Kou) and renying, whose meaning is the same as that cited in Chapter 48 (“Prohibition and Submission”- Gan Fu). Hua Ba ren (1304-1386 A.D.) states: “In antiquity, the right side of the glottis had the name “qi Kou”, and the left side, the name “renying”. Much later on, Wang She he gave these names to the radial pulse, left and right”. b) See the definition and location of these two pulses in the commentaries of Zhang Shi (Paragraph 3 of this chapter). 261.

c) Do not confuse the point renying (St 9) with the pulse renying (left radial pulse). _ renying pulse located on the left (yin) is intended to explore the state of emptiness or fullness of the yang channels. _ Mai Kou or qi Kou pulse located on the right (yang) allows exploration of the state of emptiness or fullness of the yin channels.

PARAGRAPH 9

The 3 “current-vessels” (channels) can be disturbed in the area of the great toe. If one disperses the emptiness, one has “double emptiness” (juxtaposition of emptiness) and the illness worsens. To treat this condition, it is advised to examine the pulse of these 3 vessels by pressure of the fingers. If it is full and rapid, dispersion

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must be done immediately; if it is empty and slow, one must tonify. The opposite treatment worsens the illness. During examination, the pulse of yangming (St) is found above, that of Jueyin (Li) in the center and that of shaoyin (Ki) down below.

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph speaks on the treatment of the 3 channels of the foot. One must examine well the emptiness or fullness in order to apply the method of tonification or dispersion.

The 3 channel-vessels located near the great toe are: 1. The vessel of the Foot Yangming (St), found between the 2nd and 3rd toes. The points Lidui (St 45), Xiangu (St 43), Chongyang (St 42), Jiexi (St 41) are all situated on the top of the foot. 2. The vessel of the Foot jueyin (Li), found between the great and 2nd toes. The points Dadun (Li 1), Xingjian (Li 2), Taichong (Li 3), Zhongfeng (Li 4) are all situated at the top of the foot. 3. The vessel of the Foot Shaoyin (Ki), which is found within the sole of the foot. The point Yongquan (Ki 1) is located underneath the foot. To treat the diseases of the 3 channel-vessels, one must carefully observe the emptiness or fullness because dispersion done in the event of emptiness causes the phenomenon “Zhong Xu” (double emptiness or juxtaposition of emptiness) that aggravates the disease. 262. In this manner, before needling, the finger must press on the artery (pedal) to examine the pulse. If the pulse is full and rapid, dispersion must be done on the field, and if it is empty and slow, it is tonification which one must apply. In contrast, if one disperses the emptiness or tonifies the fullness, the illness worsens. In all cases, one must locate the site of this pedal artery: _ that of yangming (St) is found at the top of the foot _ that of the Foot Jueyin (Li), between the 2 channels, yangming and taiyin _ that of the shaoyin (Ki), within the sole of the foot.” II. N.V.N.: This paragraph studies the emptiness and fullness of the 3 channels of the foot: yangming (St), jueyin (Li) and shaoyin (Ki) in order to establish adequate treatment. These channels have their vessels spread in the vicinity of the great toe. a) In the event of emptiness or fullness, dispersion or tonification done in error worsens the illness. This is why, in a general way, before treatment by acupuncture, it is advised to press the finger on the pedal artery and study the state of its pulse: _ if the pulse is full and rapid, dispersion is used and implantation of the needle is rapid. _ if the pulse is empty and slow, tonification is indicated and implantation of the needle is slow. If one erroneously applies the opposite methods, that is to say tonification used in the case of fullness and dispersion used in the case of emptiness, the disease worsens. b) As for the localization of the pulse of the channels, _ the pulse of Foot Yangming (St) is found at the point Chongyang (St 42) on the top of the foot, next to the pedal artery. _ the pulse of the Foot Jueyin (Li) is found at the point Taichong (Li 3) in the crease

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located in front of the junction point between the 1st and 2nd metatarsals on the pedal artery. _ the pulse of the Foot Shaoyin (Ki) is found at the point Taixi (Ki 3) behind the internal malleolus, above the calcaneus, on the posterior tibial artery. • We indicate, however, that according to Ma Shi, the pulse of shaoyin (Ki) is found at the point Tongquan (Ki 1), therefore below the pedal artery and not at the point Taixi (Ki 3) on the posterior tibial artery.

PARAGRAPH 10 When needling the ying shu (points of the upper part of the thorax), one must attain them properly.

263.

When needling the B u shu (dorsal shu), one must also attain them properly. These point are found in concave spots.

EXPLANATIONS AND COMMENTARIES I. Ma Shi explains: “The localization of points must be precise. In this way, in the upper part of the thorax (ying), such points as: _ qihu (St 13), Kufeng (St 14), Wuyi (St 15), yingchuang (St 16)... belong to the stomach channel, _ Yuzhong (Ki 26), shencang (Ki 25), Lingxu (Ki 24), shenfeng (Ki 23)... belong to the kidney channel. Needling must exactly touch these points. Likewise, on the dorsal part, the points belong to Du Mai (GV) and Foot Taiyang (Bl). Needling must reach them well. In order to precisely locate these points, one must look for them in creases which are soft to the touch.” II. N.V.N.: The result of needling depends on the exact localization of points, in particular the ying shu (points located at the upper thorax) belonging to the yin channels and the Bu shu (Back shu points) belonging to the yang channels. Because, the yin channels located at the upper part of the thorax (ying) treat the yin illnesses. one must needle the ying shu points such as: Zhongfu (Lu 1), Yunmen (Lu 2) of the Hand Taiyin (Lu) and Tianchi (XB 1) of the Hand Jueyin (XB), etc. The yang channels located on the back treat the yang illnesses. One must needle the Bu shu points (Back shu points) such as Jianchio (SJ 14), Tianlao (SJ 15)... belonging to the Hand Shaoyang (SJ) and Tianzong (SI 11), Quyuan (SI 13), Jianwaishu (SI 14) belonging to the Hand Taiyang (SI). On the other hand, paresthesias of the scapulo-humeral area is a syndrome of emptiness. This ailment can be treated by points located on the thorax and back because these points are linked to the channels located on the upper limbs.

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PARAGRAPH 11 In lingual edema (Zhong Zi: double tongue), one must needle the “foot of the tongue” with the “Pi” needle. EXPLANATIONS AND COMMENTARIES

264.

Ma Shi explains: “This paragraph is devoted to the technique of needling of “double tongue” (lingual edema) with needle #5 (see Chapter 1: “9 Needles and 12 yuan”- Jiu Zhen Shi Er yuan) of this classic). Needling must be performed at the level of the “foot” (frenulum) of the tongue, and one bleeds a few drops of blood.”

PARAGRAPH 12

the

Spasms of the arm preventing extension originate from illness of tendons. Extension preventing flexion is due to illness of the bones.

In the illness of the bones, one must needle the bones, and in the illness of the tendon, one must needle the tendons.

EXPLANATIONS AND COMMENTARIES I. Zhang Shi comments: “1. This paragraph completes the preceding ones concerning the energy of the “5 movements” which leaves from the foot to reach the top. In cases of emptiness, one has interest in intercepting this energy which evolves from the interior towards the exterior. 2. The points of the stomach are found at the middle of “ying” (upper part of the thorax). _ spleen points, at the lateral part of “ying” _ lung points, at the shoulder and back _ the “orifice” of the heart, at the tongue _ the energy of the liver, at the muscles and tendons _ the energy of the kidney, at the bones. As a result, in cases of disturbances of the energy of the 5 organs, it is advised to locate and needle these points well.” II. Ma Shi explains: “This paragraph studies the phenomena of contraction and extension to determine the origin of their illness located at the tendons or bones for therapeutic purpose. Normal flexion and difficult extension are of tendinous origin. Treatment consists of only needling the tendons and not the bones. Normal extension and difficult flexion are due to bony attack. Treatment consists of only needling the bones and not the tendons.”

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PARAGRAPH 13

265.

During use of the technique of tonification, one must aim for the moment of fullness of yang to apply a deep needling, then perform a light pressure on the point of impact to evacuate the perverse energy. In contrast, at the moment of emptiness of yang, needling must be superficial to preserve the energy of the vessels; then, with the finger, one obstructs the point of impact to avoid penetration of the perverse energy. When the perverse energy arrives, it is expressed as a feeling of g r a b b i n g at the level of the needle, and when the “cereal” energy arrives, its movements are slow and harmonious. When the pulse is full, one must needle deeply to facilitate the evacuation of the perverse energy, and when the pulse is empty, one must needle superficially to prevent the escape of the jing qi (energetic essence), to preserve the energy of the vessels (channels) and to evacuate only the perverse energy.

EXPLANATIONS AND COMMENTARIES I. Ma Shi explains: “The technique of tonification and dispersion consists of eliminating the perverse energy and vitalizing the essential energy. When one tonifies, one must wait for the moment of fullness of yang to perform dispersion. Needling must be deep and the point of impact must remain open to facilitate the evacuation of the perverse energy. If the moment of the emptiness of yang occurs, needling must be superficial to maintain the essential energy located in the interior of the channels, and the point of impact must be closed to not allow the perverse energy to penetrate. Arrival of perverse energy at the level of the point of the needle is recognized by the rapid movements of grabbing, and arrival of the cereal energy, by slow and harmonious movements. One deduces by experience that the disease is in emptiness or fullness in order to perform superficial or deep needling to evacuate the perverse energy and maintain the essential energy.” II. N.V.N.: Tonification and dispersion are based on the emptiness and fullness of the energy at the level of the pulses. a) When the pulse energy is in fullness, it is advised to use the technique of deep needling. After removal of the needle, one must press on the point of impact lightly to facilitate the excretion of the perverse energy. 266. b) When the pulse energy is in emptiness, it is expressly advised to use the technique of superficial needling to maintain the energy of the vessels (channels). After the needle is removed, press with the finger on the point of impact to close it to avoid a new intrusion of perverse energy.

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c) When the perverse energy arrives, one has the impression of having painful tension at the level of the needling, and when the “cereal” energy arrives, this sensation is replaced by slow and harmonious pulsations. In total, this paragraph defines the techniques of superficial needling and deep needling during tonification and dispersion.

PARAGRAPH 14 In the treatment of pain, all vessels (channels) are in fullness.

EXPLANATIONS AND COMMENTARIES I. Ma Shi explains: “This paragraph completes the previous one and emphasizes the method of dispersion in cases of fullness. Pain is a sign of fullness, and dispersion is then expressly advised.” II. N.V.N.: In all types of pain, except in the case of “moral pain”, one must always use the technique of dispersion because the corresponding vessels-channels are all in fullness.

PARAGRAPH 15 This is why it is said: The region above the lumbars belongs to the Hand Taiyin (Lu) and Hand Yangming (LI), and that below, to the Foot Taiyin (Sp) and Foot Yangming (St).

EXPLANATIONS AND COMMENTARIES I. Ma Shi explains: “All diseases are dependent on the channels. a) Above the lumbar region to the top is the domain of the Hand Taiyin (Lu) and Hand Yangming (LI) because _ the lung channel starts at the thorax and is directed to the hand _ and that of the large intestine starts at the hand and reaches the head. 267. b) Below the lumbar region to the bottom is the domain of the Foot Taiyin (Sp) and Foot Yangming (St) because _ the spleen channel goes from the foot to the thorax _ and that of the stomach from the face to the foot. c) These 4 channels each have a specific territory that one must know to localize the points well.” II. N.V.N.: According to the principle of choice of the points as a function of the channels and that of as a function of needling nearby, illnesses localized at the upper half of the body (from the lumbar region to the top) belong to the therapeutic domain of the Hand Taiyin (Lu) and Hand

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yangming (LI), and illnesses localized to the lower half of the body (from the lumbar region down to the bottom) belong to the therapeutic domain of the Foot Taiyin (Sp) and Foot Yangming (St). In our time, this technique is practiced daily by seasoned acupuncturists.

PARAGRAPH 16 To treat illnesses of the upper part of the body, one must choose points on the lower part, and to treat illnesses of the lower part of the body, one chooses points on the upper part. To treat illnesses of the cranium, one must choose points located on the foot, and to treat illnesses of the lumbar region, one must choose points located at the popliteal creases.

EXPLANATIONS AND COMMENTARIES I. Zhang Shi explains: “The top and bottom of the body respond to qijiao (“exchange” energy) of heaven and earth. One chooses points located on the foot to treat ailments of the cranium because the head and feet respond to heaven and earth, and points located at the popliteal crease to treat lumbar ailments because the “water” energy of kidney and bladder responds to the laws of si Tian and Taiquan.” II. Ma Shi: “Needling at a distance is a technique often employed because, if the illness is above, the channel communicates with the bottom, and if the illness is at below, the channel communicates with the top. This is why, in ailments of the cranium, one chooses points located at the foot, and in lumbar ailments, one chooses points located at the popliteal crease. 268. These techniques comply with the principle according to which “illness localized above, needling must be performed below and vice versa.” III. N.V.N.: This paragraph defines the method of needling at a distance according to the principles of the channels, techniques much employed in our era. For example: a) Anal ptosis (Prolapse) is treated by moxabustion applied to the point Baihui (GV 20). b) lumbalgia is relieved by needling the point weizhong (Bl 40).

PARAGRAPH 17 In ailments of the cranium, the head is heavy. In ailments of the arm, the arm is heavy. In ailments of the foot, the foot is heavy. In therapy, needling must be done first at the place where the illness manifests.

EXPLANATIONS AND COMMENTARIES I. Ma Shi explains: Treatment by acupuncture encompasses yet another technique of the choice of points.

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In effect, when the illness begins on the head, the head is heavy; treatment consists of first choosing points on the head. If the illness begins on the arm, the arm is heavy, and if the illness starts on the foot, the foot is heavy; the same method must always be used, that is to say, one must first choose points located on the arm and foot. Such is the meaning of the aphorism: “To treat the illness, one must look for the “root” (Ben).” II. N.V.N.: This passage defines the choice of points in the treatment called the “root” (Ben).

PARAGRAPH 18 In spring, the energy is found in the hair spaces. In summer, the energy is found in the skin. In fall, the energy is found in the flesh. In winter, the energy is found in the muscles and bones. 269. Treatment of these illnesses is adapted to the seasons. This is why in fat (stout) individuals, one must take fall and winter as normal, and in the case of thin individuals, one must take spring and summer as normal.

EXPLANATIONS AND COMMENTARIES I. Ma Shi explains: “This paragraph defines the depth of insertion of the needle as a function of time, season and the build of the individual. a) In spring, the perverse energy is found in the hair space. In summer, the perverse energy is found in the cutaneous space. In autumn, the perverse energy is found in the space of “distribution” of the flesh. In winter, the perverse energy is found in the musculo-skeletal space. When one treats these 4 types of illnesses, _ in spring and summer, needle insertion is slightly superficial, in the cutaneous space. _ in fall and winter, needle insertion is slightly deep, in the space of the distribution of the flesh ... . Such is the method of “needling following the seasons” in order to limit the depth of implantation of the needle.

b) In very stout individuals, the illness is deep; also one must take as normal the 2 seasons “autumn-winter”, and in thin subjects the 2 seasons “spring-summer”. Such is the method of treatment according to the constitution of the individual and the location of the illness.”

II. N.V.N.: This paragraph emphasizes the importance of the method of needling the different layers of the body called “needling according to the 4 seasons”. The energy of spring is warm. It manages “production/birth”. The illness of perverse energy generally manifests at the level of the external part of the pilocutaneous. The energy of summer is hot and stifling. yang energy is in fullness; the illness of perverse energy generally becomes manifest in the superficial part of the epidermal system.

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The energy of autumn is fresh; it manages “collection/harvesting”. The illness of perverse energy generally infiltrates into the dermal layer. The energy of winter is cold; it commands “closure/conservation”. The illness of perverse energy can penetrate deeply into the musculo-skeletal system. 270. Treatment of these illnesses is linked to the climatic phenomena of the 4 seasons; the depth of the needle is based on the movement “time-climate” and on the deep or superficial localization of the illness in order to apply adequate treatment. But the depth of needling differs in each individual. In very stout individuals, needling must be deep like that applied in autumn or winter, and in thin individuals, it must not exceed the layer belonging to spring and summer. 270.

Figure 26

PARAGRAPH 19 Illness

Technique of needling according to the 4 seasons.

characterized

by

pain

is

yin.

Upon pressure of the fingers, if this pain does not become displaced, that is to say, if the localization of the pain cannot be determined as in the case of erratic pain, it is yin and needling must be deep. Illness localized at the top (superficial) is yang, and that localized at the bottom (deep) is yin. Pruritis is yang; as a result, needling must be superficial.

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EXPLANATIONS AND COMMENTARIES

271.

I. Ma Shi explains:

“This paragraph divides illness into yin and yang. Therefore, needling is distinguished also into deep (yin) needling and superficial (yang) needling. _ The yin channel is yin and the yang channel is yang. _ Pruritis is yang and pain is yin. _ Superficial (top) is yang and deep (bottom) is yin. _ The illness localizing in yin, needling is deep, and illness localizing in yang, needling is superficial.” II. N.V.N.: This passage defines the yin and yang of the illness and the yin and yang of needling. Because, some illnesses characterized by pain, like those of perverse cold infiltrating deeply into the musculo-skeletal system, are of yin nature. In other words, pain not felt upon manual pressure is the sign revealing the deep localization of the illness of perverse energy. This pain is of yin nature; consequently, needling must be deep. Illnesses localizing in the upper half of the body are yang because yang governs ascent, and those localizing in the lower half are yin because yin governs descent. Pruritis manifests at the skin. It is a yang illness, and needling must be superficial. Depth of needling depends then on the yin and yang nature of the illness (localization).

PARAGRAPH 20

yin,

In the illness that starts in yin, one must treat, in the first place, then yang.

place,

In the illness that starts in yang, one must treat, in the first yang, then yin.

EXPLANATIONS AND COMMENTARIES I. Ma Shi notes: “This passage has the same meaning as that of Paragraph 17.” 272. II. N.V.N.: This paragraph is centered on the two key notions of energetic therapy: treatment of the “root” and “summit” (4). Because, pathological manifestations sometimes start at the level of the yin channel; it is necessary to treat, in the first place, the yin channel (that is to say “the root”), then, in the second place, the yang channel (that is to say, “the summit”). In contrast, if these pathological manifestations start at the level of the yang channel, it is necessary to treat first the yang channel (that is to say “the root”), then the yin channel (that is to say “the summit”).

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In summary, deep knowledge of the notions of “Root” and “Summit” allow differentiating the essential from the secondary, establishing a hierarchy of morbid symptoms, detecting the mechanisms that drive the cause of the symptoms and applying, as a result, a rational therapy.

PARAGRAPH 21 In the treatment of the illness re Jue (afflux of heat), the needle left in place transforms the heat into cold, and in the treatment of the illness han Ju (afflux of cold), the needle left in place transforms the cold into heat. The treatment of re Jue is based on “2 yin and 1 yang”, and the treatment of han Jue, on “2 yang and 1 yin”. When one says “2 yin” that means to say one needles the yin channel two times; and when one says “1 yang” that means that one needles the yang once.

EXPLANATIONS AND COMMENTARIES I. Ma Shi explains: “This paragraph defines the treatment of “Jue” (afflux) illnesses. In “re Jue” (afflux of heat), the needle left in place for a long time has the ability to transform the heat into cold, and heat is susceptible to being eliminated on its own. In “han Jue” (afflux of cold), the needle left in place for a long time has the ability to transform the cold into heat, and cold is susceptible to being eliminated on its own. In re Jue, one tonifies the yin channel twice and disperses the yang channel once because yin in fullness can cause the emptiness of yang and the perverse heat is then eliminated by itself.. In han Jue, one tonifies the yang twice and the yin once because yang in fullness can cause the emptiness of yin and the perverse cold is then eliminated by itself. The words “2 times yin” designates 2 yin channels, and “1 time yang”, 1 yang channel.”

4. See details in M.T.C.- N.V.N Edition.

II. N.V.N.: The treatment of “Jue” illnesses (energetic afflux), “re Jue and han Jue, is shown in this paragraph. The treatment of re Jue (afflux of heat) consists of using the method of the needle left in place, which permits transforming the heat into cold in the goal of provoking the regression of the perverse heat; inversely, the treatment of han Jue (afflux of cold) consists of using the needle left in place, which permits transforming the cold into heat in the goal of driving out the perverse cold. In re Jue, the therapeutic technique consists of tonifying “2 times” the yin channel and dispersing “1 time” the yang channel; and in han Jue, the therapeutic technique consists of tonifying “2 times” the yang channel and dispersing “1 time” the yin channel. In practice, in the course of the same treatment session for re Jue, for example, one tonifies 2 yin channels and disperses 1 yang channel, and not the same yin channel 2 times (see explanations of Ma Shi above).

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PARAGRAPH 22 In chronic diseases, the perverse energy localizing deeply, needling is deep and must be performed once every 2 days; the needle is left in place for a long time. First, one must harmonize the left and right in eliminating the blood stases. This technique is considered sufficient and complete.

EXPLANATIONS AND COMMENTARIES I. Ma Shi explains: “wei energy (defensive energy) circulates during the day in yang and during the night in yin, in agreement with the Celestial Dao which occurs day and night on earth. In chronic diseases, the infiltration of the perverse energy is deep; its attack against the essential energy obliges it to remain for a long time in the yin part of the body; it only returns to the yang part of the body once every 2 days. This is the reason why the needling must be done at one day intervals, that is to say, on the day of the return of perverse energy into the yang part. Left and right are the circulatory routes of yin and yang. The jingmai (principal channels) are the circulatory routes of the blood and energy which permeate yin and yang. This chapter studies the Dao “of ending and beginning” according to the 5 movements and 6 energies: _ The 5 movements respond to the mechanisms of entry and exit, 274. _ and the 6 energies, to the Celestial Dao. The physician who practices the methods of needling in accordance with the “Top-Bottom” movements and regulation of Jian qi (energy-exchange: qijiao, p.267) of the left and right to eliminate the stains lodged within the channel-vessels is an acupuncturist who sufficiently knows the techniques of acupuncture.” II. N.V.N.: This paragraph defines the Dao of needling of chronic diseases: _ needle deeply once every two days _ leave the needle in place a long time _ regulate the energy of the jingmai (left and right) _ eliminate blood stases contained in the channel-vessels.

PARAGRAPH 23

All acupuncture methods necessitate a complete examination of xing (bodily form) and qi (energy). When the form (flesh) is not yet divergent and the energy is deficient with agitated pulse, the illness is that of Zao Jue (agitation/ afflux); one must use the method of needling on the opposite side (Miu), which allows gathering the energy that is in a state of dissemination and dissolving the energy that is in a state of obstruction. EXPLANATIONS AND COMMENTARIES

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I. Ma Shi explains: “This passage studies the case of emptiness of the energy with full pulse treated by the method of “needling on the opposite side” (Miu). This method consists of needling the luo point of the right side when the illness is found at the left, and the luo point of the left when the illness is found at the right. This technique permits concentrating the energy that is in a scattered state and dissolving the energy that is in a state of accumulation.” II. N.V.N.: This paragraph explains the use of the method “needling on the opposite side” of the luo point in the event of emptiness of the energy with full pulse. 275.

PARAGRAPH 24 The practice of acupuncture is performed in a calm place in order to observe the movements of the shen (mental). Doors and windows are closed and cracks filled in so that the hun (vegetative soul) and po (sensitive soul) do not become scattered.

EXPLANATIONS AND COMMENTARIES Ma Shi does not comment on this paragraph. The explanations of Zhang Shi concern not only this paragraph, but also the previous one. I. Zhang Shi: “In acupuncture, one must examine the xing (Soma) and qi (energy) of the illness and study its jing-shen (essence-mental) before placing the needle. 1. “”Form-flesh” is not yet divergent” means that xing and qi are still in harmony. 2. “The energy is in insufficiency”, the energy is concentrated in the lower part (deeply). 3. “Agitated pulse (Zao)” originates from the yin movements. 4. “Illness of Zao Jue (agitation/afflux) is due to a disequilibrium of blood and energy which manifests in the top part (superficial). 5. “Needle on the opposite side”, a technique which consists of needling the left side when the illness is found at the right, and vice versa, in the goal of harmonizing the energy and blood, yin and yang, and facilitating the gathering of the energy of the jingmai that is in a disseminated state and the dissolution of the energy which accumulates in the lower part (deep). 6. “The practice of acupuncture is performed in a calm place”, to maintain the energy. 7. “Door closed and cracks filled in”, so the energy does not disperse to the exterior. 8. “hun and po do not become scattered” implies that the jing shen is maintained in the interior. This technique of treatment must be well known by the patient in order to calm his mind before acupuncture.” II. N.V.N.: This passage teaches us the behavior of the physician during the acupunctural act. 276.

PARAGRAPH 25

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The patient must concentrate his yi Chi (thought and will), in particular his jing shen (essence and mental), on the needling without being preoccupied with what occurs at the exterior. Superficial needling and the needle allowed to remain in place or light and superficial needling are acts intended to mobilize the jing shen of the patient. When the energy arrives, one stops needling. Man responds to the exterior, and woman, to the interior. In the first case, one must bring the energy back to the interior, and in the second case, one must bring the energy back to the exterior; this is what one calls d e q i (obtaining the energy). EXPLANATIONS AND COMMENTARIES I. Zhang Shi explains: “This paragraph defines the behavior of the patient during needling. he must watch over his jing shen in order to concentrate his yi Chi on the place of needling. The kidney conserves jing (essence) which exteriorizes towards the ear. This is why, to maintain the jing in place, the patient must not listen to voices coming from the exterior. “Superficial needling and the needle left in place permanently or light and superficial needling are the acts intended to mobilize the jing shen of the patient. When the energy arrives, one stops the needling.” This amounts to saying that the physician looks to associate his jing shen with that of the patient. Man responds to yang, and woman, to yin. yang is located at the exterior, which is why it is necessary to make it enter into the interior. yin is located in the interior which is why it is necessary to make it leave to the exterior. Such is the method of harmonization of yin energy and yang energy, of interior and exterior. In all, one must carefully observe the essential energy to not allow it to leave and the perverse energy to prevent it from entering. To do so in this manner is to obtain the phenomenon called deqi”. II. N.V.N.: In individuals who are treated for the first time by acupuncture or are afraid of needles, superficial needling and allowing the needle to remain in place are advised. If the patient experiences a sensation of pain, one must transmit some rotation movements to the needle and slightly elevate it toward the skin. This method tends to calm the mind of the patient. Patience and prudence are the two qualities of the acupuncturist. This is why one must know how to wait for the deqi (obtaining the energy) because the results depend on it. In relation to “yin and yang, interior and exterior, Man and Woman”, a recent, rather wellknown, translation, totally distorts this passage. This urges us to maintain a critical mind faced with modern versions of the Chinese classics, at times quite whimsical, because of the difficulty of interpretation. 277.

PARAGRAPH 26 The

234

contraindications

of

needling

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_ do not needle individuals after needling, avoid sexual relations. _ do not needle the individual in needling, avoid alcohol. _ do not needle individuals after avoid anger. _ do not needle individuals after avoid exertion. _ do not needle individuals after avoid satiety. _ do not needle individuals when needling, do not let the hunger go on. _ do not needle individuals when needling, do not let the thirst go on.

sexual relations. similarly, after a drunken state. similarly, after anger. similarly, after needling, fatigue. similarly, after needling, a meal. similarly, after needling, they are hungry. similarly, after they are thirsty. similarly, after

_ If the subject arrives fearful, calm him before needling. _ If the subject arrives by carriage, before needling let him rest the time a meal lasts (30’). _ If the subject arrives on foot, before needling let him rest the time of traveling 10 leagues (about 30’). Such are the 12 contraindications to needling. In the above-mentioned cases, the pulse is disordered and the energy dispersed, ying and wei circulate in the wrong way, the energy of the channels is disorganized... . Untimely needling provokes the overflowing of the illness from yang towards yin and the overflowing of the illness from yin towards yang, and the perverse energy becomes amplified. The poor physician who ignores these reasons injures the body. Then the form (soma) becomes exhausted, brain and marrow become empty, organic liquid is not produced and the 5 sapors escape. This is the loss of the energy (vital).

EXPLANATIONS AND COMMENTARIES

278.

I. Zhang Shi explains: “This paragraph underscores the problem of the contraindications of needling. After sexual relations, jing (essence: sperm) becomes exhausted. Alcohol, although originating from cereals, is a very potent energetic substance. This is why, in an intoxicated state, the energy is incoherent. The liver conserves the blood. Anger makes the energy of the liver ascend and provokes an anarchical circulation of the blood. Fatigue is the origin of the gathering of the shen (mental) energy at the exterior and the weakening of jing (essence) energy in the interior. Chapter 17 (“Subtleties of Pulse Examination”) of the Su Wen states: “Before a meal, the jingmai are not yet in fullness, the luos function regularly, the blood and energy are not disturbed. This is the moment to examine the pulse of the patient.” For this reason, one must not

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needle the individual after a meal. Chapter 18 (“Energetic Aspects of the Pulse of Man in good health”) specifies: “Foods enter the stomach, the yang channels help them circulate, the liquid substances penetrate into the channels and contribute to the formation of blood”. This is why one must not needle the hungry and thirsty individual. Anger injures the shen, and fear, the jing. This is why it is advised to needle when the individual is calm. By precaution, one must maintain the jing and shen stable before needling. The prolonged seated position injures the flesh. This is why one must let the patient who comes by carriage rest before needling. A long walk injures the muscles. This is why the patient who comes from a long way off must also rest before needling. If one does not obey these principles, the energy becomes dispersed, ying and wei circulate in the opposite direction and the energy of the channels is disordered... . In these cases, inopportune needling causes the overflowing of the illness from the yin into the yang and vice versa, which increases the production of perverse energy, injurious factor to the human body which weakens the form. The brain is the sea of the marrow. The organic liquid is a nutritive substance that is very useful to the brain and marrow; it permeates and humidifies the skin, maintains and softens the muscles and bones. When one does not take into account these contraindications, the organic liquid does not become transformed and the brain and marrow become exhausted. The 5 sapors that one absorbs by mouth are conserved in the stomach to maintain the 5 energies. In a state of balance, the energy produces the organic liquid, jing (essence) and shen (mental). In summary, acupuncture is a technique which essentially consists of safeguarding the shen and maintaining the transformation of the energy. If one breaks the above-cited contraindications, one provokes the escaping of jing and shen produced by the 5 sapors. This phenomenon bears the name “loss of the energy”. 279.

II. N.V.N.: The explanation of Zhang Shi is clear. Note, however, that besides these contra-indications, other are cited and classified in the Zhen Jiu Da Cheng de yang Chi Chou (5); there are also contraindications according to: 1. the depth of the needling. 2. the needling technique. 3. the state of the subject.

5. See “Art and Practice of Acupuncture and Moxabustion”, Volume 1 - N.V.N. Edition.

PARAGRAPH 27 Exhaustion of the taiyang (Bl) is characterized by the following signs: ocular contortion/eyes rolled upward, dorsal stiffness and aching all over and whitish complexion. With the appearance of droplets of sticky sweat, it is death. Exhaustion of the shaoyang (GB) is characterized by such as signs: deafness, articular laxity and blindness. With the appearance of a whitish complexion, death follows in 1 1/2 days. Exhaustion of the yangming (St) is characterized by the following signs: labial and ocular agitation, fright, contempt for speech and

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yellow complexion. With the appearance of fullness and cessation of the circulation of the channels as much at the top as at the bottom, it is death. Exhaustion of the shaoyin (Ki) is characterized by the following signs: blackish complexion, elongated and tartarous teeth, bloating and obstruction. With the disappearance of the relationship of top and bottom, it is death. Exhaustion of the taiyin (Sp) is characterized by the following signs: bloating and obstruction, frequent eructation and vomiting with flow in the wrong way marked by redness of the face. The top and bottom are no longer assured, the color of the face is blackish and the skin desquamates; this is death. Exhaustion of the jueyin (Li) is characterized by the following signs: sensation of heat in the interior, dryness of the throat, frequent urination and anxiousness In the grave state: lingual and testicular retraction; this is death. EXPLANATIONS AND COMMENTARIES

280.

I. Ma Shi explains: “This paragraph describes the signs of exhaustion of the 6 channels of the foot ending up in death. In effect, 1. The Foot Taiyang (Bl) channel starts at the internal canthus of the eye, ascends the forehead, is directed towards the top of the cranium, penetrates into the brain; then from the brain, it descends towards the nucha, passes the shoulder and reaches the muscles of the arm. Also, from the nucha, it goes down the back, runs laterally along the length the vertebral column to the lumbar belt; first, it penetrates into the gluteal muscles before linking up with the kidney. This channel belongs to the bladder. This is why, at the time of death, the eyes are rolled upward/distorted, the back is in ophisthotonus and the limbs tremble. The pale white complexion indicates the abandonment of the energy of the lung. With the appearance of droplets of sticky sweat, it is death.

2. The Foot Shaoyang (GB) channel starts at the external canthus of the eye, passes the temporal region and penetrates into the ear; then it comes back out in front of the ear... . This is why, at the moment of death, the joints are lax and the patient can no longer see. The greenish white complexion results from the action of repression of metal on wood. 3. The Foot Yangming (St) channel starts in the nose, ascends to the middle of the forehead, then descends toward the side of the nose to penetrate into the teeth, goes around the gums and comes back out below the lips at the point Chengjiang (CV 24). Another branch passes the supraclavicular region (Quepen- St 12), arrives at the stomach and links up with the spleen... . This is why, at the moment of death, the mouth and eyes become agitated, the patient panics and rambles. This is due to the fullness of perverse energy seated in yangming (St). The yellow complexion is the color of earth (Sp) which becomes exteriorized. All the channels of the top and bottom are in fullness and become stagnant following the exhaustion of the spleen energy. 4. The Foot Shaoyin (Ki) channel commands the liquid system. This is why its color is black. The kidney also controls the bony system which make up part of the teeth. The kidney

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channel is directed toward the interior of the abdomen where it opens two routes: the intestinal route and urinary route. At the moment of death, the complexion is grayish black, the teeth elongated and tartarous, the belly is bloated and obstructed. 5. The Foot Jueyin (Li) channel, from the groin, passes the genitals, reaches the lower abdomen, crosses the diaphragm, becomes attached to the ribs, ascends to the laryngo-pharyngeal apparatus. At the moment of death, the interior of the abdomen is warm and the throat becomes dry; urinary micturition is frequent and the patient presents with an upset stomach; at a higher degree, the tongue is retracted and testicles are withdrawn into the belly (ectopia). 6. The Foot Taiyin (Sp) channel starts at the great toe, passes to the internal side of the calf, reaches the thigh, penetrates into the abdomen, ascends to the diaphragm and arrives at the laryngo-pharyngeal apparatus and links up to the base of and below the tongue; this is why, at the moment of death, the abdomen is bloated and obstructed with inability to vomit but with frequent eructations and nausea. The top and bottom lose their relationship, the complexion is blackish and the skin becomes dry and desquamates.”

II. N.V.N.: The explanation of Ma Shi aids us in demonstrating that the diagrams of the channels presented in our era are inadequate because the description of the internal vessels is barely addressed, hence the difficulty of appreciating the process of triggering certain pathological signs. no 282/283.

CHAPTER X Vessels-Channels (Jing Mai)

Chapter 10 of the Lingshu is devoted: _ to the trajectories of the jingmai (principal channels) from their point of departure to their point of termination,

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_ to their circulation/distribution throughout the entire body _ and to their syndromes of exogenous origin (caused by perverse energy) and endogenous origin (caused by perturbation of the energy at the level of the organ or bowel). The emptiness and fullness of each channel are perceived at the level of the pulses. The signs of attack of each channel are treated according to therapeutic rules which are suitable to them. The topography and symptomatology of the luomai (secondary channels), called “luo bie” (distinct luos) (1), are also well studied and classified. In total, this chapter defines the action of the jingmai in the determination of the pathophysiology of the human body and the regulation of the emptiness and fullness. This is why this chapter is entitled “Vessels-Channels” (“Jing Mai”). Ma Shi states: “It is absolutely necessary to thoroughly learn this chapter in order to practice medicine correctly because clinical results depend on it. Also, it must be pointed out to future generation that ignorance of the jingmai creates error as soon as one discourses on medicine or participates in clinical work. We will be like damned fools listening to the thunder. What a pity!” 284. The study of the 14 channels cited by Hua Ba Ren (1304-1336 A.D.), like that of other books of acupuncture and moxabustion such as the Zhen Jui Fa yi Jing de Huang Fu Mi (259 A.D.), are all based on this chapter of the Lingshu, but in a much less explicit fashion. 1. In 1969, we translated them as “longitudinal luos” due to their very specific circulation.

This chapter includes 38 paragraphs.

PARAGRAPH 1 Leigong questions Huangdi: “The concepts of the Gan Mai (Forbidden Vessels) (2) and of the needling methods essentially rests on the jingmai (principal channels), the circulatory paths of ying (nutritive energy) of different energetic and blood potentials. In the interior, the jingmai respond to the 5 organs, and at the exterior, to the 6 bowels. Please explain all of this to me.” Huangdi: “In the beginning, man (fetus) is formed from jing (essence) ( 3 ) . In forming, jing produces the brain and marrow. The bones constitute Gan (like the trunk of the tree). Mai (vessels) conduct ying (blood circulating throughout the entire body). jin (tendons and muscles) are the webbing (attached to the trunks). Rou (flesh) is the wall (containing blood and energy). The skin is firm, the body and head hair is long. The cereals penetrate into the stomach, the vessels are permeable, energy and blood circulate... .” Leigong: “I would like to know how to utilize the jingmai.”

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Huangdi: “With the jingmai, one can determine life and death, treat the “100 diseases” and regulate the emptiness and fullness. One must learn them very well.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph defines the birth and beginning, exiting and entering of the 12 jingmai. ying/blood circulates within the interior of the vessels, and the “6 energies” unite at the exterior of the vessels. ying/blood begins to circulate from the Hand Taiyin (Lu) and ends at the Foot Jueyin (Li); then it starts the cycle again, in a circle without end, in perpetual motion. 285. “In the beginning, man (fetus) is formed from jing...” implies that jing qi (ovum and sperm, water/fire, yin/yang) of the procreators produces, in the first place, the two kidneys. The brain is the “sea” of jing (essence) of the marrow. In forming, the kidneys pour out their jing into the

brain; it is in this manner that the brain is the “sea of the marrow”. “Bones constitute Gan (tree trunk)” implying that the bones are created from the water organ (kidney) like a trunk of a tree. “ying” is defined as a barracks able to contain blood and energy. 2. This is an error in transcription. One must read “Gan Fu” (“forbidden prescriptions”) which is the title of Chapter 48

(“Prohibition and Submission”- Gan Fu) of this classic. 3. Sexual jing originating from the kidney.

“jin (tendons and muscles) are the webbing attached to the trunk” means that the tendons and muscles are tough and resistant. “Rou (flesh) is the wall” expresses that the flesh is produced by “earth” like a wall of protection. “The skin is firm; the body and head hair is long” defines the plethoric state of the blood and energy. In total, the skin, vessels, flesh, tendons, muscles, bones... are “external reunions” whose origin comes from the jing energy of the procreators, a priori (innate) jing. “Cereals (foods) penetrate into the stomach...” explains that ying and wei, blood and energy, are created from Cereal jing, a posteriori (acquired) jing.”

II - N.V.N.: This paragraph emphasizes the fundamental importance of the existence of the jingmai in the human organism. The jingmai allow not only explanation of the physiologic functions and pathologic processes of the human being, but also the diagnosis of diseases in order to regulate the emptiness and fullness, two primary criteria of the practice of energetic medicine.

PARAGRAPH 2 The Hand Taiyin-lung vessel starts at the zhongjiao (MJ), descends and links up with the large intestine, reascends to the orifices of the stomach and penetrates into the lung. From the lung, it reaches the axilla, descends the arm and passes in front of the Hand Jueyin (XB), penetrates into Cun Kou (radial pulse),

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ascends to the thenar eminence and exits by the tip of the thumb. Another branch departs behind the wrist, runs along the external side (energetic description) of the index finger and arrives at the tip of this finger 286. 1. Shi Dong (disorders of external origin) manifest by the following signs: _ thoracic swelling and fullness _ dyspnea and cough _ pain of Quepen (supraclavicular fossa) In the serious case: _ crossed arms and closed eyes. These signs constitute the syndrome called Bi-Jue (obstruction/afflux). 2. Ci sheng (disorders of internal origin) of this vessel are characterized by signs such as: _ cough and energetic afflux _ dyspnea _ thirst _ upset stomach _ abdominal bloating _ pain of the internal part of the arm _ sensation of heat in the palms of the hands. In the case of fullness of the perverse energy: _ scapulo-brachialgia (following attack of wind-Cold) (Fenghan). _ sweating resulting from a direct attack of wind (Zhongfeng). _ pyuria _ gnawing pains of the shoulder In the case of emptiness of the essential energy: _ pain and sensation of cold of the shoulders and arms _ hypopnea (4) _ change in color of the urine. 3. In the diseases cited above, treatment consists of: _ dispersing in the event of fullness and tonifying in the event of emptiness, _ rapidly removing the needle in the event of heat and letting the needle remain in place in the event of cold, _ applying moxabustion in the event of weakening of the vessel _ and needling the channel affected in the event of absence of emptiness and fullness. 4. The word fullness designates the Cun Kou pulse (right radial pulse) 3 times larger than the renying pulse (left radial pulse), and the word e m p t i n e s s , the Cun Kou pulse 3 times smaller than the renying pulse.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: 287. “To speak of the “lung-Vessel” is to speak of the lung organ. As for “taiyin”, according to the Maijing (Classic of Pulses of Wang shu he, 3rd century A.D.), it designates one of the

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6 energies which is invisible and immaterial. Mai (vessels) and Xue (blood) located in the interior originate from the organs and bowels; at the exterior, they respond to the 6 energies. When one studies the energy of the pulses, the diseases of the 6 energies manifest at renying (left radial pulse) and Cun Kou (right radial pulse). As a result, these diseases belong the energy and not to the pulses, and the diseases of the organs and bowels are those of the interior manifesting at the “Chi” (foot) pulse and “Cun” (inch) pulse. In summary, in the interior Zang (organs) and Fu (bowels), jing (channels) and Mai (vessels) unite with the 5 movements, and at the exterior, with the 6 energies (taiyang, shaoyang, yangming, taiyin, jueyin, shaoyin). This is why, when one speaks of the “Hand Taiyin-lung vessel”, one includes the yin and yang energy of the organ and bowel. This chapter speaks of ying/Xue (nutritive energy/blood): “ying circulates within the vessels (channels) beginning with the Hand Taiyin (Lu) and ending with the Foot Jueyin (Li). From the abdomen, it is directed toward the hand, from the hand toward the head, from the head toward the feet, from the feet toward the abdomen, forming a circle without end, in perpetual motion”. The vessels (channels) coming from the 6 organs link up with the bowels and those coming from the 6 bowels attach to the organs; yin and yang communicate; first Shi Dong (disorders of external origin) become manifest, then Ci sheng (disorders of internal origin). Shi Dong perturb the 3 yin and 3 yang. The agitation of renying and Cun Kou indicate disease at the level of the qi (energy) and not at the level of the jing (channel). This is why it is said: “Disperse in the case of fullness and tonify in the case of emptiness; follow the channels affected in order to choose the points in the case of absence of emptiness and fullness”. This 4. Breathing that is shallower, slower, or both than normal.

implies that when yin and yang energy move towards fullness, the needling is superficial. It must, therefore, only penetrate the epidermis in order to disseminate the perverse energy in a state of fullness. One leaves the needle in place permanently to await the arrival of the cereal energy with the purpose of tonifying the emptiness of yang and yin. Also, in our humble opinion, since the perverse energy is found in the superficial region, needling must be done at the energetic part of the skin without touching the channel (jing). In the case where the energy of yin and that of yang are neither in fullness nor in emptiness, with disharmony of the jingmai, one must treat at the level of the channel involved. The Ci sheng designate problems at the level of the organs and bowels manifesting at the level of the jing (channels). After reflection, here is our conclusion: 1 - Shi Dong are the diseases manifesting from the exterior. 288. 2 - Ci sheng are the diseases manifesting from the interior. 3 - In general, the cause of diseases is either external or internal. Sometimes their cause is first external, then it reaches deeply to the interior and vice versa... at other times, their cause is external and internal at the same time. This paragraph speaks of Zang (organs) and Fu (bowels), jing (channels) and qi (energy). This is why the text addresses the Hand Taiyin-lung vessel before Shi Dong and Ci sheng. But in practice, physicians classify clinical signs according to their external and internal nature and not into Shi Dong, then into Ci sheng.” II - Ma Shi comments: “ 1 - This paragraph describes the trajectory of the energetic vessel of the lung, first circulatory path of the jingmai (vessels-channels). Each time one uses the word “Shou”(hand), one implies the jing, ying, shu, jing and he points starting at the level of the hand, and each time one uses the term “Zu” (Foot), one implies

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these same points coming from the foot (i.e. the shu-antique points). The phrase “...starts at zhongjiao (MJ)” implies that food, once within the stomach, is transformed into cereal energy under the action of the zhongjiao (MJ). This starts therefore at the zhongjiao, then it descends and goes into relation with the large intestine because the lung and large intestine represent one of the 6 “yin-yang, interior-exterior” systems of the organism. From there, this cereal energy ascends to the upper mouth of the stomach (cardia) and reaches the lung which it horizontally crosses to the axillary region, that is to say, to the points Zhongfu (Lu 1) and Yunmen (Lu 2), located on the 4th thoracic line (5), then redescends to the axilla and goes around the arm. At the arm, it joins Tianfu (Lu 3) and Xiabai (Lu 4) and arrives in front of the two channels, Hand Shaoyin (He) and Hand Jueyin (XB); it reaches the elbow and passes the forearm traversing the points Kongzui (Lu 6) and Lieque (Lu 7) and arrives at the points jingqu (Lu 8) and Taiyuan (Lu 9), located in the region of Cun Kou (radial pulse); then reaches the thenar eminence at Yuji (Lu 10) and emerges at the internal side (energetic description) of the thumb, at the point Shaoshang (Lu 11). Another vessel leaves from Lieque (Lu 7), goes around the wrist, passes the Hand Yangming channel to the points hegu (LI 4), Sanjian (LI 3) and Erjian (LI 2), to end up at the point Shaoshang (Lu 11), then it follows the large intestine channel to reach the shoulder. _ at the 4th line is found the lung channel (taiyin).

2 - During the verification of the energetic points affected (Dong Xue) by perverse energy, the syndrome of fullness of the lung manifests by the following signs: _ thoracic oppression 5. In the past, one divided the thorax into 4 separate zones by 4 vertical lines: _ at the medial (1st) line is found the renmai (CV) _ at the 2nd line is found the kidney channel (shaoyin) _ at the 3rd line is found the stomach channel (yangming)

_ pain in the supraclavicular fossa _ rapid respiration and cough and in serious cases: 289. _ thoracic constriction with crossed arms (to ease the pain) This syndrome carries the name “Bi qi jue ni” (obstruction and flow of energy in the wrong way/”afflux”) which is due to an attack of the lung channel. Other syndromes can be caused either by perturbation of the energy of the channel (without perverse energy) or by an association of diseases of several channels. Clinical signs are: _ sensation of rising of the energy (afflux) _ dyspnea _ thirst _ anxiousness _ thoracic fullness _ brachialgia _ a sensation of heat in the palms of the hand. • In the case of fullness of the perverse energy: _ pain in the shoulder blade due to attack of wind-Cold _ sweating following an infiltration of wind _ frequent urination and shoulder tightness (the mother passes her disease to the son). • In the case of insufficiency of essential energy: _ scapulo-brachialgia _ or hypopnea (sign of illness of the channel) _ or change in the color of urine (perverse energy reaches the son). 3 - In the ailments cited above, one must: _ disperse in the case of fullness and tonify in the case of emptiness _ rapidly remove the needle in the case of heat and leave the needle in permanently in the

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case of cold, _ apply moxabustion in the case of blockage/weakening (accumulation) of the vesselchannel, _ and treat only the channel affected (Lung), without having recourse to the Hand Yangming (LI), in the case of absence of signs of emptiness or fullness. Emptiness and fullness are observed at the level of Cun Kou (right radial pulse) and renying (left radial pulse)”. III - N.V.N.: Historic documentation on the lung and its energetic vessel (Hand Taiyin) allows better practice of energetic medicine. 1 - According to the Nanjing of Bian Que (500 A.D.): “The lung weighs 3 jin and 3 liang (about 1.90 kilo) (6) and possesses 6 leaves and 2 auricles, that is to say, in all, 8 hanging leaves evoking the image of an umbrella hanging from the 3rd thoracic vertebrae. It is also composed of 24 conducting orifices which bring the energy toward the organs. The throat comprises 2 parts: the anterior part called “larynx”, communicating with the 5 organs, and the posterior part called “pharynx”, controlling the passage of foods. 6. The unit of weight used in the Far East from the time of the Neijing to our times is jin which weighs 0.6018 kilo. The submeasures of jin are: _ Liang: 1/16 of a jin or 37.77 gr _ Dong: 1/10 of a Liang or 3.77 gr _ Fen: 1/10 of a Dong or 0.377 gr _ Li: 1/10 of a Fen or 0.0377 gr _ Lei: 1/10 of a Li or 0.00377 gr. One also notes Yen which weighs 10 jin, being 6.018 kilo.

The larynx weighs 12 liang and consists of 9 ring-like segments 2 cun in diameter and 12 cun in length. The pharynx also weighs 12 liang and its diameter is 3 1/2 cun. Its length measured to the cardia is 16 cun.” 2 - According to the Dacheng of yang Chi Chou (1522-1620 A.D.) (7) a - The lungs have functions comparable to that of an officer: _ regulators of secretory function _ generators of energy _ receivers of po (“sensitive soul”, the jing shen of the lung) _ distributors of coolness to the pilocutaneous system and elasticity to the cutaneous surfaces. b - The lungs are the sites of storage of functional energy. Their disorders manifest at the back. They respond: _ to spicy in the area of sapors 291.... _ to metal in the cycle of the “5 movements” _ to the horse in the animal kingdom _ to wheat in the vegetable kingdom _ to autumn in the cycle of seasons _ to Venus (Tai Bai) in the area of astrology _ to the note “Shang” in music _ to the odor of fish in the gamut of odors _ to nasal mucous in the area of secretions. c - The Hand Taiyin (Lu) channel contains more energy than blood. At the yin hour, (3h-5h), the energetic and blood flow reaches its maximal volume. 290....

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7. The Dacheng has been translated under the title “Art and Practice of Acupuncture and Moxabustion (According to

Zhen Jui Dacheng of yang Chi Chou)” - NVN Edition.

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Figure 27 Hand Taiyin (Lu). From 1 to 13: direction of energy circulation.

PARAGRAPH 3

291...

1 - The Hand Yangming-large intestine vessel starts at the tip of the index finger, runs alongside the internal side of this finger (energetic description), arrives at hegu (LI 4) located in the angle formed by the first and second metacarpals, reaches the space formed by 2 tendons (anatomical “snuffbox”), runs alongside the superior part of the bone of the forearm (radius) up to the external side of the elbow. From the elbow, it goes up on the external side of the arm, arrives at the shoulder in front of the acromion then posteriorly to the 7th cervical vertebrae, descends into the supra-clavicular fossa, penetrates into the thorax, links up with the lung, crosses the diaphragm and arrives at the large intestine. Another branch leaves from the supra-clavicular fossa, goes up to the neck, crosses the lower maxilla, inserts into the lower gums, encircles the mouth and arrives at renzhong (GV 26). The left branch is directed to the right and that of the right to the left, to reach the side of the 2 nostrils. 2 - Attack of this vessel by perverse energy manifests by: _ odontalgia _ inflammation of the neck The signs of yangming governing the organic liquid are: _ yellow sclera _ dryness of the mouth _ epistaxis _ tonsillitis

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_ pain in the anterior part of the shoulder _ brachialgia _ and immobility of the thumb and index finger. In case of fullness of perverse energy, the energetic path of this vessel is overheated and inflamed, and in case of emptiness, the subject feels a sensation of cold with shivers despite exposure to heat. 292.

3 - In the diseases cited above, one must: _ disperse in case of fullness and tonify in case of emptiness. _ remove the needle rapidly in case of heat and leave it in permanently in case of cold. _ apply moxabustion in case of blockage/weakening (accumulation) of the affected vessel _ and needle the concerned channel in case of absence of emptiness and fullness. 4 - The word fullness used in this paragraph designates renying pulse 3 times larger than that of Cun Kou, and e m p t i n e s s , renying 3 times smaller than that of Cun Kou.

EXPLANATIONS AND COMMENTARIES I - Absence of commentary by Zhang Shi. II - Ma Shi comments: “This paragraph describes the trajectory of the energetic vessel of the large intestine, second circulatory route of the system of 12 jingmai (vessels-channels). 1 - The Hand Yangming channel, belonging to the large intestine, is the continuation of the energetic current of the Hand Taiyin-lung vessel. It starts at the tip of the index finger and runs alongside the internal side of this digit, successively passing by the points Shangyang (LI 1), Erjian (LI 2) and Sanjian (LI 3), _ arrives at the points hegu (LI 4) and yangxi (LI 5) _ traverses the points Pianli (LI 6), Wenliu (LI 7), Xialian (LI 8) and Sanli (LI 10) on the external side of the forearm _ arrives at Quchi (LI 11) of the external part of the elbow. _ passes to the points Zhouliao (LI 12), Wuli (LI 13) and Binao (LI 14) located on the arm, _ ascends to the shoulder to the point Jianyu (LI 15) _ passes to the acromion at the point Jugu (LI 16) _ reaches the 7th cervical vertebrae and unites with the point Dazhui (GV 14) _ redescends to the supraclavicular area to go in relationship with the Foot Yangming (St), at the point Quepen (St 12) _ penetrates into the thorax and connects with the lung _ crosses the diaphragm _ arrives outside of Tianshu (St 25) _ and unites with the large intestine. Another vessel departs at Pianli (LI 6) and arrives at Quepen (St 12) located in the supraclavicular area. _ ascends to the neck and passes the points Tianding (LI 17) and Futu (LI 18) 293.

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_ passes at the upper maxilla and penetrates into the dental interstitium _ emerges at the mouth and arrives at renzhong (GV 26). The left vessel passes to the right and the right vessel to the left, thus encircling the nose, to arrive at the points heliao (LI 19) and ying Xiang (LI 20). 2 - During the verification of energetic points affected by perverse energy, the fullness of Hand Yangming (LI) is indicated by _ odontalgia _ and cervical inflammation. The Hand Yangming governs ailments caused by disorders of the organic liquids. These illnesses are due to either a perturbation of the energy of the channel itself or perturbation of that of several channels. The clinical signs are: _ yellow sclera _ dryness of the mouth _ epistaxis _ tonsillitis _ pain in the anterior part of the shoulder _ and stiffness of the thumb and index finger because these digits are the sites where the movements of the jing, ying and shu points become transmitted. In case of fullness of perverse energy, the corresponding energetic path is overheated and inflamed, and in case of emptiness, the individual feels a strong sensation of cold with difficulty having the heat return. 3 - Treatment consists of: _ dispersing fullness and tonifying emptiness _ rapidly removing the needle in the case of heat, and leaving the needle in place in the case of cold _ applying moxabustion in the case of blockage and weakening of the vessel _ only treating the concerned channel (LI) without recourse to the Hand Taiyin (Lu) in case of the absence of signs of emptiness and fullness.”

III - N.V.N.: Documentation on the large intestine and its energetic vessel, the Hand Yangming (LI): 1 - According to Ben Cao: “The large intestine is 4 cun in circumference, 1 1/2 cun diameter and 2 shang long. It can contain 4 dou of food and 7 1/2 shang of water.” 2 - After the Nanjing: “The large intestine weighs 2 jin 12 sheng.” 3 - After the Dacheng: “The large intestine is an organ of transit, transformation, secretion and excretion. The activity of the large intestine is limited to the “white sphere” (sphere of action of the lung). The large intestine channel has much blood and energy. At the Mao hour (5h-7h), the flow of energy and blood reaches its maximum volume”. (Figure 28)

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294....

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Figure 28 Hand Yangming (LI). From 1 to 16: direction of energy circulation.

PARAGRAPH 4

294....

1 - The Foot Yangming-stomach vessel starts at the side of the ala of the nose, is directed laterally to the taiyang channel, reaches the base of the nose, penetrates into the teeth, comes back out from the mouth, goes around the lips in crossing Chengjiang (CV 24), crosses below Daying (St 5), follows the lower maxilla, ascends to the front of the ear, crosses the point Ke Zhu ren (GB 3), ascends to the root of the hair and arrives at the forehead. A branch leaving from Daying (St 5) descends to the point renying (St 9), encircles the larynx, enters into Quepen (supraclavicular regionwhere the point of the same name (St 12) is found), descends to the diaphragm, arrives at the stomach and links up with the spleen. A vertical branch emanating from Quepen (St 12) descends toward interior of the breast, hugs the umbilicus tightly and penetrates into qixie (other name qichong-St 30). A branch leaving from the orifice of the stomach descends into the abdomen, rejoins qixie (qichong- St 30) to descend to the point Biguan (St 31), arrives at Futu (St 32), reaches the knee, runs alongside the external side of the tibia, arrives at the dorsal surface of the foot and penetrates into the space between the 2nd and 3rd toes. A branch leaves from the region located 3 cun from Xialian (St 39) and arrives at the external ungual angle of the 3rd toe. Another branch detaches from the top of the foot, penetrates into the space associated with the great toe and terminates at the tip of this toe at the point Yinbai (Sp 1).

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2 - Attack of this vessel by perverse energy manifests by the following signs: _ cold sensitivity and shivers _ moaning and frequent tightness and pulling of the shoulders _ grayish black complexion _ fear of fire and fear of people _ jumpiness and fright at the sound of wood _ cardiac palpitations _ desire to remain alone in a closed room. In the serious case, _ desire to reach a height to sing or take off his clothes to run _ boborygmi and abdominal bloating. These signs constitute the syndrome called han Jie (afflux of cold). • signs of perturbation of this vessel (without being affected by perverse energy) are: _ fits of madness _ fever and cold sensitivity _ “Wen” illness (mild heat) _ sweating _ epistaxis _ deformity of the mouth _ inflammation of the lips _ swelling of the neck _ pharyngitis _ edema of the epigastric region _ swelling and pain of the knee _ swelling and pain of the anus to the region of Futu (St 32) _ immobility of the 3rd toe. • anterior a state rise to

In case of fullness of perverse energy, the vessels traveling the part of the body are overheated. When the perverse energy in of fullness reaches the stomach, it activates digestion and gives hunger and red urine. • In case of emptiness of the essential energy, the anterior part of the body is ice cold. If the stomach is cold, it expresses as obstruction with swelling. 296.

3 - In the illnesses cited above, one must: _ disperse in case of fullness and tonify in case of emptiness _ rapidly remove the needle in case of heat and let the needle remain in place in case of cold _ apply moxabustion in case of blockage/weakening _ needle the concerned channel in case of absence of emptiness and fullness 4 - The word fullness used in this paragraph designates renying (left radial pulse) 3 times larger than Cun Kou (right radial pulse), and e m p t i n e s s , renying 3 times smaller than Cun Kou.

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EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph concerns the energetic current of the stomach vessel, that is to say, the 3rd of the jingmai. 1 - The Foot Yangming (St) vessel starts at the side of the nostril at the point yingxiang (LI 20), _ ascends to the base of the nose where it crosses that of the opposite side and passes to the point jingming (Bl 1) _ descends towards the external side of the nose to the points Changqi (St 1), si Bai (St 2) and Juliao (St 3), _ penetrates into the upper maxilla and returns to the external corner of the mouth to the point Dicang (St 4), _ arrives below the lower lip where it intersects the opposite yangming vessel to the point Chengjiang (CV 24) _ returns to the base of the cheek at the point Daying (St 5) and passes to the point Jiache (St 6) _ reascends in front of the ear at the point Xiaguan (St 7) and passes to the point Ke Zhu ren (also called Shangguan- GB 3) _ reaches the root of the scalp at the points Xuanli (GB 6), hanyan (GB 4) and passes to the point Touwei (St 8), _ then it unites with the point shending (GV 24) located on the forehead. • A branch leaving from Daying (St 5) descends to the point renying (St 9), penetrates into the pharynx and arrives at the points shuitu (St 10), qishe (St 11) and Quepen (St 12), _ passes to the exterior of the point shufu (Ki 27) _ penetrates into the thorax _ crosses the diaphragm _ and arrives in the space between the 2 point Shangwan (CV 13) and Zhongwan (CV 12) to enter into the stomach before reaching the spleen. • A vertical branch leaves from Quepen (St 12) and descends to the breast, _ passes to the points qihu (St 13), Kufang (St 14), Wuyi (St 15), yinchuang (St 16), Ruzhong (St 17), Rugen (St 18), Burong (St 19), Chengmen (St 20), Liangmen (St 21), guanmen (St 22), Taiyi (St 23) and Huaroumen (St 24), 297. _ arrives at the side of the umbilicus and crosses the points Tianshu (St 25), Wailing (St 26), Daiju (St 27), shuidao (St 28) and Guilai (St 29) to penetrate into qixie (qichongSt 30). • Another branch emanating from the stomach, leaves the pylorus and vertically descends the length of the inner wall of the abdomen between the Foot Shaoyin (Ki) on the inside and the Foot Yangming (St) on the outside, _ arrives at the point qixie (qichong- St 30) and unites with the previous branch _ descends to the points Biguan (St 31) and Futu (St 32) _ traverses the points yinshi (St 33) and Liangqiu (St 34) and arrives at the knee _ passes to the point Dubi (St 35) and descends to the points Chongyang (St 42) and Xiangu (St 43) _ arrives at the point Neiting (St 44), located at the union of the 2nd and 3rd toe and ends at the point Lidui (St 45). • A luo vessel (8) leaves from the region located 5 cun below the knee at the external side of the point Sanli (St 36). _ traverses the points Shanglian (St 37), Tiaokou (St 38), Xialian (St 39), Fenglong (St 40), Jiexi (St 41), Chongyang (St 42), Xiangu (St 43) and unites with the points Neiting (St 44) and Lidui (St 45).

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• Another branch leaves from the point Chongyang (St 42), located at the top of the foot, and is directed towards the great toe, outside the point Xingjian (Li 2) of the Foot Jueyin (Li), _ follows the internal border of the first metatarsal up to the tip of the great toe to unite with the Foot Taiyin (Sp) at the point Yinbai (Sp 1).

2 - During examination of the energetic points, emptiness of Foot Yangming (St) is indicated by the following signs: _ cold sensitivity and shivers _ groaning _ frequent stretching of the shoulders _ grayish black complexion At the phase of state: _ anthrophobia _ photophobia _ igniphobia _ claustrophobia _ quivering and terror caused by sounds of wood _ cardiac palpitations. In the serious case: _ desire to climb on the wall to sing or undress to run _ meteorism (9)

298.

8. here, the term “luo” designates a secondary branch and not the longitudinal luo (Luo Bie) or transversal luo (regulator luo). 9. Also tympanites: swelling of the abdomen from gas in the intestinal or abdominal cavity.

These latter signs come from the fire of yangming in battle against the “water” element, causing abdominal bloating and distaste to hear the human voice. Due to the afflux of blood and energy, the leg from the knee down is ice cold. This ailment is due disorder of the blood part caused by the yangming. Other illnesses can be caused by the Foot Yangming itself or by an association of this channel with other channels, such as yang Madness, “Nu” illness (fever and cold sensitivity), “Wen-re” illness (warmth-heat), excessive sweating, epistaxis,, deviation of the mouth, state of lethargy/apathy, laryngo-pharyngeal inflammation, ascites, pain of the gonads and pain from the leg to the foot. * In case of fullness of perverse energy, the front of the body is hot. The presence of this heat in the stomach activates digestion with hunger sensation and red urine. * In case of emptiness of essential energy, the front of the body is cold. The presence of this cold in the stomach is the cause of abdominal bloating. 3 - In the preceding illnesses, one must: _ disperse fullness of perverse energy and tonify emptiness of the essential energy, _ apply moxabustion in case of blockage and weakening of the vessel (channel) _ only treat the channel effected in the absence of signs of emptiness and fullness without resorting to the Foot Taiyin (Sp).”

III - N.V.N.: Documentation on the stomach and its energetic vessel, the Foot Yangming (St): 1 - According to Ben Cao: “The stomach is 1 meter 5 cun (10) in height, 5 cun in diameter and 2 meters 6 cun in circumference. Its capacity is 5 dou, 5 sheng (11). reasonably, the stomach can contain 2 dou of food and 1 dou 5 sheng of liquid.”

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2 - The Nanjing states: “The stomach weighs 2 jin 1 liang. Along with the spleen, it constitutes a system of storage/depot and food metabolism.” 3 - After the Dacheng: a - “The stomach is the “sea” of foods; it governs digestion. Because, the stomach stores foods, transports them downward and transforms them into nutritive energy (ying) so that the spleen can then distribute them throughout the entire body. In other words, the spleen and stomach are indispensable to the maintainence of health. Thus, if the stomach is exhausted or if Cun Kou (radial pulse) no longer contains the energy of the stomach, it is death.” b - The stomach channel has much blood and energy. At the Chen hour (7h-9h), the flow of blood and energy reaches it maximum.” (Figure 29) 299.

10. 1 chinese meter = 0.40 European meters; 1 cun = 2 1/2 centimeters 11. Dou = measure of capacity.

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Figure 29 Foot Yangming (St). From 1 to 26: circulatory direction of energy.

PARAGRAPH 5

1 - The Foot Taiyin-spleen vessel begins at the internal ungual angle of the large toe, runs alongside the internal edge of the foot at the level of the white flesh, arrives behind the cuboid bone, ascends in front of the internal malleolus, reaches the internal side of the tibia, unites with the Foot Jueyin (Li) vessel, goes up to the knee, passes the inner thigh, reaches the abdomen, penetrates into the spleen, branches to the stomach, crosses the diaphragm, rises to the pharynx and inserts at the lower side of the tongue. A branch leaves from the stomach and inserts into the heart. 2 - Disorders of this vessel caused by perverse energy are indicated by the following signs: _ stiffness of the base of the tongue _ post-prandial vomiting _ gastralgia _ abdominal bloating _ frequent eructations _ sensation of relief after defecating and urinating.

300.

Ailments caused by the spleen are characterized by such clinical manifestations as: _ pain at the base of the tongue _ limited rotation of the body _ trouble swallowing

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_ anxiety _ pain under the heart _ difficult micturition _ icterus _ inability to stretch out/lie down _ forced standing position (caused by painful knee inflammation) or a sensation of cold at the knee _ immobility of the great toe. 3 - In the illnesses cited above, one must: _ disperse in case of fullness and tonify in case of emptiness, _ rapidly remove the needle in case of heat and leave the needle in permanently in case of cold _ apply moxabustion in case of blockage/weakening of the vessel _ needle the affected channel in case of absence of emptiness and fullness. 4 - The word fullness used in this paragraph designates Cun Kou (right radial pulse) 3 times larger than renying (left radial pulse), and e m p t i n e s s , Cun Kou 3 times smaller then renying.

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph describes the energetic vessel of the spleen , that is to say the fourth channel of the jingmai system. 1 - The Foot Taiyin-spleen starts at the point Yinbai (Sp 1) at the tip of the great toe, _ runs alongside the internal border of the foot at the level of the white flesh where the points Dadun (Sp 2), Taibai (Sp 3), gongsun (Sp 4) and Sangqiu (Sp 5) are found, _ passes in front of the internal malleolus _ reaches the calf at the point Sanyinjiao (Sp 6) _ arrives at Lougu (Sp 7) on the tibia _ 2 cun from this point, it passes in front of the Foot Jueyin (Li) and reaches the points Diji (Sp 8) and yinling (Sp 9) _ goes up the inner thigh and arrives at Xuehai (Sp 10), Jimen (Sp 11) and Chongmen (Sp 12), _ reaches the abdomen and passes the points Fushi (Sp 13), Zhongji (CV 3) and guanyuan (CV 4) _ rejoins the points Fujie (Sp 14) and Daheng (Sp 15) 301. _ unites with Xiawan (CV 10) _ passes to Fuai (Sp 16) _ crosses the points Riyue (GB 24) and qimen (Li 14) _ returns inside the channel of origin and passes to Zhongwan (CV 12) to penetrate into the spleen and branch to the stomach. From the point Fuai (Sp 16), it goes back up to the diaphragm, _ arrives at Shidou (Sp 17), Tianxi (Sp 18), Xiongxiang (Sp 19) and Zhurong (Sp 20) _ and goes back down to the point Dabao (Sp 21). From Dabao (Sp 21) it goes back up to Zhongfu (Lu 1),

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_ _ _ • _ _ _ _

passes to renying (St 9) crosses the laryngo-pharyngeal apparatus and arrives at the tongue where it branches to its base. Another branch also leaves from the point Fuai (Sp 16) reaches Zhongwan (CV 12) of the stomach goes up toward the diaphragm projects into Tanzhong (CV 17) and is directed below toward the heart to link up with the Hand Shaoyin (He).

2 - Attack of this vessel by perverse energy manifests by the following signs: _ stiffness at the base of the tongue _ post-prandial vomiting _ gastralgia _ abdominal bloating _ frequent eructations _ sensation of relief after defecating and urinating _ sensation of heaviness of the body. Other illnesses of internal origin can be caused either by perturbation of the vessel of origin or by the attack of several vessels. The clinical signs are: _ pain at the base of the tongue _ difficulty rotating the body _ disorders of swallowing _ anxiousness and pain under the heart _ liquid stools _ icterus _ inability to stretch out/lie down due to painful swelling of the thigh and knee _ cold in the extremities _ immobility of the great toe. 3 - In preceding illnesses, one must: _ disperse in case of fullness of perverse energy and tonify in case of emptiness of the essential energy 302... _ perform a rapid needling in case of heat and leave the needle in place in case of cold _ apply moxabustion in the case of obstruction and weakening of the vessel _ treat the vessel of origin without resorting to the Foot Yangming (St) in case of absence of signs of emptiness and fullness.”

III - N.V.N.: Detailed description of the trajectory of this vessel allows us to better understand the pathological process of the spleen organ. Documentation concerning the spleen and its energetic vessel, the Foot Taiyin, are the following: 1 - According to the Nanjing: “The spleen weighs 2 jin 3 liang. Its body is flat, 3 cun wide, 5 cun long and surrounded by 1/2 jin of fat. It has the function of “encapsulating” the blood and warming the 5 organs.” 2 - After the Dacheng: 303. “The spleen is the organ which assumes the role of “critic” in the organism. It is considered the seat of intelligence. It is the energetic “granary”, source of ying (nutritive energy). It confers freshness/coolness to the lips, skin and flesh. It makes up part of the taiyin communicating with the energy of earth. Like earth, the spleen is found at the center to humidify

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the four cardinal points (4 organs). The spleen governs the four limbs and contributes, along with the stomach, to the distribution of organic liquid within the organism. _ The spleen constitutes one of the sites of storage of reserve “jing” energy (essence). It communicates its energy to the mouth. This is why disorders of spleen energy often manifest at the base of the tongue and are recognizable by the state of the flesh and skin. The energy of the spleen answers to: _ sweet in the gamut of sapors _ the earth in the cycle of the 5 movements _ the buffalo in the animal kingdom _ rice in the vegetable kingdom _ the 4 seasons in the seasonal cycle _ the planet “Chan” (Saturn) in the star constellations _ the note “gong” in music _ the number 5 in the numeric system _ sweet or bland in the gamut of odors _ saliva in the area of secretions. The spleen channel has more energy than blood. At the si hour (9h-11h), the blood and energetic flow reaches its maximum degree.” 3 0 2 ...

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Figure 30 Foot Taiyin (Sp). From 1 to 12: circulatory direction of energy

PARAGRAPH 6 1 - The Hand Shaoyin-heart vessel starts at the interior of the heart, leaves the cardiac system, descends to the diaphragm and connects with the small intestine. A branch leaves the cardiac system, goes back up to the laryngopharyngeal apparatus and projects into the ocular system. A vertical branch also leaves the cardiac system, goes up to the lung, comes back out at the sub-axillary region, follows the internal surface of the arm, passes behind the Hand Taiyin (Lu) and Hand Jueyin (XB), descends to the internal side of the elbow, arrives at the tip of the apophysis of the ulna, reaches the palm of the hand by the external side (energetic description) and is directed to the tip of the little finger. the

2 - Disorders of this vessel caused by perverse energy manifest by following signs: _ dryness of the throat 304. _ pain in the heart _ thirst and desire to drink. It is a matter of the syndromes called Jue Bi ( a f f l u x / o b s t r u c t i o n ) . diseases of the heart of internal origin manifest by such signs as: _ yellow facies _ costal pain _ pain and cold sensation at the internal surface of the arm

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_ pain and heat sensation in the palm of the hand. 3 - In the preceding diseases, one must _ disperse in case of fullness and tonify in case of emptiness _ remove the needle in case of heat and leave the needle in permanently in case of cold _ apply moxabustion in obstruction/weakening of the vessel _ needle the channel of origin in the absence of emptiness and fullness. 4 - The word fullness cited in this paragraph designates Cun Kou (right radial pulse) 2 times larger than renying (left radial pulse), and e m p t i n e s s , Cun Kou 2 times smaller than renying.”

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph describes the energetic vessel of the heart, the fifth channel of the system of the 12 jingmai. 1 - The Hand Shaoyin-heart leaves from the middle of the heart, _ follows the renmai (CV) _ descends to the diaphragm _ arrives 2 cun from the umbilicus _ and enters into liason with the small intestine. • A branch leaves the cardiac complex, _ reaches the side of the renmai (CV) _ is directed towards the laryngo-pharyngeal system _ and projects into the ocular system to go into relationship with the brain. • A vertical branch also leaves the cardiac complex, _ is directed near the space located between heart and lung, _ appears at the axillary crease at the point Jiquan (he 1) _ follows the internal side of the arm, making its way behind the Hand Taiyin (Lu) and Hand Jueyin (XB) _ arrives at the point qingliang (he 2) _ reaches the internal side of the elbow where the point Shaohai (he 3) occurs 305. _ runs along the internal side of the forearm _ crosses the points Lingdao (he 4) and Tongli (he 5) _ arrives at the points yinxi (he 6) and shenmen (he 7) _ passes the hypothenar eminence where the point Shaofu (he 8) is found _ and ends at the tip of the little finger at Shaochang (he 9) to link up with the Hand Taiyang (SI).

2 - Attack of this vessel by perverse energy is indicated by the following signs: _ dryness of the throat _ cardialgia _ thirst with desire to drink This syndrome is due to obstruction (Bi) with afflux (Jue) of the energy. Other ailments can be caused either by an internal perturbation of the channel of origin or by an association of several channels. The clinical signs are: _ yellow facies

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_ costal pains _ brachialgia _ pain and sensation of heat in the palms. 3 - The treatment consists of: _ dispersing in case of fullness of perverse energy and tonifying in case of emptiness of the essential energy _ applying a rapid needling in case of heat and leaving the needle in place in case of cold _ applying moxabustion in case of stagnation/weakening of the energy _ and treating the channel effected without resorting to the Hand Taiyang (SI) in case of absence of fullness and emptiness. 4 - How do you recognize the fullness of this vessel? When Cun Kou is 2 times larger and more agitated than renying. How do you recognize the emptiness of this vessel? When Cun Kou is 2 times smaller, without agitation, than renying.

II - N.V.N.: Documentation on the heart and its energetic vessel, the Hand Shaoyin: 1 - According to the Nanjing: “The heart weighs 12 liang and is attached to the 5th dorsal vertebra. It is seated under the left lung and on the diaphragm and possesses 7 “orifices” and 3 “hairs”. Its role is to conserve the psychologic jing and house the shen.” 2 - After the Dacheng: “The heart is sovereign organ. It is the seat of the mind. The heart is the source of life; it governs mental activities and provides coolness to the face and suppleness to the blood vessels. It is the shaoyin (He) in yin, in communication with the energy of summer. It answers: _ to bitter in the gamut of sapors _ to fire in the cycle of the 5 movements _ to the goat in the animal kingdom _ to sticky rice in the vegetable kingdom _ to summer in the cycle of seasons _ to the planet “yin Hua” (Mars) in the star constellations _ to the note “Zhui” in music _ to the number 7 in the numeric system _ to burnt in the gamut of odors _ to sweat in the area of secretions. The Hand Shaoyin (He) has more blood than energy. At the Wou hour (11h-13h), the energetic and blood flow reaches its maximum level. The movement of the energy of the heart corresponds to the movement “Ding-Feu” (4th Celestial Trunk).” (Figure 31).

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Figure 31 Hand Shaoyin (He). From 1 to 11: circulatory direction of energy.

PARAGRAPH 7

307.

1 - The Hand Taiyang-small intestine vessel starts at the tip of the little finger, runs along the internal border of the hand to the wrist, follows the internal border of the forearm, passes between the 2 tendons of the internal side of the elbow, follows the posterior side of the arm, arrives at the posterior part of the shoulder joint, encircles the scapula and falls into the Dumai (GV) at the level of the 7th dorsal vertebra to unite with the opposite vessel, descends to the supraclavicular fossa (Quepen), penetrates into the thorax, goes in liason with the heart, goes back up to the pharynx, redescends to the diaphragm and reaches the stomach to enter into the small intestine to which it is allocated. A branch leaving from Quepen (supraclavicular fossa) goes back up to the neck, arrives behind the lower maxillary angle where it divides into 2 branches: the first reaches the external canthus of the eye and penetrates into the ear, and the second is directed towards the internal canthus of the eye and descends to the lower border of the zygomatic arch. the

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2 - Disorders of this vessel caused by perverse energy manifest by following signs: _ pain in the pharynx _ submental inflammation _ torticollis _ scapulo-brachialgia with sensation of a break.

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Illnesses due to an internal perturbation of the energy of the small intestine are characterized by such signs as: _ deafness _ yellow sclera _ inflammation of the maxillary angle _ cervico-brachialgia _ pain of the mentum, elbow and forearm 3 - In the preceding illnesses, one must: _ disperse in case of fullness and tonify in case of emptiness _ rapidly remove the needle in case of heat and leave the needle in permanently in case of cold _ apply moxabustion in the case of blockage and weakening _ only needle the channel involved in case of absence of emptiness and fullness. 4 - The word fullness cited in the paragraph designates the renying pulse 2 times smaller than that of Cun Kou.

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph concerns the energetic vessel of the small intestine, the sixth channel of the system of the 12 jingmai. 308. 1 - The Hand Taiyang-small intestine begins at the tip of the little finger, at the point Shaoze (SI 1), place of arrival of the Hand Shaoyin (He), _ reaches the points qiangu (SI 2), Houxi (SI 3), Wangu (SI 4), yanggu (SI 5), yanglao (SI 6) _ ascends directly to zhizheng (SI 7) on the ulnar side of the forearm _ arrives between the two tendons of the internal part of the elbow _ traverses the point Xiaohai (SI 8) _ passes the internal part of the arm outside Hand Yangming (LI) and Hand Shaoyang (SJ) _ arrives at the points Jianzhen (SI 9), Naoshu (SI 10), Tianzong (SI 11), Bingfeng (SI 12), Quyan (SI 13), Jianwaishu (SI 14) and Jianzhongshu (SI 15) _ inserts into the Dumai (GV) at the point Dazhui (GV 14) to unite with the opposite vessel _ from this point, it descends to the supraclavicular fossa _ reaches the axilla _ reaches Tanzhong (CV 17), where it branches _ goes back up to the pharynx _ redescends to the diaphragm _ crosses the point Shangwan (CV 12) _ arrives at the stomach _ passes to the side of the renmai (CV), approximately 2 cun above the umbilicus _ and penetrates into the small intestine. A branch leaves from the supraclavicular region (Quepen St 12), _ reaches the neck

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_ passes to the points Tianchuang (SI 16) and Tianrong (SI 17) _ goes back up to the cheekbone to the point Quanliao (SI 18) _ arrives at the external canthus of the eye at the point Tonqziliao (GB 1) _ and ends at the point Tinggong (SI 19), where it penetrates deeply into the ear. Another branch leaves from the zygomatic region from Quanliao (SI 18) _ crosses the malar bone _ arrives at the internal canthus of the eye _ and unites with the Foot Taiyang (Bl). 2 - The search for energetic points to determine the illnesses caused by the perverse energy permits discovery of the following clinical manifestations: _ pharyngitis _ submental inflammation with radiation to the neck _ scapulalgia with the feeling of fracture _ brachialgia with the sensation of a break. 309. These ailments originate from the insufficiency of organic liquid (12). Other illnesses of the Hand Taiyang (SI) can be caused either by an internal perturbation of the channel concerned or by that of an association of several channels. The clinical signs are: _ temporary deafness _ yellow sclera _ swelling of the cheek _ pain of the chin _ cervico-brachialgia _ pain in the neck and forearm. 12. The taiyang is a channel which carries/conducts the water of the organism.

3 - The treatment consists of: _ dispersing in case of fullness of perverse energy and tonifying in case of emptiness of the essential energy _ rapid needling in case of heat and leaving the needle in place in case of cold _ applying moxabustion in case of blockage and weakening of the concerned channel _ and treating only the channel affected without recourse to the Hand Shaoyin (He) in case of absence of emptiness and fullness.”

II - N.V.N.: Documentation on the small intestine and its energetic vessel, the Hand Taiyang: 1 - After Chapter 32 (“Normal Man Faced With a Shortage of Cereals”) of this classic: “The small intestine is 2 1/2 cun wide. Its diameter is 8 1/2 fen. Its length is 2 chang 2 Chinese meters. It can hold 2 dou 4 sheng of food and 6 sheng 3.5 he of liquid.” 2 - According to Chapter 31(“Intestines and stomach”) of this same classic: “In back, the small intestine adheres to the left side of the spine in multiple loops. It holds the alimentary products lending to evacuation by the large intestine. “In front, it adheres to the umbilical region in 16 sections. It is 2 1/2 cun large wide; its diameter is 8 1/2 fen and its length is 3 chang 3 Chinese meters”. 3 - The Dacheng states: “The small intestine is the receiving organ. It also has an important role in digestion and transformation of nutritive substances. The activity of the small intestine is confined to the “red sphere” (sphere of action of the heart which corresponds to the color red).

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The work of dividing up and reducing of food, which is already realized in the stomach, continues in the small intestine. The small intestine channel has more blood than energy. At the wei hour (13h-15h), the energetic-blood flow reaches its maximum level.” (Figure 32)

310.

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Figure 32 Hand Taiyang (SI). From 1 to 20: energetic direction of circulation.

PARAGRAPH 8

1 - The Foot Taiyang-Bladder vessel starts at the internal canthus of the eye, ascends to the forehead and arrives at the top of the cranium. A branch leaves from the top of the cranium and is directed towards the vestibulo-cochlear region. Another branch also leaves from the cranium, enters the brain, emerges at the nucha, goes around the supero-internal part of the shoulder, follows the spine in parallel to the lumbar region, penetrates into the pelvis, links up with the kidney and passes to the bladder. A branch leaves from the lumbar region, follows the spine, crosses the gluteal region and descends to the popliteal crease. 311. Another branch also leaves from the neck, also traverses the supero-internal part of the shoulder (but to the exterior of the previous one), descends the length of the vertebral column, traverses the external side of the buttock, arrives at the thigh, crosses the previous b r a n c h and is directed towards the center of the popliteal crease where it unites with the previous branch. Then, together, they descend toward the calf, reach behind the external malleolus, arrive at jinggu (great bone) at the external side of the foot and terminate at the external side of the little toe. 2 - Attack of this vessel by perverse energy is indicated by the following signs: _ headache _ sensation of bulging eyes

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_ neck pain of the torsion type _ pain in the spine _ back pain of the “broken” type _ difficulty rising up of the “compression” type _ calf pain of the “torn” type These signs constitute the syndrome Gua Jue (afflux of the malleolus). The illnesses of the bladder are: _ hemorrhoids _ fever and sensitivity to cold _ madness (demented state) _ frontal headache _ neck pain _ “yellow” tearing _ epistaxis _ nuchalgia _ dorsalgia _ lumbalgia _ pain in the coccyx _ pain of the calf and foot _ immobility of the little toe. 3 - In the illnesses cited above, one must _ disperse in case of fullness and tonify in _ remove the needle rapidly in case of heat remain in permanently in case of blockage and _ needle the concerned channel in case of and fullness

case of emptiness and allow the needle to weakening absence of emptiness

4 - When one says f u l l n e s s , it designates renying 2 times larger than that of Cun Kou, and when one says e m p t i n e s s , it designates renying 2 times smaller than that of Cun Kou. EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph describes the energetic vessel of the Foot Taiyang (Bl), the seventh channel of the system of the 12 jingmai. 312. 1 - The Foot Taiyang-Bladder begins at the point jingming (Bl 1) at the internal canthus of the eye, following after the Hand Taiyang (SI), _ ascends to the forehead _ successively passes to the points Zanshu (Bl 2) and shenting (GV 24) _ reaches the points Maichong (Bl 3), Quchai (BL 4), Wuchu (Bl 5), Chengguang (Bl 6) and Tongtian (Bl 7). From Tongtian (Bl 7), it bears off to the left and right and unites with Baihui (GV 20) at the top of the cranium. * A branch leaves from Baihui (GV 20), arrives at the region above the ear, crosses the points shuaigu (GB 8), Fubai (GB 10) and qiaoyin (GB 11) to spread and moisten the muscular fibers (Gan Mai). * Vertical branches penetrate into the brain from the points Tongtian (Bl 7), luoque (Bl 8) and Yuzhen (Bl 9) and come back out at the nucha and arrive at the point Tianzhu (Bl 10). * From Tianzhu (BL 10), a vessel descends to Taodao (GV 13),

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_ is directed towards the region located between the internal border of the scapula and the vertebral column, 1 1/2 cun from the latter, _ reaches the points Dazhu (Bl 11), Fengmen (Bl 12), Feishu (Bl 13), jueyinshu (Bl 14), Xinshu (Bl 15), Geshu (Bl 17), Ganshu (Bl 18), Danshu (Bl 19), Pishu (Bl 20), weishu (Bl 21), sanjiaoshu (Bl 22), shenshu (Bl 23), Dachangshu (Bl 27), Pangguanshu (Bl 28), Zhonglushu (Bl 29) and Baihuanshu (Bl 30), _ goes back up to the superior region of the sacral bone in passing the points Shangliao (Bl 31), Ciliao (Bl 32), Zhongliao (Bl 33), Xialiao (Bl 34) and Huiyang (Bl 35), _ redescends to the gluteal region and arrives at the points Chengfu (Bl 36), Fuxi (Bl 38) and weiyang (Bl 39), _ then it penetrates into the point weizhong (Bl 40) at the popliteal crease. * Another branch also leaves from Tianzhu (Bl 10), _ descends towards the internal border of the scapula _ runs along the spine from which it is separated by 3 cun _ passes the points Fufen (Bl 41), Phu (Bl 42), Gaohuang (Bl 43), shentang (Bl 44), yixi (Bl 45), Gueguan (Bl 46), hunmen (Bl 47), yanggang (Bl 48), yishe (Bl 49), weicang (Bl 50), Huangmen (Bl 51), zhishi (Bl 52), Baohuang (Bl 53) and zhibian (Bl 54) _ arrives at the ischium, 1 1/2 cun from the point Chengfu (Bl 36) _ descends towards the popliteal crease to unite with the previous branch _ arrives at the point heyang (Bl 55) _ traverses the calf _ passes the points Chengjin (Bl 56), Chengshan (Bl 57), Feiyang (Bl 58), Fuyang (Bl 59) _ reaches the postero-external area of the external malleolus at the point Kunlun (Bl 60) _ is directed towards the points Pushen (Bl 61), shenmai (Bl 62), jinmen (Bl 63), jinggu (Bl 64), shugu (Bl 65) and Tonggu (Bl 66) _ and arrives at the point zhiyin (Bl 67), located at the external side of the tip of the little toe, to unite with the Foot Shaoyin (Ki). 2 - The search for energetic points disturbed by perverse energy in the determination of the illness permits discovery of the following ailments: _ headache due to an ascension of perverse energy 313. _ sensation of bulging eyes _ neck pain of a “disarrayed” type _ spinal pain of a broken type _ inability to lift the thigh _ the feeling of the popliteal crease being “knotted” _ sensation of a torn calf. All these signs manifest the length of the vessel and are caused by jue ni (afflux: flow in the wrong direction). Other illnesses can arise from either a perturbation of the channel of origin or from that of an association of several channels. The clinical manifestations are: _ hemorrhoids _ fever and cold sensitivity _ yin Madnesses and yang Madnesses _ frontal or occipital headache _ yellow sclera _ epistaxis _ dorsal back pain _ lumbar back pain _ pain in the coccyx _ knee pain _ calf pain, etc... .

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3 - Treatment of these illnesses consists of: _ dispersing in case of fullness of perverse energy and tonifying in case of emptiness of the essential energy, _ making a rapid needling in case of heat and leaving the needle in place in case of cold, _ applying moxabustion in the case of blockage and weakening of the vessel _ and treating only the concerned channel without recourse to the Foot Shaoyin (Ki) in cases of absence of the signs of emptiness and fullness.”

II - Zhang Shi comments: “After the Shanghan lun (13), in disease of the taiyang, the pulse is superficial, the head and neck are stiff and painful, the individual is discontented... the headache of “taiyang” origin is cured at the end of the 7th day because the perverse energy ends its crossing of the channel. But, in diseases of the Shanghanlun (Evolutive diseases of Cold), the perverse energy also evolves according to the 6 channels (3 yin and 3 yang), then it returns to the taiyang. For this reason, these diseases are due only to an attack on the energy of the 3 yin and 3 yang without organic lesion. 314. The study of the signs of stiffness and pain of the head and neck show that the illness originates from the disorder of the channel. As a result, the perverse qi must always be eliminated from the xing (bodily form). Consequently, when the vital qi is affected, it always causes disease at the level of the xing.”

13. “Evolutive diseases of 3 yin and 3 yang” according to the Shanghan lun. NVN Edition.

III - N.V.N.: Documentation on the bladder and its energetic vessel, the Foot Taiyang: 1 - According to the Nanjing: The bladder weighs 9.2 liang; its length measures 9 cun. It is located below the kidneys and can hold 9 sheng 2 he of urine. Because of a very specific pathway, the inferior “mouth” of the small intestine is the “superior mouth” of the bladder, by which the liquid substance arrives. 315.

2 - According to the Dacheng: a - The bladder is like a “frontier post” where the organic liquid gathers. It is the last relay of energetic transformation. The activity of the bladder is limited to the “black sphere” (sphere of action of the kidney which corresponds to the color black). The bladder possesses 2 meatuses: the inferior, which excretes the urine, and the superior, which receives the components of organic water after purification at the level of the kidney and intestine. These meatuses are dependent on the essential energy. If this energy is in a hypotonic state, it provokes various disorders according to the section effected. At the level of the superior meatus, it causes an overflowing of organic liquid and its reflux into the large intestine, hence diarrhea. At the level of the inferior meatus, it provokes an accumulation of liquid in the bladder, hence urinary retention.” b - The bladder channel has more blood than energy. At the Chen hour (15h-17h), the energetic-blood flow reaches its maximum level.” (Figure 33)

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Figure 33 Foot Taiyang (Bl). From 1 to 21: energetic direction of energy.

PARAGRAPH 9 1 - The Foot Shaoyin-kidney vessel begins at the tip of the little toe, crosses the sole of the foot, arrives at the point Rangu (Ki 2), reaches behind the internal malleolus to the middle of the calcaneus to ascend to the calf, is directed towards the internal side of the popliteal crease, ascends to the postero-internal surface of the thigh, goes directly to the antero-internal surface of the vertebral column, penetrates into the kidney and links up to the bladder. A branch leaves the kidney, crosses the liver and diaphragm, penetrates into the lung, runs alongside the laryngo-pharyngeal apparatus and is directed towards the root of the tongue. Another branch leaves the lung, encircles the heart and inserts into the middle of the thorax. the

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2 - Attack of this vessel by perverse energy is characterized by following signs: _ sensation of hunger but refuses to eat _ dry face like dried wood _ blood-streaked expectoration _ dyspnea _ desire to stand up while in the seated position _ diminution of visual acuity _ upset stomach

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_ insufficient energy and fright (the subject has the feeling that one has confined him) _ cardiac palpitations. These signs constitute the syndrome Gu Jue (afflux of the energy of bone). Perturbation of internal origin of the kidney energy is characterized by the following clinical manifestations: _ sensation of heat in the mouth 316. _ dryness of the tongue _ inflammation of the throat _ sensation of energetic fullness _ dryness and pain of the throat _ anxiety _ heart pain _ icterus _ diarrhea _ spinal pain and pain of the inner thigh _ impotence and cold limbs _ clinomania ( 1 4 ) _ pain and sensation of heat in the soles of the feet. 3 - In the illnesses cited above, one must _ disperse in case of fullness and tonify in case of emptiness _ rapidly remove the needle in case of heat and leave the needle in permanently in case of cold 14. Excessive desire to stay in bed.

_ apply moxabustion in case of blockage and weakening _ needle only the concerned channel in case of absence of emptiness and fullness. After moxabustion, it is advised to consume raw meat, loosen the belt, undo the bun, lean on a cane, put one’s shoes on and walk a hundred footsteps. 4 - The word fullness designates the Cun Kou pulse 2 times larger than renying, and the word e m p t i n e s s , Cun Kou 2 times smaller than that of renying. EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph defines the energetic vessel of the Foot Shaoyin (Ki), the eighth channel of the system of 12 jingmai. 1 - The Foot Shaoyin-kidney starts under the little toe, _ is directed towards the sole of the foot to the point Yongquan (Ki 1) _ passes in front of the internal malleolus, under the scaphoid tuberosity, to Rangu (Ki 2) _ arrives behind the internal malleolus to the point Taixi (Ki 3) _ redescends below and behind the internal malleolus, in front of the Achilles tendon, to the points Dazhong (Ki 4), Shaohai (Ki 6) and shuiquan (Ki 5) (15) _ then from the external part of Dazhong (Ki 4), it reascends again to the internal malleolus _ passes behind the 2 vessels, taiyin (Sp) and jueyin (Li), and crosses the 2 points

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Fuliu (Ki 7) and Jiaoxin (Ki 8) _ reaches Sanyinjiao (Sp 6) belonging to the taiyin (Sp) vessel _ runs alongside the internal surface of the calf 317. _ crosses the point Zhubin (Ki 9) _ arrives at the internal side of the popliteal crease, to the point yingu (Ki 10) _ runs alongside the postero-internal surface of the thigh _ reaches the spine and unites with Changqiang (GV 1) _ is directed to the front, to the pubis, and crosses the points henggu (Ki 11), qixue (Ki 13), Dahe (Ki 12) (16), simen (Ki 14), Zhongzhui (Ki 15) and Huangshu (Ki 16) _ from Huangshu (Ki 16), that is to say, on both sides of the umbilicus belonging to the kidney, it passes to the umbilicus _ and is directed toward the points guanyuan (CV 4) and Zhongli (CV 3) of the renmai (CV) in order to reach the bladder where it terminates (17). A vessels leaves from Huangshu (Ki 16), _ penetrates into the kidney _ ascends directly to Shanggu (Ki 17), Shiquan (Ki 18), yindu (Ki 19), Tonggu (Ki 20), _ crosses the liver _ passes to the point Youman (Ki 21) _ crosses the diaphragm _ reaches the point Bulang (Ki 22) in order to penetrate into the lung _ comes back out at the points shenfeng (Ki 23), Lingxu (Ki 24), shentang (Ki 25), Yuzhong (Ki 26) and shufu (Ki 27) 15. According to Ma Shi, Shaohai (Ki 6) must be in front of shuiquan (Ki 5). 16. Ma Shi had placed Dahe (Ki 12) after qixie (Ki 13). Certainly, it is a matter of an error during printing. 17. This important study permits better understanding of the true energetic trajectories of the kidney at the level of the Dan Dian (sub-umbilical region).

_ reaches the laryngo-pharyngeal apparatus _ inserts into the point renying (St 9) _ and terminates at the base of the tongue. Another branch leaves from shengtang (Ki 25) _ encircles the heart _ inserts into the point Tanzhong (CV 17), at the interior of the thorax, to unite with the Hand Jueyin (XB) vessel. 2 - The search for energetic points in determination of the attack of this vessel by perverse energy permits discovery of the following clinical signs: _ hunger sensation but refuses to eat (18) _ weight loss and “dryness” of the body (19) _ blood-tinged expectoration _ shortness of breath (sterterous respiration) _ desire to get up while in the seated position _ visual trouble _ restlessness and fright (from insufficiency of energy) _ fear and anxiety (as if one wanted to confine him). `All these signs come from disorders of the energy of the kidney which commands the bones. This is why they constitute the syndrome Ge Jue (afflux of the energy of bone). Other complications have, for the most part, the same origin. 318.

3 - Treatment of these ailments consists of: _ dispersing in case of fullness of perverse energy and tonifying in case of emptiness of the essential energy _ practicing rapid needling to disperse heat and leaving the needle in permanently to

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tonify in case of cold _ applying moxabustion in case of obstruction/compression of the energy of the channel _ treating only the concerned channel without recourse to the Foot Taiyang (Bl) in case of the absence of signs of emptiness and fullness. After the moxabustion, it is wise for the patient to consume much raw meat, relax his belt, undo his hair, grasp a cane and put one’s shoes on in order to make a hundred steps and, above all, avoid fatigue to not aggravate the illness because the kidney energy is already in a state of insufficiency.” II - N.V.N.: a) Diet and advice to engage in walking after moxabustion are no longer mentioned in relation to this vessel to the exclusion of others because the kidney, governing water, is the “root” of the human body. The text has emphasized this point because the patient often neglects these precautions. b) Documentation on the kidney and its energy, the Foot Shaoyin: According to the Nanjing: “The kidneys are two in number and each weigh 1 jin 2 liang. They have an ovoid shape and attach to the 14th (2nd lumbar) vertebrae, from which they are separated by 1 1/2 cun.” According to the Dacheng: “The kidney is the generator (source) organ of the total potential energy of the organism. It confers power to the body and sharpness to the mind.

18. This is due to the fullness of “Emptiness-fire”. 19. Because the kidney governs the bones.

The kidney also collects and stores the surplus jing (essence) of all 5 organs. It is therefore the site of concentration of all jing of the organism: anatomic jing, sexual jing, sensorial jing and mentational (psychological) jing. It gives vitality to the hair and insures maintenance of the bones. It represents taiyin in yin and communicates with the energy of winter. It is in relationship with the North and the color black. It corresponds to: _ salty in the gamut of sapors _ water in the cycle of the 5 movements _ the sow in the animal kingdom _ the bean in the vegetable kingdom _ winter in the seasonal cycle _ the planet “sheng” (Mercury) in the star constellations _ the note “Yu” in music _ the number 6 in the numeric system _ stench in the gamut of odors _ urine in the area of secretions. The kidney channel contains more energy than blood. At the “You” hour (17h-19h), the energetic and blood flow reaches its maximum level.” (Figure 34)

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319.

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Figure 34 Foot Shaoyin (Ki). From 1 to 15: circulatory direction of the energy.

PARAGRAPH 10 1 - The Hand Jueyin-xin bao luo (XB) vessel starts in the middle of the thorax, links up with the xinbao (XB), descends to the diaphragm and branches to the sanjiao (SJ). A branch leaves from the middle of the thorax, comes back out by the ribs, descends 3 cun from the axillary fold, ascends to the axilla, goes around the arm between the 2 tendons, reaches the palm of the hand and arrives at the tip of the middle finger. Another branch leaves from the palm of the hand and reaches the tip of the ring finger. the

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2 - Disorders of this vessel caused by perverse energy manifest by following signs: _ sensation of heat in the palm of the hand _ brachialgia _ elbow pain _ axillary inflammation. 320. In serious cases: _ thoracic fullness and oppression _ anxiety _ cardiac palpitations _ red facies _ yellow sclera _ groundless, incessant laughter. Disorders of this vessel caused by an internal perturbation is

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indicated by the following clinical signs: _ anxiety _ heart pain _ sensation of heat in the palm of the hand. 3 - In the illnesses cited above, one must: _ disperse in case of fullness and tonify in case of emptiness _ rapidly remove the needle in case of heat and leave the needle in permanently in case of cold _ apply moxabustion in case of blockage/accumulation _ needle only the affected channel in case of absence of emptiness and fullness. 4 - The word fullness designates the Cun Kou pulse larger than the renying, and the word emptiness , the Cun Kou smaller than the renying. EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph describes the energetic vessel of the xin bao luo (XB), the ninth channel of the system of the 12 jingmai. 1 - The Hand Jueyin-xin bao luo (XB) arises in the middle of the thorax, _ passes to the xinbao below the heart to go in relationship with the Foot Shaoyin (Ki) _ arrives at Tanzhong (CV 17) _ descends to the diaphragm _ reaches the points Zhongwan (CV 12) and yinjiao (CV 7), responding to the sanjiao (SJ). • A branch leaves from the xin bao luo, _ follows the inner thoracic wall _ comes back out at the ribs _ arrives at the point Tianchi (XB 1), 3 cun below the axilla _ goes back up towards the axilla and goes around the shoulder _ arrives at the point Tianquan (XB 2) of the arm _ circulates between the 2 vessels, Hand Taiyin (Lu) and Hand Shaoyin (He) _ and penetrates into the elbow at the point Quze (XB 3). From the elbow, it descends toward the forearm, _ circulates between the two tendon and crosses the points Ximen (XB 4), Jianchi (XB 5), Neiguan (XB 6) and Daling (XB 7) _ arrives at the point Laogong (XB 8) of the palm of the hand 321. _ and directly rejoins the tip of the middle finger at the point Zhongchong (XB 9). • A branch leaves from the palm of the hand and arrives at the tip of the ring finger to connect with the Hand Shaoyang (SJ) vessel.

2 - The search for energetic points affected by perverse energy in determination of the illness permits discovery of the following clinical manifestations: _ sensation of heat in the palm of the hand _ thoracic and costal fullness and oppression _ anxiety. These signs belong to the energetic vessel of the xin bao luo (XB). 3 - Treatment consists of: _ dispersion in case of fullness of perverse energy and tonification in case of emptiness of

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essential energy _ practicing rapid needling to disperse in case of heat and leaving the needle in permanently to tonify in case of cold _ applying moxabustion to dissolve accumulation and activate the circulation of energy _ treating only the channel concerned without recourse to the Hand Shaoyang (SJ) in case of the absence of signs of emptiness and fullness. 4 - How do you recognize the fullness? When Cun Kou is larger and more agitated than renying. In this case, the xin bao luo is in fullness and one must disperse the Hand Jueyin (XB) on the one hand, and, on the other hand, tonify the Hand Shaoyang (SJ). How do you recognize the emptiness? When Cun Kou is smaller than renying, without agitation. In this case, the xin bao luo is in emptiness; one must tonify the Hand Jueyin (XB) on the one hand, and, on the other hand, disperse the Hand Shaoyang (SJ).”

II - N.V.N.: Documentation on the xin bao luo and its energetic vessel, the Hand Jueyin (XB): 1 - According to the Nanjing: “This vessel has name and form. Its external trajectory begins at the point Tianchi (XB 1) below the axilla and ends at the point Zhongchong (XB 9) at the tip of the middle finger. Its organ is located below the heart in the form of an yellow fatty mass which envelopes the heart. Its pulse waves are found at the “foot” pulse (Chi) of the right radial groove.” 2 - According to the Dacheng: “The jueyin of the hand substitutes for Ministerial fire in order to carry out the orderly movements of Imperial fire (heart). It therefore bears the name “Master of heart” (Xin Zu). But envisioned as a circuit or energetic pathway, it bears the name xin bao luo (vessel-envelope of the heart). 322. In summary, jueyin of the hand has two names: but in reality, there is only one energy, Ministerial fire, which circulates there. The Hand Jueyin (XB) contains more blood than energy. At the “Xu” hour (19h-21h), the energetic and blood flow attains it maximum level. It constitutes the site of conservation of Ministerial fire (organic heat). It forms a very dense energetic layer enveloping the heart whose purpose is to establish a system of efficient defense around the heart organ, considered to be the center of life.” 3 - Ma Shi concludes: “The xin bao luo is found underneath the heart, between the diaphragm and pleura. It adheres to the diaphragm by a substance resembling a mass of yellow fat which envelops the heart. This substance has a number of very fine ramifications which attach to the lung and heart. Lack of knowledge of this vessel by future generations will be harmful and truly reprehensible.” (Figure 35)

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Figure 35 Hand Jueyin (xinbao: XB). From 1 to 12: energetic direction of energy.

PARAGRAPH 11

323.

1 - The Hand Shaoyang-sanjiao (SJ) vessel starts at the tip of the ring finger, is directed towards the interdigital space, arrives at the wrist, reaches the interosseous space of the forearm, passes to the elbow, ascends to the arm and shoulder, passes behind the Foot Shaoyang (GB) vessel, enters into Quepen (supraclavicular region), spreads to the point Tanzhong (CV 17), connects to the xin bao luo (XB), descends to the diaphragm and penetrates into the sanjiao (SJ). A branch leaves from Tanzhong (CV 17), ascends to Quepen, reaches the neck, arrives behind the ear, ascends again to the region above the ear, descends and goes around the maxillary angle and comes back out at the cheekbone (in front of the ear). Another branch leaves from behind the ear, penetrates into the ear, comes back out in front of the ear, passes Kezhuren (GB 3), descends and crosses the previous branch at the level of the maxillary angle and terminates at the external canthus of the eye. 2 - Attack of this vessel by perverse energy results in the following signs: _ hypoacusia and tinnitus _ pharyngitis _ throat pain. Perturbation of the energy of the sanjiao is manifest by such signs as: _ excessive sweating

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_ pain of the external canthus of the eye _ maxillary inflammation _ pain in front of the ear and of the arm, elbow and forearm _ inability to move the ring or little fingers. 3 - In the illnesses cited above, one must: _ disperse in case of fullness and tonify in case of emptiness _ rapidly remove the needle in case of heat and leave the needle in permanently in case of cold _ apply moxabustion in case of blockage and weakening _ only needle the concerned channel in case of absence of emptiness and fullness. 4 - The word fullness designates renying 2 times larger than Cun Kou, and the word e m p t i n e s s , renying 2 times smaller than that of Cun Kou. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: 324. “This paragraph describes the energetic vessel of the sanjiao (SJ), the tenth channel of the system of 12 jingmai. 1 - Hand Shaoyang-sanjiao (SJ) starts at the point guanchong (SJ 1) at the tip of the ring finger, _ reaches the points Yemen (SJ 2) and Zhongzhu (SJ 3) _ arrives at yangchi (SJ 4), located at the wrist between the 2 bones of the forearm _ passes to the point Tianjing (SJ 10) _ goes up again to the posterior part of the arm _ arrives at the 2 points qinglengyuan (SJ 11) and Xiaolu (SJ 12) _ passes between the Hand Taiyang (SI) and Hand Yangming (LI) _ goes up to the shoulder _ arrives at the points Naohui (SJ 13), Jianliao (SJ 14) and Tianjiao (SJ 15) _ passes behind the Foot Shaoyang (GB) _ crosses the points Bingfeng (SI 12) and Jianjing (GB 21) _ goes down to Quepen and arrives outside the Foot Yangming (St) _ unites with the shangjiao (Upper Jiao) at the point Tanzhong (CV 17) _ then spreads around the xin bao luo (XB) _ redescends to the diaphragm _ branches to the bladder _ tightly grabs the xiajiao (Lower Jiao) _ and gathers at the upper part of the kidney. • A branch leaves from Tanzhong (CV 17), _ ascends towards the external side of Quepen (supraclavicular region) _ arrives at the nucha _ passes to the point Dazhui (GV 14) _ reaches the point Tianyou (SJ 16) _ is directed behind the ear _ crosses the points yifeng (SJ 17), qimai (SJ 18) and Jiaosun (SJ 20) _ directly rejoins the points Xuanli (GB 6) and Linqi (GB 15) _ arrives at the points yangbai (GB 14) and jingming (Bl 1) _ goes back down to the maxillary bone

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_ • _ _ _

then reascends to the zygomatic bone, to unite with the point Quanliao (SI 18). Another branch leaves from the point yifeng (SJ 17) penetrates into the ear comes back out at the point Tinggong (SI 19) arrives at Erman (SJ 21) and Erheliao (SJ 22) to be directed to the external canthus of

the eye _ unites with the point Tongziliao (GB 1) _ then goes back up to the point sizhukong (SJ 23). 2 - The search for energetic points disturbed by perverse energy in determination of the illness is indicated by the following clinical manifestations: _ temporary deafness _ tinnitus, etc... which are due to the attack of the energetic part of the sanjiao (SJ). Other ailments can be caused either by a perturbation (endogenous origin) of the channel concerned or by that of an association of several channels. The clinical signs are: _ sweating 325. _ pain of the external canthus of the eye _ pain of the ring finger _ inability to move the little finger. 3 - To treat the illnesses cited above, it is advised to: _ disperse in case of fullness of perverse energy and tonify in case of emptiness of the essential energy _ practice rapid needling to disperse in case of heat and allow the needle to remain in permanently to tonify in case of cold _ apply moxabustion in case of blockage and weakening of the energy _ and only needle the points of the channel concerned without resorting to the Hand Jueyin (XB) in case of the absence of signs of emptiness and fullness.”

II - N.V.N.: Documentation on the sanjiao (SJ) and its energetic vessel, the Hand Shaoyang (SJ): According to the Dacheng: The Hand Shaoyang (SJ) has not only name, but also form. It starts at the point guanchong (SJ 1), located at the tip of the 4th finger, and ends at the point sizhukong (SJ 23). Its bowel joins the right kidney. Some authors think that this vessel has only name without anatomic form. This error has as as its origin qiu Yue ren (alias Bian Que, 500 B.C.) and has been perpetuated by Wang shu he (210-285 A.D.) up to our times. Its pulse manifests at the “Foot” pulse of the right wrist, like that of the xin bao luo (XB). With the xin bao luo (XB), it constitutes the “yin-yang, interior-exterior” system. sanjiao (SJ) is responsible for the energetic metabolism of the entire organism. In other words, organic activities, such as the distribution of energy, blood and organic liquid, depend on the energetic effects of the sanjiao (SJ). In this manner, the functions of the sanjiao (SJ) tend to become generalized to include, therefore, the totality of the energetic systems of the body divided into 3 distinct parts: shangjiao (Upper Jiao: cardia), zhongjiao (middle jiao: fundus) and Xiaojiao (Lower Jiao: pylorus). The Hand Shaoyang (SJ) has more energy than blood. At the Hai hour (21h-23h), the energetic and blood flow reach its maximal level. The vessel of the sanjiao (SJ) receives the Hand Jueyin (XB) vessel. It is a “loyal bowel” that coordinates yin and yang and unblocks congestions.” (Figure 36)

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326.

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Figure 36 Foot Shaoyang (sanjiao: SJ). From 1 to 19: circulatory direction of energy.

PARAGRAPH 12 1- The Foot Shaoyang-Gallbladder vessel begins at the external canthus of the eye, reaches the temporal region, descends behind the ear, arrives at the neck, passes in front of the Hand Shaoyang (SJ), arrives at the shoulder, is directed behind the Hand Shaoyang (SJ) and penetrates into Quepen (supraclavicular region). A branch leaves from behind the ear, penetrates into the ear, comes back out in front of the ear and arrives at the external canthus of the eye. A branch leaves from the external canthus of the eye, descends to the point Daying (St 5), unites with the Hand Shaoyang (SJ) vessel, 327. arrives under the malar bone, above the point Jiache (St 6), descends to the neck, unites with the previous branch at Quepen to penetrate into the thorax, crosses the diaphragm, penetrates into the liver, links up with the gallbladder, descends again to the hypochondria, comes back out at the point qixie (qichong- St 30), encircles the pubis and penetrates into the coxo-femoral (hip) joint. A vertical branch also leaves from Quepen, descends to the front of the axilla, runs alongside the thorax, is directed towards the internal surface of the buttock, unites with the previous branch at the level of the coxo-femoral joint and descends the length of the external surface of the thigh, arrives at the external surface of the knee joint, descends towards the front of the fibula, runs alongside the external surface of the leg, to the point Juegu (Xuanzhong- GB 39), arrives in front of the external malleolus, crosses the top of the foot and ends at the tip of the

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4th toe. A branch leaves from the top of the foot, is directed towards the 1st intermetatarsal space and returns by the nail in crossing it to unite at the site called “three hairs”, located in front of the metatarsophalangeal joint. the

2 - Attack of this vessel by perverse energy is characterized by following signs: _ bitter mouth _ frequent sighing _ intercostal pains _ difficulty turning over. In serious cases, _ dusty complexion _ dryness of the skin _ sensation of heat at the external part of the foot. These signs constitute the syndrome yang Jue (afflux of yang). Internal disorder of the gallbladder manifests by such signs as: _ headache _ submaxillary pain _ pain at the external canthus of the eye _ painful inflammation of the supraclavicular fossa (Quepen) _ hypochondralgia _ anthrax, lymphadenitis _ sweating _ “Nue” illness (fever and cold sensitivity) _ thoraco-abdominal and coxo-femoral pain _ thigh pain and knee pain to Juegu (GB 39- Xuanzhong) _ pain in front of the external malleolus _ and inability to move the 4th and 5th toes.

3 - In the ailments cited above, one must: _ disperse in case of fullness and tonify in case of emptiness _ rapidly remove the needle in case of heat and leave the needle in permanently in case of cold _ apply moxabustion in case of blockage and weakening 328. _ only needle the concerned channel in case of the absence of emptiness and fullness. 4 - The word fullness designates the renying pulse 2 times larger than Cun Kou, and the word e m p t i n e s s , the renying pulse 2 times smaller than Cun Kou. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph concerns the energetic vessel of the gallbladder, the eleventh channel of the system of 12 jingmai. 1 - The Foot Shaoyang (GB) begins at the point Tongziliao (GB 1), located at the external canthus of the eye,

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_ passes to the points Tinghui (GB 2) and Kezhuren (Shangguan- GB 3) _ goes up to the angle of the forehead and reaches the point hanyan (GB 4) _ descends to the points Xuanlu (GB 5) and Xuanli (GB 6) _ reascends above the ear at the level of the scalp line and arrives at the points Qubin (GB 7) and shuaigu (GB 8). From shuaigu (GB 8), it goes back down, encircling the ear, _ crosses the points Tianchong (GB 9), Fubai (GB 10), qiaoyin (GB 11) and Wangu (GB 12). From Wangu (GB 12), it goes back over the front of the cranium, to the point yangbai (GB 14) to link up to the point jingming (Bl 1). From jingming (Bl 1), it goes up again to the cranium, _ passes Lingqi (GB 15), Muchuang (GB 16), Zhenying (GB 17), Chengling (GB 18), Nao Kong (GB 19) and Fengchi (GB 20), _ descends to the neck and crosses the point Tianyou (SJ 16) _ is directed toward the front of the Hand Shaoyang (SJ) and arrives at the shoulder _ passes to the point Jiangjing (GB 21) _ radiates to the left and right behind the Hand Shaoyang (SJ) vessel _ is directed towards the points Dazhui (GV 14), Dazhu (Bl 11) and Bingfeng (SI 12) _ and arrives at the external side of Quepen (supraclavicular fossa). • A branch leaving from the point Neiru (Nao Kong-GB 19), located behind the ear, _ passes to the point yifeng (SJ 17) and penetrates into the ear _ comes back out at the point Tinggong (SI 19) and goes back up towards the external canthus of the eye, to the point Tongziliao (GB 1). • A branch leaves from Tongziliao (GB 1), _ descends to the point Daying (St 5) _ unites with the Hand Shaoyang (SJ) vessel in the space where Quanliao (SI 18) is found _ passes to the point Jianche (St 6) and redescends to Quepen uniting with the previous branch, _ penetrates into the thorax 329. _ reaches the external side of the point Tianchi (Tianhui- XB 1), _ crosses the diaphragm and arrives at the point qimen (Li 14) and links up with the gallbladder _ passes to the point Riyue (GB 24) _ runs along the inner wall of the abdomen _ arrives at the points Zhangmen (Li 13) and qichong (St 30) _ goes around the pubis and is directed towards the coxo-femoral (hip) joint, where the point Huantiao (GB 30) occurs. • A vertical branch leaves from Quepen, _ descends towards the axilla _ runs alongside the thorax _ crosses the points Yuanye (Bl 22), Zheyin (GB 23), Riyue (GB 24), jingmen (GB 25), Daimai (GB 26), Wushu (GB 27), weidao (GB 28) and Juliao (GB 29) _ passes the sacral region and penetrates into Shangliao (Bl 31) and Zhongliao (Bl 32) to unite with the Foot Taiyang (Bl) _ reaches the points Zhongdu (GB 32) and yangguan (GB 33) _ arrives in front of and behind the head of the fibula, to Yanglingquan (GB 34) _ descends the length of the fibula _ passes to yangjiao (GB 35), guanming (GB 37) and Quegu (Xuanzhong- GB 39) _ arrives in front of the external malleolus _ reaches Linqi (GB 41) and Xiaxi (GB 43), located in the dorsal region of the foot _ and passes to the tip of the 4th toe, where the point qiaoyin (GB 44) is found. • A vessel arises from the point Linqi (GB 41), _ reaches the tip of the great toe

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_ and returns towards the toenail, crossing it, to end behind it at the reunion of the “three hairs”, to link up to the Foot Jueyin (Li). 2 - The search for energetic points perturbed by perverse energy in the determination of the illness permits demonstrating such clinical signs as bitter mouth, frequent sighing, etc... which are all due to the movements of reflux (contrary afflux) of the energy. Other ailments of the gallbladder can be caused either by an internal perturbation of the concerned channel or by that of an association of several channels whose clinical signs are generally headaches, submental pain, etc... . As for the syndrome called “intermittent fever and cold sensitivity”, the explanation is as follows: “shaoyang is the 1st yang. It occurs in the internal area (yin) of the external layer (yang) whose interior is the location of the 3 yin. Therefore, shaoyang is the mid-external (yang) channels and mid-internal (yin) channel. This is why attack of shaoyang manifests by intermittent signs of fever (yang) and chills (yin).” 330...

3 - Treatment of the illnesses of the Foot Shaoyang (GB) consist of: _dispersing in case of fullness of perverse energy and tonifying in case of emptiness of the essential energy _ performing rapid needling to disperse in case of heat and leaving the needle in permanently to tonify in case of cold _ apply moxabustion in case of blockage/weakening of the energy of the concerned channel _ and treating only the channel affected without recourse to the Foot Jueyin (Li) in case of the absence of signs of emptiness and fullness.”

II - N.V.N.: Documentation on the gallbladder and its energetic vessel, the Foot Shaoyang: 1 - According to the Nanjing: “The gallbladder weighs 3.3 liang. Its length is 3 cun. It is located in the interior of the “short” lobe of the liver and contains 3 he of liquid jing (bile). The gallbladder is a bowel devoted to the cause of equity and loyalty. It is that which has power over decisions. The gallbladder gives verdict on the energetic states of the 5 organs and 6 bowels.” 331.

2 - According to the Dacheng: • “The activity of the gallbladder is limited to the “green sphere” (sphere of action of the liver). It is a peaceful and silent bowel. • With the exception of the gallbadder. the other bowels allow passage of the impure elements in transit. This is why one gives it the name “pure and silent bowel”. • The Foot Shaoyang (GB) channel has more energy than blood. At the “Zi” hour (23h-1h), the energetic and blood flow reach its maximal volume. (Figure 37)

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330.

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Figure 37 Foot Shaoyang (GB). From 1 to 32: circulatory direction of the energy.

PARAGRAPH 13 1 - The Foot Jueyin-liver vessel begins at the place called “3 hairs” on top of the great toe, ascends to the top of the foot, arrives 1 cun in front of the internal malleolus and passes 8 cun above it, intersects the taiyin (Sp) vessel, reaches the internal part of the popliteal crease and inner thigh to penetrate into the pubic hair, encircles the genital organs (yin qi), ascends again to the lower abdomen, contacts the Foot Yangming (St), penetrates into the liver, branches to the gallbladder, crosses the diaphragm, distributes to the lateral side of the thorax, runs alongside the internal border of the laryngo-pharyngeal apparatus up to the nasopharynx, enters into liason with the ocular apparatus, reaches the forehead and meets the Dumai (GV) at the vertex. A branch leaves from the ocular apparatus, descends by the cheek and encircles the lips. A branch leaves the liver, crosses the diaphragm and inserts into the lung. the

2 - Attack of this vessel by perverse energy is characterized by following signs: _ lumbalgia with difficult flexion and extension _ in men: hernia _ in women: pelvic inflammation _ in serious cases: dryness of the throat and disturbed vision. Perturbation (endogenous) of the energy of the liver manifests by

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such signs as: _ thoracic oppression _ vomiting _ diarrhea _ orchitis _ dysuria _ cystitis.

332.

3 - In the diseases cited above, one must: _ disperse in case of fullness and tonify in case of emptiness _ remove the needle rapidly in case of heat and leave the needle in permanently in case of cold _ apply moxabustion in case of blockage and weakening _ needle only the concerned channel in case of the absence of emptiness and fullness. 4 - The word fullness designates Cun Kou larger than renying, and the word e m p t i n e s s , Cun Kou smaller than renying.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph concerns the energetic vessel of the liver (Foot Jueyin), the last (twelfth) channel of the system of the 12 jingmai. 1 - Foot Jueyin-liver begins at the point Dadun (Li 1), located at the tip of the great toe, _ reaches the top of the foot and arrives at the points Xingjian (Li 2) and Taichong (Li 3) _ passes to the point Zhongfeng (Li 4) 1 cun in front of the internal malleolus _ ascends to the point Sanyinjiao (Sp 6) _ traverses the points Ligou (Li 5) and Zhongdu (Li 6) _ 1 cun higher, it intersects the taiyin (Sp) vessel and reaches the internal side of the popliteal crease, passing the points Xiguan (Li 7) and Quguan (Li 8) _ reaches the points yinbao (Li 9), Wuli (Li 10) and yinlian (Li 11) on the inner surface of the thigh, inside the taiyin (Sp) vessel _ penetrates into the pubic pilosity _ encircles yinqi (external genital organs) _ arrives at the lower abdomen _ unites to the points Qugu (CV 2), Zhongji (CV 3) and guanyuan (CV 4) _ traverses the points Changmen (Li 13) and arrives at the point qimen (Li 14) _ enters into liason with the stomach _ penetrates into the liver _ passes to the point Riyue (GB 24) and branches to the gallbladder. • A vessel leaves from qimen (Li 14), _ crosses the diaphragm _ passes outside the point Shidou (Sp 17) and inside the point dabao (Sp21) and branches to Xieluo (ribcage) up to the place where the points Yunmen (Lu 2) and Yuanye (GB 22) occur _ reaches the outside of the point renying (St 9) and arrives at the posterior border of the laryngo-pharyngeal apparatus _ penetrates into the nasopharynx _ passes to the outside of the points Daying (St 5), Dicang (St 4) and sibai (St 2) to link up with the ocular system _ goes up to the forehead and reaches the point yangbai (GB 14) 333.

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_ arrives at the cranium and passes inside the point Linqi (GB 15), to unite with the Dumai (GV) at the point Baihui (GV 20), located at the vertex. • Another vessel leaves from the ocular organ, _ goes back down outside the renmai (CV) _ arrives to the inside the concerned channel _ reaches the maxilla _ and goes around the interior of the lips. • Another vessel also leaves from qimen (Li 14), _ penetrates into the liver _ goes back up, crossing the diaphragm _ passes outside the point Shidou (Sp 17)and inside the channel of origin _ inserts into the lung _ arrives at zhongjiao (middle jiao) _ redescends toward the point Zhongwan (CV 12) to go into liason with Hand Taiyin (Lu). 2 - The search for energetic points disturbed by perverse energy in the determination of the illness permits showing such signs as: _ back pain with inability fo flex the body and get up _ hernia in men _ pelvic inflammation in women. These signs all result from an attack of the concerned channel. Other pathological manifestations such as vomiting, diarrhea, etc... are due either to an internal perturbation of the channel of origin or to that of an association of several channels.

3 - Treatment consists of: _ dispersing fullness of perverse energy and tonifying emptiness of the essential energy _ performing the method of rapid removal of the needle to disperse in case of heat and the method of leaving the needle in permanently to tonify in case of cold _ applying moxabustion in case of blockage and weakening of the energy _ and treating only the channel concerned without resorting to the Foot Shaoyang (GB) in case of the absence of signs of emptiness and fullness.”

II - N.V.N.: Study documenting the liver organ and its energetic vessel, the Foot Jueyin (Li): 1 - According to the Nanjing: “The liver weighs 4 jin 3 liang. This organ possesses “3 leaflets” on the left and “4 leaflets” on the right, for a total of “7 leaflets” which are attached to the 9th dorsal vertebra. Chapter 52 (“Discourse on the Contraindications of Acupuncture“) of the Suwen reveals “The energetic liver is located below and to the left (of the diaphragm)” and physicians of the era added that the anatomic organ is found to the right. This preciseness is indeed accurate.” 334...

2 - According to the Dacheng: “The liver is the “palace organ of wind-wood”. It is the site of Ministerial fire. It likes moderation and relaxation; its role is to conserve blood. The liver fills the function of “general”. This is the strategy of the organism. It plays a prime role in the battle against fatigue. It gives vitality to the nails and firmness to the muscles. It is also the producer organ of blood and energy.” The Foot Jueyin (Li) vessel has more blood than energy. At the “Chou” hour (1h-3h), the energetic and blood flow reaches its maximal. The energy of the liver answers to:

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_ sour in the gamut of sapors _ “wood” in the cycle of the 5 movements _ chicken in the animal kingdom _ millet in the vegetable kingdom _ Jupiter (Xue jing) in the star constellations 335... _ the note “Jiao” in music _ the number 8 in the numeric system _ to stench in the gamut of odors _ tears in the domain of secretions. The pathology of the liver is complex. One most often will find conformity to 4 problems: _ compression of the energy _ tension and fullness of the fire of the liver _ disturbances of liver yang _ agitation of internal wind (organic fire). Other than its essential roles in energetic metabolism, blood formation and excretory function, the liver also possesses 2 other important functions: _ transformation of nutritional energy into organic heat _ maintenance of mental equilibrium of the individual.” (Figure 38) 334.

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Figure 38 Foot Jueyin (Li). From 1 to 17: circulatory direction of the energy

PARAGRAPH 14

335.

Exhaustion of the energy of the Hand Taiyin (Lu) is characterized by dryness of the skin and dermoskeleton. taiyin is a conducting system of the energy toward the exterior that warms up the pilocutaneous system. This is why when the energy is in insufficiency, the skin and dermoskeleton become dry. Dryness of the skin and dermoskeleton denotes the absence of organic liquid in the cutaneous layer. This absence indicates dryness of the nails and falling out of the body hair. The falling out of body hair indicates that the death of the hair o c c u r r e d in the first place. The disease is made worse on the Bing day (3rd Celestial Trunk), and death follows on the Ding day (4th Celestial Trunk), following the destructive action of fire on metal.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The energies of yin and yang originate from the 5 movements of the organs/bowels. The “death” of the energy occurs, in the first place, at the exterior, then comes that of the organs and bowels in the interior. The energy of Hand Taiyin (Lu) governs the pilocutaneous system. This is why the 336. exhaustion of the taiyin energy is the cause of dryness of the skin and dermoskeleton.

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The organic liquid follows the sanjiao (SJ) and reaches the exterior in order to heat and render perfect the epidermo-dermal system and to make the articular system supple. For this reason, when the energy becomes exhausted, the liquid of the interior cannot reach the pilocutaneous system, hence dryness of nails and body hair. This falling out of the body hair indicates that the skin is “dead” in the first place. This means to say that the energy of Hand Taiyin (Lu) is exhausted in the first place at the exterior. On the “Bing” day (3rd Celestial Trunk) the disease worsens, and death occurs on the “Ding” day. This indicates that the energy of the lung organ “dies” in the interior.”

II - Ma Shi comments: “This paragraph describes the syndrome of exhaustion of the lung energy and its fatal prognosis. The energetic vessels of the lung unite with the pilocutaneous system, and lung organ, being “master of the energy”, has the function of making this energy circulate to heat up the skin and dermoskeleton. Dryness of the skin and dermoskeleton result, therefore, from the exhaustion of the energy and that of the nails and falling out of the body hair from the depletion of the liquid substance at the level of the epidermal system. When the disease is at the stage of body hair loss, that is to say at the period of “death” of the body hairs, death inevitably follows on the day when the “fire” movement destroys metal.”

PARAGRAPH 15 Exhaustion of the energy of Hand Shaoyin (He) expresses as an obstruction of the vessels causing a stoppage of blood circulation. When the blood does not circulate, the head hair loses its brilliance and the color of the face becomes black like lacquer and dry like a stick of wood. It is the “death” of blood which occurs first. The disease worsens on the ren day (9th Celestial trunk) and death occurs on the Gui day (10th Celestial Trunk), following the victorious action of water over fire. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The heart governs the blood. When the energy of the Hand Shaoyin (He) becomes exhausted, the vessels are blocked because it is the energy which directs the blood. The heart unites with the vessels and manifests by the complexion. The head hairs are created by blood and energy. When the blood does not circulate, the head hair and complexion lose their freshness and brilliance and the facies is black like lacquer and dry like a stick of wood. This originates from the exhaustion of the energy of the Hand Shaoyin (He), explaining the “death” of blood. The disease becomes aggravated on the ren day (9th Celestial Trunk), following the destruction of the “fire” energy of the heart organ by water.” II - Ma Shi comments: “This paragraph concerns the exhaustion syndrome of the heart energy and its fatal prognosis. The heart governs the vessels and produces the blood. When its energy becomes

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337.

exhausted, the blood “dries out” and the specific signs are cited in the text. since the blood is “dead” in the first place, the fatal day is inevitable on the day of destruction of fire by water.”

PARAGRAPH 16 E xhaustion of the energy of Foot Taiyin (Sp) causes undernourishing at the level of the “flesh” (dermal) system. The lips and tongue are sites called “root” of the flesh. This is why, when the Foot Taiyin (Sp) vessel no longer maintains the “flesh” system, it softens and becomes transformed into the illness Rou wei (atrophic impotence of the flesh) (19), renzhong (nasolabial groove, where the point of the same name occurs) thickens and the lips are everted. E v e r t e d lips indicate the flesh is “dead” in the first place. On the Jia day (1st Celestial trunk), the illness worsens, and death occurs on the yi day (2nd Celestial Trunk), that is to say, on the day when wood triumphs over earth. 20. See Chapter 44 (“Study on Atrophic Impotence”) of the Huangdi Neijing Suwen,,Vol. III, pg. 189, NVN Edition.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The energy of Foot Taiyin (Sp) is produced at the level of the spleen organ whose role is to conserve ying (nutritive energy) and maintain the dermal (flesh) system. When the energy of the spleen becomes exhausted, the vessel can no longer reach the flesh. The lips and tongue constitute the “root” of the “flesh” system. When the vessel no longer permeates the flesh, it transforms into Rou wei with everted lips, denoting the exhaustion of the energy of taiyin at the exterior level. 338. On the Jia day, the disease worsens, and death occurs on the yi day indicating the exhaustion of the energy of the spleen organ located in the interior.”

II - Ma Shi comments: “This paragraph explains the fatal prognosis of the syndrome of exhaustion of the spleen energy. In effect, the spleen controls the system of connective tissues (flesh-dermis) whose “root” occurs at the lips and tongue. When the spleen energy no longer humidifies the flesh, it loses its consistency and transforms into Rou wei; the lips are then everted and renzhong becomes thick. This is the sign of exhaustion of the flesh; on the day when wood suppresses earth, death is inevitable.”

PARAGRAPH 17 Exhaustion of the energy of Foot Shaoyin (Ki) causes drying of the bones. Foot Shaoyin (Ki) is a vessel responding to winter. It is concealed in the interior in order to permeate the osteomedullary system. When the

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bones and marrow are no longer humidified, the flesh is without adherence and softens, teeth decalcify and tartar, hair is no longer shiny. Loss of brilliance of the hair indicates the bones are “dead” in the first place. On the Wu day (5th Celestial Trunk), the disease worsens, and death occurs on the Ji day (6th Celestial Trunk), that is to say on the day earth triumphs over water.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The energy of Foot Shaoyin (Ki) controls the osseous system. This is why the exhaustion of kidney energy has as a corollary drying of the bones. “shaoyin is a vessel responding to winter”, implies that the energetic vessels of the 5 organs unite with the 4 seasons to permeate the skin and flesh, muscles and bones. When the bones are malnourished, the flesh no longer adheres to the bones. This loss of adherence of the flesh and bones indicates escape of the energy of the bones to the exterior, and the loss of brilliance of the hair explains the exhaustion of jing energy (essence) of the kidney organ. In other words, “death” of the bones occurs before that of the kidney organ located in the interior.” 339.

II - Ma Shi comments: “This paragraph concerns the fatal prognosis of the syndrome of exhaustion of the energy of Foot Shaoyin (Ki). The energy of the kidney governs the bones. Its vessel circulates according to the climatic movement of winter to moisten the bones and marrow. Exhaustion of the bones manifests by the syndrome described in the text. During this exhaustion, death is inevitable on the day when water is suppressed by earth.”

PARAGRAPH 18 Exhaustion of the energy of Foot Jueyin (Li) causes that of the muscles. jueyin is a vessel belonging to the liver whose energy unites with the muscles and gathers together at yin qi (external genitalia). Furthermore, this vessel is linked to the base of the tongue. This is why the deficiency of this vessel expresses as muscular spasm with pain radiating to the tongue and testicles, responsible for lip cyanosis (literally, blue lips), lingual retraction, etc... denoting the “death” of the muscles in the first place (before that of the kidney organ). On the Keng day (7th Celestial Trunk), the disease worsens and death occurs on the Xin day (8th Celestial Trunk), that is to say on the day when metal suppresses wood.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The energy of Foot Jueyin (Li) governs the muscles. This is why exhaustion of this energy causes that of the muscles with the signs of muscular spasm, protracted tongue, etc... .

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Deficiency of the energy of jueyin is, therefore, an essential factor which drives, in the first place, the muscles to “death”. On the Keng day, the disease worsens, and death occurs on the Xin day because the Xin day is the day when metal carries out its destructive action on wood, the day of total depletion of “wood” energy of the liver organ.”

II - Ma Shi comments: “This paragraph concerns the fatal prognosis of the syndrome of exhaustion of the energy of the liver. The liver energy unites with the muscles and the muscles gather down below at yin qi (external genitalia), and above, at the tongue. 340. In the depletion of the liver energy, the muscles become tense, the tongue and testicles retract. This is why, on the Keng day, the day when metal destroys wood, death is inevitable.”

PARAGRAPH 19 simultaneous exhaustion of the energies of the 5 yin channels causes revulsion and oscillation of the eyes, indicating annihilation of zhi (will). zhi is “dead” first; then the fatal day occurs in 1 1/2 days. EXPLANATIONS AND COMMENTARIES I - Zhang Shi comments: “Globally, the energy of the 5 organs and 5 movements originates a priori from water and fire. The cardiovascular system is linked above to the ocular system. Therefore, exhaustion of the energy of the heart causes the revulsion and oscillation of the eyes. The jing (essence) of fire is the shen (mental) and the jing of water is the zhi (will); the shen originates from the jing and fire comes from water. This is why “death” of the zhi causes, in the first place, the exhaustion of the shen... in accordance with the saying “To live and die together”.” II - Ma Shi explains: “This paragraph explains the fatal prognosis of the syndrome of simultaneous exhaustion of the yin channels of the foot and hand. The 5 yin channels are: _ Hand Shaoyin (He) _ Foot Jueyin (Li) _ Foot Taiyin (Sp) _ Hand Taiyin (Lu) _ Foot Shaoyin (Ki). The text does not mention the Hand Jueyin (XB) because it is already included in the Hand Shaoyin (He). The ocular system is composed of the jing (essence) of the 5 organs. This is why the exhaustion of the energy of the 5 organs is responsible for rolling back and oscillation of the eyes, indicating annihilation of zhi (will); then death occurs after a 1 1/2 day delay.” 341.

PARAGRAPH 20

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The exhaustion of the energies of the 6 yang channels causes the separation of yin and yang characterized by excretion and sweating. This is why the disease manifests in the morning, and death occurs in the evening. EXPLANATIONS AND COMMENTARIES I - Zhang Shi comments: “This paragraph concerns the exhaustion of the energy of the 3 yang (taiyang- SI and Bl, shaoyang- SJ and GB, yangming- LI and St) of the 6 bowels. The energy of the 3 yang takes its “source” from yin and manifests in yang. In the course of exhaustion of the 6 yang channels, yin and yang become uncoupled and, during this separation, the yang energy escapes to the exterior. Cou Li (sweat glands) open up and sweating is excessive. The energy of the 3 yang respond to heaven. This is why, when the disease appears in morning, death occurs in the evening and vice versa.”

II - Ma Shi explains: “This paragraph concerns the syndrome of exhaustion of the energies of the 6 yang channels of the foot and hand, with deduction of the occurrence of “death”. The 6 yang channels are: _ Foot Shaoyang (GB) _ Foot Yangming (St) _ Hand Yangming (LI) _ Hand Taiyang (SI) _ Foot Taiyang (Bl) _ Hand Shaoyang (SJ). When the energy of the 6 yang channels becomes exhausted, the yin channels become separated for good from the yang channels, sweat appears in the form of droplets and death occurs very rapidly.”

PARAGRAPH 21

342.

The 12 jingmai circulate deeply in the space of distribution of the flesh (dermis). They are invisible, except for the portion of the Foot Taiyin (Sp) located above the internal malleolus (21). As for the other emerging and visible vessels, they all belong to the group of luomai (secondary vessels) (22). The luo vessels of the 6 jing (3 yin and 3 yang channels), in particular the great luo of the Hand Yangming (LI) and Hand Shaoyang (SJ), all begin in the region located between the wrist and elbow. In alcoholics, the wei energy becomes mobilized in the first place towards the skin and causes a fullness at the level of the luomai; the wei energy is in abundance, ying is overflowing and the jingmai are very flourishing. The suddenness of fullness of these vessels results from the infiltration of perverse energy (alcohol) which becomes fixed either at the “root” or at the “summit”. The absence of change (of the principal channels) becomes expressed by heat (released by the alcohol) and the

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absence of “closing” (of the luo vessels), by emptiness and stagnation, which permits differentiation of the jingmai from the luomai. Leigong asks: “How do you recognize the jingmai from the luomai?” Huangdi replies: “The jingmai are not visible. Their emptiness and their fullness are perceived at Cun Kou (radial pulse). As for the detectable vessels, they are all the luomai.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi comments: “The system of 12 channels begins at the Hand Taiyin (Lu) and ends with the Foot Jueyin (Li), then the cycle begins again... . This concerns the circulation of ying-Xue (ying-blood) in the 21. In French and German translations, “Foot Taiyin (Sp) located above the internal malleolus” is replaced by the lung channel located at the wrist. This error of interpretation comes from modern version published in Shanghai. 22. In 1954/69, Chamfrault and ourselves introduced the luomai system (secondary vessels) into the current practice of acupuncture in Europe (see The Energetic Human, Angouleme Edition, 1969) and a new nomenclature of points with numbering according to the classical circulation of the channels.

vessels-channels. As for the energy of the 12 jingmai manifesting at the jing point, arriving at the ying point, crossing the jing point, gathering at the he point, etc... it concerns qi Xue (energy/blood) coming from the pilocutaneous system in order to unite with qi Xue of the jingmai at the level of the elbow and knee. The effect of ethyl alcohol is a good example to explain the movement of wei energy towards the cutaneous system where the luomai are situated. These latter then go into an 343. excessive state, the energy is at ease, qi Xue (energy/blood) overflows and the jingmai are very flourishing... . This explanation concerns qi Xue outside the channels, which follows the jing Sui (“satisfying” channels- which carry out the concerned function with satisfaction) in order to reach the sunluo (little branches at the level of the skin) of the one hand, and on the other hand, the routes of the sanjiao (SJ) to warm up the epidermo-dermal system. In summary, the energy and blood consist of 2 paths of exit towards the skin and the flesh. (Figure 39) For the movements of penetration of qi Xue (energy/blood) in the vessels (principal and secondary channels), there also exists two paths: _ path of penetration into the jingmai (principal channels) via the jing points in order to arrive at the ying, shu, jing and he points.... _ and path of penetration into the luomai (secondary channels) (Figure 40). These paths of penetration and of exiting of the jingluo (principal and secondary channels) agree with the movements of “heaven-earth, yin-yang” (5 circumductions and 6 energies) (23). We must memorize this notion because it concerns the fundamental rudiments of energetic medicine.”

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Figure 39 Routes of exit of qi Xue (blood/energy) towards the exterior (epidermo-dermal system).

23. These are the spatio-temporal movements. 344.

Figure 40 Routes of penetration of qi Xue (energy/blood) into the luomai and jingmai.

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II - Ma Shi explains: “This paragraph emphasizes the invisibility of the jingmai, such as the principal channel of the lung departing from Zhongfu (Lu 1) to Shaochang (Lu 11) and the visibility of the luomai emanating from the point Lieque (Lu 7), Pianli (LI 6)... . In other words, the jingmai circulating deeply, at the level of the distribution of the flesh, are invisible except for the portion of the spleen channel located above the internal malleolus. In contrast, the emerging and detectable vessels are all the luomai. In individuals who indulge in alcoholic drinks, wei energy becomes mobilized to the skin and provokes, in the first place, a fullness at the level of the luomai, then that of the ying (nutritive energy), hence the excess of wei energy and fullness of the jingmai. It is at this occasion that the jingmai are no longer detectable. If the pulse is agitated, it is a matter of Fullness-heat. If the pulse is not firm, it is a matter of Empty-Cold. In conclusion, _ in alcoholics, the pulse is necessarily agitated and firm, and during the absorption of alcohol one can detect the disturbed channel which begins at the level of the digits. _ the emptiness and fullness of the jingmai are detectable at the level of Cun Kou (radial pulse), while the emptiness and fullness of the luomai are detectable visually without resorting to the examination of the pulse.”

PARAGRAPH 22

345.

Leigong: “Your humble disciple still has not grasped well the meaning of this distinction.” Huangdi: “The luomai do not traverse the large articulations. One must know their Dao of entering and exiting. They insert into the skin, and their site of reunion is perfectly detectable at the exterior. This is why during the needling of the luo, it is imperative to implant the needle at the sites of their congested “reunion” (“nodes”) even if these sites are not visible. The needling is urgent and bleeding of these “nodes” is necessary to evacuate the perverse energy at the risk of causing “Bi” syndrome (obstruction/paresthesias). During the examination of the luomai: _ the blue color indicates a syndrome of cold with pain, and the red color, a syndrome of heat, _ blue color at the thenar eminence indicates a syndrome of cold of the stomach, and the red color a syndrome of heat of the stomach, _ the sudden appearance of black color at the thenar eminence heralds the chronicity of the “Bi” disease, and simultaneous appearance of black, red and blue, the illness of Cold-heat (fever and chills). To treat the disease of Cold-heat, one must first needle the luo points to make them bleed, once every 2 days, then regulate the emptiness and fullness. Throughout the session, the brief appearance of a bluish complexion indicates a loss of energy which, in serious cases, can bring about suffocation and even fainting. In this type of suffocation, one must sit the patient down very urgently.”

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EXPLANATIONS AND COMMENTARIES I - Zhang Shi comments: “This paragraph, based on acupuncture technique, stresses the existence of Birth/ beginning and Entering/Exiting of qi Xue (energy/blood). The following chapter (Ch. 11- “Distinct Channels”) states: “First evaluate the length and size of the bone, then determine the width of the vessels...”. since the 12 jingmai follow the bones and cross the articulations, one can deduce the length of the channels. As for the Da luo (Great luos- luobie or longitudinal luo), they do not pass the large articulations and must borrow the cutaneous path to affect their movements of Entry/Exit (see Figure. 41). 346. blood and energy originate from the stomach bowel and are conducted by the Distinct Channels (Jing Bie), which take them along with the luomai in order to unite at the skin in the form of “nodes” (reunions) appearing at the cutaneous surface. This is why, in order to treat the luomai, one must needle the places where these nodes occur. One must make these points of reunion bleed, whether saturated with blood or not, to evacuate the perverse energy because the fixation and stagnation of perverse energy into the skin favors its encroachment on the flesh, muscles and bones to trigger Bi disease (obstruction/paresthesias). This ailment is entirely different from that cited in the previous paragraph.”

II - Ma Shi explains: “This paragraph concerns the acupuncture method of the luomai, which basically consists of making the points of reunion (Luo points) bleed and the method of examination of the luomai, which resides in the observation of the complexion. Unlike the jingmai, the luomai do not cross the large joints. They are obliged to follow a path called “distinct path” (Luo Bie or longitudinal luo) which unites with the skin (cutaneous path). The sites of reunion called luo points are visible. In order to needle the luomai, one must always make the luo points bleed, whether they are engorged with blood or not, with the purpose of evacuating perverse energy to protect against the Bi disease. Examination of the color of the luomai permits detection with precision of certain diseases cited in the text. In this manner, in the syndrome of cold or of heat, the technique of bleeding the reunion points is compulsory. In contrast, the brief blue color of the luomai, located at the thenar eminence, indicates an insufficiency of essential energy; for this reason, it is strictly ill-advised to use the dispersion method, in particular the bleeding method, at the risk of provoking fainting.”

III - N.V.N.: Paragraph 22 and the following ones of this chapter broach the explanatory study of the existence of the luobie (longitudinal luo) The treatment of these vessels necessarily consists of utilizing the technique of bleeding, except in the case of the emptiness of the essential energy.

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PARAGRAPH 23

Figure 41 Circulatory path of the jingmai and luomai.

The luobie (Longitudinal or distinct luo) of the Hand Taiyin (Lu) is called Lieque (Lu 7). It starts above the wrist, runs alongside the principal route (channel) of the taiyin (Lu), penetrates into the palm of the hand and branches to the thenar eminence. The fullness of this vessel is characterized by a sensation of heat at the radial apophysis and in the palm of the hand, and e m p t i n e s s , by frequent yawning, stretching out of the shoulders and frequent urination. It is advised to needle the point Lieque (Lu 7), located 1 1/2 cun above the wrist. From this point, another vessel (transversal luo or luo yin) ( 2 4 ) also leaves that goes toward the Hand Yangming (LI). EXPLANATIONS AND COMMENTARIES I - Zhang Shi comments: “The luobie (longitudinal luo or distinct luo) are the great secondary vessels (Da luo) belonging to the 5 organs and 6 bowels. In this way, for example: _ the luobie of the Hand Taiyin (Lu) is a large vessel leaving from the point Lieque (Lu 7) _ the luobie of Hand Shaoyin (He) is a large vessel leaving from the point Tongli (he 5) _ the luobie of Foot Taiyang (Bl) is a large vessel leaving from the point Faiyang (Bl 58)... These luobie vessels have no relation to the shu antique points (jing, ying, shu, jing, he). “It begins above the wrist...”, means that the principal channel of the Hand Taiyin (Lu) and its luobie separate at this site. 348. “Fullness of this vessel is characterized by frequent yawning...”, a phenomenon of the manifestation of the energy in a state of insufficiency in the interior.

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From the fact that the blood and energy are disordered at the level of the cutaneous layer where the luomai are found, needling must be performed at the site located 1 1/2 cun above the wrist, at the point Lieque (Lu 7). “... where a vessel also leaves from that goes toward the Hand Yangming” means that the luo-yin, leaving from this site, is directed toward the Hand Yangming (LI).”

II - Ma Shi comments: “This Paragraph 23 and the following ones concern the 12 luo points whose first study is that of the lung channel. The vessel emanating from the luo point does not bear the name luo, but that of luobie (distinct luo or longitudinal luo) because it follows a trajectory parallel to that of the principal channel involved. 1 - The luobie of Hand Taiyin (Lu) is called Lieque (Lu 7) because it leaves from the point of the same name, located 1 1/2 cun from the wrist (needle depth 0.2 cun, left in during 3 expirations, disperse during 5 inspirations and apply 5 moxas). From the point Lieque (Lu 7), it runs alongside the principal channel, _ passes directly towards the palm of the hand _ enters into liason with the Hand Yangming (LI) at the index finger, where the point 24. Chamfrault and ourselves have given the name “transversal luo” to all the luo-yin leaving from the luo point of the yin channel toward a yang channel, and vice versa.

Shangyang (LI 1) is found _ and spreads to the thenar eminence. 2 - The fullness of this vessel caused by perverse energy basically manifests by a sensation of heat at the radial apophysis and in the palm of the hand. The emptiness of this vessel caused by an insufficiency of essential energy is indicated by frequent urination. 3 - Treatment consists of needling Lieque (Lu 7), where a vessel also leaves from towards the Hand Yangming (LI) because the lung channel and that of the large intestine constitute a “yin-yang - interior-exterior” system of liason.” III - N.V.N.: See the detailed study of the longitudinal luo (Luo Bie) and transversal luos and their method of use in “Medecine Traditionelle Chinoise” (“Classical Chinese Medicine”) (N.V.N. Edition, 1971) and “The Energetic Human” (Angouleme Edition, 1969).

PARAGRAPH 24 The luobie of the Hand Shaoyin (He) is called Tongli because this vessel arises from the point of the same name (he 5), located at 1 1/2 cun ( 2 5 ) . It ascends the length of the principal channel involved, penetrates into the heart organ, links up with the tongue and enters into liason with the eyes. In the event of fullness caused by perverse energy, this vessel manifests by a sensation of the “separation of the diaphragm” (thoracoabdominal oppression), and in the event of emptiness following an insufficiency of essential energy, by anarthria. It is advised to needle Tongli (he 5), from which another vessel∆ also leaves which bifurcates toward the Hand Taiyang (SI).

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EXPLANATIONS AND COMMENTARIES I - Zhang Shi comments: “The luobie of the Hand Shaoyin (He) bears the name Tongli because the point Tongli (he 5) is its site of departure. This vessel follows the principal channel (heart), _ reaches the heart _ links up to the base of the tongue _ and adheres to the eyes. Fullness of this vessel is characterized by an obstruction of the diaphragm, and emptiness by dysphasia because the luobie of the heart is attached to the base of the tongue.” II - Ma Shi explains: “This paragraph concerns the luo point of the heart channel called Tongli. From this point, a vessel departs which directly reaches the heart, then links up to the base of the tongue and to the eyes (26). 25. One must read it as 1 cun. It is a probably a matter of an error in printing. 26. The principal channel of the heart and its luobie together reach the throat and eyes because the second follows the parallel path of the first (principal channel).

The point Tongli (he 5) is located 1 cun behind the wrist. In the event of disorders of this vessel, treatment consists of needling Tongli to 0.3 cun depth and apply 3 moxas there. From this point Tongli (he 5) also arises another vessel (transversal luo) which flows directly to the Hand Taiyang (SI) (27) because the heart and small intestine constitute a “yinyang, interior-exterior” system of liason.”

PARAGRAPH 25

350.

The luobie of the Hand Jueyin (XB) is called Neiguan because this vessel arises from the point of the same name (XB 6), located 2 cun behind the wrist between 2 tendons. This vessel ascends the length of the principal channel and links up to the xin bao luo (energetic envelope of the heart). Fullness of the “heart” system (28) expresses as heart pains, and emptiness by cervical stiffness. It is advised to needle the point located between the 2 tendons (Neiguan- XB 6), where a vessel also departs towards Hand Shaoyang (SJ).

EXPLANATIONS AND COMMENTARIES I - Zhang Shi comments: “The luobie of the Hand Jueyin (XB) and its principal channel (XB) are in liason with the point Neiguan (XB 6), located 2 cun above the wrist. This luobie separates from the principal channel, _ circulates in the space of the 2 tendons _ goes back up the length of the principal channel _ penetrates into the xin bao luo (XB), etc...”.

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II - Ma Shi explains: “This paragraph concerns the luo point of the Hand Jueyin (XB). The Hand Jueyin also bears the name “Master of heart” because it replaces the heart channel in order to fulfill certain well-determined functions. The heart is sovereign organ belonging to the 5 organs and 6 bowels. When perverse energy attacks the heart, it remains in the xin bao luo (XB). From the point Neiguan (XB 6) a vessel departs which is directed towards the yuan point (yangchi- SJ 4) of the Hand Shaoyang (SJ) because the channel of the xin bao luo and that of the sanjiao (SJ) constitute a “yin-yang, interior-exterior” system of liason.”

PARAGRAPH 26 The luobie of the Hand Taiyang (SI) is called Shizheng because this vessel departs from the point of the same name (SI 7), located 5 cun above the wrist. 27. That is to say, to the yuan point (Wangu- SI 4) 28. “heart-xinbao” system.

This luobie ascends to the elbow and reaches the shoulder at the point Jianyu (SI 15). Fullness of this vessel provokes laxity of the elbow joint with disorders of motility, and emptiness by the formation of warts, and in benign cases, interdigital eczema. It is advised to needle Shizheng (SI 7). From this point a vessel also departs towards the Hand Shaoyin (He). EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “Five cun from the wrist the point zhizheng (SI 7) occurs, from where is issued two vessels, one directed to the Hand Shaoyin (He) (29) and the other ascends to the elbow and branches to the point Jianyu (SI 15). The Hand Taiyang (SI) controls the organic liquid. When its luobie is in fullness, the organic liquid stagnates and cannot permeate the articulations, hence joint laxity and elbow immobility; and when it is in emptiness, the essential energy accumulates, with formation of warts or pruritis with eczema of the fingers, etc...”. II - Ma Shi comments: “This paragraph concerns the luo point of the small intestine channel, Shizheng (SI 7) (needle depth 0.3 cun and apply 3 moxas). Other than the luobie, another vessel emanates from this point which flows down into the Hand Shaoyin (He) at the yuan point (shenmen- he 7) because the small intestine channel and that of the heart constitute a “yin-yang, interior-exterior” system of liason.”

PARAGRAPH 27

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The luobie of the Hand Yangming (LI) is called Pianli because this vessel arises from the point of the same name (LI 6), located 3 cun above the wrist. From this point Pianli two vessels depart: _ one directed towards the Hand Taiyin (Lu) _ and the other reascends the arm up to the shoulder at the point Jianyu (SI 15), reaching the maxillary angle, distributing into the teeth and penetrating into the ear to unite with the auricular Sun Mai (little energetic intra-auricular branches). Fullness of this luobie causes pain in the teeth and deafness, and emptiness, a sensation of cold in the teeth and diaphragmatic obstruction (Ge Bi). It is advised to needle the point of the luobie, Pianli (LI 6). 352.

29. It involves the transversal luo vessel of the small intestine channel.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The fullness of the luobie of Hand Yangming (LI) causes a stagnation of the energy at the level of the teeth and ears, hence dental caries and temporary deafness.” II - Ma Shi comments: “This paragraph concerns the luo point of the large intestine channel. Pianli (LI 6) is located 3 cun above the wrist. From this point two vessels arise: _ one reaches the lung channel because the Hand Yangming (LI) and Hand Taiyin (Lu) constitute the “yin-yang, interior-exterior” system” _ the other runs alongside the principal channel and is directed towards the shoulder to

the point Jianyu (SI 15) located at the level of the antero-inferior region of the acromion; then from there, it carries itself to the maxillary angle to distribute to the teeth and anastomose to the Sun Mai of the ear.”

PARAGRAPH 28 The luobie of the Hand Shaoyang (SJ) is called W a i g u a n . It begins 2 cun above the wrist, encircles the arm and flows down into the thorax. From Waiguan (SJ 5) another vessel reaches the xin bao luo (XB). Fullness of this luobie is indicated by spasm of the elbow, and emptiness, by laxity. It is advised to needle Waiguan (SJ 5). EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The point Waiguan (SJ 5) is located 2 cun above the wrist. It is the site of departure of

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the luobie of the Hand Shaoyang (SJ). This vessel encircles the arm and inserts into the thorax to unite with the luobie of the Hand Jueyin (xin bao luo). Fullness of this vessel causes spasms, and its emptiness, laxity because the shaoyang (SJ and GB) and jueyin (Li and XB) control the muscular system.” II -Ma Shi comments: “This paragraph concerns the luo point of the Hand Shaoyang (SJ). Waiguan (SJ 5) occurs 2 cun above the wrist. The luobie departs from this point which goes around the arm and falls into the thorax in order to communicate with that of the Hand Jueyin (XB) because the sanjiao (SJ) and the xinbao (XB) constitute one of the 6 systems of “yin-yang, interior-exterior” of the organism.” 353.

PARAGRAPH 29 The luobie of the Foot Taiyang (Bl) is called Feiyang (Bl 58), located 7 cun above the external malleoli. It follows the principal channel in direction to the cranium, reaches the face and goes into relationship with the nose and mouth. Fullness of this vessel is indicated by nasal obstruction, headache and dorso-lumbar pain, and emptiness, by epistaxis. It is advised to needle the luo point (Feiyang-Bl 58), where a vessel also departs from which is directed towards the Foot Shaoyin (Ki). EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “Seven cun above the malleoli the point Feiyang (Bl 58) occurs where two vessels depart from: the luobie and Transversal Vessel which unite with the Foot Shaoyin (Ki). Fullness of the luobie is characterized by such signs as nasal obstruction, headache and back pain, and its emptiness, by epistaxis because the luobie accompany the principal channel to reach the back and head.” II - Ma Shi comments: “This paragraph concerns the luo point of the Foot Taiyang (Bl). From Feiyang (Bl 58), located 7 cun above the external malleolus, a vessel emanates which is directed towards the Foot Shaoyin (Ki) because the kidney channel and that of the bladder constitute one of the 6 systems of “yin-yang, interior-exterior” liason.” III - N.V.N.: Ma Shi omitted commentary on the trajectory of the luobie of the Foot Taiyang (Bl).

PARAGRAPH 30 The luobie of the Foot Shaoyang (GB) is called guanming (GB 37). From this point, located 5 cun above the external malleolus, a vessel emanates toward the jueyin (Li) and another toward the foot. 354. Fullness of this luobie is indicated by ice cold feet, and emptiness, by trouble walking and inability to stand up after sitting down.

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It is advised to needle guanming (GB 37).

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “Five cun above the external malleolus the point guanming (GB 37) of the Foot Shaoyang (GB) is found. The luobie of the Foot Shaoyang (GB) is linked to the principal channel and distributes to the dorsal surface of the foot. The shaoyang is the first energy. Fullness of its luobie hinders the ascending movement of the energy and provokes an energetic stasis at the lower part of the body, hence cold feet, and its emptiness causes disturbance of walking with difficulty standing up after a seated position.” II - Ma Shi comments: “This paragraph concerns the luo point of the gallbladder. The point guanming (GB 37), located 5 cun above the external malleolus, gives rise to two vessels: _one reaches to the Foot Jueyin (Li) because the gallbladder and liver constitute one of the 6 systems of “yin-yang, interior-exterior” liason of the organism _ and the other spreads to the dorsal surface of the foot where the points Xiaxi (GB 43), Diwuhui (GB 42), Linqi (GB 41)... are found. Fullness of this luobie is indicated by ni Jue (contrary afflux, responsible for cold feet), because the liver vessel is located at the lower part of the body (feet), and its emptiness, by the syndrome wei Bi (disturbance in walking, inability to get up) because the liver governs the muscles. It is advised to needle guanming (GB 37), luo point of the gallbladder.”

PARAGRAPH 31 The luobie of the Foot Yangming (St) is called Fenlong (St 40). From this point, located 8 cun above the external malleolus, two vessels emanate: _ one is directed toward the Foot Taiyin (Sp) _ and another goes back up the length of the principal channel (St), outside the spine, reaches the neck and head, anastomoses to the energy of the other channels and redescends to the laryngo-pharyngeal apparatus. 355. The illness jue ni (contrary afflux) of the energy is characterized by painful blockage of the throat and sudden aphasia. Fullness of this luobie is characterized by yin madness and yang madness (Dian-Kuang), and emptiness, by paralysis of the lower limbs and atrophy of the leg. It is advised to needle Fenlong (St 40), the luo point of the Foot Yangming (St).

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains:

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“The blood and energy of the 15 Da luo (Luo Bie or longitudinal luo) come from shui Gu (water of the cereals) of the stomach. This is why the luobie of the Foot Yangming (St) reascends to the cranium to anastomose with the energy of the yang channels (at the point Bahui- GV 20).”

II - Ma Shi comments: “This paragraph concerns the luo point of the stomach channel. From Fenlong (St 40), located 8 cun above the external malleolus, two vessels emanate: _ one which is directed towards the Foot Taiyin (Sp) because the stomach and spleen constitute one of the 6 “yin-yang, interior-exterior” systems of liason of the organism _ and another which follows the external surface of the leg, reaching the vertex to anastomose with the energy of the other channels because the stomach is the “sea” of the 5 organs and 6 bowels. Painful blockage of the pharynx resulting from a contrary flow (afflux- jue ni) of the energy of the stomach is due to the disorders of the vessels which branch to the throat. In the ailments due to fullness and emptiness of this luobie, it is advised to needle Fenlong (St 40) because it is the luo point of the Foot Yangming (St).”

PARAGRAPH 32 The luobie of the Foot Taiyin (Sp) is called gongsun (Sp 4). From this point, located 1 cun behind the first metatarso-phalangeal joint, emanates: _ a vessel towards the yangming (St) _ and another which is directed toward the intestines and stomach. The contrary afflux (jue ni) of the energy is characterized by gastrointestinal disturbances (Huo luan). 356. Fullness of this luobie is indicated by sharp, colicky abdominal pains, and emptiness, by abdominal swelling (belly tense like a drum). It is advised to needle gongsun (Sp 4), luo point of the spleen.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “One cun behind the metatarso-phalangeal joint of the great toe the point gongsun (Sp 4) is found from where emanates: _ a vessel towards the Foot Yangming (St) _ and another which goes to the stomach and intestines. The afflux of the energy causes gastrointestinal disturbances. Fullness causes violent abdominal pains, and emptiness abdominal bloating.”

II - Ma Shi comments: “This paragraph concerns the luo point of the Foot Taiyin (Sp). From the point gongsun (Sp 4), located 1 cun behind the first metatarso-phalangeal joint, emanates two vessels: _ one directed toward the stomach channel because spleen and stomach constitute one of the 6 “yin-yang, interior-exterior” systems of liason of the organism.

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_ another directly reaches the intestines and stomach because the luobie is the shortest path to go from exterior (from the luo point) to the interior (bowels: stomach and intestines).”

PARAGRAPH 33 The luobie of the Foot Shaoyin (Ki) is called Dazhong (Ki 4). From this point, located behind the internal malleolus, two vessels emanate: _ one encircles the calcaneus and arrives at the Foot Taiyang (Bl) _ and the other follows the principal channel, ascends to the xin bao luo(XB) and passes to the back and vertebral column. The contrary afflux (jue ni) of the energy provokes anxiety. Fullness of this luobie causes urinary retention, and emptiness, lumbalgia. It is advised to needle Dazhong (Ki 4), luo point of Foot Shaoyin (Ki). EXPLANATIONS AND COMMENTARIES

357.

I - Zhang Shi explains: “The luobie of the Foot Shaoyin (Ki) and the kidney channel unite at the point Dazhong (Ki 4). From this point two vessels detach: _ one directed towards Foot Taiyang (Bl) _ and the other follows the principal channel of the kidney and ascends to the region below the xin bao luo (XB) (30), then emerges at the lumbar region. The contrary afflux (jue ni) of the energy provokes anxiety because the “heart” energy is insulted by “water” energy. Fullness of the luobie of kidney causes urinary retention because the vessel which arrives at the Foot Taiyang (Bl) prevents the energy from being metabolized. Emptiness of the luobie of kidney causes back pains because the lumbar vertebrae are the “palaces” of the kidney.” II - Ma Shi comments: “This paragraph concerns the luo point of the kidney channel. From the point Dazhong (Ki 4), located behind the internal malleolus, a vessel emanates which encircles the calcaneus and inserts into the Foot Taiyang (Bl) because the kidney and bladder constitute one if the 6 “yin-yang, interior-exterior” systems of liason of the organism.” Another vessel, also emanating from the point Dazhong (Ki 4), follows the principal channel of the kidney, goes back up toward the region below the xin bao luo (XB) and emerges at the dorso-lumbar region; this is why the contrary afflux of the energy provokes anxiety.”

PARAGRAPH 34 The luobie of the Foot Jueyin (Li) is called Ligou (Li 5). From this point, located 5 cun above the internal malleolus, two vessels emanate: _ one directed toward the Foot Shaoyang (GB)

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_ and the other passes by the tibia, ascends to the testicles and attaches to the penis. The contrary afflux of the energy provokes inflammation of the testicles (orchitis); fullness causes lengthening of the penis ( 3 1 ) , and emptiness, genital pruritis. It is advised to needle Ligou (Li 5), luo point of the liver. EXPLANATIONS AND COMMENTARIES

358.

I - Zhang Shi explains: “Five cun above the internal malleolus the point Ligou (Li 5) is found. The luobie of the Foot Jueyin (Li) follows the principal channel of the liver; as for the other vessel, it passes to the Foot Shaoyang (GB). It is necessary to needle the luo point of the liver because this obeys the therapeutic principles according to which “Illnesses located at the 30. The energy of Hand Shaoyang (SJ) and that of Hand Jueyin (XB) come from the kidney organ; this is why their luo follow the parallel route of the kidney channel to arrive at the region located below the xin bao luo (XB). 31. The translation of Ma Shi is persistent erection (priapism).

yang must be treated at the yin” (32).” II - Ma Shi comments: “This paragraph concerns the luo point of the liver channel. Ligou (Li 5) is located in a crease 5 cun above the internal malleolus. The Foot Jueyin (Li) possesses, besides a luobie, another vessel which goes directly to the Foot Shaoyang (GB) because the liver and gallbladder constitute one the 6 “yin-yang, interiorexterior” systems of liason.” The illnesses cited in this paragraph belong to the luobie; treatment consists of needling Ligou (Li 5), luo point of the liver.”

PARAGRAPH 35 The luobie of renmai (CV) is called weiji (other name Jiuwei- CV 15) . This vessel distributes to the abdomen. Fullness provokes cutaneous abdominal pain, and emptiness, intolerable pruritis. It is advised to needle Jiuwei (CV 15).

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: 359. “The renmai (CV) begins at the bottom, below Zhongji (CV 3), goes back up to the pubic hair, submerges into the abdomen and reappears at the point Quanyuan (CV 4), reaches the lips, passes to the cheek and penetrates into the eye. weiji is the name of the point located at the top (superficial), above Jiuwei (CV 15) which is below (deep). The luobie of renmai (CV) starts at Jiuwei (CV 15), first reaches the superficial (top), then redescends (bottom) to its site of origin to distribute to the abdomen.”

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II - Ma Shi comments: “This paragraph concerns the luobie of renmai (CV), which begins at Jiuwei (CV 15), emerges at weiji, then redescends to its point of departure to distribute to the abdomen. This is why, fullness of perverse energy causes cutaneous abdominal pain, and emptiness of the essential energy, ferocious itching. It is advised to needle Jiuwei (CV 15), luo point of the renmai.” III - N.V.N.: The teachings of Zhang and Ma permit understanding that the point Jiuwei (CV 15) is deep and that the needling must also be deep without crossing the peritoneum. According to the Da Cheng, needling this point is reserved for experienced acupuncturists because too significant a loss of energy can be bring about death (33).

32. Some translators, mistaking the exact meaning of the term “yin-yang” used in this wording, had deleted this phrase which is fundamental to the practice of acupuncture. “Illness located at the yang” means that it occurs at the secondary channel (yang), and “must be treated at the yin” implies that treatment must be done at the principal channel because the luobie (longitudinal luo) make up part of the group of secondary channels (yang, superficial) and the luo points belong to the principal channels (yin, deep). (see “Medecine Traditionnelle Chinoise” - NVN Edition) 33. See “Art and Practice of Acupuncture and Moxabustion (According to the Zhen Jiu Dacheng)”, Vol. III - NVN Edition.

PARAGRAPH 36 The luobie of the Dumai (GV) is called Changqiang (GV 1). This luo runs alongside the paravertebral muscles on either side of the spine, arrives at the neck, redescends to the shoulder blades, arrives at the taiyang (Bl) and inserts into the paravertebral muscles. Fullness causes pains of the spine, and emptiness, a sensation of heaviness of the head. It is advised to needle Changqiang (GV 1), luo point of the Dumai (GV).

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The luobie of the Dumai (GV) starts at the point Changqiang (GV 1), runs alongside both sides of the spine, ascends to the cranium and spreads to the head. Other secondary routes of the Dumai come back out from the head and neck and redescend to the shoulders.” II - Ma Shi comments: 360. “This paragraph concerns the luobie of the Dumai (GV), which starts at the point Changqiang (GV 1), runs alongside the spine, goes back up to the neck, branches to the head and below the cranium, and spreads to the shoulders. Other vessels reach the taiyang (Bl) and penetrate deeply into the paravertebral muscles. The fullness of perverse energy provokes stiffness of the spine, and emptiness of the essential energy, a sensation of heaviness of the head with repetitive shaking movements and restlessness of the neck. These ailments all are of spinal origin and must be treated at Changqiang (GV 1), luo point of the Dumai (GV).”

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The Da luo (great luo) of the spleen is called Dabao (Sp 21), located 3 cun below the point Yuanye (GB 22). This vessel spreads to the thorax. Fullness is indicated by generalized pains, and emptiness, by muscular laxity. This vessel spreads within the thorax like the mesh of a net spattered with blood. It is necessary to needle Dabao (Sp 21) of the spleen. EXPLANATION AND COMMENTARIES I - Zhang Shi explains: “Dabao is the name of a point belonging to the spleen channel, located 3 cun below the point Yuanye (GB 22). A number of small vessels departing from this point diffuse at the level of the inner wall of the thorax as easily in the interior as at the exterior. Fullness of perverse energy causes generalized pains, and emptiness, laxity of the joints. “... spreads like the mesh of a net spattered with blood” implies that the energy and blood of the Da luo spread to the sunluo (energetic branches) of the skin and that the Da luo controls all the secondary vessels (secondary channels). This is why the disorders of the Da luo manifest by generalized pains (case of fullness) or by joint laxity (case of emptiness). The luobie (longitudinal luo) of the Foot Taiyin (Sp) follows the principal channel; its blood and its energy only spread into the region to which it is associated (see above). For this reason, the spleen channel possesses two luo vessels: the luobie and Dabao.” II - Ma Shi comments: 361. “This paragraph concerns the Dabao, great luo of the spleen, which distributes to the inner thoracic walls like the mesh of a belt spattered with blood. In the event of generalized pains or joint laxity, one must needle Dabao (Sp 21).” (34).

PARAGRAPH 38 The 15 luo cited above are detectable in cases of fullness, and in case of emptiness, they are deeply hidden, therefore invisible. One must detect them by the top and bottom of the channel because the jingmai, as well as the luomai, differ in individuals. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “When the 15 luo are sufficient enough in blood and energy, they spread into the sunluo (Little luos) of the skin. This is why they are visible in the case of fullness and invisible in the case of emptiness (because they become weakened in the interior). “One must detect them by the top and bottom” means that the luomai intersect at the top (superficial) and at the bottom (deep), within yang and within yin. When the illness occurs in the yang (superficial) part, one must detect it at the bottom (yin, deep) and vice versa, and when it is at the yin, one must treat the yang and vice versa. (35) The 15 great luo are in direct liason with the jingmai and open to the “four sides”. Their energy does not have a fixed location. They interlace the principal channels (jingmai)

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without penetrating them; this is why they neither gather at the jingmai nor at the other groups of secondary (tendinomuscular, distinct and curious) channels.” II - Ma Shi comments: “This paragraph concerns the method of utilization of the luo points which number 15: _ 12 luo of the 12 jingmai _ 2 luo of the 2 curious vessels: renmai (CV) and Dumai (GV) _ and Dabao (Sp 21), great luo of the spleen. These luo points are detectable when the perverse energy is in fullness there; they weaken and become invisible when the essential energy is in emptiness there. In the latter case, one must detect the luo points not weakened located at the top (superficial) and at the bottom (deep) in order to determine the point sought.” III - N.V.N.: 362. This paragraph emphasizes the importance of the 15 luo and does not address the great luo (Da luo) of the stomach. 34. This definition permits us to understand that the human being possesses two “belts”: one abdominal (Daimai) and the other thoracic (Dabao). 35. See “Principles of treatment according to the “yin-yang” localization of the illness” in Paragraph 34) & footnote 31).

In Chapter 18 (“Energetic Aspects of the Pulse of Man in good health”) of the Suwen, we read:

“The Da luo of the stomach is called “Xu Li”. It begins at the stomach and crosses the diaphragm to link up with the lung and emerge below the left breast, at the point Rugen (St 18). These movements can be transmitted through the clothes and allow, in this way, examination of Tongqi (original or a priori energy). If these movements are very strong, rapid and gasping (as in dyspnea) and are interrupted by a stoppage, this is the sign of attack of the Tanzhong (middle of the thorax). If these movements assume the aspect of the “knotted” pulse (slow pulse presenting with pauses) whose energetic current becomes wider in the intercostal space, it is the sign of accumulation of the energy. The absence of beating and movements indicates death. Sometimes, the beatings of Xu Li are so intense, entirely bursting, that they show through under the clothes; this is the sign of the liberation of Tongqi; it is also death.” In total, the energetic system of the body is comprised, among the luomai, of 16 luobie, of which one, internal, comes from the stomach bowel.

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363.

Book III Book 3 contains 11 chapters:

Chapter 11: Distinct Channels (Jing Bie) Chapter 12: River Ways (Jing Shui) Chapter 13: Tendinomuscular Channels (Jing Jin)

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Chapter 14: Measurement of the Bones (Gu Duo) Chapter 15: Fifty Rong (ying) (Wu Shi Rong) Chapter 16: Nutritive Energy (Ying Qi) Chapter 17: Measurement of the Vessels (Mai Duo) Chapter 18: Production and Reunion of Ying and Wei (Ying Wei Sheng Hui)

364.

Chapter 19: Energies of the 4 Seasons (Si She Qi) Chapter 20: Five Perverse (Wu Xie) Chapter 21: Diseases of Cold and Heat (Han Re Bing)

365.

CHAPTER XI Distinct Channels (Jing Bie)

Chapter 11 of the Lingshu is devoted to the study of the 12 Jing Bie. The Jing Bie constitute a particular system of secondary pathways of the 12 jingmai (principal channels). Their trajectories are long and deep and form an original system of “6 unions” .

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In this manner, the 12 jingmai establish not only a direct, interrelated system of “yin-yang, “interior-exterior” at the level of the organs/bowels and of the hands/feet, but also a system of union with the other parts of the body via the intermediary of the 12 Jing Bie. This is why this chapter is entitled: “Jing Bie” or “Distinct Channels” . This chapter consists of 7 paragraphs.

PARAGRAPH 1 Huangdi: “I have understood it is said that man is in harmony with the Celestial Dao. In the interior, he is endowed with 5 organs in order to respond to the 5 sounds, 5 colors, 5 seasons, 5 flavors, 5 directions... . At the exterior, he has at his disposal 6 bowels to respond to the “6 laws”. These “6 laws” create the yin channels and yang channels to coincide with the 12 months, 12 stars, 12 divisions, 12 jing shui (rivers), 12 hours, 12 jingmai ( 1 ) ... . The 5 organs and 6 bowels are then in accord with the Celestial Dao. The concept of the 12 jingmai constitute the foundation of the notions of health, illness, treatment, cure... . Future doctors begin their study in this way and practitioners integrate it perfectly. The poor doctor neglects it and the good doctor finds it arduous. Please tell me of their “separation” and their “union”. Qi Bo, bowing his head respectfully, replies: “Your question is profoundly worthy. It is quite true that the poor doctor neglects them and the good doctor seeks to study them attentively.”

EXPLANATIONS AND COMMENTARIES I- Zhang Shi explains:

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“Besides the 12 luobie (longitudinal luo) (2), the jingmai (principal channels) also are composed of 12 Jing Bie (Distinct Channels). The 5 directions designate the 5 cardinal points (North, South, East, West and Center), and the phrase “the 6 laws create the yin and yang channels” implies that these channels are the 12 jingmai, 12 luobie and 12 Jing Bie. These 6 laws are grouped together into yin and yang to respond to the “12 months, 12 branches, 12 “hours” of heaven, 12 water courses (jing shui: rivers) of the earth and to the 12 jingmai of man. It is in this way that the 5 organs and 6 bowels respond to the Celestial Dao. The 6 vessels of the 6 organs are linked to the bowels and those of the 6 bowels to the organs. Such is the principal of the circulation of ying-Xue (nutritive energy-blood) within the 12 jingmai. But besides the 12 jingmai, there exists also the Da luo (great luo) and there exists also the Jing Bie (Distinct Channels). For this reason, the poor doctor finds these notions easy and the conscientious doctor regards them as difficult. The separation and union designate the three yang channels detaching from their vessels of origin to unite with the 3 yin channels, and the 3 yin channels detaching from their vessels of origin to unite with the 3 yang channels. Explanation of these notions is found in Chapter 64 (“Discourse on Contrary and Favorable Needling of the 4 Seasons“) of the Suwen: “The great needling, or Cu Ji, is reserved for the jing (principal channels). Because, when the left radial pulse is in fullness, the illness is necessarily on the right and vice versa. In this case, the great needling must be used and performed at the jing (principal channels) and not at the luomai (secondary channels).” 1. See the explanation of all these elements in M.T.C.- N.V.N. 2. See Chapter 10 (“Vessels-Channels) of this classic.

In the previous chapter (Ch. 10 “Vessels-Channels”)) , the word Bie (distinct) encompasses, besides the 12 jingmai (principal channels), the 12 luobie (secondary channels). In contrast, in this Chapter 11, the word Bie designates the Jing Bie (Distinct Channels). 367. The system of jingmai and luobie (Longitudinal or distinct luo) constitutes the “source” (genesis) of the human being. blood and energy, yin and yang can present disturbances and, therefore, initiate illnesses perceived at the level of the pulses; the “singular” (3) illnesses are provoked at the level of the luobie and Jing Bie, explaining the gamut of various treatments : _ epidermal needling _ needling of the channels _ needling on the opposite side _ great needling, etc. because the jingluo (principal and secondary channels) are multiple. These notions appear difficult to conscientious doctors.” II - Ma shi explains : “In this paragraph, Huangdi questions Qi Bo about the terms “Separation” and “Union”. Man follows the movements of the natural world. Because the 5 organs are yin, they respond to : _ the 5 sounds: Jiao (wood), Zi (fire), gong (earth), Zhang (metal) and Yu (water), (4) _ the 5 colors: green (wood), red (fire), yellow (earth), white (metal) and black (water), _ the 5 flavors: sour (wood), bitter (fire), sweet (earth), pungent (metal), salty (water), _ the 5 cardinal directions: North (water), South (fire), East (wood), West (metal) and Center (earth) _ the 5 planets: Xue jing (wood:Jupiter), xing Hua (fire:Mars), Chan jing (earth:Saturn), Tai Bai (metal:Venus) and sheng jing (water:Mercury). (5) The 6 bowels are yang. They respond to the “6 laws” classified as yin and yang in order to determine the 3 yin and 3 yang (taiyin, jueyin, shaoyin, taiyang, shaoyang, yangming) corresponding to the 12 months, 12 branches (6), 12 jing shui (currents of water; rivers) and

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12 jingmai (principal channels). Physiologically, the 12 jingmai are energetic currents which maintain life; pathologically, they determine the processes of the activation of illness and their evolutive principles, and clinically, they play a fundamental role in disease classification, diagnosis and treatment. The concept of the jingmai represents, therefore, a basic theory for those who become initiated into energetic medicine. Wise doctors discern the movements of “separation/union” and “entering/exiting” of the jingmai in their therapeutic research.”

PARAGRAPH 2

368.

1. The “principal” (Zheng) of the Foot Taiyang (Bl) isolates in the popliteal crease, ascends to 5 cun below the coccyx, penetrates into the anus, goes into relation with the bladder, branches to the kidney, runs alongside the paraspinous muscles and distributes to the heart. Another vessel ascends to the neck and inserts into the taiyang (Bl). Such is the circulatory route of the Jing Bie of the Foot Taiyang (Bl). 3. See Chapter 47 (“Essay on the singular diseases) of the Suwen, Volume III- N.V.N. Edition; the phrase “singular diseases” designates illnesses caused by disturbances in the secondary vessels. 4. See Chapter 71 (“Great Study on the Preparation of Cyclic recordings of the 6 Energetic Sources”) of the Suwen, Volume IV- N.V.N. Edition. 5. See Chapter 67 (“Great Discourse on the Circumductions of the “5 movements””) of the Suwen, Volume IV- N.V.N. Edition. 6. See M.T.C., page 36, N.V.N. Edition.

2. The “principal” (Zheng) of the Foot Shaoyin (Ki) also isolates in the popliteal crease, unites with the taiyang (Bl), reaches the kidney and reconnects at the 14th (2nd lumbar) vertebrae to link up with the Daimai (heartvessel); then, beyond that, a vertical vessel reaches the base of the tongue, comes back out via the nucha and inserts into the taiyang (Bl) to constitute (with the preceding Jing Bie) the first system of union. In this way, the Jing Bie of the yin channels unite with all the yang channels.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi comments : 1. “The Foot Taiyang (Bl) and Foot Shaoyin (Ki) constitute the first system of union. The term “principal (Zheng)” implies that, beside the jingmai, there also exists the Jing Bie (Distinct Channels) which are different from the luobie (Longitudinal or distinct luo) described in Chapter 10 (“Vessels-Channels”) of this classic. “Another vessel” implies that the Jing Bie comprise two pathways, one external and one internal. “ ... penetrates within the anus ... comes back out via the neck and inserts into the taiyang” indicates that the Jing Bie emanate from the jingmai, penetrate into the abdomen via the anal route, reach the thorax and arrive at the neck then rejoin the channel of origin.

2. The “principal” of the Foot Shaoyin (Ki) detaches from the principal channel at the popliteal crease, unites with the “principal” of the taiyang (Bl), ascends to the neck, emerges at the 14th (2nd lumbar) vertebrae to anastomose with the Daimai (vessel-belt). A vertical vessel

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leaves the kidney, reaches the base of the tongue, comes back out at the nucha to reunite with the “principal” of the Foot Taiyang (Bl). This fusion of channels constitutes the first system of union. Chapter 6 (“Separation and Reunion of Yin and Yang“) of the Suwen specifies: “Yang being considered as the “principal”, yin becomes the “master”. Above shaoyin is taiyang. In front of taiyin is yangming. And outside jueyin is shaoyang.” 369. This assertion means that yang is the “principal” vessel of yin and that yin commands it. yang is created by yin. This means to say that the principal vessels of the 3 yang unite with the 3 yin to form the Jing Bie (Distinct Channels) of the 3 yin of the foot and hand. As a result, the 3 yang always return toward the principal vessels of the 3 yin. This is why it is said: “They are all principal channels”.” II - Ma Shi comments : “This paragraph defines the first system of union formed by the channels of the bladder and kidney. 1. Foot Taiyang (Bl) has a “distinct branch” which detaches from the principal channel, _ is directed toward the middle of the popliteal crease where one finds weizhong (Bl 40) _ ascends to 5 cun below the coccyx _ passes the point Chengfu (Bl 36) to penetrate into the anus _ arrives at the bladder _ runs alongside the paraspinous muscles up to the region of the heart where it branches. A vertical vessel directly leaves from the paraspinous muscles, that is to say, from the points jineiyushu (or Zhonglushu- Bl 29), Pangguanshu (Bl 28), etc., _ reaches the nucha _ and inserts into the Foot Taiyang (Bl), at the point Tianzhu (Bl 10). Such is the trajectory of the Distinct Channel (Jing Bie) of the bladder.

2. The Foot Shaoyin (Ki) is the principal vessel of the kidney channel. It starts at the point Yongquan (Ki 1), reaches the internal malleolus, arrives at the popliteal crease, gives rise to a “distinct branch” which unites with the Foot Taiyang (Bl) at the point weizhong (Bl 40). It ascends to the kidney, _ exits at the level of the 14th (2nd lumbar) vertebrae via the point shenshu (Bl 23) to link up with the Daimai (vessel-belt) _ a vertical vessel directly reaches the base of the tongue _ comes back out at the nape to reunite with the Foot Taiyang (Bl) at the point Tianshu (Bl 10) forming, in this manner, the first system of union (Figures 42 and 43). In this way, the presence of the yang channels summon those of the yin channels, and the Jing Bie of these yin unite with the yang channels.

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370.

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Figure 42. Distinct Channels of the Bladder and kidney (first system of union) After “Theory and Practice of Acupuncture Analgesia” (N.V.N. Edition) 371.

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Figure 43 : Synthetic study of the first system of union (Distinct Channel of the Bladder and kidney)

PARAGRAPH 3 1. The “principal” of the Foot Shaoyang (GB) encircles the inguinal region, penetrates into the pubic hair, unites with the jueyin (Li), reaches the hypochondria (Ji Lie), penetrates into the thorax, branches to the gallbladder, ascends to the liver, traverses the heart, reaches the laryngo-pharyngeal apparatus, reappears at the chin, spreads to the face, integrates with the ocular system and unites with the Foot Shaoyang (GB) at the external canthus of the eye. 2. The “principal” of the Foot Jueyin (Li) detaches from its channel of origin at the top of the foot, ascends to the pubic hair, unites with the Foot Shaoyang (GB) and circulates together with it to constitute the second system of union.

EXPLANATIONS AND COMMENTARIES

372...

I - Zhang Shi explains : 1. “ The Foot Shaoyang vessel starts at the external canthus of the eye, reaches the head and face, descends to the dorsum of the foot where the trajectory of departure of the Jing Bie is located. The latter encircles the internal surface of the thigh, ascends to the external canthus of the eye and reunites with its channel of origin, the Foot Shaoyang (GB). The principal channel of the gallbladder and its Jing Bie circulate, therefore, in opposite directions.

2. The “principal” of the Foot Jueyin (Li) starts at the dorsum of the foot, arrives at the pubic hair, unites with the Foot Shaoyang (GB) forming, in this way, the second system of union.” (Figures 44 and 45)

II - N.V.N. : Commentary by Ma Shi on this paragraph could not be found.

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373.

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Figure 44 : Distinct Channels of the Gallbladder and liver (second system of union) After “Theory and Practice of Acupuncture Analgesia” (N.V.N. Edition) From 1 to 8: circulatory direction 374...

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Figure 45 :

PARAGRAPH 4

Synthetic study of the second system of union (Distinct Channel of the Gallbladder and liver) 372....

The “principal” (Zheng) of the Foot Yangming (St) arrives at the inner thigh (Bi), penetrates into the abdomen, goes into liason with the stomach, branches to the spleen, communicates with the heart, arrives at the laryngo-pharyngeal apparatus, reaches the mouth, ascends to the forehead, links up with the ocular system and unites with the yangming (St). The “principal” of the Foot taiyin (Sp) arrives at the inner thigh, unites with yangming (St), circulates together with the Jing Bie of this latter, links with the laryngo-pharyngeal apparatus and penetrates deeply into the tongue. This is the third system of union.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains : “The word Bi (or Be) designates the inner thigh. After the point Futu (St 32), the point Biguan (St 31) is found, which means “door of the thigh”. 1. The “principal” of the Foot Yangming (St) starts at the top of the foot, _ arrives at the inner thigh _ penetrates into the abdomen and thorax _ arrives at the face and head _ unites with the Hand Yangming (LI) in the space where the points Chengqi (St 1) and sibai (St 2)are found. This trajectory constitutes a circulation opposite to that of the principal

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channel (Foot Yangming- St). 2. The “principal” of the Foot Taiyin (Sp) detaches from its channel of origin, _ reaches the internal face of the thigh

374.

_ unites with the Jing Bie of the yangming (St) _ circulates together with it _ inserts into the laryngo-pharyngeal apparatus _ and penetrates deeply within the tongue. This is the third system of union.” (Figures 46 and 47)

II - Ma Shi comments : “This paragraph concerns the third system of union formed by the distinct channels of the stomach and spleen. 1. Chapter 10 (“Vessels-Channels”) of this classic addresses the circulatory movements of the energy of the principal channel of the stomach, which starts at the point yingxiang (LI 20) and ends at the point Lidui (St 45). In contrast, in this paragraph, the circulation begins at the jing, ying, shu, jing and he points located at the lower part of the body and reascends toward the upper part. This is why it is said: The “principal” (Zheng: distinct channel) starts at the tip of the 2nd toe, _ reaches the top of the foot 376.... _ runs alongside the external surface of the leg up to the knee _ arrives at the points Futu (St 32), Biguan (St 31) and qichong (St 30) _ penetrates within the abdomen _ links up with the stomach _ traverses the heart _ enters into Quepen (supra-clavicular fossa) _ reaches the laryngopharyngeal apparatus _ arrives at the mouth _ ascends toward the side of the nose _ and unites with the “jing Sui” (“satisfying vessels”; or segmental linking vessels) of the Foot Yangming (St).

The circulation of the Jing Bie of the stomach takes place, therefore, in the opposite direction to that of the principal channel of origin.

377...

2. The Foot Taiyin (Sp) and Foot Yangming (St) are in “yin-yang”, “interior-exterior” relationship. Their Jing Bie interacts with the points Biguan (St 31) and qichong (St 30), where the longitudinal luo (Luo Bie) of the stomach also arrives. Together, they penetrate into the abdomen and thorax, arrive at the laryngo-pharyngeal apparatus, connect to the base of the tongue and enter deeply there. These Jing Bie of the stomach and spleen form the third system of union.” (Figures 46 and 47).

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375.

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Figure 46 : Distinct Channels of the stomach and spleen (third system of union) After “Theory and Practice of Acupuncture Analgesia” (N.V.N. Edition) From 1 to 8: circulatory direction 376....

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Figure 47 : Synthetic study of the third system of union (Distinct Channel of the stomach and spleen)

PARAGRAPH 5

377...

The “principal” of the Hand Taiyang (SI) “belongs to the earth”. It starts at the shoulder, penetrates into the axilla, reaches the heart and attaches to the small intestine. The “principal” of the Hand Shaoyin (He) reaches Yuanye (GB22), at the level of the 2 tendons, links up with the heart, reaches the laryngopharyngeal apparatus, exits from the face and unites at the internal canthus of the eye. This is the fourth system of union. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains : “The “principal” of the Hand Taiyang (SI) belongs to the earth” expresses that the connection of the Hand Taiyin (Lu) and the taiyang is located at the bottom because the 12 jingmai are divided into Shou (hand) and Zu (foot). When one speaks of the two energies, yin and yang, one elaborates on the 3 yin and 3 yang without dividing them into hand and foot. The 6 bowels manifest from the 3 yang of the foot which unite above with those of the hand. This is why the “principal” of the Hand Shaoyin (He), located above, manifests at the eyes and unites with the Foot Taiyang (Bl) at the point jingming (Bl 1), at the internal canthus of the eye. Such is the situation of the union of water and fire of the top and bottom of the body. Logically, the Hand Taiyang (SI) responds to water and the Hand Shaoyin (He), to fire: heaven follows the number 1 to create the water of earth, and the number 2, to create fire; fire is at the top and water, at the bottom; it fulfills therefore the phenomena of exchanges of potential between yin and yang. This is why the Hand Taiyang (SI), belonging to earth, circulates toward the

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bottom to unite with Zu (foot), and the Hand Shaoyin (He) is directed above to unite with the bladder channel (taiyang). Such is the dissertation on water and fire of heaven and earth whose exchange, originating from their “top-bottom” positions, always conducts them in an original state, that is to say, reduces them to one single and unique energy (7). It is also so in the human being, the organs/bowels and jingmai respond to the Celestial Dao.” 378...

II - Ma Shi comments : “This paragraph explains the formation of the fourth system of union. 1. The Hand Taiyang (SI) channel starts at the tip of the little finger, runs alongside the external side of the hand, reaches the wrist, follows the forearm, arrives at the elbow, passes to the outside surface of the arm up to the shoulder, penetrates into Quepen (supra-clavicular fossa), descends toward the heart, reascends to the laryngopharyngeal apparatus, redescends toward the diaphragm, arrives at the stomach and links up with the small intestine. This is why, the text states, “ ... penetrates into the axilla, reaches the heart and attaches to the small intestine.” 2. The Hand Shaoyin (He) and Hand Taiyang (SI) channels form a “yin-yang”, “interiorexterior” system. The Hand Shaoyin (He) starts at the heart, reaches the “heart” system (Xin he) (8), descends to the diaphragm and links up with the small intestine. A vessel leaves the “heart” system, arrives at the lung, reaches the point Yuanye (GB 22) below the laryngopharyngeal apparatus, leaves via the face and unites at the internal canthus of the eye, at the point jingming 7. See “The Monistic System” (energetic system reducible to unity), Volume I of the “Art and Practice of AcupuntureMoxabustion” According to the Da Cheng, page 287. N.V.N. Edition. 8. The system “heart” implies the system “heart-Master of heart”.

(Bl 1) where a vessel of the Hand Taiyang (SI) also arrives. This is the fourth system of union.” (Figures 48 and 49) 379.

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Figure 48 Distinct Channels of the heart and small intestine (4th system of union) After “Theory and Practice of Acupuncture Analgesia” (Edition N.V.N.) From 1-4: circulatory direction

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Figure 49: Synthetic study of the fourth system of union (Distinct Channel of the Small intestine and heart)

PARAGRAPH 6

378.

The “principal” of the Hand Shaoyang (SJ) belongs to heaven. It starts at the vertex of the cranium, penetrates into Quepen (supraclavicular fossa), descends to the sanjiao (SJ) and disperses into the thorax. The “principal” of the Hand Jueyin (XB) descends to the axilla to the point Yuanye (GB 22), penetrates into the with the sanjiao (SJ), ascends to the laryngo-pharyngeal reaches behind the ear and unites with the shaoyang (SJ) point Wangu (GB 12). This is the fifth system of union.

3 cun below thorax, links apparatus, below the

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “ 1. The shaoyang is primary yang created by yin. Consequently, from the bottom, it is directed toward the top. The term “principal” of the Hand Shaoyang” expresses that Shou (hand) must unite with Zu (foot), and the term “... belongs to heaven” explains that Zu (foot) must unite with Shou (hand). When one studies the system of the two channels “shaoyang/jueyin” (SJ-XB), one determines the nature of the 6 unions. In contrast, when one studies it according to the yin energy and yang energy, one only analyzes the 3 unions. 380.

2. Yuanye (GB 22) belongs to the Foot Shaoyang (GB) channel. It is located 3 cun below the

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axilla. The “principal” of the Master of the heart (xin bao luo) of the hand descends to Yuanye (GB 22) to penetrate into the thorax; it links up with the sanjiao (SJ), _ reaches the laryngopharyngeal apparatus _ emerges behind the ear _ rejoins the shaoyang (SJ) _ unites below the point Wangu (GB 12). This is the fifth system of union.” (Figures 50 and 51) II - Ma Shi clarifies: “This paragraph concerns the system of union of Hand Shaoyang (SJ) and Hand Jueyin (XB). 1. Hand Shaoyang (SJ) starts at the tip of the little finger. reaches the wrist, arrives at the elbow, ascends the arm to the shoulder, descends to Quepen (supraclavicular crease, arrives at the sanjiao (SJ) and disperses into the thorax. From the fact that its Jing Bie takes off from the vertex, the text qualifies the shaoyang (SJ) channel as “belonging to heaven”. 381....

2. The Jing Bie of the Hand Jueyin (XB) begins at Tianchi (XB 1) below the axilla, _ penetrates into the thorax and abdomen, _ joins with the sanjiao (SJ), _ reascends to the thorax, _arrives behind the ear, _and unites with the Hand Shaoyang (SJ) below the point Wangu (GB 12), that is to say, at the point Tianfu (SJ 16), to form the fifth system of union.” (Figures 50 and 51) 382.

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Figure 50: Distinct Channels of xinbao and sanjiao (fifth system of union) After “Theory and Practice of Acupuncture Analgesia” (N.V.N. Edition) From 1 to 4: circulatory direction 383....

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Figure 51: Synthetic study of the fifth system of union (Distinct Channel of the sanjiao and xinbao)

PARAGRAPH 7 The “principal” of the Hand Yangming (LI) leaves from the arm at the level of the breast, arrives at the point Jianyu (LI 15), reaches the 7th cervical vertebrae, descends to Quepen (supraclavicular fossa), arrives at the large intestine, joins with the lung, reascends to the laryngopharyngeal apparatus, comes back out at Quepen and unites with the yangming (LI). The “principal” of the Hand Taiyin (Lu) penetrates into the point Yuanye (GB 22) in front of the shaoyin (He) vessel, enters the lung, branches to the taiyang (SI), reascends to Quepen, runs alongside the laryngo-pharyngeal apparatus and unites with the yangming (LI) to constitute the sixth system of union.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi clarifies: “ 1. The “principal” of the Hand Yangming (LI) follows the jingmai of the hand up to the arm, at the height of the breast, detaches from its channel of origin and arrives alone at Jianyu (LI 15), reaches the area underlying the 7th cervical vertebrae to the point Dazhui (GV 14), descends towards the large intestine, links with the lung, reascends to the laryngopharyngeal apparatus, comes back out at Quepen and unites with the jingmai of Hand Yangming (LI). 2. The “principal” of the Hand Taiyin (Lu) separates from its channel of origin at the level of the area of the points Zhongfu (Lu 1) and Yunmen (Lu 2),

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_ _ _ _ _ _ and 53)

arrives at the point Yuanye (GB 22) is directed to the front of the taiyin (Lu) arrives at the lung and the region near the heart where it branches to the taiyang (SI) reascends to Quepen reaches the laryngo-pharyngeal apparatus unites with Hand Yangming (LI) to constitute the sixth system of union.” (Figures 52 383.

II - Ma Shi comments : “This paragraph concerns the system of union of the large intestine and lung channels. 1. The “principal” of the Hand Yangming (LI) leaves at the point Jianyu (LI 15), _ reaches Dazhui (GV 14) _ descends to the large intestine and links up with the lung _ reascends to the laryngo-pharyngeal apparatus _ and unites with the Hand Yangming (LI), its channel of origin, at the point Futu (LI 18).

2. The “principal” of the Hand Taiyin (Lu) reaches Yuanyue (GB 22), _ joins the xinbao (XB) channel _ passes in front of the Hand Shaoyin (He) _ arrives at the lung _ connects to its channel of origin _ reascends to Quepen 384. _ reaches the laryngo-pharyngeal apparatus _ and unites with the Hand Yangming (LI) at the point Futu (LI 18) to constitute the sixth system of union.” (Figures 52 and 53) 385.

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Figure 52 : Distinct Channels of lung and large intestine (sixth system of union) After “Theory and Practice of Acupuncture Analgesia” (N.V.N. Edition) From 1 to 5: circulatory direction 386...

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Figure 53 : Synthetic study of the sixth system of union (Distinct Channel of the large intestine and lung)

III - N.V.N.: 384. In conclusion, the Jing Bie (distinct channels) are vessels belonging to the 12 jingmai (principal channels). They differ from the other luomai (secondary vessels) and constitute a particular system of pathways derived from the principal channel.

I. Original system of inter-unions The Jing Bie do not possess a “yin-yang, interior-exterior” system of relationship characteristic of to the 6 yin and 6 yang channels, but establish an original system of “6 unions”: 1. The Jing Bie of the Foot Taiyang (Bl) and that of the Foot Shaoyin (Ki) unite below at the popliteal crease at weizhong (Bl 40), and above at the nucha at Tianzhu (Bl 10) (Fig. 42 and 43). 2. The Jing Bie of the Foot Shaoyang (GB) and that of the Foot Jueyin (Li) unites below at the pubis symphysis at the point Qugu (CV 2), and above at the external canthus of the eye at the point Tongziliao (GB 1) (Fig. 44 and 45). 3. The Jing Bie of the Foot Yangming (St) and that of the Foot Taiyin (Sp) unite below at the groin at the point qichong (St 30), and above at the neck at renying (St 9) (Fig. 46 and 47). 4. The Jing Bie of the Hand Taiyang (SI) and that of the Hand Shaoyin (He) unite below at the sub-axillary region at the point Yuanye (GB 22), and above at the internal canthus of the eye at the point jingming (Bl 1) (Fig. 48 and 49). 5. The Jing Bie of the Hand Shaoyang (SJ) and that of the Hand Jueyin (XB) unite below at the sanjiao bowel (shangjiao, zhongjiao, xiajiao), and above below the mastoid process at the point Tianfu (SJ 16) (Fig. 50 and 51). 6. The Jing Bie of the Hand Yangming (LI) and that of the Hand Taiyin (Lu) unite below at

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the large intestine bowel, and above at the neck at the point Futu (LI 18) (Fig. 52 and 53). In this way, the 12 jingmai (principal channels) possess not only a direct system of interrelation at the level of the organs/bowels and at the foot/hand, but also an indirect system of “inter-union” in the other parts of the body via the intermediary of the Distinct Channels.

II. Physiologic role The Jing Bie reinforce the circulatory paths of the jingmai in the interior of the organism. 1. They reinforce them by their connection with the yang channels. The Jing Bie begin at the level of the great articulations and become intraabdominal and intrathoracic to reach the organs/bowels; then they cross the heart before emerging at the neck, nucha or face and project themselves exclusively into the yang channels. 2. This connection explains the fact that the 12 jingmai are not only dependent on their own system of inter-union, but also on the system of “entering/exiting-separation/union” of the distinct channels. The organization of these latter systems is more complex than those located at the level of the feet/hands. In other words, the physiological activities of the organism depend not only on the 12 jingmai (principal channels), but also on the 12 Jing Bie. 3. The role of the Jing Bie is complementary to that of the jingmai because _ the regions not covered by the jingmai are under the control of the Jing Bie. _ the yin principal channels all have one influence on the head and face (with the exception of the jueyin- Li), although their trajectories ends at the thorax and pharynx. This action explains the fact that the 6 yin distinct channels collateralize from the yin principal channels, arriving at the neck or the face, to anastomose with the collateral yang distinct channels from the yang channels. The yang principal channels located at the facial-cervical area, therefore, receive the blood and energy of the yin distinct channels. 387.

III. Disease description and classification and therapeutic nature Chapter 11 describes the circulatory routes of the 12 Jing Bie, but does not mention disturbances which can affect them. Nevertheless, by therapeutic plan, one can choose “the points following the channels” based on the yin or yang nature of the illness and symptomatology. The study of the classification of the 12 jingmai shows us that there exists numerous illnesses that are located outside of the area of the principal channels; they localize within the area of the Jing Bie (distinct channels). One understands as well that the distinct channels have a certain role in physiology and that they can be sites of attack of the illness. The action of the points of the principal channels outside their trajectories, therefore, allows explaining that of the distinct channels. In this manner, for example, the principal channel of Hand Jueyin (XB) does not reach the neck, but its points, Jianshi (XB 5) and Daling (XB 7), act on ailments of the laryngo-pharyngeal apparatus. This is to say that the symptomatology of the distinct channels on the whole may be superimposable on that of the corresponding principal channel. They nevertheless call attention to the intermittent nature of some clinical signs. This particular characteristic establishes the treatment by “needling on the opposite side” . In-depth study of the text, particularly of the explanations of Zhang and Ma, allow us to draw more analytic and more precise outlines according to the thinking of our times, toward the

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goal of better grasping the energetic physiology of the Jing Bie.

no 388/389

CHAPTER XII River Ways (jing shui)

Chapter 12 of the Lingshu is devoted to the 12 rivers (qing, wei, Hai, he, Ru, Zang, Huai, Lei, Jiang, Ha, Ji and Zhang) of Huangdi’s era. These rivers are differentiated by their extent, depth, source, location and length. They are used as an

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example of similarity with the 12 jingmai (principal channels). This analogous study illustrates more than ever the symbiosis of man with the natural world, particularly due to the conformity of the depth and length of each channel with that of a waterway (river). In this way, one can deduce by analogy that the depth of needling and the time to leave the needle in permanently at the level of the energetic points and channels must be established according to precise constants. This chapter has the basic property: _ of establishing a parallel study of the 12 jingmai with that of the 12 rivers (jing shui) in the search for the depth of implantation of the needle and its duration permanently at the level of the 3 yin and 3 yang of the hand and foot. _ and of making us understand needling as a function of age, build and the constitution of the individual. It is only after having assimilated all these components that one will be able to resolve the problem of emptiness and fullness. This is why this chapter is entitled “jing shui” (waterways; rivers). This chapter consists of 4 paragraphs.

PARAGRAPH 1

390.

Huangdi questions Qi Bo: “At the exterior, the jingmai respond to the 12 jing shui, and in the interior they belong to the 5 organs and 6 bowels. The 12 jingmai differ in their extent, depth and distance. In contrast, the 5 organs and 6 bowels are distinguishes by their location at the top or bottom, their morphology, their utilization and reception of nutritive substances... . What then are their correspondences?” The jing shui contain water for their circulation; the 5 organs combine the shen qi (mental energy), hun (vegetative soul) and po (sensitive soul) for their reception; the 6 bowels receive the “cereal” water (nutritive liquid) for their transport and energy for their activity; the jingmai contain ying-Xue (nutritive energy-blood) for their impregnation... . How then are all these elements combined to execute a treatment? Is it necessary to needle superficially or deep? What is the number of moxas to utilize? I would like to clearly understand you.” Qi Bo responds: “ The height of heaven is unfathomable and the size of earth immeasurable. Man being born in the space between heaven and earth, within the 6 Unions (1), the height of heaven and the magnitude of earth cannot be measured by the human mind.

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As for the body of man, the skin and flesh are well localized and can be examined by simple palpation of the fingers. At death, autopsy permits recognizing the firmness and suppleness of the organs, the magnitude or narrowness of the bowels, the quantity of food products absorbed, the length of the vessels, the purity or impurity of the blood, the abundance or shortage of energy... and among the 12 jingmai, which contain more blood than energy, less blood and more energy, much blood and energy, less blood and energy... . All that is well known. In therapy, acupuncture and moxabustion are used with the purpose of balancing the energy of the channel according to a precise “number”.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph establishes the parallel study of the 12 jingmai and 12 jing shui. The jing shui are distinguished by their expanse, depth... and the 5 organs by their locations, morphology... . But if the height of heaven and the size of earth are difficult to estimate, man’s body can be examined by the methods of measurement, palpation and dissection.

1.“6 Unions” indicates Top (heaven) and Bottom (earth) and the 4 cardinal points: North (front), South (back), East (right) and West (left).

As for treatment, acupuncture and moxabustion are executed as a function of precise “numbers”. Example: 0.6 cun depth, 7 expirations, 3 moxas, etc.” II - Ma Shi comments: “This paragraph concerns the correspondence between the 12 jingmai and 12 jing shui. This correspondence permits determining the “number” of needling and moxabustion. The jing shui differ in their surface, depth and length, and the 12 jingmai also by their size, location and energetic and blood content. Moreover, the 5 organs receive the shen, qi, hun and po, while the 6 bowels receive foods and transform them into energy intended for all organic systems of the body. Therefore, when one compares the organs/bowels and the 12 jingmai to the 12 jing shui, one notices that needling can be deep or superficial and that the quantity of leaves of artemesia (moxa constituent) is variable. Yet, all these are perfectly enumerated. Why? Qi Bo has said: “The height of heaven is unfathomable, and the size of earth immeasurable. But the human body can be dissected in light of examining the state of the organs and bowels, the quantity of absorbed food, the length of the vessels, the state of the purity of the blood... . As for treatment, deep or superficial needling and the number of moxas used are copied exactly from the extent and depth of the jing shui”. This explanation will be detailed in the following paragraphs.”

PARAGRAPH 2 Huangdi: “I have heard you with joy, but, sincerely, I have not entirely understood. Please tell me more.” Qi Bo:

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and to earth, to yin and to yang. One must indeed delve deeply into them because, _ at the exterior, the Foot Taiyang (Bl) responds to the water of the river q i n g , and in the interior, it belongs to the bladder. It is in that way that the shui Dao (waterways) are carried out. _ at the exterior, the Foot Shaoyang (GB) responds to the water of the river w e i , and in the interior, it belongs to the gallbladder. _ at the exterior, the Foot Yangming (St) responds to the water of t h e river H a i , and in the interior, it belongs to the stomach. 392. _ at the exterior, the Foot Taiyin (Sp) responds to the water of the river h e , and in the interior, it belongs to the spleen. _ at the exterior, the Foot Shaoyin (Ki) responds to the water of the river R u , and in the interior, it belongs to the kidney. _ at the exterior, the Foot Jueyin (Li) responds to the water of the r i v e r Zang, and in the interior, it belongs to the liver. _ at the exterior, the Hand Taiyang (SI) responds to the water of t h e r i v e r Huai, and in the interior, it belongs to the small intestine. It is in that way that the water ways (shui Dao) exit. _ at the exterior, the Hand Shaoyang (SJ) responds to the water of t h e r i v e r Lei, and in the interior, it belongs to the sanjiao (SJ) _ at the exterior, the Hand Yangming (LI) responds to the water of the river J i a n g , and in the interior, it belongs to the large intestine. _ at the exterior, the Hand Taiyin (Lu) responds to the water of the river H a , and in the interior, it belongs to the lung. _ at the exterior, the Hand Shaoyin (He) responds to the water of the river Ji, and in the interior, it belongs to the heart. _ at the exterior, the Hand Jueyin (XB) responds to the water of the river Z h a n g , and in the interior, it belongs to the xinbao (XB).

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The 3 yin and 3 yang unite with the 6 energies of heaven, and Shou and Zu (hand and Foot) channels respond to the 12 jing shui of earth. At the exterior, the 12 jingmai unite with the 6 energies, and in the interior, they belong to the organs and bowels. This is why, at the exterior, the 3 yin and 3 yang of the foot and hand respond to the 12 jing shui, and the jing shui unite with the organs and bowels. This indicates that man unites with heaven and earth and responds to yin and yang.

1. The qing shui (Clear River) originates from the union of two rivers, the Huangha and Huai. The lung responds to heaven and governs the energy, and the bladder is the “palace” of the organic liquid; both adapt to the energetic transformations to emit their movements. The liquid substance contained in the bowels is impure, except that of the bladder. For this reason, the Foot Taiyang (Bl) unites with the exterior at qing shui, and in the interior with the bladder, and it is in that way that the waterway circulates. 2. The wei shui takes its source at ying Zhou and unites with the rivers jing, Ru, Xi, Jiu, Min, etc. among which the water of the wei river is pure. The liquid substance responding to the yang channels is impure, except that contained in the gallbladder. This is why the Foot Shaoyang (GB) responds to the exterior at wei shui and unites in the interior with the gallbladder.

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3. The Hai shui is immense and overflows; the earth is found then under the Hai. The yangming, located at the Center-earth by which all beings return, is the “sea” of the cereal water (nutritive liquid). This is why the Foot Yangming (St) unite at the exterior with the Hai shui and in the interior with the stomach. 393.

4. The he shui is composed of 5 lakes which are the Dong, Ding, Bengze, Zanze, etc. The spleen, located at the center, permeates the four sides; this is why the Foot Taiyin (Sp) unites at the exterior with the he shui, and in the interior, with the spleen. 5. The Ru shui takes its source from hanam, at Tainzu Mountain; hanam Province is located in “the space between heaven and earth” (read: high region), and Tianzu reaches the “central limit of heaven” (means: high altitude). Because the celestial energy envelops the earth and penetrates deeply there, this mountain has the name Tianzu (celestial landscape). The kidney governs water and constitutes the source of production of energy; above, it attaches to the laryngo-pharyngeal apparatus to control the respiratory movements; this is why the Foot Shaoyin (Ki) responds to the exterior at Ru shui and in the interior it unites with the kidney. 6. The Zang shui takes its source at the Linzi in qing Zhou Province. To the west, it flows into the Huai river. All the courses of water flow toward the east, except the Zang shui which circulates toward the west. This is why it responds to the Foot Jueyin (Li), that is to say, to “West-liver-wood”. 7. The Huai shui receives the water of the sea and flows into two rivers, Huai and si. The small intestine contains the liquid substances coming from the stomach. These will be decanted along the entire length of their passage (2) to the bladder. This is why the Hand Taiyang (SI) responds to Huai shui at the exterior, and in the interior, it belongs to the small intestine. 8. The Lei Ji is a large river located to the northwest. The Lei unites with the Ji and flows down into Xuan and You Provinces. The shaoyang is an imperial officer; yin and yang are linked; this is why at the exterior the Hand Shaoyang (GB) responds to the Lei Ji, and in the interior, it belongs to the sanjiao (SJ). 9. The Jiang shui takes its source in the west at Zanshan Mountain. Its current is tortuous and flow down toward the east where it flows into the sea. The large intestine accumulates the food wastes and decants from it the liquid substances. These follow the tortuous way of the bowel equipped with 16 lops before arriving at the bladder. This is why at the exterior the Hand Yangming (LI) responds to Jiang shui, and in the interior, it belongs to the large intestine. 394.

10. The Ha shui takes its source from the jing Zu Sea and arrives at the Gao wei. Its course is a thousand miles and only forms a single bend. The lung belongs to geng-metal (“geng”, name of the 7th Celestial trunk) and responds to heaven; it is the source-producer of the liquid substance. This is why at the exterior the Hand Taiyin (Lu) responds to Ha shui, and in the interior, it belongs to the lung. 11. The Ji shui takes its source from Wan Wu Shan Mountain and flow down toward the Huang Ha River; its water is clear, hence the name qing Ji. Its bed is narrow, but its role is sizable. The heart is the sovereign organ whose role is also sizable. This is why at the exterior the Hand Shaoyin (He) responds to Ji shui, and in the interior, it unites with the heart. 12. The Zhang shui has two tributaries of which one takes its source in Shang Dan Dai Meng Mountain and has the name qing Zhang (pure Zhang), and the other takes its source at the foot of luo Gu Mountain and has the name Zhuo Zhang (impure Zhang). These two rivers come,

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therefore, from different sources to unite at the delta. The blood, equipped with shen qi (mental energy), is a pure substance circulating in the yin governed by the heart and it is associated with the xin bao luo (XB) to control the circulation of this pure substance within the jingmai. This is why at the exterior the Hand Jueyin (XB) responds to Zhang shui, and in the interior, it unites with the xin bao luo (XB). Man responds, therefore, to heaven and earth, to yin and yang. On the other hand, the 5 organs/6 bowels and 12 jing shui (rivers) cited above therefore possess one origin at both the interior and exterior. This communication/circulation takes place in a circle without end. It is the same for the 12 jingmai (principal channels). This is why: _ heaven is yang and earth is yin. _ the region located from the lumbars up to the top belongs to heaven and that located from the lumbars to the bottom belongs to earth. This is why: _ the Hai River flowing down toward the north is yin _ the he River also flowing down toward the north is yin in yin _ the Ha River flowing toward the south to the Zhang river is yin in yang. _ the Lei River flowing down toward the south to the Jiang River is the taiyang in yang. In relation to these rivers and mountains, man in eternal movement is a little element who also responds to heaven and earth.” 2. The food/nutritive liquids are not only purified and decanted in the small intestine, but also successively at the level of the large intestine, kidney, bladder and gallbladder. This passage has been designated by Chamfrault and ourselves in 1969 under the name “Internal Canal of the sanjiao (SJ).

II - Ma Shi comments: 395. “The reason why Qi Bo associates the organs/bowels with the 12 jing shui (rivers) is the following: At the top, heaven is yang. At the bottom, earth is yin. In the living being: _ the region located from the lumbar vertebrae up to the top corresponds to heaven _ and the region located from the lumbar vertebrae to the bottom responds to earth. This is why the jing shui (rivers) are regrouped according to their orientation (East, West, South, North) to divide them into yin and yang. It is the same for the organs/bowels which are classed according to their correspondences (East, West, South, North) in order to respond to the 12 jing shui; this explains the adage: “Man unites with heaven and with earth”.”

III - N.V.N.: A - The study of the sites of flowing of the jing shui (rivers) permits determining their yin and yang aspect and their direction (East, West, South, North). Like the jing shui, the jingmai (principal channels) are divided according to the criteria “front/back “(upstream-downstream), top/bottom” (mountain-plain) and comprise a very precise location and well-determined yin-yang nature.

1. The Hai shui adopting the north is yin. The Hai shui responds to the stomach channel (Foot Yangming). Based on the law of Orientation/Location of Fu Hi (3), according to which “left represents East; right, West; top, South; bottom, North”, “the Hai River adopting the North” designates the two channels “gallbladder and bladder” which are located below the stomach channel. similarly, based on the principle according to which “below the lumbar region is yin”, the Hai River designates the 3 yang channels of the foot among which:

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_ the Foot Yangming (St) is found in front _ the Foot Shaoyang (GB) is located in the middle (center) _ the Foot Taiyang (Bl) is localized in back. In the supine position, the gallbladder and bladder channels are underneath the stomach channel. This is why, the Hai River adopting North is yin.

2. The he shui adopting the North is yin in yin.

396.

The he River responds to the spleen channel (Foot Taiyin). “The he River adopting the north” designates the 2 channels “liver-kidney”, located below the stomach channel. “yin in yin” represents the internal surface of the lower limb. This term explains the position of the 3 yin channels of the foot: _ the Foot Taiyin (Sp) is found in front _ the Foot Jueyin (Li) is found in the center _ the Foot Shaoyin (Ki) is found in back. In the supine position, the liver and kidney channels are underneath the spleen channel. This is why the he River adopting the north is yin in yin.

3. The Zhang shui adopting the South is yang. The Zhang River responds to the xinbao (XB) channel. “The Zhang River adopting the south” designates the lung channel located above the xinbao (XB) channel. 3. Designated under the name “Ba Que” or “8 Spatio-temporals”. For Westerners, is concerns the “8 Trigrams”.

Based on the principle according to which “above the lumbar region is yang”, the xinbao (XB) and lung channels are located on the upper limb; the second is found in front of the first. In the supine position, the xinbao (XB) channel is below the lung channel. This is why the Zhang River adopting the south is yang.

4. The Ha shui extending toward the north , ending up at the Zhang River, is yin in yang. The Ha River responds to the lung channel (Hand Taiyin). “The Ha River extends towards the north and ends up at the Zhang River” corresponds to the union of the Ha River with the lung channel and xinbao (XB) channel. “yin in yang” designates the internal part of the upper limb. In the supine position, above the channel of xinbao (XB) the lung channel is found. This is why the Zhang River adopting the north and ending up in the Zhang River is yin in yang. 5. The Lei shui adopting the South and ending up in the Jiang River is taiyang in yang. The Lei River responds to the sanjiao (SJ) channel (Hand Shaoyang). A - “taiyang in yang” designates the external side of the upper limb and expresses the external localization of the sanjiao (SJ) channel and large intestine channel; this latter (LI) is found in front of the first (SJ), which is at the center. In the supine position, the sanjiao (SJ) channel is underneath the large intestine channel. This is why The Lei River adopting the south is taiyang in yang. B - The 5 organs/6 bowels manifest at the exterior from their source and torrent, and in the interior, each of these elements is under the same influence of the natural world. It is a matter of a comparison to reestablish the reciprocal relation/penetration between the interior and exterior, like a circle in perpetual motion. 397. 1. The jingmai (principal channels) spread everywhere to the exterior of the organism, and in the interior, they belong to the organs/bowels. At the exterior as in the interior, their perpetual circulatory system resembles that of rivers. 2. Among yin and yang natures, top is yang and bottom is yin. Therefore, it is said of

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the universe that: _ heaven, at the top, is yang _ and earth, at the bottom, is yin. In man, it is said that the lumbar region _ up to the top, belonging to heaven, is yang. _ down to the bottom, belonging to earth, is yin. 3. Based on the classical method (4) of the localization of yin-yang, heaven is at the South and earth is at the North. This is why: a) The Hai shui adopting the north is yin. Because: _ the stomach channel responds to the river Hai _ the gallbladder channel and bladder channel, leaving from the area belonging to the stomach channel to the bottom, go from the head to the feet and from the lumbar region to the bottom and become distributed into the yin part (lower limb). b) The he shui adopting the north is yin in yin. Because: _ the spleen channel responds to the river he. _ the liver channel and kidney channel arrive up to the thoracic region which is yin, and at the bottom, they come from the internal region of the lower limbs which is also yin. c) The Zhang shui adopting the south is yang. Because: _ the xinbao (XB) channel responds to the river Zhang _ the lung channel is above that of the xinbao (XB) which is at the top of the 4. Law of orientation/location of Fu Hi called “Ba que” or “8 spatio-temporal signs”. See page 363.

lumbar region and is found on the upper limb (which is yang). d) The Ha shui adopting the north, ending up at the river Zhang, is yin in yang. In effect: _ the lung channel responds to the river Ha _ ending up at the river Zhang, it unites with the region belonging to the xinbao (XB) and distributes to the posterior surface (which is yin- energetic description) of the upper limb (which is yang). e) Lei shui adopting the south, ending up at the river Jiang, is taiyang in yang. In effect: _ the sanjiao (SJ) channel responds to the river Lei. _ at the top to the river Jiang, it unites with the region belonging to the large intestine channel. Together, they become distributed to the anterior side (which is yang- energetic description) of the upper limb (which is also yang). 398.

In this manner, from the river network of ancient China and the yin-yang system of the jingmai (principal channels), one can explain the perfect resonance of the human being with the natural world. This paragraph describes the 12 jing shui which are the 12 great rivers of the time of Huangdi, whose name, extent, depth and place of flowing are totally different from the current time. Over the course of time, these rivers were subjected to great change; for this reason, as physicians, it is illusory to attempt to go deeply into their origin, place of circulation, extent or depth. The essential interest of the text is of understanding the analogy of the routes of uninterrupted flow of the 12 jing shui with the incessant movements of the blood and energy in the human organism.

PARAGRAPH 3 348

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Huangdi: “The jing shui respond to the jingmai whose distance, depth and abundance of blood and energy are different. How do you needle them?” Qi Bo:

“The Foot Yangming (St) is the “sea” of the 5 organs and 6 bowels. This vessel is large and contains an abundance of blood. When the energy is in fullness, the heat is strong. Not needling this channel deeply does not cure the disease, and not placing the needle in permanently does not disperse it. For this reason, the needling of Foot Yangming (St) is 0.6 cun depth and is placed permanently during 10 expirations. The needling of Foot Taiyang (Bl) is to 0.5 cun depth and the duration of placing the needle permanently is 7 expirations. The needling of Foot Shaoyang (GB) is to 0.4 cun depth and the duration of placing the needle permanently is 5 expirations. The needling of Foot Taiyin (Sp) is to 0.3 cun depth and the duration of placing the needle permanently is 4 expirations. The needling of Foot Shaoyin (Ki) is to 0.2 cun depth and the duration of placing the needle permanently is 3 expirations. The needling of Foot Jueyin (Li) is to 0.1 cun depth and the duration of placing the needle in permanently is 2 expirations. As for the yin and yang channels of the hand, their secretory and receptive routes neighbor one another; the energy arrives rapidly. This is why the depth of the needling does not exceed 0.2 cun and the duration of placing the needle permanently does not exceed one expiration. 399. In young people and adults, in large and small, fat and thin, needling must be a function of the decision of the “heart”. This technique bears the name imitative process of the standard method of heaven and earth. It is the same for moxabustion. If moxabustion is excessive, the fire employed is called “cruel fire”, able to cause the illness of drying out of the bones (bony atrophy) with slowing down of the vessels. If the limit of the needling exceeds the numbers cited above, it can provoke the syndrome of escape of the energy.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph gives dissertation on the method of acupuncture and moxabustion. The yin and yang channels of the hand and foot, whose blood and energy are in abundance

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or shortage, are compared with the depth of the jing shui in order to respond to the normal celestial number. The part located above the lumbar region responds to heaven. This is why the yin and yang channels belong to the hand; their secretory and receptive routes are close to one another, and the arrival of the energy is rapid. Needling then is superficial and the removal of the needle quick. It is stated in the text: “In the fat, needling must be performed in the convenient conditions of autumn and winter. In the thin, needling must be done in the convenient conditions of spring and summer.” This is why it is advised to conform to the “decision of the heart” to determine the depth of the needling, transmitting to the needle rapid or slow movements to imitate the normal number of heaven. It is the same for moxabustion. Moxabustion exceeding this principle bears the name “Cruel fire”, which is the origin of the illness of “drying out of the bones” (bony atrophy) with slowing of the vessels, and needling exceeding the celestial number (disproportionate needling) can create the syndrome of escaping of the energy.”

II - Ma Shi comments: “This paragraph concerns the practice of acupuncture and moxabustion. 1. The Foot Yangming (St) contains much blood and energy. Its pulse is large and often accompanied by signs of heat. This is why needling is to 0.6 depth and the duration of placing the needle is 10 expirations.

• _ _ _ • _ _ _

During dispersion, implantation of the needle must be done at the moment of inspiration (5) rotatory movements are transmitted to the needle at the moment of inspiration and needle removal at the moment of expiration (5). During tonification, implantation of the needle must be done at the moment of expiration rotatory movements are transmitted to the needle at the moment of expiration and needle removal at the moment of inspiration.

400.

“A needling of 0.6 cun depth” is a very deep needling. “Placing the needle in permanently during ten expirations” implies that the duration of dispersion can sometimes equal the total duration of 10 expirations. Because needle implantation is done with inspiration, the rotatory movements must be done upon inspiration and removal with the 10th expiration. The text describes the method of dispersion, but does not make mention of the method of tonification because it is understood that in tonification all maneuvers are executed in a fashion opposite to that of dispersion. The Foot Taiyang (Bl) contains much blood and little energy. This is why, during the needling, one must implant the needle to 0.5 cun depth, therefore 0.1 cun less than that for the Foot Yangming (St). For dispersion, one must leave the needle in during 7 expirations before removing it at the moment of inspiration, therefore 3 expirations less than that of the Foot Yangming (St). The Foot Shaoyang (GB) contains little blood and much energy. During needling, the needle is implanted to 0.4 cun depth, therefore 0.1 cun less than that of Foot Taiyang (Bl). During dispersion, leave the needle in during 5 expirations before removing it at the moment of inspiration, therefore 2 expirations less than that of Foot Taiyang (Bl). Such are the “needling numbers” of the 3 yang of the foot. 401.

2. The Foot Taiyin (Sp) contains much energy and little blood. The depth of needling is

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0.3 cun, therefore 0.1 cun less than that of the Foot Shaoyang (GB), and the duration of letting the needle remain in is for 4 expirations, therefore 1 less than that of the Foot Shaoyang (GB). The Foot Shaoyin (Ki) contains little blood and much energy. The depth of needling is 0.2 cun, therefore 0.1 cun less than that of the Foot Taiyin (Sp); the duration of leaving the needle in place is 3 expirations, therefore 1 expiration less that that of the Foot Taiyin (Sp). The Foot Jueyin (Li) contains much blood and little energy. The depth of needling is 0.1 cun, therefore 0.1 cun less than that of the Foot Shaoyin (Ki); the duration of letting the needle remain in place is 2 expirations, therefore 1 expiration less than that of the Foot Shaoyin (Ki). Such are the “needling numbers” of the 3 yin of the foot. 3. Physiologically, the 3 yin and 3 yang channels of the hand do not differ from those of the foot; but clinically, the methods of needling are not the same. This difference is due to the position of the 6 channels located at the top part of the body, therefore near the lung. The lung receives the “cereal” energy from the stomach in order to direct it toward the channels; and the channels receive the “great energy” of the lung in order to circulate. since the 5. Much later on, according to the classic books of acupuncture like the Zhen Jiu si ying, etc., inspiration belonged to the method of tonification (first expiration, then inspiration), and expiration to the method of dispersion (first inspiration, then expiration). In the Zhen Fu (Song of the Practice of Acupuncture), it is said: “To tonify, one must first expire then inspire, and to disperse one must first inspire, then expire”. This is the exact meaning of the concept “Inspiration/Expiration” in the current practice of acupuncture. In our time (from 1954), some Chinese brothers substituted expiration for “cough” and inspiration for “closed lips” associated with aspiration movements. In contrast, Westerners confined it to the control of the movements (expiratory and inspiratory) of the thorax.

receptive routes of the energy are close to the lung, the arrival of the energy is rapid. It is therefore not advised to needle more than to a depth of 0.2 cun and to not leave the needle in more than 1 expiration. 4. Young and old, small and large, fat and thin all have different constitutions. It is the “heart” that decides the depth of implantation of the needle, according to the Celestial Dao. It is the same for the number of moxas used. Not exceeding the “number” indicated for the “celestial fire” (moderate fire used) will not transform it into “cruel fire”, responsible for the “drying out of the bones” (bony atrophy) with slowing of the circulation of the vessels. As for acupuncture, exceeding the ‘number” indicated is the origin of the escaping of the energy.”

III - N.V.N.: This paragraph establishes the comparison between the depth and length of the jingmai (principal channels) with those of the jing shui (waterways; rivers) to standardize the degree of the depth of needling and the duration of allowing the needle to remain in place. Generally, the determination of depth of implantation of the needle at the level of the epidermo-dermal and musculo-skeletal layers is very precise. In this manner, for example, to puncture the point Huantiao (GB 30), located in the musculo-skeletal layer, it is advised to use a long needle to apply a deep stick. In contrast, for the point Shaoshang (Lu 11) and Bahui (GV20), located in the superficial epidermis, one must use short needles to apply a superficial stick. In this way, one understands that this standardization of needling depth is a global, rather than determinant, study because, clinically, determination of depth of needle implantation is essentially based: _ on the topography of the channel and, above all, of the energetic point 402. _ on the evolutive nature of the illness _ and on the reactive phenomena of the individual. This is why the text states: “In young and old, large and small, fat and thin, needling must be a function of the decision of the heart.”

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• Age: One must not practice deep needling in aged individuals because of the deficiency of energy and blood, or in children (6) because of the incomplete formation of the yin and yang elements of their organs. • Constitution: Schematically, one can distinguish 4 types of constitutions: thin, fat, strong and weak. In fat or robust subjects, it is advisable to needle deeply, and in thin or weak subjects, it is advised to stick superficially. The determination of the depth is obviously dependent on the appreciation of the depth of the energetic point itself, but it depends also on the topographic anatomy of the region where the point is located. In the final analysis, consideration of the location of the energetic point must be taken into account. In this manner, _ for the energetic points of the head, it is advisable in general to not practice vertical needling. One can perform tangential punctures (7), directed from front to back, with needles of 0.5 cun. The depth to attain is 0.3 to 0.4 cun. For points on the thorax (chest and back), it is forbidden to needle deeply because of the existence of underlying organs. _ for points located in the intercostal spaces, one can execute oblique punctures (8) of 0.3 to 0.5 cun depth with the aid of a 2 cun needle. 6. In unweaned infants, the jingluo are not yet definitively developed and needling is strictly forbidden. 7. This technique is especially applied with superficial needling. The angle made by the needle with the surface of the skin is 15º to 20º. 8. This technique is especially applied to points overlying bone. The angle made by the needle with the cutaneous surface is 45º.

_ for points on the spine or in paravertebral muscles (Hua Ta points), one often practices tangential punctures of 0.3 to 0.5 cun with the aid of 2 cun needles. _ for points on the abdomen, a region endowed with relatively thick muscles, one often practices vertical punctures (9) of 0.8 to 1.2 cun depth. _ for points on the thigh or buttock, where muscular masses are particularly sizable, one can attain depths of 1.5 to 2.5 cun by means of needles of 3 to 4 cun length. _ for points on hands and feet, one practices oblique punctures directed from below upward. 403.

This is the traditional scheme of actual acupuncture modalities. But in practice, one must know how to apply them with flexibility, adapting the appropriate modality to each concretelyobserved clinical situation.

Correspondence of the 12 jingmai and 12 jing shui and needling depth of the yin and yang channels of the foot and hand with duration of placing the needle permanently.

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jingmai

Belonging to the interior (organsbowels) responding to the exterior (jingshui) Depth of Puncture (cun)

Duration of Needle Placement (expir.)

Foot Tai yang (Bl)

Foot Shao yang (GB)

Foot yang ming (St)

Foot Tai yin (Sp)

Foot Shao yin (Ki)

Bl

GB

St

Sp

Ki

Li

wei

Hai

he

Ru

0.4

0.6

0.3

5

10

4

qiang

0.5

7

Foot Jue hand yin Tai (Li) yang (SI)

hand Shao yang (SJ)

hand yang ming (LI)

hand Tai yin (Lu)

hand Shao yin (He)

hand Jue yin (XB)

SI

SJ

LI

lu

he

Xin Bao

Zang

Jiang

Lei

Jiang

Ha

Ji

Zhang

0.2

0.1

0.2

0.2

0.2

0.2

0.2

0.2

3

2

1

1

1

1

1

1

9. This technique is applied in the majority of energetic points. The angle formed by the needle with the cutaneous surface is 90º.

PARAGRAPH 4 Huangdi: “Should one consider as constant the dimensions of the jingmai, the abundance of blood and energy, the thickness of the skin, the firmness of the muscles, the size of the popliteal crease... ?” Qi Bo:

“One can standardize them only in the case of individuals of average constitution, neither too thin, nor too muscular, nor too emaciated, nor in a state of abundance or shortage of blood and energy because thinness and emaciation cannot be taken as a model in acupuncture. One must know how to examine, palpate, inspect and observe in order to properly evaluate cold and heat, emptiness and fullness for therapeutic purpose. Such is the principle of needling according to the individual.” EXPLANATIONS AND COMMENTARIES

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404.

I - Ma Shi clarifies: “Acupuncture can only be applied in the case of individuals whose musculature is not too emaciated or too deficient. In the opposite case, only phytotherapy should be used.”

II - N.V.N.: In energetic medicine, particularly in acupuncture and phytotherapy, “examine, palpate, inspect and observe” are the four indispensable components allowing establishment of the diagnosis, components which must be employed in methodical and integrated fashion directly with the principle of the “Eight Rules, Five Movements, jingluo” (10).

10. See “Medecine Traditionelle Chinoise” - N.V.N. Edition. 405.

CHAPTER

XIII

Tendinomuscular Channels (Jing Jin) 354

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The 12 Jing Jin constitute an interconnected circulatory system located in the dermo-muscular space of the superficial, external layer of the 12 jingmai. All start at the tip of the fingers and toes, run alongside the 4 limbs, reach the nucho-cervical region and end up at the face and head. Disturbances of the Jing Jin manifest in two forms, the “cold” form and the “heat” form, evolving according to their circulatory routes and have for characteristic symptoms spasm and pain. Chapter 13 basically demonstrates the characteristics of the circulatory routes, classification and treatment of the 12 Jing Jin. In this case, acupuncture if often used, the depth of needling depending on the acquired knowledge of the physician. The points to needle are painful points called “points of celestial reaction”. The jing (principal channels) possess their own jin (tendinomuscular channels), which themselves possess their own pathology and treatment. hence the title of this chapter, “Jing Jin” or “Tendinomuscular Channels”. “jin” encompasses the sense of “muscles, nerves, tendons and ligaments”. In 1959, with Chamfrault, we designated them under the name “Tendinomuscular Channels” to simplify the term “Neuro-tendino-ligamento-muscular”. This chapter consists of 13 paragraphs.

PARAGRAPH 1

406.

1. The jin (tendinomuscular channel) of the starts at the tip of the little toe, inserts into the ascends and inserts into the knee, descends again malleolus and inserts into the heel, goes back up the leg and arrives at the popliteal crease.

Foot Taiyang (Bl) external malleolus, to the external the posterior side of

A vessel inserts into the external part of the calf, reaches the popliteal crease, inserts into the buttock, runs alongside the spine and arrives at the nucha. A vessel attaches to the mastoid, reaches the cranium, descends to the face and inserts into the nose. A vessel branches like a net around the eye, goes back down and attaches to the cheekbone. Another vessel leaves from the postero-external region of the axilla and inserts into the point Jianyu (LI 15) .

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Another vessel penetrates into the subaxillary region, ascends to Quepen (supraclavicular fossa) and inserts into the point Wangu (GB 12) . Another vessel leaves from Quepen and is directed toward the cheekbone. 2. _ _ _ _ _ _ _

Disturbances of this channel manifest by such signs as: pain of the little toe and heel spasm of the popliteal crease feeling of break in the spine spasm of the neck muscles blockage of the shoulder pain in the subaxillary region and Quepen. inability to turn to the right or left.

3. Treatment consists of utilizing the method of “heated Needles/ Rapid Needling” (Fan Zhen Jie Ci) , choosing painful points like the shu (energetic) points and needling until blood and energy are harmonized. This syndrome has the name Zhong Chun Bi (obstruction algoparesthesias of the second month of spring).

with

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “ 1. The jin of the Foot Taiyang (Bl) starts at the point zhiyin (Bl 67) of the little toe, _ reaches the external malleolus _ links with the knee joint 407. _ redescends to the calf and heel _ ascends to the popliteal crease _ links with the buttock _ ascends vertically to the neck _ inserts into the mastoid _ reaches the cranium _ redescends to the face _ and inserts into the nose where little vessels leave from that branch above the eye (Figure 54). This vessel runs directly from the bottom upward. The other collateral vessels, like the “distinct vessels” of the jingmai, are derived from the Jing Jin (tendinomuscular channels).

2. The signs of attack of this Jing Jin are: _ painful swelling of the little toe _ spasm of the popliteal crease _ arched vertebral column, etc. 3. In the treatment of illnesses of the Jing Jin of the Foot Taiyang (Bl), the method of heated needles is advocated; rotation movements transmitted to the needle are rapid; The points of “celestial reaction” are painful points, before being considered as shu points, points to needle. 4. The skin and body hair are yang; muscles and flesh are yin. The illness of yin is “Bi”,

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which means obstruction or energetic-blood stasis with pain and paresthesias. Mao (4th Terrestrial Branch) responds to the 2nd month (Lunar) and represents taiyang. This is why Bi manifesting at this period has the name Zhong Chun Bi (obstruction of the 2nd month of spring)”.

II - Ma Shi comments: “This paragraph concerns the Jing Jin of Foot Taiyang (Bl) whose illness is called Chun Bi (spring-like obstruction) and must be treated by the method of “heated needles/rapid needling”.

1. The Jing Jin of the Foot Taiyang (Bl) begins at the point zhiyin (Bl 67) located at the external ungual angle of the little toe, _ passes via the points Tonggu (Bl 66), shugu (Bl 65), jinggu (Bl 64), jingmen (Bl 63) and shenmai (Bl 62) to attach to the points Pushen (Bl 61) and Kunlun (Bl 60) at the heel region; _ from the heel, it ascends to the external malleolus, _ and passes via the points Fuyang (Bl 59), Feiyang (Bl 58), Chengshan (Bl 57), Chengjin (Bl 56) and heyang (Bl 55) to attach to the point weizhong (Bl 40) located at the middle of the popliteal crease. A vessel leaves from Feiyang (Bl 58), 409. _ unites with the previous vessel _ and arrives at the points weizhong (Bl 40), Fuxi (Bl 38), yinmen (Bl 37), etc. to insert into the buttock; _ then from there, it ascends again to the points Huiyang (Bl 35), Zhongliao (Bl 33), Ciliao (Bl 32) and Baihuanshu (Bl 30)... then vertically to the point Dazhui (GV 14), that is to say, 21 separate points, 1.5 cun from the midline, _ then it follows this midline and arrives at the points Tianzhu (Bl 10) and Wangu (GB 12), located at the neck. 408.

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Figure 54: Tendinomuscular channel of the Bladder From 1 to 23: energetic circulatory direction and points of insertion (After “Theory and Practice of Analgesia by Acupuncture”- N.V.N. Edition.) Another vertical vessel arrives below the point Wangu (GB 12) on the mastoid, _ passes via the cranium, 409. _ descends to the forehead and eye, _ and inserts into the subocular (zygomatic) bone. Another vessel leaves from the postero-internal region of the armpit and inserts into the point Wangu (GB 12). Another vessel leaves Quepen (supraclavicular fossa) and is directed toward the zygomatic bone where the point Quanliao (SI 18) is found. 2. The signs of attack of this Jing Jin are: _ swelling and pain of the tip of the little toe, _ spasm of the popliteal crease, etc. 3. One must needle the painful points by the method of “heated Needles/Rapid Needling”. Because the illness generally manifests in the 2nd month (Lunar), it bears the name Zhong Chun Bi (stasis and pain of the 2nd month of spring).”

III - N.V.N.: According to traditional Chinese medicine, the 6 channels of the hand and 6 channels of the foot respond to the 12 months (Lunar) of the year, and the energy of each of these channels responds to that of the corresponding month. Climatic variation due to the change of the energy of the month can influence that of the corresponding channel to provoke a phenomena of “Bi” (stasis or obstruction with

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algoparesthesias). It is therefore a matter of reactive and monthly Bi and not of “Bi” provoked by the presence of perverse energy. It is for this reason that Qi Bo stresses the method of the “heated Needles/Rapid Needling” to treat these types of Bi. In contrast, in the case of “Bi” due to an infiltration of perverse energy, the therapeutic method must be based on the principle “yin-yang, Emptiness-Fullness”, according to which one must disperse the perverse energy found in the yang superficial layer of the body (where the Jing Jin are found) in a state of fullness and tonify the essential energy in an empty state in the deep yin layer (where the principal channels (jingmai) are found). here, it concerns one basic method (see further on). a) The 3 yang channels of the foot respond to spring, that is to say, to the 1st, 2nd and 3rd months of the year: 1. The Foot Shaoyang (GB) corresponds to the first month and the illness bears the name Meng Chun Bi (“obstruction with algoparesthesias of the first month of spring”). 2. The Foot Taiyang (Bl) corresponds to the 2nd month and its illness bears the name Zhong Chun Bi (“obstruction with algoparesthesias of the second month of spring”). 3. The Foot Yangming (St) corresponds to the 3rd month and the illness bears the name Ji Chun Bi (“obstruction with algoparesthesias of the third month of spring”). 410.

b) The 3 yin channels of the foot correspond to autumn, that is to say to the 7th, 8th and 9th months of the year: 1. The Foot Taiyin (Sp) responds to the 7th month and its illness bears the name Meng qiu Bi (“obstruction with algoparesthesias of the first month of autumn”). 2. The Foot Shaoyin (Ki) responds to the 8th month and its illness bears the name Zhong qiu Bi (“obstruction with algoparesthesias of the second month of autumn”). 3. The Foot Jueyin (Li) responds to the 9th month and its illness bears the name Ji Jiu Bi (“obstruction with algoparesthesias of the third month of autumn”). c) The 3 yang channels of the hand correspond to summer, that is to say the 4th, 5th and 6th months of the year: 1. The Hand Yangming (LI) responds to the 4th month and its illness bears the name Meng Xia Bi (“obstruction with algoparesthesias of the first month of summer”). 2. The Hand Taiyang (SI) responds to the 5th month and its illness bears the name Zhong Xia Bi (“obstruction with algoparesthesias of the second month of summer”). 3. The Hand Shaoyang (SJ) responds to the 6th month and its illness bears the name Ji Xia Bi (“obstruction with algoparesthesias of the third month of summer”). d) The 3 yin channels of the hand correspond to winter, that is to say to the 10th, 11th and 12th months of the year: 1. The Hand Jueyin (XB) responds to the 10th month and its illness bears the name Meng Dong Bi (“obstruction with algoparesthesias of the first month of winter”). 2. The Hand Taiyin (Lu) responds to the 11th month and its illness bears the name Zhong Dong Bi (“obstruction with algoparesthesias of the second month of winter”). 3. The Hand Shaoyin (Ki) responds to the 12th month and its illness bears the name jing Dong Bi (“obstruction with algoparesthesias of the third month of winter”). This classification of the 6 yin and 6 yang channels of the foot and hand as a function of the month of the season permits determining the channel influenced by the variation of the energy of the concerned month with therapeutic and diagnostic purpose.

PARAGRAPH 2

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1. The Jing Jin of the Foot Shaoyang (GB) starts at the tip of the 4th toe and inserts into the external malleolus, runs alongside the external surface of the leg and inserts into the external side of the knee. A branch leaves from the fibula, reaches the front of the thigh and inserts into the point Futu (St 32) ; another branch ascends to the gluteal region and inserts into Gao Gu (coccyx). A vertical vessel reaches the hypochondria, passes to the anterior surface of the thorax, attaches to the breast and inserts into Quepen (supraclavicular fossa). A vertical vessel ascends to the subaxillary region, crosses Quepen, comes back out in front of the taiyang, goes around the back of the ear, reaches the angle of the forehead, crosses the opposite vessel at the top of the cranium, redescends to the maxillary region and inserts into the zygomatic (arch). Another vessel inserts into the external canthus of the eye and constitutes Wai wei (terminal knots of the vessels of the external part of the body). 2. The signs of attack of this Jing Jin are: _ torsion-type pain of the 4th toe radiating up to the external side of the knee _ inability to flex and extend the knee _ spasm from the popliteal crease to the front of the thigh and gluteal region with pain in the coccyx _ pain in the breast and at Quepen _ spasm of the neck muscles _ inability to open the right eye following the radiation of spasms from the left side to the right. This Jing Jin follows the curious vessel yangwei. At the top, that of the left passes to the right and vice versa. This phenomenon bears the name wei jin Xiang Jiao (phenomenon of tendinomuscular intervessels). 3. Treatment consists of applying the method of heated Needles/ Rapid Needling (Fan Zhen Jie Ci) and choosing painful points as shu (energetic) points. The illness is called Meng Chun Bi (obstruction with algoparesthesias of the first month of spring).

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The Jing Jin of the Foot Shaoyang (GB) starts at the jing point qiaoyin (GB 44), located at the external ungual angle of the 4th toe, _ reaches the various musculoskeletal regions 413... _ and ends at the head and eye. (Figure 55) The word wei jin designates a group of little vessels belonging to the curious vessel yang wei. The yangwei vessel and the Foot Shaoyang (GB) unite at the points Jianjing (GB 21),

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Fengchi (GB 20), Naokong (GB 19), Muchuang (GB 16), Linqi (GB 15), yangbai (GB 14) (1), located behind and above the eye. “The right does not open” because the attack of the left side influences the right side, like the movement of yang energy of spring going from left to right. wei jin also implies the sense of the tangling up of the two tendinomusculars, that of the left and right. The left attaches to the right and the ailment is related to the topography, hence influence of disturbances of the left side on the right side. “The right foot is paralyzed” because the sickness localizing at the left and at the top has reached the bottom. wei also implies the sense of attaching and linking like the mesh of a net covering the entire body, from left to right, from right to left, from below upward and from above downward, hence the name “intersection of jin (tendinomuscular) of the Foot Shaoyang (GB) and of jin (little tendinomuscular vessels) of yang wei”, designated by the name wei jin Xiang Jiao. Disturbances of the Jing Jin of the Foot Shaoyang (GB) are mentioned in the text and the illness is called Meng Chun Bi (obstruction with algoparesthesias of the first month of spring) because yin (3rd Terrestrial Branch) corresponds to the period of birth of yang energy of the first month of the year (Lunar) and responds to the channel of the Foot Shaoyang (GB)”.

1. All these points make up part of the “reunion-meeting” group described in M.T.C.-N.V.N. Edition.

412.

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Figure 55: Tendino-muscular channel of the Gallbladder From 1 to 17: energetic circulatory direction and points of insertion (After “Theory and Practice of Analgesia By Acupuncture” - N.V.N. Edition.)

PARAGRAPH 3

413.

1. The Jing Jin of the Foot Yangming (St) starts at the tip of the 3rd toe, inserts into the neck-of-the-foot, ascends obliquely the length of the fibula and inserts into the external side of the knee, vertically reaches the hip joint where the point Huantiao (GB 30) is found, runs alongside the false ribs and terminates at the spine. A vertical vessel arrives at the knee and inserts into... ( 2 ) ; another vessel inserts into the fibula and unites with the shaoyang (GB). A vertical vessel arrives at the point Futu (St 32) , inserts at the thigh, goes around the genitals, divides itself at the abdomen, inserts at Quepen (supraclavicular fossa), ascends to the neck, goes around the mouth, links up with the zygomatic bone, inserts into the nose and unites with the taiyang. The taiyang is like a net enveloping the upper eyelid (Mu Shang Gang) and the yangming is like a net enveloping the lower eyelid (Mu Xia geng) . 414.

A vessel leaves the cheekbone and inserts in front of the ear.

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2. Disturbances of this Jing Jin manifest by the following signs: _ pain of the 3rd toe radiating up to the muscles of the leg _ spasm of the sole of the foot _ retraction of the region of Futu (St 32) _ swelling of the internal side of the thigh _ inflammation of the scrotum _ spasm and pain of the abdominal muscles radiating up to Quepen (supraclavicular fossa) _ deviation of the mouth (facial paralysis). In case of the mouth with In case of deviation of the

heat: laxity of the muscles of the cheek and deviation of inability to open the eye. cold: spasmodic contracture of the cheek muscles and mouth with inability to completely close the eye.

3. Treatment consists of several phases: _ Apply Mao Gao (3) at the level of the spasm. _ Apply an alcohol solution of cinnamon (Ramulus Cinnamomi -Guizhi) at the level of the lax muscles. _ Pile up branches of blackberry bush and underneath it burn into the ground the charcoal of the same wood. _ Stretch out a matting on this pile of wood on which one asks the patient to take a seat in order to fumigate. _ Apply Mao Gao on the cheek affected. _ Have him drink a good wine and eat good meat. For patients who do not like this drink, require them to drink. _ repeat this fumigation 3 times and massage the ill parts. 2. Omitted in the original text. 3. Ointment of horse grease (Ma Cao) which has the ability to maintain the muscles and tendons and treat “Bi”.

• Concerning acupuncture, one must apply the method Fan Zhen Jie Ci (heated Needles/Rapid Needling) and use the painful points as “shu” (energetic) points. It involves the syndrome Ji Chun Bi (blockage with algoparesthesias of the last month of spring). EXPLANATIONS AND COMMENTARIES Ma Shi explains: “This paragraph concerns the Jing Jin of the Foot Yangming (St), its illness bearing the name Ji Chun Bi and its treatment according to the method of “heated Needles/Rapid Needling”. 1. The Jing Jin of the Foot Yangming starts at the 3rd toe, _ inserts into the points Chongyang (St 42) and Jiexi (St 41) 415. _ ascends obliquely to the fibula _ crosses the points Xiajuxu (St 39), Tiao Kou (ST 38) and Shangjuxu (ST 37) _ inserts into Sanli (St 36) underneath the knee _ reaches the hip joint _ runs alongside the false ribs _ and adheres to the spine. A vertical vessel reascends the length of the leg and inserts at the knee where it divides in two bundles: _ one inserts at the external part of the fibula to unite with the shaoyang (GB)

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_ the other vertically crosses the point Futu (St 32) to insert at the point Biguan (St 31), condenses at the genitals, goes back up to the abdomen where it branches, arrives at Quepen, inserts into the neck, hugs tightly to the mouth and unites with the cheekbone (zygomatic) where three vessels leave from: • one inserts into the nose • another reunites with the Jing Jin of the Foot Taiyang (Bl) located at the upper eyelid • the third inserts in front of the ear. 2. Disturbances of this Jing Jin are: _ spasms and pain of the 3rd toe radiating to the leg _ heel spasm and cramps _ spasm and pain at the level of the point Futu (St 32) _ swelling of the groin region with inflammation of the scrotum _ abdominal muscle spasm and pain radiating up to Quepen and to the cheekbone _ sudden deviation of the mouth with inability to close the eye. In case of attack by heat: muscular laxity with inability to open the eye and deviation of the mouth. In case of attack by cold: muscular cramps with inability to close the eye and deviation of the mouth. 3. In the first case (muscular laxity), one must use Ma Gao (horse grease salve), and in the second case (muscular cramps), one must apply an alcohol solution of the powder of Ramulus Cinnamomi (Guizhi) on the affected cheek. In the case of heat with muscular laxity, one asks the patient to sit down on a chair made of branches of blackberry under which one burns the charcoal of the same wood for the purpose of fumigation. Then one applies a very warm poultice on the affected cheek and one drinks a good wine and eats good meat. For the patients who do not like to drink (4), one must make them drink. 4. Because wine activates the energetic-blood circulation.

At the same time, one mobilizes the circulation of blood and energy at the level of the spasmed cheek by massage according to the technique of tapping/pressure (5). 417... As for acupuncture, the method of “heated Needles/Rapid Needling” is recommended, taking the painful points for shu points. One ceases treatment upon obtaining the equilibrium of blood and energy. This illness generally manifests in the 3rd month of the year (Lunar), hence the name Ji Chun Bi (stasis with algoparesthesias of the third month of spring)”.

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5. See “Medecine Traditionelle Chinoise”- N.V.N. Edition, 1984. 416.

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Figure 56: Tendino-muscular channel of the stomach. From 1 to 18: energetic circulatory direction and points of insertion. (After “Theory and Practice of Analgesia By Acupuncture”- N.V.N. Edition)

PARAGRAPH 4

417...

1. The Jing Jin of the Foot Taiyin (Sp) starts at the internal side of the tip of the great toe and inserts at the internal malleolus. A vertical vessel reaches the internal tuberosity of the tibia, inserts into the supero-internal part of the thigh, concentrates at the genitals, reaches the abdomen and inserts into the umbilicus, follows the inner wall of the abdomen, inserts into the ribcage and branches into the inner wall of the thorax. The internal branch attaches to the vertebral column. 2. _ _ _ _ _

Disturbances of this Jing Jin manifest by the following signs: spasm and pain of the great toe and internal malleolus pain from the internal surface of the knee to the groin torsion-type spasm of the genitals umbilical and hypochondrial pain thoraco-spinal pain.

3. Treatment consists of utilizing the method “heated Needles/ Rapid Needling” and of taking the painful points for the shu points (energetic points). One ceases treatment when the pain ceases. This ailment has the name Meng Jiu Bi (stasis and algoparesthesia of the first month of autumn).

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EXPLANATIONS AND COMMENTARIES Ma Shi explains: “This paragraph concerns the physiology, pathology and treatment of the Jing Jin of the spleen channel. 1. The Jing Jin of the Foot Taiyin (Sp) starts at Yinbai (Sp 1) located at the internal ungual angle of the great toe, and inserts into the point Shangqiu (Sp 5) underneath and in front of the internal malleolus. A vertical vessel divides at the point Diji (Sp 8) at the level of the tibia, _ crosses the point Yinlingquan (Sp 9) _ ascends to the internal surface of the thigh 418.... _ inserts into the supero-internal surface (Scarpa’s Triangle) _ concentrates at the genitals _ ascends to the abdomen _ inserts into the umbilicus _ and penetrates into the abdomen. By the internal abdominal path, it inserts into the points Daheng (Sp 15) and Fujie (Sp 14) _ reaches the ribs _ and branches into the thorax (Figure 57).

2. The signs of attack of this Jing Jin are: _ pain and spasm of the great toe and internal malleolus _ pain of the internal tuberosity of the knee _ pain of the internal and supero-internal side of the thigh (Scarpa’s Triangle) _ pain of the thoracic cage and vertebral column. 3. For treatment, the method of “heated Needles/Rapid Needling”, etc. is advised. This ailment generally manifests with the 7th month of the year (Lunar), hence the name Meng Jiu Bi (stasis and algoparesthesia of the first month of Autumn)”. 419.

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Figure 57:

Tendino-muscular channel of the spleen. From 1 to 18: energetic circulatory direction and points of insertion (After “Theory and Practice of Acupuncture Analgesia”- N.V.N. Edition)

PARAGRAPH

5

418.

1. The Jing Jin of the Foot Shaoyin (Ki) starts underneath the little toe, follows the Jing Jin of the Foot Taiyin (Sp), reaches below the internal malleolus, inserts at the heel where it unites with the Jing Jin of the Foot Taiyang (Bl), goes back up and inserts into the internal tuberosity of the knee, unites with the Jing Jin of the Foot Taiyin (Sp) to reascend to the supero-internal side of the thigh and inserts into the genitals, penetrates into the pelvic region, comes back out at the buttock, runs alongside the vertebral column following the spinous muscles, inserts into the occiput and unites with the Jing Jin of the Foot Taiyang (Bl). 2. Disturbances of this Jing Jin manifest by the following signs: _ spasms of the plantar muscles _ spasms and pain of the sites of insertion of this channel. In summary, the basic signs of attack of this channel are spasm cramps. When the illness is located at the exterior, the subject cannot bend over forward, and when the illness is located in the interior, the subject cannot bend backward. This is why, the patient being yang, the lumbar region is in ophisthotonus, and the patient being in yin, the and

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lumbar

region

is

in

orthotonus.

3. Treatment consists of using the method Fan Zhen Jie Ci (heated Needles/Rapid Needling), taking the painful points for the shu points (energetic points) and needling to harmonize blood and energy 420...

In the case of illness located in the interior, warm poultices, massage and decoctions are recommended. repeated bouts of spasm are incurable and the prognosis is fatal. This ailment has the name Zhong Jiu Bi (stasis and algoparesthesia of the 2nd month of autumn). EXPLANATIONS AND COMMENTARIES Ma Shi explains: “This paragraph concerns the illness of the Jing Jin of the kidney channel called Zhong Jiu Bi (stasis and algoparesthesia of the 2nd month of autumn or of the eighth month of the year) and the treatment method. 1. The Jing Jin of Foot Shaoyin (Ki) starts below the little toe at the point Yongquan (Ki 1), _ reaches underneath the internal malleolus where it joins with the Foot Taiyin (Sp) _ crosses the points Rangu (Ki 2) and Taixi (Ki 3) located below the internal malleolus _ inserts into the points Shaohai (Ki 6), Fuliu (Ki 7) and shuiquan (Ki 5) _ unites with the Jing Jin of Foot Taiyang (Bl) and ascends the length of the inner thigh _ inserts into the genitals _ runs alongside the spinous muscles up to the nucha _ inserts into the occiput _ and unites with the Foot Taiyang (Bl). (Figure 58)

2. The attack of this Jing Jin expresses as _ spasm of the plantar muscles _ and spasm and pain at the level of the points of insertion, etc. 3. Treatment consists of using the method “heated Needles/Rapid Needling” (Fan Zhen Jie Ci), taking the painful points for the shu points and needling until equilibrium of the blood and energy is obtained. In muscular cramps located in the interior, one must prescribe poultices, massage, phytotherapy, etc. recurring bouts of cramps is fatal. This ailment generally manifests towards the eighth month of the lunar year . This is why it has the name Zhong Jiu Bi (stasis and algoparesthesias of the second month of autumn). shu Bai yin clarifies: “The Jing Jin of the Foot Shaoyin (Ki) and Jing Jin of the Foot Taiyang (Bl) unite at the neck and nucha. This union-meeting constitutes the phenomenon of the external relationship of organ and bowel, of yin and yang. The illness located at the exterior designates the illness of the energy of the Foot Taiyang (Bl); the subject cannot bend over forward. As for the illness localized in the interior, it designates the illness of the energy of the Foot Shaoyin (Ki); the subject cannot bend backwards. Therefore, for example, in the illness of Shanghan of cosmic origin reaching the Foot Shaoyin (Ki), the subject curls up in his bed.”

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421.

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Figure 58:

Tendino-muscular channel of the kidney. From 1 to 9: energteic circulatory direction and insertion points. (After “Theory and Practice of Analgesia By Acupuncture” - N.V.N. Edition)

PARAGRAPH 6

422.

1. The Jing Jin of the Foot Jueyin (Li) starts on top of the great toe ( 6 ) , ascends and inserts in front of the internal malleolus, follows the tibia and inserts underneath the tuberosity of it, ascends the inner thigh, inserts into the genitals to anastomose with the other Jing Jin (7). 2. The attack of this Jing Jin manifests by the following signs: _ pain of the great toe radiating in front of the internal malleolus _ pain of the internal tibial tuberosity _ disturbances of the genitals (impotence). This impotence is of internal origin following a sexual license or of “wind-Cold” origin causing retraction of the penis, or else of “heat” origin causing stiffness of the penis (priapism). 3. Treatment consists of activating the circulation of the liquid paths to purify the energy of the genitals. If it is a matter only of spasms (without genital disturbances), it is advised to use the method Fan Zhen Jie Ci (heated Needles/Rapid Needling), taking painful points for shu points (energetic) points until harmonization of blood and energy.

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This ailment has the name Ji Jiu Bi (stasis and algoparesthesia of the 3rd month of autumn).

EXPLANATIONS AND COMMENTARIES Zhang Shi explains: 1. “The Jing Jin of the Foot Jueyin (Li) starts at the point Dadun (Li 1) of the great toe _ ascends and inserts at the point Zhongfeng (Li 4) in front of the internal malleolus _ runs alongside the antero-internal side of the leg _ arrives underneath the point Ququan (Li 8) behind the internal condyle of the tibia _ runs alongside the inner thigh _ inserts into the genitals (yin qi) _ and goes in liason with the other Jing Jin. yin qi (genitals organs) is the site of reunion of Jing Jin (tendinomusculars). since the jueyin (Li) governs the muscles and tendons, its Jing Jin is in permanent relationship with the Jing Jin of the 3 yin and 3 yang. In case of disturbance, the points of insertion and trajectory of this Jing Jin are painful. The jueyin (Li) follows “the tranformation of fire” of the shaoyang (GB). Therefore, the clinical signs are regrouped into syndromes of cold and heat. Logically, underneath the “metal” energy is the domain of the “water” energy; a “step” below that, the domain of the “wood” energy is found whose source comes from water. Consequently, in the event of disturbance, it is advised to use the method of activation of the “water” movements to refresh the energy of jueyin (Li). In contrast, in the event of disturbance of the components having form, such as the muscles and tendons, one must use the method “Fan Zhen Jie Ci” (heated Needles/Rapid Needling). Zheng Yu gong states: “The end of yin and yang is called jueyin. At the maximal degree of 6. At the level of the region called “Three Hairs”. 7. Those of the spleen and kidney.

yin is produced the yang which is the source energy of jueyin; in case of disturbance, two different syndromes appear, that of cold and that of heat.” 423.

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Figure 59: Tendino-muscular channel of the liver. From 1 to 4: energetic circulatory direction and insertion points (After “Theory and Practice of Analgesia By Acupuncture” - N.V.N. Edition).

PARAGRAPH 7

424.

1. The Jing Jin of the Hand Taiyang (SI) starts at the tip of the 5th finger, inserts at the wrist, runs alongside the forearm and inserts at the epitrochlea at the place where tapping provokes a sensation of numbness along the 5th finger, ascends to the arm and inserts below the axilla. A vessel reaches the posterior side of the axilla, goes around the scapula, passes in front of the Foot Taiyang (Bl) and inserts at the mastoid. A vessel penetrates into the ear, reaches the supraauricular area, redescends and inserts into the chin, then ascends again to the external canthus of the eye. 2. Disturbances of this Jing Jin basically are the following signs: _ pain of the tip of the little finger radiating to the forearm and elbow, _ pain from the internal side of the arm to the axilla and posterior part of it, _ pain of the scapula radiating to the neck with buzzing of the ear and transitory disturbance of vision,

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_ spasmodic contraction of the neck muscles later causing cervical adenopathy. 425.

3. Treatment consists of utilizing the method Fan Zhen Jie Ci (heated needles/Rapid Needling) and taking the painful points as the shu (energetic) points. In the case of swelling, one must needle with slender needles (Rui Zhen). • A vessel ascends toward the maxillary angle, crosses the front of the ear, arrives at the external canthus of the eye, redescends to the chin, then ascends again and inserts at the forehead angle. Disorders of this trajectory basically are spasm and pain along the routes of passage of this Jing Jin. Treatment also consists of using the method Fan Zhen Jie Ci until equilibrium of blood and energy is obtained. This ailment has the name Zheng Xia Bi (stasis and algoparesthesia of the 2nd month of summer). EXPLANATIONS AND COMMENTARIES Ma Shi explains: “This paragraph concerns the illness of the Jing Jin of the small intestine and its treatment. 1. The Jing Jin of the Hand Taiyang (SI) starts at the point Shaoze (SI 1), at the tip of the little finger, _ inserts at the points Wangu (SI 4), yanggu (SI 5) and yangliao (SI 6) _ runs alongside the foream and inserts at the point Xiaohai (SI 8), located at the end of the humerus (tapping on this spot provokes a reaction at the tip of the little finger), _ then reascends and inserts below the ear. • A vessel reaches the posterior side of the axilla, _ goes around the scapula, passing the points Jianzhen (SI 9), Naoshu (SI 10), Tianrong (SI 11), Bingfeng (SI 12), Ququan (SI 13), Jianwaishu (SI 14), to penetrate into the point Jianzhongshu (SI 15) _ comes back out via the neck and passes in front of the Foot Taiyang (Bl) and inserts at the point Wangu (GB 12) (8) located behind the ear. • A vessel penetrates into the ear and resurfaces on top of it, _ descends and inserts at the chin _ and reascends at the external side of the external canthus of the eye.

2. Disturbance of this Jing Jin manifests by pains located along its trajectory. 3. Treatment consists of utilizing the method “heated Needles/Rapid Needling” and taking the painful points for the shu points. In case of swelling (adenitis) and cervicalgia, one must needle with slender needles (Rui Zhen). This ailment generally manifests at the 5th month of the lunar year, hence the name Zhong Xia Bi (stasis and algoparesthesia of the 2nd month of summer)”.

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8. Not to be confused with the point Wangu located at the external side (energetic description) of the hand. 426.

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Figure 60: Tendino-muscular channel of the small intestine. From 1 to 13: energetic circulatory direction and insertion points (After “Theory and Practice of Analgesia By Acupuncture”- N.V.N. Edition).

PARAGRAPH 8

427.

1. The Jing Jin of the Hand Shaoyang (SJ) starts at the tip of the ring finger, inserts at the wrist, reaches the forearm, inserts at the elbow, ascends to the shoulder, passes to the neck and links up to the Hand Taiyang (SI). A vessel leaves from the maxillary angle, penetrates deeply there and attaches to the base of the tongue. Another vessel reaches the maxillary angle, passes in front of the ear, ascends to the external canthus of the eye, goes back down to the chin and goes up again to insert into the angle of the forehead. 2. Disturbance of this Jing Jin expresses by the following signs: _ spasm and pain of the areas of passage of this channel _ lingual retraction. 3. Treatment of this Jing Jin consists of using the method Fan Zhen Jie Ci (heated Needles/Rapid Nedling), taking the painful points for the shu (energetic) points and needling until harmonization of blood and energy. This ailment has the name Ji Xia Bi (stasis and algoparesthesia of

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the 3rd month of summer).

EXPLANATIONS AND COMMENTAIRES Ma Shi explains: “This paragraph concerns the illness of the Jing Jin of the Hand Shaoyang (SJ) channel called Ji Xia Bi and its treatment. 1. The Jing Jin of the Hand Shaoyang (SJ) starts at the point guanchong (SJ 1), at the tip of the ring finger, _ traverses the points Yemen (SJ 2) and Zhongzhu (SJ 3) _ inserts at the point yangchi (SJ 4), located at the wrist _ reaches the points Waiguan (SJ 5), zhigou (SJ 6), Huizong (SJ 7) and Sanyangluo (SJ 8), located on the forearm, _ inserts at the points sidu (SJ 9) and Tianjing (SJ 10), located at the elbow, _ goes around the arm and crosses the point Naohui (SJ 13), _ arrives at the points Jianliao (SJ 14) and Tianliao (SJ 15), located at the shoulder. _ reaches Tianyou (SJ 16), located at the neck _ and inserts at the point taiyang (PC 9). A vessel leaves from the maxillary angle and connects to the base of the tongue. Another vessel ascends to the maxillary angle, 429... _ crosses the points Jiaosun (SJ 20) and heliao (SJ 21), located in front of the ear _ penetrates into the point sizhukong (SJ 23) _ redescends to the chin _ reascends and inserts at the angle of the forehead.

2. Attack of this Jing Jin manifests by the following signs: _ pain and spasm of the zone of passage of this channel _ or else lingual retraction, etc. 3. In order to treat this ailment, it is advised to use the method “Fan Zhen Jie Ci”. This illness generally manifests in the 6th month of the year (Lunar), hence the name Ji Xia Bi (stasis and algoparesthesia of the third month of summer)”. 428.

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Figure 61: Tendino-musclar channel of the sanjiao. From 1 to 18: energetic circulatory direction and points of insertion (After “Theory and Practice of Analgesia By Acupuncture”-N.V.N. Edition)

PARAGRAPH 9

429.

1. The Jing Jin of the Hand Yangming (LI) starts at the tip of the index finger and inserts at the wrist, runs alongside the forearm and inserts into the external side of the elbow, ascends the arm and inserts into the shoulder. A vessel goes around the scapula and arrives at the vertebral column. Another vessel reaches the cheekbone and inserts at the internal canthus of the eye; that of the left penetrates into the brain and redescends to the right maxilla, and vice versa. 2. _ _ _

Distrubances of this Jing Jin are basically the following signs: pain and spasm of the area of passage of this channel inability to lift the shoulder blockage of movement of the neck.

3. Treatment consists of using the method Fan Zhen Jie Ci (heated Needles/Rapid Needling) until the regulation of blood and energy is obtained and taking the painful points for shu (energetic) points. This illness has the name Meng Xia Bi of the first month of summer).

378

(stasis

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algoparesthesia

EXPLANATIONS AND COMMENTARIES Ma Shi explains: “This paragraph concerns the pathophysiology and treatment of the Jing Jin of the large intestine channel. 1. The Jing Jin of the Hand Yangming (LI) starts at the tip of the index finger, at the point Shangyang (LI 1), 431.... _ traverses the points Erjian (LI 2), Sanjian (LI 3) and hegu (LI 4) _ inserts at the wrist, at the point yangxi (LI 5) _ goes up the forearm _ inserts into the external side of the elbow, at the point Quchi (LI 11) _ reascends the arm and inserts at the shoulder, at the point Juxu (LI 16). A vessel reaches the scapula and arrives at the vertebral column. Another vertical vessel leaves from Jianyu (LI 15) and arrives at the neck, at the point Tianding (LI 17). Another vessel ascends to the cheek and inserts at the external angle of the orbital bone. Another vertical vessel ascend in front of the curious point taiyang (PC 9), reaches the angle of the forehead, penetrates into the brain and redescends to the opposite maxilla, etc.

2. The signs of attack of this Jing Jin are: _ pain and spasm of the areas of passage of this channel _ inability to raise the shoulder, etc. 3. Treatment consists of using the method Fan Zhen Jie Ci (heated Needles/Rapid Needling) until blood and energy are regulated. This ailment generally manifests in the 4th month of the year (Lunar), hence the name Meng Xia Bi (stasis and algoparesthesia of the first month of summer)”. 430.

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Figure 62: Tendino-muscular channel of the large intestine. From 1 to 10: energetic circulatory direction and points of insertion (After “Theory and Practice of Analgesia By Acupuncture”-N.V.N. Edition)

PARAGRAPH 10

431....

1. The Jing Jin of the Hand Taiyin (Lu) starts at the tip of the thumb, runs alongside it to insert into the thenar eminence, passes outside Cun Kou (radial pulse), runs alongside the forearm, reaches the interior of the elbow, runs alongside the inner arm (energetic description), penetrates into the axillary region, comes back out underneath Quepen (supraclavicular region), returns in front of the shoulder joint, ascends and inserts into Quepen, goes back down and inserts into the thorax, branches into the cardia, descends again and inserts into the hypochondria. 2. _ In _ _ _

Attack of this Jing Jin manifests by the following signs: pain and spasm of the muscles served by this channel serious cases: supraclavicular compression (Xi Ben) ( 9 ) severe intercostal pains hematemesis.

432...

3. Treatment consists of using the method Fan Zhen Jie Ci ( h e a t e d Needles/Rapid Needling) until regularization of blood and energy and taking the painful points as shu (energetic) points.

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This ailment has the name Zhong Dong Bi (stasis of the 2nd month of winter).

and

algoparesthesia

EXPLANATIONS AND COMMENTARIES Ma Shi explains: “This paragraph concerns the illness of the Jing Jin of the lung channel called Zhong Dong Bi and its treatment. 1. The Jing Jin of the Hand Taiyin (Lu) starts at shaoyang (Lu 11), at the tip of the thumb, _ runs alongside it to come to insert behind the thenar emminence (Yuji) _ passes outside Cun Kou (radial pulse) _ runs alongside the forearm _ inserts into the elbow, at the point Chize (Lu 5) _ runs alongside the internal side of the arm _ penetrates into the point Tianfu (Lu 3) _ ascends to Quepen (supraclavicular fossa) and inserts in front of the shoulder joint _ reacsends again to insert into Quepen _ descends into the thorax _ branches to the cardia _ then redescends to the hypochondria.

2. Disturbances of this Jing Jin are basically the following signs: _ pain and spasm in the areas served by this channel _ thoracic pain _ dyspnea. 9.”Xi Ben” indicates supraclavicular respiration (dyspnea).

3. For treatment, the method Fan Zhen Jie Ci (heated Needles/Rapid Needling) is recommended. This ailment generally manifests in the 11th month of the year (Lunar). This is why one gives it the name Zhong Dong Bi or stasis and algoparesthesia of the second month of winter”. 433.

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Figure 63: Tendino-muscular channel of the lung. From 1 to 10: energetic circulatory path and points of insertion (After “Theory and Practice of Analgesia By Acupuncture”- N.V.N. Edition)

PARAGRAPH 11

432...

1. The Jing Jin of the Hand Jueyin (xin bao luo: XB) starts at the tip of the middle finger, takes the direction of the Jing Jin of the Hand Taiyin (Lu), inserts at the elbow, runs along the inner arm, arrives at the subclavicular region and branches in front of and behind the ribcage. A vessel penetrates deeply into the axilla, branches into the inner wall of the thorax and inserts into the cardia. 435... 2. _ _ _

Attack of this Jing Jin manifests by such signs as: pain and spasm of the routes of passage of this channel thoracic pain dyspnea.

3. Treatment consists of using the method Fan Zhen Jie Ci (heated Needles/Rapid Needling) until harmonization of blood and energy and taking the painful points as shu (energetic) points. This ailment has the name Meng Dong Bi (stasis of the first month of winter).

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algoparesthesia

EXPLANATIONS AND COMMENTARIES Ma Shi explains: “This paragraph concerns the illness of the Jing Jin of the xin bao luo (XB), called “Meng Dong Bi”, and its treatment. 1. The Jing Jin of the Hand Jueyin (XB) starts at the point Zhongchong (XB 9), at the tip of the middle finger, _ follows the direction of the Jing Jin of the Hand Taiyin (Lu) _ inserts into the point Quze (XB 3) _ ascends the arm to insert into the points Tianquan (XB 2) and Tianchi (XB 1), located in front of and below the axilla _ branches in front of and behind the ribcage.

A vessel penetrates into the axilla and branches to the cardia. 2. Disturbance of this Jing Jin manifest by the signs of pain and spasm of the regions of passage of this channel, etc. This ailment generally manifests in the 10th month of the year (Lunar), hence the name of Meng Dong Bi or stasis and algoparesthesias of the first month of winter.” Zheng Yu gong states: “At the foot, one calls it jueyin, and at the hand it bears the name Xin Zhu (Master of heart). This ailment originates from the site of birth of the energy of the 3 yin and 3 yang, birth whose site is at the bottom. The source of the energy is therefore at the foot. It is in this way that the 6 channels of the foot unite with those of the hand.” 434.

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Figure 64: Tendino-muscular channel of the xinbao (XB) From 1 to 5: energetic circulatory direction and insertion points (After “Theory and Practice of Analgesia By Acupuncture”- N.V.N. Edition)

PARAGRAPH 12

435....

1. The Jing Jin of the Hand Shaoyin (He) starts at the internal ungual angle of the little finger, inserts at the styloid apophysis of the ulna, ascends to the internal side of the elbow, reaches the axilla, crosses the Jing Jin of the Hand Taiyin (Lu), works its way into the interior of the breast, penetrates into the interior of the thorax, traverses the cardia and inserts into the umbilicus. 436.

2. Disturbance of this Jing Jin manifest by the following signs: _ spasm and pain of the muscles served by this channel _ intrathoracic spasm and pain producing the syndrome Fu Liang . 3. Treatment consists of using the method Fan Zhen Jie Ci (heated Needles/Rapid Needling) until harmonization of energy and blood and taking the painful points as shu (energetic) points. In the syndrome Fu Liang ( 1 0 ) with vomiting of blood clots, the illness is incurable and prognosis fatal. Generally, the illness of the Jing Jin of the “cold” type is characterized by muscular spasm with inability to bend backward, and that of the “heat” type, by muscular laxity with loss of virility.

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In the yang syndrome, the individual bends backward with inability to bend forward, and in yin syndromes, the individual bends forward with inability to bend backward. In all cases, in the syndrome of heat with muscular laxity, the method Fan Zhen Jie Ci (heated Needles/Rapid Needling) is strictly advised against. This ailment has the name Ji Dong Bi (stasis and algoparesthesia of the third month of winter).

EXPLANATIONS AND COMMENTARIES Ma Shi explains: “This paragraph concerns the illness of the Jing Jin of the heart channel called Ji Dong Bi and its treatment. 1. The Jing Jin of the Hand Shaoyin (He) starts at the tip of the little finger at the point Shaochong (he 9), _ passes to the point shenmen (he 7), located at the tip of the ulna _ runs along the forearm and inserts into qingling (he 2), above and inside the elbow _ ascends to the axillary region where it crosses the Jing Jin of the Hand Taiyin (Lu) to penetrate into the breast, _ inserts into the thorax _ redescends and works its way into the umbilicus. 10. Energetic “piling up” (accumulation) in the form of a “tumor” in the area “under the heart” (epigastric).

2. Attack of this Jing Jin manifests by internal spasm (intrathoracic and abdominal) and the Fu Liang syndrome, etc. This ailment generally manifests in the 12th month of the year (Lunar), hence the name Ji Dong Bi (stasis and algoparesthesia of the third month of winter). 438... Zhang Qe zhi has said: “Chapter 13 and the following 6 chapters speaks on the energetic routes of the Jing Jin, the measurement of bones, the length of the vessels, the circulation of ying (nutritive energy) (also called “Rong”- see explanation, Ch. 16) and wei (defensive energy), etc. In this Chapter 13, only the Bi syndromes are presented because these kinds of illnesses are taken as examples to demonstrate that the Jing Jin unite with the 3 yin and 3 yang, the 4 seasons and 6 energies of heaven... . In reality, the Jing Jin do not present only as the syndromes of Bi, but indeed many others... .”. 437.

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Figure 65: Tendino-muscular channel of the heart. From 1 to 6: energetic circulatory path and points of insertion (After “Theory and Practice of Acupuncture Analgesia”- N.V.N. Edition

PARAGRAPH 13

438...

In the simultaneous illness of the Jing Jin of Foot Yangming (St) and Hand Taiyang (SI), with deviation of the face and eyes accompanied by visual disturbance..., treatment is the same as that already indicated.

EXPLANATIONS AND COMENTARIES I - Ma Shi explains: “This paragraph shows the treatment of the illness associated with 2 Jing Jin, that of the Foot Yangming (St) and Hand Taiyang (SI). When the two Jing Jin are simultaneously affected, spasm is followed by deviation of the mouth and eyes. The ocular canthi are then contracted, and the gaze is no longer clear. Fan Zhen Jie Ci method is imperatively advised, as in the previous cases.” II - Zhang Shi concludes: “This Chapter 13 concerns the Jing Jin of the 12 yin and yang channels of the foot and hand distributed to the two sides, left and right, of the body. In this Paragraph 13, the sign of deviation of the mouth and eyes is taken as an example intended for practical demonstration because the Jing Jin of the Foot Yangming (St) attaches to the mouth and inserts into the lower eyelid, and that of the Hand Taiyang (SI) connects to the chin and

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inserts into the upper eyelid. This is why: _ when these two Jing Jin of the left side are affected, deviation of the mouth and eye forms at the left and the treatment must be performed on the left. _ when those of the right side are affected, the deviation of the mouth and eye forms at the right and the treatment must be performed on the right. _ when the left eye is suddenly disturbed, the illness is at the left side. _ when the right eye is suddenly affected, the illness is at the right side. As for treatment, it is that already recommended in the previous paragraphs.” 439. III - N.V.N.: I - Characteristics of the Jing Jin A. The 12 jingmai (principal channels) constitute a continuous and cyclic circulatory system having a direct relationship as much at the exterior (skin, flesh, muscles and bone) as in the interior (organs and bowels), while the 12 Jing Jin (tendinomuscular channels) form a discontinuous and acyclic circulation exclusively involving the superficial (never the deep) part of the body. B. The Jing Jin always start at the tips of the fingers and toes; they relay from the large articulations of the upper limb (wrist, elbow, shoulder) and lower limb (ankle, knee, hip) and all end at the neck and head. C. The region of distribution of these Jing Jin are very extensive. a) The Jing Jin of the 3 yang of the foot all cross Quepen and arrive around the eye. But they each have an area of predilection: _ that of the Foot Taiyang (Bl) circulates in the posterior zone of the body. _ that of the Foot Shaoyang (GB) circulates in the lateral zone of the body. _ that of the Foot Yangming (St) circulates in the anterior zone of the body. b) The Jing Jin of the 3 yang of the hand all reach the head and face and arrive at the frontal angle. c) The Jing Jin of the 3 yin of the foot all insert into the genitals. But, _ that of Foot Taiyin (Sp) also inserts into the ribcage and links to the vertebral column _ that of Foot Shaoyin (Ki) also reaches the buttock, run alongside the spinous muscles and inserts into the mastoid. d) The Jing Jin of the 3 yin of the hand all reach the lateral side of the thorax and descend into the region of the cardia. But, _ that of the Hand Taiyin (Lu) involves more the hypochondria _ and that of the Hand Shaoyin (He) involves more the umbilicus. The areas of distribution of the Jing Jin (tendinomuscular channels) therefore exceed the circulatory paths of the jingmai (principal channels) and Jing Bie (distinct channels). But their activity is permanently supported by the energy of these latter, hence the importance of the relationship between these three groups of channels. This relationship allows explanation of the therapeutic effect of certain acupuncture points on ailments which manifest outside the areas of action of the principal channels. In this way, for example, hegu (LI 4) and yangshi (LI 5) can treat headache via the intermediary of the Jing Jin of the large intestine which “ascends the left side of the forehead, passes to the front of the cranium, then redescends toward the right maxilla to spread to the neck.” II - System of union of the Jing Jin 441... The Jing Jin are not under the influence of the law of alternation of yin-yang, but they constitute the Four System of Union at the expense of the 3 yin and 3 yang of the foot and hand. Because,

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1. The first system of union is established between the Jing Jin of the 3 yang of the foot Foot Taiyang (Bl), Foot Shaoyang (GB) and Foot Yangming (St), which unite at the cheekbone (zygomatic arch where the point Quanliao- SI 18 is found). (Figure 66) 2. The second system of union is formed by the Jing Jin of the 3 yin of the foot - Foot Taiyin (Sp), Foot Shaoyin (Ki) and Foot Jueyin (Li), which unite at the genitals (pubic symphysis where the point is Zhongli- CV 3 is found). (Figure 67) 3. The third system of union is established between the Jing Jin of the 3 yang of the handHand Taiyang (SI), Hand Shaoyang (SJ) and Hand Yangming (LI), which unite at the frontal angle (where the point Touwei - St 8 is found). (Figure 68) 4. The fourth system of union is established between the Jing Jin of the 3 yin of the handHand Taiyin (Lu), Hand Jueyin (XB) and Hand Shaoyin (He). which unite in the subaxillary region (where the point Yuanye- GB 22 is found). (Figure 69) 442...

This study permits the differentiation of the Jing Jin from the jingmai which are founded on the yin/yang movements at the level of the foot and hand, constituting the cyclic system of the energy, while the Jing Bie are established according to the “Entering/Exiting - Separation/Union” system of the 2 yin/yang channels of the foot and hand having a “Top/Bottom - interior/exterior” relationship. Clinically, in the simultaneous illness of the Jing Jin of the 3 yang or 3 yin of the foot or hand, these points of union are always painful. (See Paragraph 13 of this chapter).

440.

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Figure 66: Areas of union of the three Tendinomuscular Channels (yang) of the foot.

Figure 67: Areas of union of the three Tendinomuscular Channels of (yin) of the foot. 441...

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Figure 68: Zones of union of the three Tendinomusculars of yang nature of the hand. 443.

Figure 69: Zones of union of the three Tendinomusculars of yin nature of the hand. III - Pathological role and therapy of the Jing Jin This chapter give dissertation on the seasonal and monthly “Bi” of the 3 yin and 3 yang of the foot and hand. 1. Disturbance of the Jing Jin of the 3 yang of the foot (Foot Taiyang, Foot Shaoyang and Foot Yangming) generally manifest during the three months of spring (Chun). 2. Disturbance of the Jing Jin of the 3 yin of the foot (Foot Taiyin, Foot Jueyin and Foot Shaoyin) generally manifest during the three months of autumn (Jiu). 3. Disturbance of the Jing Jin of the 3 yang of the hand (Hand Taiyang, Hand Shaoyang and Hand Yangming) generally manifest during the three months of summer (Xia). 4. Disturbance of the Jing Jin of the 3 yin of the hand (Hand Taiyin, Hand Jueyin and Hand Shaoyin) generally manifest during the three months of winter (Dong). In other words, each Jing Jin responds to a month (Lunar) during which its energy is under the influence of a temporary modification conforming to that of the environment. An inappropriate response of the Jing Jin to cosmic demand is the origin of energetic stagnation at the level of the muscles and tendons, responsible for spasm and pain. This Bi is therefore of internal origin and must be treated according to the method “heated Needles/Rapid Needling”. But the treatment of the Bi of the Jing Jin is not so simple because Paragraph 13 of this chapter states: “In illnesses of the Jing Jin caused by cold, the muscles contract, and in those caused by heat, the muscles become lax”. Therefore, the Bi of the Jing Jin can be of external origin caused by infiltration of perverse energy, blocking the circulation of the Jing Jin which also provokes spasm and pain.

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In this manner, in the illness of Jing Jin caused by cold, one must promptly needle the painful points with heated needles, and in that caused by heat, one must rapidly disperse the perverse yang with unheated needles. In these two cases, _ rotatory movements transmitted to the needle in view of dispersion of perverse cold or perverse heat are rapid _ and rotatory movements transmitted to the needle in view of tonification of the energy of the body at the level of the corresponding principal channel (jingmai) are slow. 444. This technique therefore is based on the circulatory route and symptomatology of the Jing Jin on the one hand, and on the other hand, on the energetic state of the jingmai of the area affected. In other words, in disturbance of the Jing Jin, one must disperse the painful points on the one hand, and on the other hand, tonify the corresponding jingmai (principal channels). In this manner, in traditional Chinese medicine, isolated treatment of the Jing Jin, neglecting the terrain of the individual, is harmful, and real comprehension of this technique is the condition sine qua non of good clinical practice.

445.

CHAPTER XIV Measurement of the Bones (Gu Duo)

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The importance of Chapter 14 of the Lingshu is to make clear, in view of standardization, the length of the bones in man of average build, estimated in Haungdi’s era to be 7 feet 5 inches. It concerns a method of measurement according to the length of the bones which allows not only the evaluation of the length of the jingmai, but also of marking out the different parts of the body in “cun” or “inches” (unit of measure) to determine, in a practical way, the topography of the energetic (shu) points. These means of measurement are always well utilized in our time. This chapter consists of 14 paragraphs.

PARAGRAPH 1 Huangdi questions Baigao: “ Mai Duo (measurement of the vessels) (1) deals with the length of the jingmai. What is it based on?” Baigao: “It is first necessary to evaluate the measurement of the bones (Gu Duo) , the length and size of the joints... . By this means, one can determine that of the jingmai.” 1. The name of Chapter 17 of this classic.

EXPLANATIONS AND COMMENTARIES Ma Shi explains: “This paragraph concerns the measurement of the vessels (Mai Duo) in the human being, which is determined after that of the bones. “Measurement of the Vessels” is the title of Chapter 17 of this classic. 446. The following paragraphs deals with the “measurement of the bones” (Gu Duo). here, it is a matter of a simple introduction to Chapter 14.”

PARAGRAPH 2 Huangdi: “Please be clear on the measurement of the bones in man of average size of 7 feet 5 inches. What is the size and width of his joints?” Baigao: “The circumference of the cranium is 2 feet 6 inches.”

EXPLANATIONS AND COMMENTARIES

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I - Zhang Shi explains: “7 feet 5 inches” is the average size of man of olden days. In man of average size, cranial circumference is proportional to the size and length of the other bones of the body.” II - N.V.N.: 1 foot = 0.324 m (actual measurement) 1 inch = 1/10th of a foot or 0.0324 m. The size of ancient man is 7 feet 5 inches, that is (0.324m X 7 + 0.0324m X 5 =) 2.42 m (?). The girth of the cranium is 2 feet 6 inches, that is (0.324m X 2 + 0.0324m X 6 =) 0.8424 m.

PARAGRAPH 3 The circumference of the thorax is 4 feet 5 inches and that of the lumbar region is 4 feet 2 inches.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph concerns the measure of girth of the thoracic cage and belt region.” II - N.V.N.: The girth of the thorax is 4 feet 5 inches, that is (0.324m X 4 + 0.0324m X 5 =) 1.458 m. The girth of the waist is 4 feet 2 inches, that is (0.324m X 4 + 0.0324m X 2 =) 1.33 m.

PARAGRAPH 4

447.

“The distance from the anterior limit to the posterior limit of the hairline from forehead to nucha is 1 foot 2 inches, and that of the anterior limit from the hair to the labial commisure is 1 foot. In some sages, the eclectic (Zie Zhong) method is advised. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “Measurement according to the eclectic method is applied by some sages of square face where the anterior root of the hair is moved back more than normal. This method consists of evaluating the distance from the vertex of the cranium to the nucha, which is 1 foot 1 inch, and that from the anterior root of the hair to the labial commisure, which is also 1 foot 1 inch, that is to say a total of 2 feet 2 inches as indicated in the text. This method of measurement suggests that some sages differ from other individuals and that there also exists in them phenomena of excess and insufficiency.” II - N.V.N.: “Eclecticism” (Zie Zhong) is a philosophic method recommending the derivation of various systems of argument, best when they are reconcilable, rather than creating a new system.

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PARAGRAPH 5 From the upper part of the laryngo-pharyngeal apparatus to the middle of Quepen (supraclavicular fossa), the length is 4 inches. From Quepen to the xiphoid appendage , the length is 9 inches. If this distance is longer, the lungs are large; if it is shorter, the lungs are small. From the xiphoid appendage to Tianshu (St 25) , the length is 8 inches. If this distance is longer, the stomach is large; if it is shorter, the stomach is small. From Tianshu (St 25) to the pubic symphysis, the length is 6.5 inches. If this distance is shorter, the colon is narrow and short. The length of the pubis is 6.5 inches. 448. From the upper border of the pubis to the upper border of the internal condyle of the femur, the length is 1 foot, 8 inches. From the upper border of the internal condyle of the femur to the lower border of the internal condyle of the tibia is 3.5 inches. From the knee and popliteal crease to the upper border of the heel, the distance is 1 foot 6 inches. From heel to the ground, the distance is 3 inches. This is why, when the contour of the bone is large, the bone is large; if it is small, the bone is small.

EXPLANATIONS AND COMMENTARIES Ma Shi explains: “Paragraph 4 concerns the configuration of the cranium and its relationship to the evaluation of the length of certain bones in man lying supine. 1. From the anterior root of the hair to the nucha, the length is 1 foot 2 inches, and from the anterior root of the hair to the labial commisure is 1 foot, that is, a total of 2 feet 2 inches. The eclectic method (Zie Zhong) consists of artificially dividing the face of the sage into three equal parts, called “beginning, middle and end” (shui, Zhong, Shong), to perform a numerical approximation; it is not applicable in normal individuals (see explanation above).

2. Within the supraclavicular fossa (Quepen) the point Quepen (St 12) is found belonging to the Foot Yangming (St). From the superior border of the laryngo-pharyngeal apparatus to the middle of Quepen is 4 inches in length. The xiphoid appendage has three names: Jiuwei, weiji and heyu. It is located 0.5 inches below the tip of the sternum. In individuals lacking a xiphoid appendage, the point Jiuwei (CV 15) is located one inch below the sternum. From Quepen (St 12) to Jiuwei (CV 15) the length is 9 inches. if it exceeds 9 inches, the lungs are certainly large; if it is smaller than 9 inches, the lungs are surely small. Tianshu (St 25), located 2 inches to the side of the umbilicus, is a point belonging to the Foot Yangming (St). From the xiphoid appendage to Tianshu (St 25) is 8 inches. If the length exceeds 8 inches, the stomach is ceertainly large; if it does not reach 8 inches, the stomach is surely small. But Tianshu (St 25) is an energetic-energetic point, therefore immaterial. For this

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reason, this distance must be measured as a function of the height of the umbilicus. 449. The point henggu (Ki 11) (2) is to the side and slightly below the point Qugu (CV 2). Four cun below the umbilicus the point Zhongji (CV 3) is found, located at the boundary of the pubic hair. To the side of Qugu (CV 2) is the point henggu (Ki 11); from Tianshu (St 25) to henggu (Ki 11) is 6.5 inches. If this distance exceeds 6.5 inches, the colon is large and long; in the opposite case, the colon is narrow and short. From henggu (Ki 11) to the superior border of the internal condyle of the femur, the length is 1 foot 8 inches. From the superior border of the internal condyle of the femur to the inferior border of the internal condyle of the tibia the length is 3.5 inches. From the superior border of the internal condyle of the tibia to the external malleolus is 1 foot 3 inches. From the internal malleolus to the ground, the length is 3 inches. The front of the knee and behind the knee (popliteal crease) are at the same height. From the front and rear of the knee to the heel, the length is 1 foot 6 inches. From the heel to the ground, the height is 3 inches.”

2. “henggu” means pubic bone.

PARAGRAPH 6 From distance is From From From From 9 inches. From From From

the parietal bone (Jiao) to the shoulder bone (Zugu), the 1 foot. the shoulder bone to the axilla, the distance is 4 inches. the axilla to the floating ribs, the distance is 1 foot 2 inches. the floating ribs to hip joint, the distance is 6 inches. the hip joint to the middle of the knee, the distance is 1 foot knee to external malleolus, the distance is 1 feet 6 inches. the external malleolus to the point jinggu (Bl 64) is 3 inches. jinggu (Bl 64) to the ground, the distance is 1 inch.

EXPLANATIONS AND COMMENTARIES Ma Shi explains: “This paragraph concerns the length of the bones in the individual lying supine. To the side and above the ear is Gu Jia (temporal bone). The place of union of the shoulder bone (scapulo-humeral joint) has the name Zugu (“support bone”). 450. From the temporal bone to the shoulder joint is 1 foot. From the shoulder joint to the axilla is 4 inches.

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Underneath the floating ribs is the hypochondria (Ji Xia). From the axilla to the hypochondria is 1 foot 2 inches. From the hypochondria to the hip joint is 6 inches. From the hip joint to the middle of the knee is 1 foot 6 inches. From the knee to the external malleolus is 1 foot 6 inches. jinggu (Bl 64) is the name of the point belonging to the Foot Taiyang (Bl). From the external malleolus to jinggu (Bl 64) is 3 inches; from jinggu (Bl 64) to the ground is 1 inch”.

PARAGRAPH 7 The space separating the two petrosal bones (mastoid: W a n g u ) behind the ears is wide at 9 inches.

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph concerns the distance separating the two Wangu behind the ears which is 9 inches. The line formed is horizontal.” II - Zhang Shi adds: “The point Wangu (GB 12)is found on the bony hump behind the ear (mastoid). This point is located 4 cun below the frontal hairline.”

PARAGRAPH 8 The distance separating the points Ermen (SJ 21), located in front of the ear, is 1 chi 3 cun (13 cun) and that between the two cheekbones (Quan) is 7 cun. EXPLANATIONS AND COMMENTARIES Zhang Shi explains: “here, Baigao tells of the distance bewteen the 2 Erman (SJ 21) and that between the 2 Quanliao (LI 18) in passing by the nose.”

PARAGRAPH 9

451.

The distance separating the two breasts is 9.5 cun.

EXPLANATIONS AND COMMENTARIES

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Zhang Shi clarifies: “here, Baigao informs of the distance between the two points of the breasts.”

PARAGRAPH 10 The distance separating the two groins is 6.5 cun.

EXPLANATIONS AND COMMENTARIES Zhang Shi explains: “here, Baigao informs of the distance between the two groins in the supine subject.”

PARAGRAPH 11 The foot is 1 chi 2 cun long, 4.5 cun wide.

EXPLANATIONS AND COMMENTARIES Zhang Shi explains: “here, Baigao informs of the measurement of the foot.”

PARAGRAPH 12 From the posterior root of the hair to bone of the back is 2.5 cun. From lugu (1st dorsal vertebra) to the coccyx is 3 feet. The length of each cervical vertebra is 1.4 cun 1 li (1/10 cun), that is to say a total of 9.8 cun 7 li for the 7 cervical vertebrae. 452.

EXPLANATIONS AND COMMENTARIES Ma Shi explains: “here, Baigao informs on the measurement of the bones of prone individuals. From the hair root of the nucha to the top of the dorsal spine the distance is 2.5 cun. From lugu to the coccyx, one counts 21 vertebra whose length is 3 chi, 1 cun, 4 fen, 1 li. For each upper (cervical) vertebra, the thickness is 1 cun 4 fen 1 li, that is to say, 1 cun 4 fen 1 li X 7 = 9 cun 8 fen 7 li for the 7 cervical vertebra.”

PARAGRAPH 13 Such is the measurement of the bones in the normal individual

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permitting the determination of the During examination of the jingmai, resistence denotes an abundance of movement and their depth indicate

measurement of their superficial blood, and their an abundance of

the jingmai. tension and their galloping energy.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph represents the conclusion of the chapter on the determination of the length of the jingmai. The superficiality and firmness of the jingmai indicate their size and affluence of blood. In contrast, the rapidity of their circulation and deep location denotes their abundance of energy. This chapter concludes by the blood and energy of the jingmai, blood and energy being created by the kidney. If the jing qi (energetic essence) of the bone is thriving, the energy and blood are also thriving.” II - Ma Shi states: “Due to the activity of the Xin-shen (heart-mental), the jing Ye (liquid essence) of the kidney is transformed into red substance which is none other than blood/energy, that is to say jing qi (energetic essence). This is why in the jing qi, superficiality, although yang, concerns the blood, and deep, although yin, concerns the energy. Therefore, the conclusion of this chapter is centered on: _ the measurement of the bones from which one deduces the length of the vessels (jingmai) _ and the method of examination of the jing qi: its visibility (superficiality) marks the state of the abundance of blood, and its invisibility (depth) indicates the state of the abundance of energy. Consequently, one must disperse in the two cases; in contrast, if they are in shortage of blood and energy, one must tonify”. III - N.V.N.: The measurement of the bones of the different parts of the body is one of the most captivating chapters of Far Eastern anatomy, studied more than 2000 years before Christ by the Chinese people. This method consists of evaluating the length of the bones in chi (feet), cun (inch), fen (1/10 th cun) and li (1/10th fen) in order to determine, more precisely, the topography of the energetic-energetic points to diagnostic and therapeutic ends. Some information from these measurements have been enriched and modernized. We present below a table of measurement of the bones in “cun” (inches) mentionned in this chapter:

Measurement of the Bones (in “cun”) of ancient man

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regions

From one region to another

Measurement in “cun”

1. From ant.root of hair to post.root of hair 2. Dist.between 2 mastoids(Wangu-GB12) 3. Cranial contour 4. From ant. root of hair to cheekbone 5. Distance between 2 zygomatic bones 6. Distance between 2 Ermen (SJ 21) 7. From frontal angle to Dazhui(GV 14)

12 cun 9 cun 26 cun 10 cun 7 cun 13 cun 10 cun

1. From post.root of hair to Dazhui GV14 2. From sup.part of throat to Quepen

2.5 cun 4 cun

1. From base of sternum to xiphoid 2. From xiphoid to umbilicus 3. From Tianshu St25 to pubic bone 4. Length of pubic bone 5. Distance between the 2 breasts 6. Contour of thorax

9 cun 8 cun 6.5 cun 6.5 cun 9.5 cun 45 cun

Back-lumbars

1. From L2 to the tip of the coccyx 2. Contour of the lumbar region

30 cun 42 cun

Lateral side of the thoraco-abdominal region

1. From axilla to false ribs 2. From false ribs to coxo-femoral joint

12 cun 6 cun

head-Face

Neck-Nucha

Thorax-Abdomen

Measurement of the Bones (in “cun”) in ancient man (continued)

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454.

regions

Upper Limb

Lower limb

From one region to another 1. From shoulder to elbow 2. From Dazhui GV 14 to axillary fold 3. From elbow to wrist 4. From wrist to MCP joint of the middle finger 5. From MCP joint of middle finger to tip of finger 1. Distance between the 2 hip joints 2. From sup.bord.pubic symph.to sup.bord.int.condyle femur (i.c.f.) 3. From sup.bord.i.c.f. to inf.bord.int.condyle of tibia (i.c.t.) 4. From inf.bord.i.c.t. to internal malleolus 5. From internal malleolus to the ground 6. From popliteal crease to top of foot 7. From external malleolus to the ground 8. From hip joint to middle of knee 9. From knee to external malleolus 10. From external malleolus to jinggu Bl 64 11. From jinggu to the ground 12. Length of sole of foot 13. Width of sole of foot

Measurement in “cun” 17 cun 4 cun 12.5 cun 4 cun 4.5 cun 6.5 cun 18 cun 3.5 cun 13 cun 3 cun 16 cun 3 cun 19 cun 16 cun 3 cun 1 cun 12 cun 4.5 cun

455.

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CHAPTER XV Fifty Rong (Wu Shi Rong)

“Rong” implies the sense of “cyclic movements” of Rong (nutritive energy) (1). The object of Chapter 15 of the Lingshu is to show the number of Zhu (cycles, circuits), the distance covered and the circulatory time of the energy of the 28 jingmai in conformity with the 28 constellatons of the universe. Because in the space of one day and one night (24 actual hours or 12 Chinese hours), the energy carries out 50 Zhu lasting 13,500 respirations (inspirations and expirations). With each respiration the energy advances by 6 cun, and in the course of 13,500 respirations it progresses 13,500 X 6 = 81,000 cun or 810 zhang (1 zhang = 100 cun); during this time, the sun takes 100 Ke (time indicated by the clepsydra or 24 actual hours) in order to travel the 28 constellations. From this axiom, one can easily deduce the number of Zhu of the energy of the 28 jingmai during 24 hours (12 Chinese hours or 100 ancient Ke), hence the title of this chapter: “Fifty Rong” (Wu Shi Rong). This chapter is composed of a single paragraph.

1. “Rong” also has the name “ying”. See Chapter 16 (“Nutritive energy”). 456.

Huangdi: “I would like to hear you discourse upon Fifty Rong (Wu Shi Rong).”

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Qi Bo:

“The sun cuts across the space of 28 constellations. The distance between each constellation is 36 fen (that is, 28 X 36 = 1,008 fen for the 28 constellations). In man, the distance travelled by the energy of the jingmai in one day and one night (24 hours) is similar to that of the sun, that is to say, 1,008 fen. Because, lasting one day and one night, the sun travels the 28 constellations, the passing of the clepsydra marks 100 Ke, and in man, the jingmai, numbering 28, circulate above and below, front and back, to the left and to the right and accomplish a distance of 16 zhang 2 chi ( 2 ) in response to the distance separating the 28 constellations. The 100 Ke marked by the clepsydra are used as normal measures to distinguish day and night. In this way, in man, one notes that one expiration corresponds to 2 pulsations and an advance of the energy of 3 cun and that one inspiration also corresponds to 2 pulsations and an advance of the energy of 3 cun. The energy therefore moves forward 6 cun in one respiration (inspiration and expiration); in 10 respirations, it moves forward 6 chi (60 cun); and in 270 respirations it advances 270 X 6 = 1,620 cun, that is, 16 zhang and 2 chi. While the energy accomplishes a Zhu (cycle) of 16 chang 2 chi around the body, the clepsydra marks 2 Ke and the sun moves forward 20 fen. In 540 respirations (270 X 2), the energy carries out 2 Zhu , the clepsydra marks 4 Ke (2 X 2) and the sun advances 40 fen (20 X 2). In 2,700 respirations (270 X 10), the energy carries out 10 Zhu , the clepsydra marks 20 Ke (2 X 10), and the sun travels 5 constellations and 2 fen. In 13,500 respirations (270 X 50), the energy accomplishes 50 Zhu , the clepsydra marks 100 Ke and the sun travels 28 constellations; the water of the clepsydra arrives at its end and the energy terminates its journey within the jingmai. The cyclic paths of communication of the energy are always the same. The ease of the circulatory rhythm of the Fifty Rong (50 cycles) allows appreciation of the longevity accorded by heaven and earth. The 50 cycles determine the distance traveled by the energy of the jingmai, that is, 810 Zhang (16 Shang 2 chi X 50) in one day and one night.”

2. 1 zhang = 10 chi 1 chi = 10 cun 1 cun = 10 fen; hence: 16 zhang 2 chi = 1,620 cun (distance traveled during 1 cycle).

I - Zhang Shi explains: 457.... “This chapter concens the Tong qi or Dongqi (a priori or ancestral energy) (3) and the Ying Qi (nutritive energy, also called Rong qi) circulating within the 28 jingmai following one cycle of 16 zhang 2 chi (1,620 cun), calculated as a function of inspiration and expiration and as a function of the passage of the clepsydra (water clock of the ancient era).

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The celestial canopy possesses 28 constellations, that is to say, 7 constellations for each of the 4 cardinal directions. Zi-Wu, also called “Feng-Xi”, constitutes jing (longitude). Mao-You, also called “Xu-Chang”, wei (latitude). Feng-Xi is also jing. From Feng to Xi is yang; from Mao to You is yin. yang governs day, and yin, night. The distance separating 2 constellations is 36 fen, that is, 36 X 28 = 1,008 fen for the 28 constellations. (Figure 70) 458. The energy of man performs “Fifty Rong” (cycle in one day and one night = 24 hours); during that time, the sun travels 28 constellations, that is to say, 1,008 fen. The earth turns around the sun (4) and the sun is displaced in the celestial canopy. As a result, the earth itself also travels 28 constellations. The human being (inhabitant of the earth) is composed of 28 jingmai traveling above and below, left and right, front and back within the body, responding to the 28 constellations. These 28 jingmai are: _ 3 yin and 3 yang of the hand and 3 yin and 3 yang of the foot of the 2 sides of the body, that is to say, 24 channels, to which are added: _ the qiao of the left and right (5), renmai (CV) and Dumai (GV), for a total of 28 jingmai. The energy travels these 28 jingmai, that is to say, performs 16 chang 2 chi in one circuit of the body. In one day and one night (24 hours), it carries out 50 circuits (cycles), that is to say, 16 chang 2 chi x 50 = 810 Zhang in order to respond to the 28 constellations and to the 100 Ke of the clepsydra (24 actual hours). During this time, in one inspiration, the pulse emits 2 pulsations and the energy advances 3 cun, and in one expiration the pulse emits also 2 pulsations and the energy advances also 3 cun. Therefore, _ in 1 respiration (inspiration and expiration), the energy advances 6 cun _ in 10 respirations, it advances 60 cun or 6 chi _ in 270 respirations, it advances 1,620 cun or 16 zhang 2 chi, that is to say, one circuit around the body, and the clepsydra marks 2 Ke and the sun advances 20 fen and one fraction _ in 540 respirations (270 x 2), the energy performs 2 circuits around the body, the clepsydra marks 4 Ke and the sun advances by 40 fen and one fraction _ in 2,700 respirations (270 x 10), the energy performs 10 circuits around the body, the clepsydra marks 20 Ke and the sun traverses 5 constellations, that is to say, it advances by 200 fen and one fraction _ in 13,500 respirations (270 x 50), the energy performs 50 circuits around the body, the clepsydra marks 100 Ke (24 hours) and the sun traverses 28 constellations, which is to say it advances 1,008 fen (20 x 50 and one fraction). At this phase, ending the passage of water from the clepsydra, the energy ends its 50 cycles performed during one day and one night. These circulatory and cyclic movements are, under the action of Tong qi (a priori 459. or thoracic energy), transmitted to the xinbao (XB), to permit the Ying Qi to circulate in the 3. Tong qi (Dong qi), whose source is found at the kidney, controls respiratory and heart movements. Therefore, some of our Chinese brothers give it the name “Thoracic energy”. Tong qi is innate energy in perpetual motion, energy formed during the meeting of yin and yang (ovule and spermatozoa; that is to say, during the formation of the fetus). Diaphragmatic movements are also dependent on Tong qi. 4. This phrase has been translated: “the sun turns around the earth” by Westerners (!). 5. The human body possesses 4 qiao and not 2. But here, according to the context, yinqiao and yangqiao of the same side (left or right) only make up one, because of their “yin-yang/Day-night” nature.

interior (6) of the vessels, correlated with the inspiratory and expiratory movements (commanded by the Tong qi) and with the passage of water in the clepsydra.

457...

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Figure 70 : Distribution of the 28 constellations (After: “Semiology and Therapeutics in Oriental Energetic Medicine”, NVN Edition)

6. Zhang Shi”s explanation is fundamental. It clarifies the circulatory mode of the ying (Rong, nutritive) energy.

By deduction, the lung governs the energy and controls the pilocutneous system, including 84,000 sweat glands. These glands are closed during expiration and open during inspiration. These movements of opening and closing of the pores, under the action of Tong qi (a priori or thoracic energy), therefore play a fundamental role in respiration. The word “communcation” cited in the text implies the sense of “diffusion/exchange” of the Tong qi located at the exterior at the level of the skin and in the interior at the level of the

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jingmai, following the rhthym of passage of the water of the clepsydra. Finally, heaven governs the energy, and earth, the blood vessels. Fifty Rong (50 cycles) realize one complete circulation directed by the energy, at both the exterior and the interior, factor of longevity. We indicate, always, that Tong qi, circulating outside and inside the jingmai, is able to accomplish with exactitude 810 Zhang (81,000 cun or about 2,050 meters) during one day and one night (24 h.).” II - N.V.N.: 1. ying (Rong: nutritive) energy and wei (defensive) energy circulate within the organism and each of them performs 25 cycles around the body during the day and 25 cycles during the night, following the principles of yin-yang: _ at midnight, the yin energetic potential is at its maximum. After midnight, the yin energy retires little by little until dawn. At the moment when it reaches its minimum, the yang energy rises and succeeds it. _ at noon, the yang energetic potential is maximal. As soon as the sun is displaced to the West, the yang energy retires little by little until dusk. At the moment when it reaches its minimum, the yin energy rises and succeeds it. In this manner, ying and wei energies, although different circulations, gather at midnight to create the phenomena called “reunion of yin”. At daybreak, maximal yin becomes minimal yin, and it is at this moment when yang rises to succeed it. This perpetual circulation agrees perfectly with the apparent movements of the sun and moon of the natural world (Chapter 18, Lingshu, “Production and reunion of ying and wei”). • One is given, without explanation, the timetables of maximum ying (nutritive) energy. As for those of the wei (defensive) energy, one cannot find them anywhere. Energetic medicine is therefore amputated from its foundation. To avoid confusion, often unfortunate in clinical training and the practice of acupuncture, our duty is to deepen the study of the movements of the wei and ying energy, drawn from different chapters of the Lingshu: _ Chapter 18: “Production and reunion of ying and wei” _ Chapter 52: “wei energy” _ Chapter 59: “Irregular Circulation of wei energy” _ Chapter 76: “Movements of wei energy”. 460. 2. ying energy and wei energy have the same origin, originating from Dietary jing (essence). Dietary jing has two components: _ the “pure” component is the ying energy _ the “impure” component is the wei energy. The terms “pure” and “impure” are not to be taken in the literal sense; they denote the yin and yang nature of this energetic essence: _ the first, “pure”, encompasses the sense of organization, care, restoration and consumption/expenditure that requires maintaining it in a good state. ying energy is therefore necessary to the material existence of the body. Its role is to maintain the interior of the organism (yin); _ the second, “impure”, implies the sense of protection of the organism against the effects of cosmic influence (perverse energy). Wei energy is therefore necessary for the defense of the exterior of the organism (yang). 3. Their production, distribution and use have a very strict relationship with the sanjiao (Three Metabolisms/Three Jiao). According to the Neijing Lingshu (Ch. 18: “Production and reunion of ying and wei”): “ying energy is emitted by the middle jiao (zhongjiao); wei energy, by the Lower Jiao

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(Xiaojiao). The energy of the Upper Jiao (shangjiao) is emitted at the level of the heart. It traverses the diaphragm, follows the esophagus and spreads within the thorax. At the subaxillary region, it follows the path of the Hand Taiyin (Lu), then passes to the Hand yangming (LI) to ascend up to the tongue. From the tongue, it descends and unites with the Foot Yangming (St) in order to follow the paths of the 12 principal channels. It evolves, with the ying energy, carrying out 25 cycles around the body during the day (12 hours) and 25 during the night (12 hours), that is, 50 cycles in 24 hours (12 Chinese hours). The next day, the cycle begins again at the level of the Hand Taiyin (Lu).” 4. ying energy circulates within the principal channels. It begins and ends at the Hand Taiyin (Lu). This is why the taiyin governs the interior. This idea is already known by all. wei energy circulates outside the principal channels. It begins and ends at the Foot Taiyang (Bl). This is why the taiyang governs the exterior. This notion remains misunderstood in the Western acupuncture world to this day; it needs to be explained.

461.

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CHAPTER XVI Nutritive energy (Ying Qi) (1)

Chapter 16 of the Lingshu defines the Ying Qi (Rong: nutritive energy), derived from food metabolism. This energy circulates within the jingmai (principal channels) and luomai (secondary channels), travelling through the entire body. Its vessel of departure is the Hand Taiyin (Lu) and then successively the channels of the large intestine (LI), stomach (St), spleen (Sp), heart (He), small intestine (SI), bladder (Bl), kidney (Ki), xin bao luo (XB), sanjiao (SJ), gallbladder (GB) and, finally, the liver (Li); then it returns to the Hand Taiyin (Lu). This circulation consists of two routes of derivation borrowing from the routes of the Dumai (GV) and that of the renmai (CV), which also empty into the lung. At the lung, the energy begins its cycle again. The purpose of this chapter is to present the chronologic circulation of Ying Qi, hence its title: “Ying Qi” (“Nutritive energy”). This chapter consists of a single paragraph.

1. “Ying Qi” means “glorious energy”.

Huangdi: “Most invaluable in the circulation of Ying Qi (2) is the reception of food products. Because, once in the stomach, foods are transformed into energy which is transmitted to the lung, flooding the interior and

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spreading to the exterior. The pure part of this energy circulates continuously in the jing Sui (deep, subterranean routes). Such is the cyclic rule dictated by heaven and earth. Because, the energy leaves the taiyin (Lu), circulates in the Hand Yangming (LI), ascends and goes along the Foot Yangming (St), descends by the top of the foot, flows down into the space of the great toe and unites with the Foot Taiyin (Sp). It goes back up the thigh and inserts into the heart. By the route of the Hand Shaoyin (He), it 462. exteriorizes at the axilla, goes back down the length of the arm and is directed toward the tip of the little finger to unite with the Hand Taiyang (SI). Then from there, it goes back up to the axilla, reaches the internal side of the the facial bone, flows down into the internal canthus of the eye, reaches the top of the cranium, goes back down to the nucha and links up with the Foot Taiyang (Bl). It runs along the vertebral column down to the sacrum, arrives at the tip of the little toe, comes out again by the sole of the foot, flows down into the Foot Shaoyin (Ki), reascends and inserts into the kidney. From the kidney, it flow into the heart, spreads within the thorax, follows the xin bao luo (XB), comes back out via the axilla, redescends to the arm, arrives in the space located between the 2 tendons, penetrates into the palm of the hand and resurfaces via the tip of the middle finger; from the palm of the hand, a branch reaches the tip of the ring finger and unites with the Hand Shaoyang (SJ). It goes back up and arrives at Tanzhong (CV 17), spreads to the sanjiao (SJ), projects into the gallbladder, comes back out via the hypochondria, flows down into the Foot Shaoyang (GB), redescends and arrives at the top of the foot, reaching the space of the large toe to unite with the Foot Jueyin (Li). It goes back up to the liver, directly reaching the laryngopharyngeal system, penetrates into the internal orifices of the nose (sinuses) and finally arrives at the external nasal orifices. A vessel ascends to the forehead, arrives at the top of the cranium, redescends to the nucha above the first cervical vertebrae, in the middle of the implantation of the hair, where the Dumai (GV) is found. A vessel attaches to yin qi (genitals), crosses the pubic hair, penetrates into the umbilicus, follows the inner wall of the abdomen, 2. Also known as “Rong qi” (nutritive energy). See the explanation of Zhang Shi.

enters into Quepen (supraclavicular fossa), redescends to the lung and follows the Hand Taiyin (Lu). Such is the circulatory path of Ying Qi (nutritive energy). EXPLANATIONS AND COMMENTARIES

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I - Zhang Shi explains: 1. This chapter concerns ying-Xue (energy-blood) which circulates within the jing Sui (3) (deep channels), which begin via the Hand Taiyin (Lu) and ends via the Foot Jueyin (Li) This circulation is perpetual; the cycle begins again via its uninterrupted trajectory. ying-Xue (ying-blood) results from the inhalation of liquid (food) substances by the energy of the zhongjiao (middle jiao-MJ) to produce blood, allowing maintenance of the organism. No other substance is as invaluable as ying-blood. This is why ying-blood circulating within the jing Sui has the name “ying-blood” (honorable blood); that means to also state that the energy of the blood is Ying Qi (nutrtitive energy). 463. The actions “...flooding the interior and spreading to the exterior”, imply that the liquid substance originating from the zhongjiao (MJ), flooding the interior, is called jing (essence) which, under the action of Xin-shen (heart-mental), transforms into blood. The Chongmai and renmai (CV) distribute it to the exterior to fortify the skin, heat up the muscles and embellish the body hair and head hair. The most precious substance contained within the “Cereal water” (food water/nutritive liquid), under the action of the Xin-shen, is red in color. It circulates continuously in a cycle without end within the jing Sui. This circulation has the name “Cycle of heaven and earth”. since it spreads to the pilocutaneous level, it responds to the energy of heaven and circulates at the exterior. since it circulates in the interior of the jingmai (principal channels), it responds to the jing shui (4) (rivers- waterways) .

2. Ying Qi (nutritive energy) leaves from the Hand Taiyin (Lu) and flows down into the point Shaoshang (Lu 11), located at the tip of the thumb; a vessel is directed to the tip of the index finger to unite with the Hand Yangming (LI). It ascends to the nose, is directed into the Foot Yangming (St), redescends to the point Chongyang (St 42), located on top of the foot and inserts into the space of the great toe to unite with the Foot Taiyin (Sp) vessel, at the point Yinbai (Sp 1). It ascends to the thigh and flows into the heart. Via the Hand Shaoyin (He) vessel, it exteriorizes at the point Ququan (he 1), below the axilla, reaches the arm and inserts into the point Shaochong (he 9), located at the tip of the little finger, reascends to the axilla, arrives at the suborbital region and falls into the internal canthus of the eye to unite with the point jingming (Bl 1) of the Foot Taiyang (Bl). It goes back up to the top of the cranium, goes back down to the nucha, runs alongside the vertebral column, arrives at the sacrum, goes back down and inserts into the point zhiyin (Bl 67) of the little toe, reaches the sole of the foot at the point Yongquan (Ki 1) of the Foot Shaoyin (Ki), goes back up and projects into the kidney. From the kidney, it is directed to the heart, spreads into the thorax, links up with the xin bao luo (XB). Via the path of the Hand Jueyin (XB), it comes back out at Zhongchong (XB 9) of the middle finger; a vessel reaches guanchong (SJ 1) of the ring finger to unite with the Hand Shaoyang (SJ). 3. “jing Sui”: deep routes or principal channels within which circulate ying-blood (nutritive energy and blood). See Chapter 17 (“Measurement of the Vessels”), pages 430-1. 4. “jing shui”: waterways, rivers. See Chapter 12 (“River Routes”), page 358.

It ascends and inserts into the point Danzhong (CV 17) and becomes dispersed into the sanjiao (SJ). By the path of the sanjiao (SJ), it flows down into the gallbladder, comes back out at the hypochondria and inserts into the Foot Shaoyang (GB). It redescends and reaches the top of the foot. It inserts into the point Dadun (Sp 1) of the great toe, unites with the Foot Jueyin (Li) and goes back up to the liver. From the liver, it flows into the lung, reaches the laryngo-pharyngeal system, penetrates into the sinuses of the nose and ends up at the nasal orifices (nostrils).

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A vessel arises from the liver, ascends to the forehead, reaches the vertex and links up with the Dumai (GV), descends to the nucha, runs alongside the vertebral column to the coccyx... . This trajectory belongs to the Dumai (GV). A vessel of the Dumai reaches the anterior part of the body, links to yin qi (genital organs), goes up to the pubic hair, penetrates into the umbilicus, follows the inner wall of the abdomen, arrives at Quepen (supraclavicular fossa), goes back down and flows down into the lung and reaches the Hand Taiyin (Lu)... . Such is the circulatory pathway of the ying energy of the organism.”

II - Ma Shi comments: “This chapter concerns the circulation of Ying Qi (nutritive energy), similar to Tong qi (a priori energy) (5). Tong qi is the Great energy (daqi) contained within the thorax, ending up at the laryngopharyngeal apparatus. This innate energy coming from the kidney (source organ) controls respiratory function and activates the circulation in the jing Sui (deep channels). Ying Qi (nutritive energy) is yin qi (yin energy); it comes from the zhongjiao (MJ) which brings it toward the xiajiao (Lower Jiao-LJ) in order to become yin qi. This is why the text states: “The pure substance is jing (essence); under the action of the zhongjiao (MJ), it becomes Ying Qi”. But Ying Qi is able to be obtained only from the pure substances of the “Cereal water (foods). This is why it is said: “The most precious in the circulation of the Ying Qi is the reception of the food products.” In this manner, without the cereal energy, there is no production of Ying Qi, and without Ying Qi, no production of blood. In other words, once in the stomach, foods, under the action of the zhongjiao (MJ), become transformed into pure substance (Cereal jing) which, in turn, under the action of Tong qi (a priori or thoracic energy), reaches the points Chongfu (Lu 1) and Yuanmen (Lu 2) to flow down into the Hand Taiyin (Lu). From the Hand Taiyin (Lu), it passes successively into the Hand Yangming (LI), Foot Yangming (St), Foot Taiyin (Sp), Hand Shaoyin (He), Hand Taiyang (SI), Foot Taiyang (Bl), Foot Shaoyin (Ki), Hand Jueyin (XB), Hand Shaoyang (SJ), Foot Shaoyang (GB), Foot Jueyin (Li)... . In the interior, it floods the organs and bowels; at the exterior, it spreads outside the jingmai. As for Ying Qi, being “yin-jing” ,therefore the most precious substance under the action of Tong qi (a priori or thoracic energy), it circulates within the interior of the jing Sui (deep principal channels). Its circulation begins at the Hand Taiyin (Lu) and terminates at the Foot Jueyin (Li), then it restarts the cycle again... . This is the principle of heaven and earth which never changes.”

III - N.V.N.: The circulation of ying (nutritive) energy can be diagrammed in the following fashion:

5. See Chapter 10 (“Vessels-Channels”) on the jingmai. 465.

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Figure 71: Circadian circulation of ying (nutritive) energy no 466/467.

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CHAPTER XVII Measurement of the Vessels (Mai Duo)

Chapter 17 consists of three parts: 1. The length of the 3 yin and 3 yang of the foot and hand (that is to say, the 24 bilateral principal channels), the 2 qiaomai and 2 medial channels (renmai and Dumai), that is to say, 28 channels whose length totals 16 Zhang 2 Chi. 2. The liason of the jing qi (essence) of the 5 organs with the “7 orifices”. This jing energy plays a fundamental role in the maintenance of the harmonious state of sensory functions (olfaction, hearing, vision, taste...). In contrast, the disequilibrium of this energy has an excessive fullness of yin and yang as a consequence, causing the syndrome guan Ge (energetic separation), determining factor of premature death. 3. The presentation of the yinqiao. It starts at the foot and reaches the ocular system; it plays a preponderant role in the nutrition of the ophthalmic system. But the essential aspect of this chapter concerns the measurement of the jingmai, hence the name “Measurement of the Vessels” (Mai Duo). This chapter consists of 6 paragraphs.

PARAGRAPH 1 Huangdi: “Please instruct me on the measurement of the vessels (Mai Duo)”. Qi Bo:

“The 6 yang channels of the hand go from the hand to the head. They each have a length of 5 chi, that is, 5 X 6 = 30 chi or 3 zhang.

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468.

The 6 yin channels of the hand go from the thorax to the hand. They each have a length of 3 chi 5 cun, that is, 3.5 X 6 = 21 chi or 2.1 zhang. The 6 yang channels of the foot go from head to foot. They each have a length of 8 chi, that is, 8 X 6 = 48 chi or 4.8 zhang. The 6 yin channels of the foot go from foot to thorax. They each have a length of 6 chi 5 cun, that is, 6.5 X 6 = 39 chi or 3.9 zhang. The 2 qiaomai go from the foot to the eyes. They each have a length of 7 chi 5 cun, that is, 7.5 X 2 = 15 chi or 1 zhang 5 chi. Dumai (GV) and renami (CV) each have a length of 4 chi 5 cun, that is, 4.5 X 2 = 9 chi or 0.9 zhang. The total length of these channels is 16 zhang 2 chi. These channels are the deep routes (jing Sui)”.

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph concerns the measurement of the vessels (Mai Duo). “6 yin and 6 yang” designate the 3 yin and 3 yang bilaterally. 1. The words “... from the hand to the head” describes the circulatory direction of the yang channels of the hand because, _ the Hand Taiyang (SI) starts at the point Shaoze (SI 1), located at the tip of the little finger, and ends at the point Tinggong (SI 19), located on the face. _ the Hand Yangming (LI) starts at the point Shangyang (LI 1), at the tip of the index finger, and ends at the point yingxiang (LI 20), located on the face. _ the Hand Shaoyang (SJ) starts at the point guanchong (SJ 1), at the tip of the ring finger, and end at the point Huajiao (sizhukong-SJ 23), located on the face. Each yang channel of the hand measures 5 chi long, for the group of 6 channels, that is, 5 X 6 = 30 chi or 3 zhang.

2. The words “... from the thorax to the hand” describes the circulatory direction of the yin channels of the hand because, _ the Hand Taiyin (Lu) starts at the center of the axillary crease at the point Zhongfu (Lu 1) and ends at the tip of the thumb at the point Shaoshang (Lu 11). _ the Hand Shaoyin (He) starts at the thorax (axillary region) at the point Jiquan (he 1) and ends at the tip of the little finger at the point Shaochong (he 9). _ the Hand Jueyin (XB) starts at the thorax at the point Tianchi (XB 1) and ends at the tip of the middle finger at the point Zhongchong (XB 9). Each yin channel of the hand measures 3 chi 5 cun long, for the group of channels, that is, 3.5 X 6 = 21 chi or 2.1 zhang. 469. 3. The words “... from the head to the foot” describe the circulatory direction of the yang of the foot because, _ the Foot Taiyang (Bl) starts on the head at the point jingming (Bl 1) and ends at the 5th toe at the point zhiyin (Bl 67).

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_ the Foot Yangming (St) starts on the head at the point shenggi (St 1) and ends at the 2nd toe at the point Lidui (St 45). _ the Foot Shaoyang (GB) starts on the head at the point Tongziliao (GB 1) and ends at the 4th toe at the point qiaoyin (GB 44). Each yang channel of the foot measures 8 chi long, for all the 6 channels, that is 8 X 6 = 48 chi or 4.8 zhang. 4. The words “... from foot to the thorax” describess the circulatory direction of the yin channels of the foot because, _ the Foot Taiyin (Sp) starts at the great toe at the point Yinbai (Sp 1) and ends at the thorax at the point Dabao (Sp 21). _ the Foot Shaoyin (Ki) starts at the sole of the foot at the point Rongquan (Ki 1) and ends on the thorax at the point shufu (Ki 27). _ the Foot Jueyin (Li) starts at the great toe at the point Dadun (Li 1) and ends on the thorax at the point qimen (Li 14). Each yin channel of the foot measures 6 chi 5 cun, for all the 6 channels, that is, 6.5 X 6 = 39 chi or 3 zhang 9 chi. 5. The qiaomai goes from the foot to the eyes. Their length is 7 chi 5 cun, that is, 7.5 X 2 = 15 chi or 1 zhang 5 chi. 6. The Dumai (GV) is the medial posterior route, and the renmai (CV) the medial anterior route. Each of these channels measures 4.5 chi, that is, 4.5 X 2 = 9 chi. In this manner, the total length of the 24 channels, the 2 qiaomai, renmai and Dumai represent 16 zhang 2 chi. These channels constitute one system called jing Sui (large deep routes).”

III - N.V.N.: The qiaomai are divided into yinqiao and yangqiao, of left and right, that is to say, 4 qiao. This paragraph only mentions 2 qiao because the measurement of the vessels takes into account in woman (yin), 2 yinqiao (left and right), and in men (yang), 2 yangqiao (left and right). Nevertheless, in clinic, it is the rule to consider yinqiao and yangqiao, of the left and right, together.

PARAGRAPH 2

470.

The jingmai are in the interior ( 1 ) . Their routes of deviation are called l u o , and the branches of the luo bear the name S u n . If these vessels are in fullness with plethora of blood, treatment must be done urgently; dispersion is used in the case of fullness and phytotherapy in the case of emptiness.

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EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph completes the previous chapters. The words “jing, luo, sunluo” are welldefined and treatment by acupuncture or phytotherapy is also advised according to the case of emptiness or fullness of the luo and sunluo. The phrase “jingmai are in the interior” consists of the same meaning as the word jing Sui (deep paths). The paths of deviation (Luo) are the transversal paths going from a yin principal channel toward the yang principal channel and vice versa to constitute a “yin-yang” system. For example: the vessel leaving from the point Lieque (Lu 7) (Luo) toward the point hegu (LI 4) (yuan). (2) The Bie luo (longitudinal luo) (3) possess branches called sunluo (energetic capillaries). In the presence of fullness of these vessels, it is advised to apply an urgent treatment. How do you treat them? If the perverse energy is in fullness, one should disperse by acupuncture, and if the essential energy is in emptiness, one should prescribe phytotherapy to tonify it.”

II - N.V.N.: See also Chapter 10 (“Vessels-Channels”) of this classic.

PARAGRAPH 3 1. The jing qi (energetic essence) of the 5 organs have a close relationship with the “7 orifices”. In effect: _ the jing qi of the lung communicates with the nose; the lung being in harmony, the nose can perceive odors. _ the jing qi of the heart communicates with the tongue. The heart being in harmony, the tongue can recognize the 5 flavors. _ the jing qi of the liver communicates with the eyes. The liver being in harmony, the eyes can distinguish the 5 colors. _ the jing qi of the spleen communicates with the mouth. The spleen being in harmony, the mouth can appreciate the “5 cereals” (to eat with appetite). _ the jing qi of the kidney communicates with the ears. The kidney being in harmony, the ears can perceive the 5 sounds. 471. 1. Implies the sense of “deep”. 2. With Chamfrault, we designated this vessel of deviation under the nametransversal luo. 3. Bie luo are the longitudinal luo which go from the exterior to the interior, directly reaching the organs and bowels.

When the 5 organs are in disharmony, the “7 orifices” are obstructed, and when the 6 bowels are in disequilibrium, the energy stagnates and is transformed into abcess. 2. This is why, when perverse energy occurs in the bowels, the yang vessels are not harmonious. The disharmony of these vessels causes the stagnation of energy; stagnation of energy is a phenomenon of fullness of yang energy. The yang energy in great fullness is not favorable to the yin vessels; the blood stagnates and causes fullness of yin energy.

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The yin energy being in great fullness, the yang energy cannot circulate. This phenomenon is called guan (barrier, obstruction). The yang energy being in great fullness, the yin energy cannot circulate and the phenomenon bears the name Ge ( s e p a r a t i o n ) . When yin and yang energy are simultaneously in great fullness, their circulation is paralyzed and the phenomenon is named guan Ge (door/separation). That which attains guan Ge does not live long. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: 1. “In the interior, the 6 yang channels of the hand and foot communicate with the bowels, and the 6 yin channels, with the 6 organs. blood and energy originate from the organs and bowels. This is why “it is necessary to prescribe medicines to tonify them.” Such is the situation of the energy circulating within the vessels. But this paragraph also concerns the relationship of the energy of the 5 organs with the pilocutaneous system and the “7 orifices” to demonstrate their correspondences with the Celestial and Terrestrial Dao.

2. The energy of the 5 organs communicates with the “7 orifices”. As a result, their disharmony is the cause of disturbances at the level of the sensory organs. In the interior, the 6 bowels belong to yang, and at the exterior, the skin and body hair are yang. In that connection, the text states: “When yang energy is in excess, ying energy (nutritive energy) cannot circulate and transforms into abcess, etc.”. This means to say that when the 6 bowels are in dysharmony, the blood and energy stagnate and this accumulation at the level of pilocutaneous-sweat gland system is a dominant factor in the formation of furunculosis or abscess. The illness therefore manifests first in the interior, then evolves toward the exterior. “Perverse energy is at the bowel” means that it is found at the exterior, which is yang. In this case, “the yang vessels are not harmonious”, implying that renying (left radial pulse) is unbalanced. 3. The disharmony of the yang vessels causes the stagnation/accumulation of the energy. Because of this stagnation, the yang energy is in fullness, yet great fullness of the yang energy is an unfavorable phenomenon for the yin vessels. This means to say that qi Kou (right radial pulse) is unbalanced. 472. 4. The yin vessels in a state of disequilibrium causes stagnation/accumulation of blood and energy that is responsible for the fullness of yin energy. When the yin energy is in great fullness, the yang energy cannot circulate. This phenomenon bears the name guan (door, barrier). If this door is closed, the yin energy is retained in the interior, and the yang energy, isolated at the exterior, is found in a state of disequilibrium. When the yang energy is in great fullness, the yin energy cannot circulate. This term is utilized when the energy of the exterior is separated from the energy of the interior and the yin energy is no longer in a harmonious state. Therefore, when yin and yang are simultaneously in fullness, their disharmony bears the name guan-Ge (door/separation)and the illness is difficult to treat.”

II - N.V.N.: This “Gate Control” theory advocated by Chinese medical genius for over 2,000 years

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before Christ has always been and is still utilized in our time as one of the basic elements of therapy. It is founded on the opening and closing of the door of entering and exiting of yin and yang, at the level of the epidermo-dermal system. This notion of “door” possesses a pragmatic value and, as a result, is used in clinical practice. As for the “Gate Control” theory of Malzack and Wall in pain physiology, it assigns a role to the marrow in the control of painful influx. These influxes evoked by exteroreceptive stimulation are transmitted to three systems: _ the cells of the gelatinous substance of Rolando _ the central “T” cells of the posterior cornea _ the ascending lemniscal system, that is, the long fibers of the posterior cord which project toward the brain. This theory is, admittedly, passionate and conforms to the scientific thinking of our time, but it remains conjectural because it is useless in everyday clinical reasoning.

PARAGRAPH 4 Huangdi: “Where do the qiaomai leave from and where do they stop? With what energy from which jingmai are they entrusted to propel the “water” movement?” ( 4 ) Qi Bo:

473.

“The qiaomai is the “Bie” (collateral or distinct vessel) of the shaoyin (Ki). It starts behind Rangu (scaphoid bone, where the point of the same name is found: Ki 2), reaches the internal malleolus, ascends to the inner thigh, penetrates into the abdomen and reaches the interior of the thorax, penetrates into Quepen (supraclavicular fossa, where St 12 is found) and arrives in front of renying (St 9) , penetrates into the malar bone and reaches the internal canthus of the eye to unite with the taiyang (Bl) and yangqiao. The energy of yinqiao and that of yangqiao take care of one another in order to moisten the eye, If the yin energy is in deficiency, the eyes can no longer close.”

4. This phrase has never been correctly translated into Western language.

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph concerns the point of departure and arrival of the qiaomai. Huangdi’s question is centered on the two qiaomai, but Qi Bo’s reply only bears on the yinqiao. energy and blood circulate like water on the surface of the earth. This is why Huangdi questions: “By which energy do they propel the “water” movement? and Qi Bo replies: The yinqiao is a “Bie” vessel belonging to the Foot Shaoyin (Ki). It starts at the point Zhaohai (Ki 6) underneath and behind Rangu (Ki 2),

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_ ascends to the internal malleolus and reaches the length of the inner thigh _ ascends into the abdomen and reaches the interior of the thorax _ penetrates into Quepen and reaches the front of the point renying (St 9) _ penetrates into the malar bone and arrives at the point jingming (Bl 1), located at the internal canthus of the eye, to unite with the yangqiao belonging to the Foot Taiyang (Bl). The union of the energy of yinqiao and that of yangqiao permits maintaining in perfect fashion their saturating action within the ocular system, In the opposite case, the eye cannot close.” II - N.V.N.: 1. This paragraph concerns the trajectory of the yinqiao which consists of three parts: _ the infero-internal part of the lower limb _ the intra-abdomino-thoracic part _ and the supero-external part at the level of the cranium. The study of this trajectory allows understanding the action of Zhaohai (Ki 6- point of departure of the yinqiao) on cardio-pulmonary and abdominal pathology (5). As for the trajectory of yangqiao, it is only external. As a result, shenmai (Bl 62- point of departure of the yangqiao) acts only on external pathology. 474.

2. We summarize below disorders of the yinqiao and yangqiao cited in the classic books. a) yinqiao: _ In the attack of the yinqiao, yang (fire) of the body grows weaker and yin (water) becomes very strong. This is why one is always sleepy. _ In the attack of the yinqiao, yang is slow and yin is hurried, hence somnolence (Lingshu, Ch. 20 “The Five Perverse”). _ Disturbances of yinqiao can cause pain without localization (erratic pain). One needles the yinqiao in women and yangqiao in men (Lingshu, Ch. 73 “Ability in the Practice of Acupuncture”). _ When the yinqiao is disturbed by perverse energy, lumbar pain radiates to the neck. The patient has blurred vision. If the ailment is serious, the body is inverted backwards, the tongue stiffens and the patient cannot speak (Su Wen, Ch. 41“Acupuncture and the Treatment of lumbalgia). _ Faced with yin symptomatology, in the interior of the body, with oligo-anuria, one should think of disturbance of the yinqiao (Lingshu, Ch. 22 “yin Madnesses and yang Madnesses”). b) yangqiao: _ In the attack of the yangqiao, yin (water) grows weaker, yang (fire) is very strong; this is why one suffers from insomnia. _ The key sign of attack of the yangqiao is insomnia. In this case, yin (water) slows and yang (fire) accelerates (from the Nanjing). 5. As a result of this assertion, it is clear that the trajectory of the yinqiao as it has been presented to us up to this day does not conform to the energetic physiology of Classical Chinese Medicine.

_ This insomnia can be accompanied or not by specific signs according to whether the yangqiao is attacked by perverse energy or not : • lumbar pain, like the blow of a hammer, sometimes accompanied by swelling of this region (Su Wen, Ch. 41 “Acupuncture and the Treatment of lumbalgia”). • inability to close the eyes. Absence or, oppositely, abundance of tears (see yinqiao). • eye pain. This eye pain always starts at the internal canthus of the eye (Su Wen, Ch. 43: “Discourse on Obstructions”). • erratic pains. Movements are difficult (loss of agility).

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PARAGRAPH 5 Huangdi: “The energy of the yin vessels circulates only in the 5 organs and reaches the 6 bowels. Why?” 475.

Qi Bo:

“The energy can no longer circulate. It is like a current of water and like the apparent and eternal movements of the sun and moon. This is why the jing qi (energetic essence) of the yin vessels circulate in supplying the organs, and the jing qi of the yang vessels circulates in supplying the bowels, in a cycle without end, without pause. This energy floods the interior and permeates the 5 organs, and at the exterior it humidifies the sweat glands. EXPLANATIONS AND COMMENTARIES Ma Shi explains: “This paragraph concerns the energy circulating at the level of the organs/bowels. The yin vessels are the 6 yin channels of the hand and foot. Their energy circulates at the level of the 5 organs. The yang vessels are the 6 yang channels of the hand and foot. Their energy circulates at the level of the 6 bowels. yin comes back out toward yang. Ex: The channel of the lung circulates toward the large intestine. yang goes back into yin. Ex: The channel of the stomach circulates toward the spleen. This circulation therefore resembles a circle without end, always in motion, without ever pausing. In the interior, the energy permeates the 5 organs/6 bowels, and at the exterior, it moistens the sweat glands. In this manner, the energy not only circulates at the level of the 5 organs but also at the level of the 6 bowels.”

PARAGRAPH 6 Huangdi: “The qiaomai are divided into yinqiao and yangqiao. The number 1 zhang 5 chi that we have put forth above concerns which vessels?” Qi Bo: and

“The number calculated concerns the jing (principal channel), the non-calculated number, the luo (secondary vessels)”.

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph completes the previous one concerning the yangqiao responding to man, and the yinqiao to woman. It is in this manner that the qiaomai are divided into yin and yang.

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In man, the yangqiao is a principal vessel, and the yinqiao is a secondary vessel (Luo), and in women it is the reverse.” 476.

II - N.V.N.: We present below the table of lengths of the 28 vessels cited in the text and the diagrams of the two qiao:

jingmai

Measurement of Length

Total Length (left and right)

Shou taiyang (SI) Shou shaoyang (SJ) Shou yangming (LI)

From hand to head: 5 chi From hand to head: 5 chi From hand to head: 5 chi

5 x 2 = 10 chi 5 x 2 = 10 chi 5 x 2 = 10 chi

Shou taiyin (Lu) Shou jueyin (XB) Shou shaoyin (He)

From thorax to hand: 3 chi 5 cun From thorax to hand: 3 chi 5 cun From thorax to hand: 3 chi 5 cun

3.5 x 2 = 7 chi 3.5 x 2 = 7 chi 3.5 x 2 = 7 chi

Zu taiyin (Sp) Zu jueyin (Li) Zu shaoyin (Ki)

From foot to thorax: 6 chi 5 cun From foot to thorax: 6 chi 5 cun From foot to thorax: 6 chi 5 cun

6.5 x 2 = 13 chi 6.5 x 2 = 13 chi 6.5 x 2 = 13 chi

Zu taiyang (Bl) Zu shaoyang (GB) Zu yangming (St)

From head to foot: 8 chi From head to foot: 8 chi From head to foot: 8 chi

8 x 2 = 16 chi 8 x 2 = 16 chi 8 x 2 = 16 chi

qiaomai Dumai (GV) renmai (CV)

From foot to eye: 7 chi 5 cun From coccyx to face: 4 chi 5 cun From perineum to face: 4 chi 5 cun

7.5 x 2 = 15 chi (medial) 4 chi 5 cun (medial) 4 chi 5 cun

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Figure 72: yinqiao

Figure 73: yangqiao

477.

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CHAPTER XVIII Production and reunion of ying and wei (ying wei sheng Hui)

ying (Rong: nutritive energy) and wei (defensive energy) come from the same dietary source. “ying” encompasses the sense of organization, care, restoration and expenditure and consumption which requires maintaining a good state of health. ying energy is therefore necessary for the material existence of the body; its role is the maintenance of the interior of the organism.

“wei” signifies “protection”. Its role is to defend the exterior of the organism. The production, distribution and functions of these two energies have a close relationship with the sanjiao (SJ). Chapter 18 of the Lingshu studies the production and reunion of ying and wei, hence its title. It consists of 10 paragraphs.

PARAGRAPH 1 Huangdi: “Where does the energy of man come from? Where do the yin and yang reunite? What is the energy called “ y i n g ” , and what is the energy called “wei” ? What is the site of production of ying, and what is the site of reunion of wei? In the case of aged and young people, the energy is not the same; yin and yang move differently. I would like you to inform me of the site of reunion of the wei.”

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Qi Bo:

478.

“Man receives the energy originating from foods. This energy is transmitted to the lung, and from the lung, to the 5 organs and 6 bowels. The pure component of the food energy is the ying, and the impure component is the wei. The first circulates within the vessels, and the second outside the vessels. These two energies circulate in the body without stopping, like a circle without end. wei energy circulates 25 times in the yin part during the night and 25 times in the yang part during the day, that is to say, 50 times in one day and one night. As a result, when it arrives at yang, it “awakens”, and when it arrives at yin, it ”goes to sleep”. For this reason, it is said: “At noon, yang is in fullness and has the name Zhong yang (yang juxtaposition); at midnight, yin is in fullness and is called Zhong yin (yin juxtaposition).” In this manner, the taiyin controls the interior, and the taiyang the exterior; each executes its role 25 times following day and night. At midnight, yin is at its height. Passed midnight, yin declines. At dawn, yin disappears, and yang begins to receive the energy. At noon, yang is at its height. At dusk, yang weakens, and at sundown yang disappears and yin begins to receive the energy. Midnight is the moment of Grand reunion (Da Hui); all the people go to bed, and this phenomenon is designated by the name “ Gathering of yin” (he yin) . At dawn, yin disappears and yang begins again to receive the energy... . This circulation is perpetual; heaven and earth follow the same rule.”

EXPLANATIONS AND COMMENTARIES I- Zhang Shi explains: 1. “This paragraph concerns the production and circulation, the reunion and gathering of the ying and wei. 2. The phrase “Foods penetrate into the stomach”; their energy is transmitted to the lung and from the lung to the 5 organs and 6 bowels...” informs about the circulation of ying-Xue (ying-blood) at the level of the 5 organs and 6 bowels and the 12 jingmai. “The pure component is the ying, and the impure component the wei” implies that there exists two energetic circulatory pathways, that of ying and that of wei. ying circulates within the channels, and wei, outside the channels. This circulation is perpetual; the energy only reunites at the Hand Taiyin (Lu) after having accomplished a daily cycle of 50 turns through the yin regions and yang regions of the body, carrying out circles without end. Such is the cyclic circulation of Ying Qi within the vessels responding to the respiratory movements and temporal movements of the clepsydra (see Chapter 15: “Fifty Rong”). 479.

3. Wei qi (defensive energy) circulates 25 times in yin during the night and 25 times in yang during the day. This circulation is distinguished into nocturnal circulation and diurnal circulation. This is why, when the energy arrives at yang, the individual awakens and opens the eyes, and when it arrives at the yin, the individual closes the eyes and goes to sleep.

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4. At noon, the yang energy is at its apogee; this is the moment of the circulation of the wei into yang. This evolutive phase has the name Zhong yang (juxtaposition of yang). At mdinight, the yin energy is at its apogee; this is the moment of the circulation of the wei into yin. This evolutive phase is called Zhong yin (juxtaposition of yin). 5. The taiyin reponds to earth, and the taiyang, to heaven. Wei qi circulates during the day at the level of the cutaneous system, therefore at the exterior which responds to taiyang, and during the night, at the level of the deep membranous layers belonging to the 5 organs, which are none other than the “principal sites” governed by the taiyin. Wei Qi performs the movements 25 times at the exterior of the body during one day and 25 times in the interior during one night. Such is the circulation of Wei Qi. 6. At midnight, yin is at its apogee; passed midnight, yin grows weaker. At dawn, yin disappears and yang begins to receive the energy. At noon, yang is at its apogee; at dusk, yang grows weaker and at sundown yang disappears and yin begins to receive the energy. At exactly midnight, yin and yang reunite; all the people go to sleep. This phenomenon is designated by the name he yin (gathering of yin). This is the energy circulating in yin which unites at the yin following the rules “yin/yang-Day/night” of heaven and earth. At dawn, Wei Qi ends its circulation in yin; the exterior/yang receives it in order to control its movements. In this manner, Wei Qi circulates without ceasing; yin and yang of heaven and earth obey the same law.”

II - N.V.N.: ying energy and wei energy originate from dietary jing elaborated at the level of the stomach under the action of the zhongjiao (middle jiao). ying energy is controlled by Tong qi (a priori energy) and the xinbao (XB) whose action is to transmit to it an orderly and chronologic circulation within the interior of the jingmai. It begins and ends at the Hand Taiyin (Lu); this is why the taiyin governs the interior (1). As for wei energy, it freely circulates without being controlled by the Tong qi and xinbao. As a result, during the day, it circulates in the yang areas (where the yang channel are found), and during the night in the yin areas (where the yin channels are found). It begins and ends at the Foot Taiyang (Bl); this is why the taiyang governs the exterior. (2) 480. Briefly, ying and wei energy circulate in the organism, each evolving in 25 circuits during the day and 25 circuits during the night following the correlation “yin/yang-Day/night”. 1. In the sense of “inside the channels”

2. “yin Zhang yang Jiang” in pinyin.

At midnight, the energetic yin potential is maximum. After midnight, the yin energy retires little by little until dawn. At the moment when it reaches its minimum, the yang energy rises and succeeds it. At noon, the energetic yang potential is maximum. When the sun is displaced to the West, the yang energy retires little by little until dusk. At the moment when it reaches its minimum, the yin energy rises and succeeds it (Figure 70). ying and wei energy, despite being independent circulations, reunite at midnight to create the phenomenon “reunion of yin” (he yin). At daybreak, maximal yin becomes minimal yin, and this is the moment when yang rises in to succeed it. This perpetual circulation agrees perfectly with the apparent movements of the sun and the moon of the natural world.

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Figure 74 Maximal evolution of yin and yang. In the natural world, yin ascends (from earth to heaven) and yang descends (from heaven to earth). (2)

PARAGRAPH 2

481.

Huangdi: “In aged individuals, which type of energy is responsible for insomnia? And in the young, which type of energy prevents them from going to sleep during the day?” Qi Bo:

“In the young, the blood and energy are in abundance, the tissues fibers are full and solid, the energetic paths are free and fluid and the ying and wei circulate freely without being contrary. This is why they are awake during the day and only sleep at night.

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In contrast, in the elderly, the blood and energy are weak, tissues fibers are thin and dried out, the energetic paths are hindered, the activities of the 5 organs are slowed down and the weakening of Ying Qi favors the encroachment of Wei Qi. This is why they are not very awake during the day, and at night, they cannot fall asleep.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “ying and wei each possess a site of production and a specific path of circulation. Their site of reunion is located in the pilocutaneous spaces and sweat glands. They circulate together, go in and come back out together. Also, in Chapter 52 (“Defensive energy”- Wei Qi) of this classic it is clearly stated: “By qijie (other name qichong- St 30), the blood and energy circulating within the vessels reach the skin to unite with the Wei Qi with which it circulates together. While the blood and energy circulating within the vessels moves in one direction, the blood and energy circulating outside the vessels moves in the opposite direction. Such is the rule of the normal circulation of yin and yang, of blood and energy.”

II - Ma Shi comments: “The preceding paragraph notes the different states of blood and energy in the case of young and old persons, while this paragraph completes it in taking the state of wakefulness in the elderly during the night and the state of wakefulness in the young during the day as examples. The term “energetic routes” employed in this paragraph designates the circulatory pathways of the energetic vessels. The rule of circulation of ying and wei has already been shown in the previous paragraph.” 482.

III - N.V.N.: Insomnia constitutes a real medical problem of modern life. This paragraph offers us the possibility of solving one of the clinical forms of insomnia by the energetic route of Oriental medicine.

PARAGRAPH 3 Huangdi: “I wish to be informed of the movements of ying and wei. Where do they come from?” Qi Bo:

“ying energy is emitted by zhongjiao (middle jiao), and wei, by xiajiao (Lower Jiao).”

EXPLANATIONS AND COMMENTARIES I - Ma Shi notes:

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“This paragraph informs of the sites of emmission of ying and wei energy.”

PARAGRAPH 4 Huangdi: “I wish to be informed on the sites of emission and the routes of distribution of the energy of the sanjiao (SJ).” Qi Bo:

“The energy of shangjiao (Upper Jiao- UJ) is emitted at the “upper mouth” (cardia) of the stomach; it follows the esophagus in crossing the diaphragm and spreads into the thorax; it arrives at the subaxillary region and goes back down (to the hand), following the route of the Hand Taiyin (Lu); it returns by the path of the Hand Yangming (LI) in order to go back up to the tongue; then descends again following the path of the Foot Yangming (St). Usually, it circulates jointly with the ying energy and accomplishes 25 turns in yang and 25 turns in yin, that is to say, 50 circuits during one day and one night; then it ends up at the Grand reunion (Da Hui) at the level of the Hand Taiyin (Lu).”( 3 ) 483.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains “This paragraph instructs on the sites of emission of the energy of the sanjiao (SJ) in order to explain the production and reunion of ying (nutritive) and wei (defensive) energy. The shangjiao (Upper Jiao) (4) starts at the cardia, _ runs alongside the esophagus, crossing the diaphragm _ spreads into the thorax _ arrives at the subaxillary region _ passes by the points Yunmen (Lu 2) and Zhongfu (Lu 1), to circulate following the path of 3. To start the cycle again. 4. See zhongjiao (middle jiao) and xiajiao (Lower Jiao) in the following paragraphs.

the Hand Taiyin (Lu) _ returns to the Hand Yangming (LI) to ascend to the tongue _ then redescends in the region belonging to the Foot Yangming (St)... . Usually, the energy of shangjiao (UJ) circulates with the ying (nutritive) energy in accomplishing 25 circuits in the yang channels and 25 circuits in the yin channels, that is to say, one cycle of 50 circuits. At the end of each cycle, it links up to the Hand Taiyin (Lu), at the site called “Grand reunion” (Da Hui), before beginning another cycle again. In summary, the energy of shangjiao (UJ) begins at the taiyin (Lu), located in the thorax, and ends at the “Grand reunion”, located at the same taiyin. Following another angle, the 3 yin channels of the hand, leaving from the organs, arrive at the bowels, and the 3 yang channels of the foot, leaving from the foot, arrive at the organs; Ying Qi circulates in the 28 vessels (channels) (5) during 270 expirations in order to respond to 2 Ke of the clepsydra, forming in this manner one circuit of the body. This circulation travels the yin and yang, the interior and exterior, the jingmai and the organs/bowels during one day (24 hours = one

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day and one night) in order to accomplish one cycle of 50 circuits. As a result, this circulation does not only take place in yang during the day and only in yin during the night.” II - N.V.N.: shangjiao (Upper Jiao) is the site of concentration of Tong qi (a priori energy, also called “thoracic energy” by our Chinese friends). Tong qi results from the meeting of yin (ovum) and yang (sperm). Its movements are therefore innate and constitute the motor-center of all activities of the acquired energy: respiratory and cardiac movements, diaphragmatic and liquid movements... given off at the level of the zhongjiao (middle jiao) and at the level of the xiajiao (Lower Jiao). Zhang jin Yue states: “The cardia (shangjiao=Upper Jiao) is the abode of the lung and the site of gathering of Tong qi (innate energy). Ying Qi (nutritive energy) is able to carry out 25 circuits during the day and 25 circuits during the night, that is to say, one cycle of 50 circuits of the body during one day (24 hours), due to the propulsive action of Tong qi (innate energy).” (6)

PARAGRAPH 5

484.

Huangdi: “From the arrival of warm foods into the stomach, some individuals perspire at the face, back or middle of the body. Why does the perspiration not follow the route of the Wei Qi?” Qi Bo:

“At the exterior, this individual is affected by the wind, and at the interior, his sweat glands are opened widely and his tissue fibers are markedly dilated. In this case, wei energy becomes promptly mobilized toward the exterior and does have the time to follow its characteristic route. This energy is hardy, rapid and robust; this is why it exudes from the opening of the pores and does not follow the usual route. This phenomenon has the name lu Xie (secretion by oozing).” 5. See the explanation in the previous chapters. 6. See also our explanation regarding the action of the xinbao (XB) on ying energy (Paragraph 1 of this chapter).

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “wei energy follows the energy of shangjiao (Upper Jiao- UJ) in order to spread into the entire body. 1. The energy of the shangjiao (UJ) starts at the cardia, _ traverses the diaphragm _ diffuses into the thorax _ comes back out via the axilla and arrives at the region belonging to the taiyin (Lu) _ reaches the point Futu (LI 18) _ descends to the point renying (St 9) _ then disseminates to the skin and sweat gland system. The energy of the shangjiao (UJ), as a rule, circulates with the ying (nutritive) energy at

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the level of the yin and yang. 2. Wei energy (defensive energy) follows the energy of the shangjiao (UJ) in order to spread to the exterior. Above, it does not arrive at the face; behind, it does not reach the back. As a result, at the time of the arrival of food into the stomach, like ying, wei and Tong are not yet clearly individualized; perspiration occurs at the face and back because the wei energy has not yet become exteriorized according to a definite route. wei energy spreads into the entire body. If perspiration occurs at the middle of the body, it is because the wei is not consistent and regular. wei energy originates from the cereal liquids (han qi) (7). It is of a fiery, rapid and volatile nature; it escapes to the exterior as soon as the pores are not tightly closed. This is why in this case, it is written: “The wei energy does not follow its characteristic path.” 485.

3. In this paragraph, the infiltration of perverse wind is the origin of the perspiration. It explains the mobilization of the energy toward the exterior according to the path of the shangjiao (UJ). The energy of the shangjiao circulates together with the ying energy, and they go in and come back out together. II - Ma Shi comments: “In some individuals, the ingestion of warm drinks and foods can cause sweating either at the face or back. This example is chosen to justify the opening of the pores during an infiltration of perverse wind and during the non-determination of the energies (ying, wei and Tong) at the level of the stomach, causing in this manner sweating of the face or back. wind is perverse yang, therefore, an external heat; warm food during ingestion is an internal heat. The presence of these two heats constitutes a factor in opening the pores by which wei energy escapes to the exterior without having followed its proper pathway: this phenomenon is called lu Xie (secretion by oozing).” III - N.V.N.: This paragraph concerns the mechanism of activation of sweating in certain individuals during ingestion of warm drinks and food. It is a matter of an example to demonstrate one type of non-conforming circulation of wei energy because of its volatile and transient nature.

7. Literally, “Sweat-energy” (obtained at the time of food metabolism).

PARAGRAPH 6 Huangdi: “I want you to inform me about the zhongjiao (middle jiao- MJ). Where does it leave from?” Qi Bo:

“The energy of zhongjiao (MJ) starts at the middle of the stoamch (fundus). Its manifestations are produced after those of the shangjiao (Upper Jiao). zhongjiao (MJ) is the site of reception of the cereal products. It eliminates the residues and decants the food liquid and transforms it into Cereal jing (food essence). This is directed towards the top and flows down into the vessels of the lung.

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The mixture of this Cereal jing and organic liquids are converted into blood to maintain the organism. This nutritive substance is the most invaluable; it originates from the zhongjiao (MJ) and circulates only within the jingmai. This is why one gives it the name Ying Qi (also called Rong qi). ( 8 ) EXPLANATIONS AND COMMENTARIES

486.

Ma Shi explains: “Ying Qi (nutritive energy) is yin energy (yin qi) which starts at the zhongjiao (MJ), located at Zhongwan (center of the stomach: fundus). This energy originates from food metabolism. ying energy follows Tong qi (innate or thoracic energy) which conducts it to the lung to circulate within the 12 jingmai. Under the action of the heart, Ying Qi is transformed into blood, substance which maintains the body; therefore, there is not another substance more precious than it. Ying Qi is of yin nature. This is why it circulates alone within the jingmai. Compared to Wei Qi, it circulates within the jingmai like an officer (in charge) of the barracks. This is why one gives it the name “Rong qi”.”

PARAGRAPH 7 Huangdi: “energy (qi) and blood (Xue) are two different designations and yet they belong to the same source. How is that?” Qi Bo:

“ying (also named Rong) and wei are very closely correlated with jing qi (essence of the energy), and blood, with shen qi (mental energy). This is why blood and energy have two different names but are of the same kind. 8. See definition of the words “Rong” and “ying” in Chapter 16 (“Nutritive energy”) of this classic.

“In this manner, in the case of Dua Xue (loss of blood), sweating is absent, and in the case of Dua han (loss of sweat), blood is absent. Man has, therefore, two circumstances which cause him to die, but not two circumstances which bring him back to life.”

EXPLANATIONS AND COMMENTARIES

487.

I - Zhang Shi explains: “ying and wei, just like Xue (blood), originate from cereal energy (essence of food energy). This is why they are different in name but of the same origin. Sweat is a liquid substance belonging to the blood, emanating in the course of energetic modification. This is why the “loss of blood” (Dua Xue) is characterized by the absence of sweat, and the “loss of sweat” (Dua han), by the absence of blood. For this reason, it is said: “Man has two circumstances which bring him to death, but not two circumstances which bring him back to life.”

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II - N.V.N.: This paragraph defines therapeutic management in the case of excessive sweating and hemorrhage: a) Sweating is strictly forbidden in the case of bleeding. b) blood transfusion is expressly advised against in the case where the donor is affected by sweating.

PARAGRAPH 8 Huangdi: “I would like you to inform me about the xiajiao (Lower Jiao- LJ). How is it distributed? What is its role in “production/transformation”?” Qi Bo:

“xiajiao (LJ) detaches from Hui Chang (inferior portion of the small intestine) and inserts into the area belonging to the bladder. Because, “water” and “cereal” are first accumulated in the stomach; they are then transformed into residues which will be brought to the large intestine. This journey is controled and animated by the xiajiao to saturate the bladder. EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “The energy of xiajiao (LJ) gathers 1 cun from the subumbilical region (9), that of the shangjiao (UJ) at Tanzhong (CV 17) and that of zhongjiao (MJ) at Zhongwan (CV 12). With the help of the spleen, the stomach plays an important role in food metabolism. After metabolization, the residues and residual liquid are carried on to the small intestine. 488. The “lower mouth” of the small intestine attaches at the right to the large intestine, and at 9. It concerns the point yinjiao (CV 7) which is the Mu point of the xiajiao (LJ). But xiajiao possesses 2 Mu points). See MTC, NVN Edition).

the left it possesses vessels which communicates with the bladder (10). The residues contained in the large intestine are eliminated via the anal route, and the residual liquid, by the urethral route. All these metabolic processes taking place in the intestines and bladder are directed by the energy of xiajiao (LJ). The energy of xiajiao (LJ) is activated by shangjiao (UJ) and zhongjiao (MJ) to flow out toward the bottom. The “internal duct” of the sanjiao (SJ) is formed in this manner. But the xiajiao (LJ) is of the nature “yang in yin”. Its energy ascends and reaches the kidney and liver (11) to constitute the yang energy which is none other than Wei Qi (defensive energy). This is why it is said: “Wei Qi comes from xiajiao (LJ).”

II - N.V.N.: The explanation of Ma Shi is fundamental. It clarifies numerous ideas concerning: a) The Mu point of shangjiao (UJ), Tanzhong (CV 17), which directs cardio-pulmonary movements.

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b) The Mu point of zhongjiao (MJ), Zhongwan (CV 12), which controls digestive movements (gastro-splenic). c) The 2 Mu points of xiajiao (LJ): _ yinjiao (CV 7), whch controls the “water” movements. _ Shiman (CV 5), which establishes hepato-renal movements. d) The formation/production of wei energy, whose initial phase occurs at xiajiao (LJ) and final phase occurs at the “hepato-renal” system.

PARAGRAPH 9 Huangdi: “When one drinks wine with a meal, the foods are not yet digested then the wine is already evacuated via the urine. How is that?” Qi Bo:

“Wine is an alcoholic drink originating from the fermentation of “cereals”. Its energy is fiery, rapid and pure. This is why its evacuation is carried out before that of the foods.” EXPLANATIONS AND COMMENTARIES Ma Shi explains: “This paragraph completes the preceding one illustrated by this phrase “... falls into the area belonging to the bladder.” For this reason, Huangdi bases his judgment on the nature of wine in order to pose the question to Qi Bo whose response is the following: “Alcohol is a drink coming from the fermentation of rice. Its nature is fiery and pure. This is why its evacuation is more rapid than that of the foods.””

10. The small intestine and bladder constitute the taiyang. 11. See the preceding chapters.

PARAGRAPH 10 Huangdi concludes: “Excellent! I have heard it said that the shangjiao (UJ) is compared to mist, the zhongjiao (MJ) is compared to foam and the xiajiao (LJ) is compared to the gutter√ . This comparison is therefore just.” EXPLANATIONS AND COMMENTARIES I - Zhang Shi comments: “This paragraph studies the “production” and “reunion” of ying and wei. The Cereal jing (dietary essence) has two components: _ the “pure” component called “ying” (“Rong”) _ the “impure” component called “wei”.

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ying circulates within the channels, and wei circulates outside the channels. Their site of production/circulation is established in this way. yin and yang are of opposite natures. Where then do they gather? To answer this question, one must study their site of “exit” to be able to justify their site of “reunion”. Wei Qi, starting at shangjiao (Upper Jiao), usually circulates with Ying Qi during 25 circuits in yang and 25 circuitss in yin during one day and one night. After having accomplished one cycle of 50 circuits, they reunite before starting another cycle. Ying Qi starts at zhongjiao (middle jiao). The organic liquid follows the shangjiao (Upper Jiao) to heat up the epidermo-dermal system and become transformed, under the action of the jing-shen (heart), into blood in order to maintain the body. In total, ying and wei circulate according to a very characteristic mode. This mode permits determining their site of production/circulation and reunion.”

II - N.V.N.: The sanjiao (SJ) is responsible for the energetic metabolism of the entire body because organic activities such as: _ the production and distribution of blood, energy and organic liquid, _ digestion 490. _ and excretion of food residues and liquid residues are dependent on the energetic effects of the sanjiao. In other words, the functions of the sanjiao tend toward becoming widespread and therefore include the collection of energetic systems of the body in three distinct parts: upper, middle and lower. The pathophysiology is extremely important. It basically becomes manifest by a dimunition of energetic potential, therefore by a poor circulation of organic liquid, responsible for the stagnation of water-Humidity, one of the causes of disease of the sanjiao. This is why, clinically, swellng and edema, energetic afflux, abdominal flatulence, dysuria... are the basic signs of attack of the sanjiao. since the sanjiao is linked to the organs/bowels, its disorders have repercussions on the lung, spleen, kidney and bladder. In this way, for example a) a sanjiao in a state of energetic hypofunctioning can hamper the movements of the descent of the energy of the lung b) a sanjiao in a hypotonic state can disturb the ascending movements of the spleen and the movements of descent of the stomach c) a sanjiao in a liquid hypofunctioning state can have influence on the calorific/ heat converting function of the kidney and bladder and, via that, on the metabolism of organic liquid. Briefly, one diagnoses the state of the sanjiao by the dysfunctioning of the organs/bowels. According to Bian Que (500 A.D.) (12), the sanjiao form at the level of the stomach: “sanjiao are the routes of entry and exit of the food energy, as well as the sites of birth and production of all energetic activities of the human being. The energy of the 3 Jiao (upper, middle, lower) take their origin respectively from the cardia, fundus and pylorus: a - shangjiao (Upper Jiao) has the role of receiving the foods. When disordered, one treats Tanzhong (CV 17), located on the path of the renmai (CV) in a crease 1.6 cun from the breasts. b - zhongjiao (middle jiao) has for a function the energetic transformation of the foods. During disorder, one treats Tianshu (St 25) (13), located on the path of the yangming (St) at the level of the umbilicus.

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c - xiajiao (Lower Jiao), beginning at the pylorus and ending at the urethral meatus, has a triple function: _ distinction of “pure” and “impure” _ elimination of food wastes and residual liquids 491. _ activation of this expulsion. In the event of disorders, one treats yinjiao (CV 7) (14), located on the path of the renmai (CV) below the umbilicus. The collection of the 3 Jiao form the sanjiao (SJ) whose energy is concentrated at Qihai (CV 6).” As a result, the sanjiao (SJ) constitutes an energetic system assuring the function of the organs and bowels. This system is divided into three distinct stages corresponding to the three levels of activity of the organism: 1. First Stage: The part of the body which extends from the cardia up to the base of the tongue, in passing via the thorax, heart and lung, occurs in the sphere of the shangjiao (Upper Jiao). It assures the respiration of cosmic energy and its transformation into biologic energy. 2. Second Stage: The part which extends from the cardia to the pylorus, there comprising the upper abdominal area, spleen and stomach, occurs in the sphere of the zhongjiao (middle jiao). It assures the absorption of metabolites and their distribution throughout the entire body. 3. Third Stage: The part which extends from the pylorus to the genitourinary system, there comprising the lower abdominal area, liver, kidney, small intestine, large intestine and bladder, occurs in the sphere of the xiajiao (Lower Jiao). It assures the formation of defensive energy (wei) and the evacuation of wastes towards the exterior. Briefly, the sanjiao (SJ) are the sites of meeting of the different sources of water. From there, the liquid pathways leave, ending up at the bladder. Leijing concludes: “The sanjiao (SJ) constitutes the border of exterior defense of the organs and bowels, while the xin bao luo (XB) constitutes the border of external defense of the heart.” 12. His true name is qin Ye ren. 13. According to Bian Que, the zhongjiao (MJ) has two Mu points: Tianshu (St 25) and Zhongwan (CV 12) - See MTC NVN Edition, 1984. 14. The xiajiao (LJ) also has 2 Mu points: yinjiao (CV 7) and Shiman (CV 5). 492.

We present below a therapeutic table of the 5 organs and stomach from the sanjiao (SJ):

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“Back shu” of the sanjiao (SJ)

“Mu” of the sanjiao (SJ)

5 Organs and stomach

lung

Feishu - Bl 13 Zhongfu - lu 1

heart

Xinshu - Bl 15 Juque - CV 14

spleen

Pishu - Bl 20 Zhongmen - Li 13

stomach

weishu - Bl 21 Zhongwan - CV 12

liver

Genshu - Bl 18 qimen - Li 14

shangjiao (Upper Jiao) (Tanzhong - CV 17)

sanjiao (SJ) (Three Jiao)

(sanjiaoshu - Bl 22)

zhongjiao (middle jiao) (Zhongwan - CV 12) or (Tianshu - St 25)

xiajiao (Lower Jiao)

(yinjiao - CV 7) or (Shimen - CV 5)

“Back shu” and “Mu” of the 5 Organs and stomach

kidney

shenshu - Bl 23 jingmen - GB 25

Note: These treatments are usually reinforced by the action of the “yinwei/Chongmai” system (see MTC - NVN Edition).

493.

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CHAPTER XIX Energies of the 4 Seasons (si She qi)

Chapter 19 of the Lingshu demonstrates the rules of needling and the choice of points according to the 4 seasons with numerous clinical examples: _ _ _ _ _ _ _ _ _ _ _ _ _

Fever and chills Edema of “wind-water” origin postprandial diarrhea Cramps Edema of “water” origin Blockage of the energy (preventing movement) Emptiness-constipation and fullness-constipation Lai Feng (Leprosy) Boborygmi Orhcialgia “Biliary” vomiting Dysphagia Pelvic pain.

The energy of the 4 seasons is unstable and the manifestations of the illness are variable. This is why, therapeutically, it is necessary to base one’s judgment on the variations of the 4 seasons and on the localization of the corresponding energetic points (which are none other than the Wu shu, called “shu-antique points”), hence the title of this chapter: “Energies of the 4 Seasons (si She qi)”. This chapter consists of 16 paragraphs.

PARAGRAPH 1

494.

Huangdi: “The energies of the 4 seasons are not of the same nature and the illnesses are generally brought about by different causes. On what criteria then are the establishment of the rules of Acupuncture and Moxabustion based?”

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Qi Bo:

“The energies of the 4 seasons each have a place of manifestation which is particular to them, and the rules of Acupuncture and Moxabustion are determined by the obtaining of the energy (deqi) at the level of the energetic points utilized. This is why, _ in spring, one must needle the l u o , located in the flesh (dermis). Needling must be deep in serious cases and superficial in benign cases; _ in summer, one must needle the channels in a state of fullness and the sunluo (energetic capillaries), located in the epidermo-dermal spaces; _ in fall, one must needle the shu of the channels. If perverse energy is found in the bowels, one must needle the he p o i n t s ; _ in winter, one must needle the jing and y i n g . Needling must be deep and the needle placed permanently for a long time.”

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The energy of the 4 seasons manifests at the pilocutaneous region where the luomai (secondary vessels) are found, while that of the 6 bowels reunites at the exterior at the level of the epidermodermal and musculoskeletal systems. For this reason, illnesses of external etiology, located at the skin and flesh, muscles and bones, can contaminate the 6 bowels of the interior, and illnesses of internal etiology, located at the level of the bowels, can reach the exterior to contaminate the different layers of the body. Beside their endogenous or exogenous origins, illnesses all have a characteristic site of manifestation. In this way, knowledge of the site of entry and exit of the energy permits determining the therapeutic rules because the energy of each season has its own characteristic place of dwelling. This is why, _ In spring, it is necessary to needle the luomai, located in the dermis, and in summer, the sunluo and the channels in a state of fullness (1), located in the epidermo-dermal spaces because the energy of these two season goes from the interior to the exterior. _ In autumn, it is necessary to needle the shu point of the channels; if perverse energy is found in the bowel, it is necessary to needle the he point because the energy of autumn goes from the exterior toward the interior. 495. _ In winter, it is necessary to needle deeply the jing and ying points and leave the needle in a long time because the energy of winter is conserved in the interior. Therefore, the energy of the human being carries out movements of entering and exiting to respond to the movements of the 4 seasons of heaven and earth. This is why “the rules of 1. “Channels in a state of fullness” designates the yang channels of the foot and hand (see Suwen, Chapter 61 (“Study on

the “water-heat” points”) - N.V.N. Edition).

acupuncture are determined by obtaining the energy at the level of the energetic point”.” II - Ma Shi comments: “This paragraph explains the rules of acupuncture and moxabustion according to the energy of the 4 seasons. _ In spring, it is necessary to needle the luo points located between the blood vessels in the dermis, such as Lieque (Lu 7).

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_ In summer, it is necessary to needle the sunluo and the channels in a state of fullness located in the epidermo-dermal spaces, like the point yangxi (LI 5) (jing-river point). _ In fall, it is necessary to needle the shu (yuan) points of the yin channels, like Taiyuan (Lu 9). If the illness is located in the bowels, it is necessary to treat the he points (he of the yang channels), like Quchi (LI 11). _ In winter, it is necessary to needle the jing-well and ying-spring points. Because the energy of the organism has already deeply reached the interior, the needling must be deep and the needle left in permanently for a long time.” III - N.V.N.: This paragraph constitutes one of the fundamental bases of the practice of acupuncture and moxabustion. Unfortunately, translations into Western language presented up to this day have not always been loyal to the detriment of the quality of the practice of this speciality. We present below the table of points, chosen according to the 4 seasons:

Season

Localization of the energy

points to Needle

Examples

luo

Lieque (Lu 7)

Spring

luomai (in the dermis)

Summer

sunluo (in the epidermodermal space)

jing-river of the yang Channels

yangxi (LI 5)

jingmai (principal channel)

yuan (shu) of the yin ch. and he of the yang ch.

Taiyuan (Lu 9) Quchi (LI 11)

Needle deeply the yin channels

jing-well and ying-spring

shaoyang (Lu 11) Yuji (Lu 10)

Fall Winter

PARAGRAPH 2 In Wen Nu illnesses (fever and chills) without sweating, one must needle the 59 “anti-heat” points. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The illness of Cold-heat (Wen Nu) is of exogenous origin. It manifests in winter following an attack by wind-Cold which is retained in the bony marrow. In spring, perverse energy trapped in the interior encounters the damp-heat which warms up the marrow and flesh, and the perverse energy is then evacuated by sweating. Such is the autoevacuation mechanism of the perverse energy of the illness seated in the interior. In contrast, in the case of absence of sweating, the perverse energy being held in the interior, the method of deep needling of the 59 “anti-heat” points is expressly advised.” II - N.V.N.: 1. The text uses the word “wei” which signifies “task/work” to designate the “anti-heat” points (2). 2. In spring and summer, the illness of Cold-heat can manifest either by fever then by

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cold sensitivity (shivers) or by fever without cold sensitivity. In phytotherapy, if this illness of Cold-heat appears in spring, prescription of a small decoction of Radix Bupleuri (Chaibu) is the rule. In contrast, if it manifests in summer, the bi-medication decoction Gypsum fribrosum-Ramulus Cinnamomi” (Chaihu-Guizi) is advised (3).

PARAGRAPH 3 In illnesses of Fong shui (wind-water) with cutaneous edema, one must use the 57 “anti-water” points until cure. These points are all located at the level of the pilocutaneous system.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “Fong shui is an illness of exogenous etiology seated in the epidermis. This edema results from the meeting of the sweat and the wind in the skin. The treatment consists of using the method of the needling the 57 “Anti-water” points, all located at the skin.” II - Ma Shi adds: Fong shui (edema of “wind” etiology) is an illness often encountered which has for an origin an attack of the Foot Taiyang (Bl) generally manifesting at the 4 limbs. In serious cases, this edema reaches the face and eyes and is characterized by a superficial and full pulse and joint pains. Treatment consists of evacuating the perverse wind. III - N.V.N.: See detail in Chapter 60 (“Dissertation on the Three Bone Holes”) and 61 (“Study on the “water-heat” points”) of the Suwen (Volume III - N.V.N. Edition).

PARAGRAPH 4 In post-prandial diarrheas (Shan Xi) , one must tonify the union of the 3 yin and Yinlingquan (Sp 9) and leave the needle in place until the arrival of the “heat” energy.

2. The “anti-heat” and “anti-water” points are described in Chapter 61 (“Study on the “water-heat” points - shui re lun) of the Suwen - Volume III, NVN Edition. 3. See “Evolutive diseases of the 3 yin and 3 yang” - Shanghan lun, N.V.N. Edition.

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This illness is of endogenous origin located at the level of the spleen. The spleen corresponds to earth-Humidity; it is the zhi yin in yin. post-prandial diarrhea originates from the Cold-wind of the energy of the spleen. Treatment consists of needling the union of the 3 yin, that is to say Sanyinjiao (Sp 6), and the point Yinlingquan (Sp 9), which is the

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he point of the spleen”. II - Ma Shi explains: “In a general fashion, Shan Xi (post-prandial diarrhea) is an illness belonging to the bowels. Why is the treatment done at the level of the channel of the spleen organ? The reason is that yangming (St) does not follow the principle “Root-Summit” but rather obeys the formation of the “central” energy, that is to say, the taiyin (Sp), because of their reciprocal (yin-yang) relationship, determining factors of the production of blood and energy.” III - N.V.N.: 498. The explanation of Ma Shi is essential to the practice of acupuncture and moxabustion because our masters of antiquity proposed not only to treat the stomach during their study on the pathology of the bowels, but also to treat the spleen because of their “yin-yang” relationship. As for the “central” energy, it occupies an extremely important place in the reasoning of the practice of oriental medicine. The appearance and position of the “central” energies described in Chapter 68 (“Great Presentation of the Secrets of six”) of the Suwen (4) can be synthesized in the following fashion: _ When shaoyang is produced with “fire” energy in predominance, jueyin appears at the center. _ When yangming is produced with “dryness” energy in predominance, taiyin appears at the center. _ When taiyang is produced with “cold” energy in predominance, shaoyin appears at the center. _ When jueyin is produced with “wind” energy in predominance, shaoyang appears at the center. _ When shaoyin is produced with “heat” energy in predominance, taiyang appears at the center. _ When taiyin is produced with “humidity” energy in predominance, yangming appears at the center (see table below). In Chapter 74 of the Suwen(“Great Study on the True Basic Notions”), the 6 energies above are divided into 3 groups subject to the principle “Root-Summit-Center”: _ shaoyang and taiyin are subject to the “Root” principle. _ shaoyin and taiyang are subject to the “Summit” principle. _ yangming and jueyin are neither subject to the “Root” principle nor “Summit” principle, but to the appearance of the “central” energy. Based on these various notions, we can explain the treatment of post-prandial diarrhea at the level of the channel of the spleen, while the etiology of this illness is of “yangming” origin. In effect: the Hand Yangming (LI) = Dryness-metal and the Foot Yangming (St) = Dryness-earth. The 2 yangming (LI and St) belong therefore to dryness. The “central” energy of yangming is the taiyin (see table). According to the laws of the “5 movements/energetic mutations, when metal encounters earth, dryness is subjected to humidity. Such is the principle known as “mutual 4. See “Huangdi Neijing Suwen” - Volume IV - N.V.N. Edition.

engagement of energies of the same nature” cited in the yi jing (I jing: Book of Changes).

Table of the formation of “Root”, “Summit” and “Central” energy:

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3 yin & 3 yang Root-Summit Central energy

shaoyang

yangming

taiyang

jueyin

shaoyin

taiyin

Root

fire

Dryness

Cold

wind

heat

Humidity

Central energy

jueyin

taiyin

shaoyin

shaoyang

taiyang

yangming

Summit

shaoyang

yangming

taiyang

jueyin

shaoyin

taiyin

PARAGRAPH 5

499.

Cramps (Zhuan jing) of the yang part must be treated at the yang, and that of the yin part, at the yin, with heated needles (Fan Zhen) ( 5 ) . EXPLANATIONS AND COMMENTARIES Zhang Shi explains: “The external part of the limbs belongs to the yang channels. If cramps manifest at this yang part, one must immediately needle the yang channels. The internal part of the limbs belongs to the yin channels. If cramps manifest at this yin part, one must needle, on the field, the yin channels. The technique of the “heated needles” is expressly recommended”.

PARAGRAPH 6 In edema-water without wind (Xi shui) , one must first needle the point located 3 cun below H u a n g u with the “Fi” (#3) type needle. After implantation, one transmits advancing and recoiling movements to the needle to facilitate the evacuation of the edema. In this way, the flesh will be reinforced and made firmer. If the evacuation of the edema is slow, the individual is anxious, and if it is rapid, he experiences a sensation of relief. The needling must be performed once every two days until the disappearance of the edema. After each puncture, drinks are generally prescribed and foods are prohibited; if foods are prescribed, drinks must be prohibited. Various foods are advised against. The illness will be cured at the end of 135 days. 5. See Chapter 13 (“Tendinomuscular Channels”- Jing Jin) of this classic.

EXPLANATIONS AND COMMENTARIES I - Ma Shi comments: “This paragraph concerns the needling technique applied to Xi shui (water-edema), that is to say, “edema without wind”, while the previous one defines Feng shui as a form of edema

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provoked by the wind. 500. The phrase “one must needle the point located 3 cun below Huangu (GB 30)...” was the object of numerous studies because the point Huangu had never been cited in the classical works. In contrast, the Foot Shaoyang (GB) possesses a point called Huantiao (GB 30), 3 cun below which one finds Fengchi (GB 31) (6), which is acceptable from the point of view of reasoning; but according to si ying, this point does not have any therapeutic action on edema. During treatment by acupuncture, the water not yet being completely evacuated, there are constant disturbances in diuresis. After the disappearance of the edema, diuretics are recommended to prevent relapse. Under the effect of the diuretics, it is advised to abstain from all food except rice for 135 days.” II - Zhang Shi states: 1. “Xi shui (water-edema without wind) is due to Cold-wind of the spleen with overflowing of water into the flesh and pores. The word Xi implies the sense of abundance. 2. The spleen is located at the “center” and has the function of humidifying the “4 Seas”. During its insufficiency, the “water” energy of the “4 Seas” returns to earth (spleen), hence edema. 3. The 365 points gather in the small valleys (Xi) and valleys (Gu) (“flesh” system). The great reunion of the flesh bears the name Gu (valley); the term Dai Hui (great reunion) designates therefore the fleshy parts of the arms and thighs where the “anti-water” points are found. For this reason, the term Huangu encompasses the sense of needling the energetic points of these regions of the body to evacuate the edema. 4. Upon the arrival of drinks in the stomach, the energy circulates toward the head and lungs; upon the arrival of foods in the stomach, the energy spreads toward the heart and liver; and upon the simultaneous arrival of drinks and foods in the stomach, the energy of the sanjiao (SJ) transforms them into pure nutritive substances (jing: essence). This is why, in a state of insufficiency, the zhongjiao (middle jiao) loses its functions of metabolization of food products and water accumulates at the “center”. In this case, foods are prohibited after the taking of drinks and drinks are forbidden after food ingestion because the insufficiency of energy of the spleen causes the stagnation of water (edema). The sanjiao (SJ) has the roles of activating the circulation of the “water” energy and of reuniting the source energy (Yuan qi) and essential energy at the level of the flesh and pores. In a state of insufficiency, it is the cause of undernourishment of the epidermo-dermal system and sweat gland system, hence opening of these systems allowing water to infiltrate toward the interior. It is therefore advised to only nourish by cereals (such as rice, for example) responding to the energy of earth-spleen.” 501.

PARAGRAPH 7 In Zhu Bi (blockage of the energy preventing movement), the “cold” energy is not eliminated. One must use heated needle to puncture Sanli (St 36). 6. It is certainly not a matter of Fengchi (GB 31) because it is located 11 cun below Huantiao (GB 30). See M.T.C. - N.V.N. Edition.

EXPLANATIONS AND COMMENTARIES Zhang Shi explains: “This paragraph concerns the syndrome of prolonged fixation of perverse energy within the joints (Zhu Bi).

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Because humidity floods the joints, cold stagnates and cannot be eliminated. It is then necessary to needle Sanli (St 36) according to the principle of using the “dryness-heat” energy of yangming to triumph over the “cold-humid” energy.”

PARAGRAPH 8 The bones are like a framework.

EXPLANATIONS AND COMMENTARIES I - Ma Shi comments: “This phrase is extra because it has no relationship to the previous and following paragraphs.” II - Zhang Shi explains: “This paragraph completes the previous one concerning the illness of the bones, that is to say, the illnesses at the level of the marrow and joints. The bony framework, the skeleton, is solid and hard like the trunk of a tree. During the aggression of perverse energy, the ailment is found at the level of the bones and marrows. As for the energy “Bi-heat”, it also flows out toward the joints but does not affect the bony framework.”

PARAGRAPH 9

502.

In Bi of the large intestine with constipation, one must needle Sanli (St 36). If it concerns fullness-constipation, one must disperse it; if it concerns emptiness-constipation, one must tonify it.

EXPLANATIONS AND COMMENTARIES I - Ma Shi comments: “This paragraph concerns the treatment of constipation. One must disperse Sanli (St 36) in case of fullness-constipation because this is of exogenous origin. In contrast, in the case of emptiness-constipation, one must tonify it because it is a matter of a constipation of endogenous origin, the essential energy being in insuficiency. II - Zhang Shi explains: “In the event of disturbances, the small intestine loses its function of metabolization of nutrient products, and the large intestine, its transit function. The small intestine and large intestine belong to the stomach. For this reason, in practice, the point Sanli (St 36) is chosen to treat intestinal pathology.”

PARAGRAPH 10 In Lai Feng (leprosy) , acupuncture is generally practiced on the inflammatory areas. After needling, one uses again fine and pointed needles to stick the paresthetic areas, then one presses on these latter

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to eliminate contaminated blood. One only stops needling after the disappearance of the inflammed area. A customary diet is advised because new dishes are strictly forbidden. EXPLANATIONS AND COMMENTARIES I - Ma Shi comments: “This paragraph explains the needling method in the treatment of leprosy (Lai Feng). According to Chapter 42 (“Dissertation on wind”- Feng lun) of the Suwen, Lai Feng is characterized by an overheating of ying energy and wei energy; the energy then is contaminated, the nasal bone collapses, the shen and complexion are completely deteriorated; the non-evacuated wind-Cold becomes immobilized within the energetico-blood vessels and bears the name Lai Feng (leprosy). “wind” energy infiltrates into the taiyang, reaches the energetic points within the epidermo-dermal region where the wei (defensive) energy is located. During the confrontation of perverse energy and wei energy, the energetic paths weaken, the flesh and skin are inflammed and ulcerated, the wei energy stagnates and the affected regions are paresthetic... . 503. First, one needles the inflammed sites; after each needling, one sticks again with the finer and very pointed needles to eliminate the contaminated blood. One repeats the process (once per day) until the complete disappearance of the inflammatory zone. Customary nutritional hygiene is prescribed; choice dishes are rigorously advised against.” II - N.V.N.: In Western medicine, leprosy is an infectious disease due to the development within the organism of hansen’s bacillus. It is characterized either by the formation of more or less bulky nodules appearing on the skin or mucous membranes or by a macular eruption or by various nervous disorders (muscular atrophy, gangrene of the limbs...) accompanied or not by cutaneous eruption, or by nervous disorders and bullae which, upon bursting, leave depressed and consistent scarring. In Oriental medicine, Lai Feng is due to disorders of the blood and energy during the confrontation of wei and perverse energies. In the presence of Humidity-heat, blood and energy degenerate and become contaminated; then they progressively transform into Lai Feng. Toxic energy can deeply penetrate into the organs and provoke: _ at the lung, falling out of the eyebrows _ at the liver, the appearance of bloody, violaceous vesicles on the face _ at the kidney, only plantar pains _ at the spleen, abscesses and ulcerations of the body. Other clincal signs give evidence of the seriousness of the disease: _ paresthesia, indicating the “death” of the cutaneous system _ the absence of pain at the needled sites, indicating the “death” of the dermal system _ abscesses and ulcerations, indicating the “death” of the blood _ falling out of the nails, indicating the “death” of the muscles _ melting of the nasal crest, indicating the “death” of the bones. When Lai Feng manifests at the head and face, the disease has a favorable evolution. If it starts in the middle of the soles of the feet, the disease has an unfavorable evolution. In the presence of a superficial (Fu) and late (Huan) pulse, the disease is curable. In contrast, it is incurable in the case of the full (Hong) and changing (Da) pulse and in the case of anarthria and loss of vision. The illness is also incurable in the case of upper localization of the illness with deep (Chen) pulse and especially in the event of absence of sweating. Before any treatment, one must first reinforce the potential state of the wei (defensive) energy.

PARAGRAPH 11 444

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Boborygmi follows the afflux of the energy toward the thorax, with dyspnea preventing the patient from standing upright for a long time, indicating the presence of perverse energy in the large intestine. One must needle the yuan point (source point) of Huang and the points Juxu Shanglian (St 37) and Sanli (St 36). EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The large intestine is a bowel of transit. During its disorder, the energy affluxes toward the top with noise, hence boborygmi. When this afflux reaches the thorax, it causes dyspnea preventing the patient from standing upright for a long time. Gao Huang (Bl 43) is the source-site of the membranes (Ma yuan) of the organs and bowels. Gao is at the top and Huang has its source (yuan) located down below. The yuan (source) of Huang is found 1.5 cun below the umbilicus and has the name Boyan (also named Qihai- CV 6). Juxu Shanglian (St 37), located 3 cun below Sanli (St 36), is the he point of the large intestine. One needles this point because the large intestine belongs to the stomach.” II - Ma Shi comments: “This paragraph concerns the method used in treatment of pathology of the large intestine. Boborygmi originates from the sudden and noisy gathering of the “water-fire” elements. Dyspnea is due to an afflux of energy toward the thorax following the presence of perverse energy in the large intestine. The yuan (source) of Huang, located 1.5 cun below the umbilicus, belongs to renmai (CV) and has several names: Boyan, Xiahuang, Huang yuan and Qihai - CV 6 (7). This point is needled to a depth of 0.8 cun, first in dispersion, then in tonification. Further, one must needle Juxu Shanglian (St 37), he point of the large intestine, and Sanli (St 36), he point of the stomach.”

PARAGRAPH 12 The presence of perverse energy in the small intestine causes orchialgia radiating toward the loins, spine and heart because the small intestine has a relationship with the kidney and vertebral column on the one hand, and with the liver, lung and heart on the other hand. 505. When perverse energy is in excess, it produces the phenomena of afflux which first becomes directed toward the intestines and stomach, then toward the liver and finally toward Huang (designating Qihai - CV 6) 7. See “Wording 146” (“points of Several Designations”) in “Art and Practice of Acupuncture and Moxabustion (Zhen Jiu Da Cheng)”, Volume III - N.V.N. Edition.

and accumulates at the umbilicus. This is why one must needle Huang yuan (Qihai - CV 6) and Juxu Xialian (St 39) to disperse the perverse energy. Furthermore, one must observe the routes of passage of the perverse energy to regulate them.

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EXPLANATIONS AND COMMENTRIES I - Ma Shi explains: “This paragraph justifies the method used in treatment of pathology of the small intestine. Often, disease of the small intestine manifests by lower abdominal pains radiating toward the testicles, then toward the loins and heart... because the small intestine is linked to the kidney and vertebral column, to the liver and lung (8) and is in direct relation with the cardiovascular system (9). For this reason, when perverse energy is in fullness, it follows those routes affluxing toward the gastrointestinal system, reaching the liver, spreading to Huang yuan (Qihai- CV 6) and accumulating at shenque (CV 8). This is why it is necessary to needle Huang yuan (CV 6) and Juxu Xialian (St 39), he point of the small intestine, to eliminate the syndrome of accumulation. One must also needle the Hand Taiyin (Lu) to tonify the essential energy, Foot Jueyin (Li) to evacuate the perverse energy and Hand Taiyang (SI) to regulate the small intestine.” II - N.V.N.: Treatment of pathology of the small intestine consists then of needling the following points: _ Qihai (CV 6) and Juxu Xialian (St 39) to eliminate the accumulation of perverse energy in the lower abdomen _ Taiyuan (Lu 9) and Feishu (Bl 13) to tonify the essential energy _ Xingjian (Li 2) to eliminate the perverse energy _ Wangu (SI 4) to regulate the energy of the small intestine.

PARAGRAPH 13 repeated vomiting of sour liquid, with frequent sighs and anguish of being incarcerated, signals the presence of perverse energy in the gallbladder with afflux of bile toward the stomach. The secretion of bile is therefore the origin of acidity in the mouth, and the ascent of the energy of the stomach toward the top is the cause of “biliary” vomiting or “Ou Dan”. One must needle Sanli (St 36) to bring the energy of the stomach back toward the bottom and bleed the little blood vessels (Xue luo) to stop the afflux of bile; then balance the emptiness and fullness to eliminate the perverse energy.

8. According to the laws of the “5 movements’. 9. According to the laws of “yin-yang”.

EXPLANATIONS AND COMMENTARIES Zhang Shi explains: “This paragraph defines the disease of the gallbladder. “Vomiting bitter liquid” originates from the afflux of the energy of the gallbladder toward the stomach. During the reascent of the energy (of the gallbladder), the patient sighs strongly to

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expel it toward the top. “Anguish of being incarcerated” indicates the state of emptiness of the energy of the gallbladder. When the energy of the gallbladder aflfuxes toward the stomach, the phenomena is called “encroachment of wood-liver on earth-spleen”. The gallbladder communicates with the two points Lianquan (CV 23) and Yuying (CV 18) (also named Yutang). This is why, during biliary secretion, the individual has the sensation of an acid mouth (sour). Treatment consists of needling the Xue luo (blood capillaries) (10) to bring the energy of the stomach back toward the bottom and of balancing the emptiness and fullness to evacuate the perverse energy.”

PARAGRAPH 14 In d y s p h a g i a , the diaphragm is obstructed by the presence of perverse energy in the stomach canal. If the disease is located at the upper part of the stomach, the needling must facilitate its descent; if it is found in the lower part of the stomach, the needling must favor its elimination. EXPLANATION AND COMMENTARIES I - Zhang Shi explains: 507. “This paragraph concerns disease of the stomach and its treatment. When the perverse energy is located at Shangwan (cardia/upper part of the stomach or shangjiao- Upper Jiao), it prevents the descent of the cereals; the objective is to make it descend. When it is located at Xiawan (pylorus/lower part of the stomach or xiajiao- Lower Jiao), it prevents the transit of food wastes; the objective is to dissolve them and evacuate them.

Of these words, Chen Liang shen has said: “In the inability to swallow foods, the diaphragm is obstructed and the illness is located at shangjiao (Upper Jiao- Cardia). But obstruction of xiajiao (Lower Jiao- Pylorus) causes that of shangjiao (UJ). Immediately after deglutition, the stomach is full and the intestines are empty. When the bottom is obstructed, the foods cannot descend. As a result, the stomach is full and the diaphragm is obstructed at the level of shangjiao (UJ). here, the text describes disease of the stomach in global fashion. But in practice, the disease localized above or below must be treated differently”.” II - N.V.N.: In conclusion, 10. By the technique of bleeding.

_ In the illness of the shangjiao (Upper Jiao- cardia), preventing descent of foods and liquids, one must needle Shangwan (CV 13), Mu point of the shangjiao (UJ), so as to favor the descent of the stomach energy _ and in the illness of the xiajiao (Lower Jiao- pylorus), causing disturbances at the level of the intestines, one must heat up Xiawan (CV 10), Mu point of the xiajiao (LJ), to dissolve the stagnation caused by the cold.

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PARAGRAPH 15 Lower abdominal pains , with inflammation and oligoanuria, are due to the fixation of perverse energy at the site where the sanjiao (SJ) is in liason with the bladder. One must carefully examine the Dai luo (great vessels) of the taiyang (Bl), as well as the luomai (vessels) and Xiao luo (little vessels), to practice bleding in the event of blood stagnation (presence of little blood capillaries). If the inflammation extends to the stomach, one must needle Sanli (St 36). EXPLANATIONS AND COMMENTARIES Zhang Shi explains:

508.

“This paragraph concerns the illness of the bladder and its treatment. From weiyang (Bl 39), lower he point of the sanjiao (SJ), a vessel leaves which follows the luo (Longitudinal) of taiyang (Bl), in charge of anastomosing with the bladder and watching over the xiajiao (Lower Jiao). The fullness of this vessel is the cause of urinary continence, and emptiness, the cause of involuntary emission of urine (urinary incontinence). “Lower abdominal pain with inflammation and oligo-anuria” originates therefore from the presence of perverse energy in the bladder at the site where the bladder is in liason with the sanjiao (SJ); this is why one must needle Dai luo, the vessel leaving from weiyang (Bl 39) toward the bladder, as well as the Xiao luo and Xun (Sun) luo (capillaries) of the taiyang (Bl). The luo of the taiyang (Bl) and that of the jueyin (Li) cross at the top of the foot and at the malleoli. It is essential to examine them and, in the event of blood stasis, needle them (make them bleed) to evacuate the perverse energy. The jueyin (Li) controls secretion, in particular urinary secretion. Therefore, if the perverse energy is fixed at the luo of the liver, it can cause oligo-anuria. If edema and inflammation of the lower abdomen becomes extended to the stomach, it is advised to needle Sanli (St 36).

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Figure 71: Liason of weiyang with the bladder.

PARAGRAPH 16

509.

By examination of the complexion, one recognizes the end and the evolution of the disease, and by examining the color of the eyes, one determines the persistence and disappearance of the disease. It is necessary to be calm and serene to observe for the harmony

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of xing (form) and shen (mental) in order to favor the examination of the pulse waves of qi Kou (right radial pulse) and renying (left radial pulse) (11). The firm and slippery pulse indicates progression of the disease, and the soft pulse, regression of the disease. If the channels are in a state of fullness, the illness evolves in three days toward cure. qi Kou pulse is intended to determine the state of the yin channels, and the renying pulse to determine the state of the yang channels. EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “Clinically, inspection, listening, questioning and palpation are the 4 integral ways of observation permitting reconstruction of the history of the illness and establishing the diagnosis. a) Examination of the complexion to search for the causes of the illness permits detection of the state of “dissipation” or “concentration” of the illness. One must also observe the color of the eyes to determine the persistence or disappearance of the illness. b) Examination of the pulses is aimed at appreciating the state of aggravation or amelioration of the illness. Examination of qi Kou is performed at the right wrist, and examination of renying, at the left wrist... . If qi Kou is neither firm, nor full, nor slippery, but soft, it denotes the regression of the illness of endogenous etiology; if renying reveals the same characteristics, it indicates the illness of exogenous origin in the process of disappearing. In the presence of these pulses, if the channels are also in a state of fullness, the illness evolves in three days toward cure. c) qi Kou (right radial pulse) is intended to respond to the illnesses localizing at the 6 yin channels (feet and hands) because they belong to the energy coming from the organs (yin). similarly, renying, belonging to the energy coming from the bowels (yang), is intended to respond to the illnesses localizing at the 6 yang channels (feet and hands).” 510.

II - Zhang Shi comments: 1. “Examination of the color of the eyes” implies that of the color of the blood. Because, the skin, flesh, muscles and bones are the external elements responding to the 6 bowels, which unite with the 5 organs. As a result, the external or internal illnesses each have a characteristic color originating from the change of color of the blood conditioned by the 5 movements. In this way, by examination of the color of the blood of the eyes, one can determine the persistence or disappearance of the illness. 2. The non-liberation of perverse energy with weak pulse, without force, is grave. If the illness of internal origin evolves toward the channels with a full and firm pulse, it is that it becomes oriented toward the exterior; the prognosis is favorable and the illness evolves in three days toward cure.”

11. here, the term “renying” designates the left radial pulse and not the carotid pulse at the level of the point renying (St 9). This error in translation has been frequently commited much to the consternation of experienced acupuncturists

511.

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CHAPTER XX The Five Perverse (Wu Xie)

Chapter 20 of the Lingshu is devoted to the study of the syndromes called “Five Perverse” and their treatment, The “Five Perverse” represent the attack of the 5 organs (Lung, liver, spleen, kidney and heart) by perverse energy with their diagnosis and treatment, hence the title: “The Five Perverse” (Wu Xie). This chapter consists of 5 paragraphs.

PARAGRAPH 1 the

Infiltration of perverse energy into the lung is characterized by following signs: _ cutaneous pain _ cold and heat (chills and fever) _ dyspnea _ sweating _ and cough reflecting toward the shoulder and back.

One must needle the points of the supero-external region of the thorax and the point outside the 3rd dorsal vertebrae, next to the 5 organs. The localization of these points is assured by a sensation of relief during pressure of the fingers. One must also needle Quepen (St 12) ( 1 ) to make the perverse energy “spurt out” . 1. Quepen (St 12), belonging to the Foot Yangming (St), is the site of passage of a vessel coming from the Hand Yangming (LI) which penetrates deeply into the thorax and abdomen.

EXPLANATIONS AND COMMENTARIES

512.

I - Ma Shi explains: “This paragraph concerns the illness of the lung caused by perverse energy and its treatment by acupuncture. Infiltration of perverse energy into the lung organ is characterized by cutaneous pain, fever and chills and ascent of the energy with dyspnea... .

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“Sweating” is due to the dilation of the pores. “Cough reflecting to the shoulder and back” because these regions are the sites traveled by the circulatory paths of the energy of the lung. It is recommended to needle the points Yunmen (Lu 2) and Chongfu (Lu 1), located in the supero-external area of the thorax, and the points Feishu (Bl 13) and Xinshu (Bl 15), located to the side of the apophysis of the 3rd and 5th dorsal vertebrae respectively. It is therefore the deciding factor to locate these points well because these determine the excellent practice of acupuncture-moxabuston; good localization demands looking for a sensation of relief in the patient during pressure of the finger on the specific point. Needling Quepen (St 12) of the Foot Yangming (St) is also advised to favor the evacuation of perverse energy fixed in the lung organ. The depth of needling of this point must not exceed 0.2 cun and the needle is left in place during 7 expirations. The use of the point Quepen (St 12) constitutes what one calls “the method of utilization of the bowel to drive out the perverse energy lodged in the organ”.” II - Zhang Shi comments: “This chapter completes the previous one and concerns the study of nosology and therapy of the illness of perverse energy in the 5 organs. 1. The 6 bowels each have a site of “reflexion” at the level of the epidermo-dermal and musculoskeletal systems. These are also sites of localization, called “reunions”, of the energy of the organs-bowels. In summary, the energy of the 5 organs exteriorizes, and the yin energy and yang energy enter and exit at the level of these systems. 2. To speak of cold and heat is to speak of the cold and heat at the level of the cutaneous surfaces. The organ being yin and the skin being yang, simultaneous fullness of the energy of the interior and that of the exterior is the condition of production of the phenomena of cold and heat. 3. The points located outside the apophysis of the 3rd dorsal vertebra are Feishu (Bl 13) and pohu (Bl 42), and the point in the supraclavicular fossa is Quepen (St 12).”

PARAGRAPH 2

the

Infiltration of perverse energy into the liver is characterized by following signs: _ hypchondralgia 513. _ “Cold at the Center” (han Zhong) ( 2 ) _ stagnation and blood accumulation in the interior _ spasm and joint pains while walking _ sometimes, edema of the feet. 2. Expression designating the invasive action of wood-liver on earth-spleen following the prosperity of wood and

insufficiency of earth. In this case, the “cold” energy of zhongjiao (MJ) becomes oriented toward fullness to later trigger the syndrome “Emptiness-Cold” of the stomach.

One must needle Xingjian (Li 2) , to bring the energy toward the bottom, to put an end to the hypochondrial pains; tonify Sanli (St 36) to heat up the stomach; bleed the capillaries to evacuate the contaminated blood and needle the venous post-auricular points (Hujingmai - PA 13) (3) to remove the joint pains and spasm.

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EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph concerns the fixation of perverse energy in the liver organ. Hypochondralgia denotes the localization of perverse energy in the costal portion of the liver channel. The interior of the stomach is cold (han Zhong) because of the fullness of water with insufficiency of fire. Contaminated blood expresses because the liver energy is not ventilated. Pains and spasm walking... and edema of the foot are signs of attack of the liver channel. It starts at the great toe, arrives at the internal malleolus, penetrates into the genitals before reaching the hypochondria. One needles Xingjian (Li 2) to attract the perverse energy to the bottom. This point is located on an artery; the depth of puncture is 0.3 cun and the number of moxas to apply is 3. One tonifies Sanli (St 36) to provide heat to the stomach. One practices bleeding at the level of the blood capillaries (Xue luo), visible to the naked eye, belonging to the Foot Jueyin (Li), to evacuate the contaminated blood. The venous post-auricular points (Hujingmai- PA 13) are from the small luo of the shaoyang (GB). One needles them to remove the joint pains”. II - Zhang Shi comments: “The liver channel runs alongside the lateral side of the iliac bone and ribs. During the infiltration of perverse energy into the liver, the hypochondria and iliac bone are painful. jueyin (Li) implies “2 yin”, which cross at the end of the energetic cycle of the channels. When the jueyin (Li) is disturbed, yang cannot be produced, hence “Cold at the Center” (han Zhong) with pains of the hip and ribs (hypochondralgia). 514. Pains of the hip and ribs are ailments having form (xing). As for the “Cold at the Center”. it concerns ailments of the energy of jueyin (Li).” “Blue post-auricular veins” (Hujingmai- PA 13) also has the name “blue chicken feet” owing to their form in the shape of the feet of fowl.”

PARAGRAPH 3 Infiltration of perverse energy into the spleen and stomach is manifest by the following signs: _ dermalgias _ hunger sensation (due to the presence of heat in the “center” resulting from an excess of yang energy and an insufficiency of yin energy) _ either boborygmi or abdominal pain (due to the presence of cold in the “center” resulting from an insufficiency of yang energy and an excess of yin energy) 3. Auriculopuncture was already used in Huangdi’s time- see nomenclature in M.T.C.- N.V.N. Edition.

_ or also fever or chills (due to the simultaneous excess or insufficiency of the yang and yin energy). In all cases, one must treat at the level of the point Sanli (St 36) .

EXPLANATIONS AND COMMENTARIES

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Zhang Shi explains: “The spleen and stomach govern the dermal (flesh) system. This is why, during the illness of stomach-spleen, the flesh is painful. The spleen is zhiyin (extreme yin) in yin, and the stomach is an organ responding to “yang-heat”. When the yangming accompanies the Taiyin in its transmutation, yin and yang are in equilibrium. If yang energy is in excess, yin energy is found in a state of insufficiency. In that case, digestion is rapid and the subject feels a sensation of hunger. In contrast, if yang energy is in insufficiency, yin energy is in excess. In this case, it produces a syndrome called “Cold at the Center” with boborygmi and abdominal pains. If yin and yang are simultaneously in excess, the perverse energy is in a state of overabundance. If yin and yang are jointly in insufficiency, the essential energy is found in a state of deficiency. In all cases, one must harmonize Sanli (St 36) according to the principle of treating the bowel to equilibrate the organ.” 515.

PARAGRAPH 4 Infiltration of perverse energy into the kidney manifests by yin Bi whose essential sign is ostealgia. Called “yin Bi” , the energetic obstruction in the yin part is expressed by the absence of pain during pressure of the fingers. Other manifestations are: _ lower abdominal bloating _ lumbalgia _ dysuria _ constipation _ scapula pain _ dorsalgia _ cervicalgia _ nuchalgia _ sometimes vertigo. One must needle Yongquan (Ki 1) and Kunlun (Bl 60) and practice the technique of bleeding in the event of blood stagnation. EXPLANATIONS AND COMMENTARIES Ma Shi explains: “This paragraph defines the technique of needling used in the illness of the kidney caused by perverse energy. The presence of perverse energy in the kidney expresses as ostealgia because the kidney is “master” of the bones. yin Bi syndrome only manifests in the yin part. In yin Bi, the pain is the result of the victory of the “cold” energy; this pain cannot be felt upon pressure of the fingers. The lower abdomen is painful because it is basically controlled by the kidney energy. The lumbars are painful because they constitute the “palace” of the kidney. The energy of the kidney has a relationship with the intestinal and urinary paths, hence, in the event of disturbance, dysuria and constipation.

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The shoulders, lumbars, neck and nucha are painful because they are the sites of passage of the Foot Taiyang (Bl) which is in “external-internal” relationship with the Foot Shaoyin (Ki). It is advised to needle Yongquan (Ki 1) (belonging to the kidney), 0.3 cun depth with needle left in for 3 expirations, and Kunlun (Bl 60) (belonging to the bladder), also to a depth of 0.3 cun. These points are prohibited in pregnant women. In the event of the presence of blood capillaries, one must disperse by bleeding.”

PARAGRAPH 5 Infiltration

of

perverse

energy

into

the

heart

is

characterized

by:

_ cardialgia and affliction _ sometimes, dizziness and loss of consciousness. One must discern the excess and insufficiency and treat them at the level of the shu p o i n t . EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph concerns the illness of the heart and the technique of treatment. The excessive state of the perverse energy or the insufficient state of the essential energy can manifest via the same syndrome. As a result, one must carefully differentiate them in order to apply the technique of dispersion or tonification at the level of shenmen (he 7), shu point of the heart (needle to 0.3 cun depth, let the needle stay in for 7 expirations and apply 7 moxas). Chen Liang shen has said: “The aggression of perverse energy against any organ can bring about death. The five paragraphs above give an account of this aggression against regions belonging to each of the 5 organs and not against the organ itself. In other words, this chaper describes the illnesses of the energy of the 5 organs. The formula “...next to the 5 organs” cited in Paragraph 1 implies the sense of “energetic dwelling” of the organs. Because the illness is energetic, one should treat at the level of the energy. This is why pressure at this level provokes a sensation of relief. Such is one of the characteristic aspects of the energy”.” II - N.V.N.: Attack of the 5 organs by perverse energy and their treatment can be synthesized in table form as shown below: 517.

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Organs

lung

liver

spleen

kidney

heart

Symptomatology

_ cutaneous pain _ cold and heat (fever and chills) _ dyspnea _ cough _ sweating

_ hypochondralgias _ cold at the “center” (hanzhong) _ blood stagnation _ spasm and joint pains _ edema of the feet _ dermalgias _ sensation of hunger _ either boborygmi and abdominal pains _ or also cold and heat (fever and chiils) _ “yin Bi”, particularly ostealgias Other signs: _ lower abdominal bloating _ lumbalgia and dysuria _ constipation _ scapulalgia, dorsalgia, cervicalgia... _ cardialgia _ affliction _ sometimes, loss of consciousness

Treatment Yunmen (Lu 2) Chongfu (Lu 1) Feishu (Bl 13) Xinshu (Bl 15) Complementary points: Quepen (St 12) pohu (Bl 42) Xingjian (Li 2) Sanli (St 36) Hujingmai (PA 13)

Sanli (St 36)

Yongquan (Ki 1) Kunlun (Bl 60) Technique of bleeding in case of blood stagnation at the Xunluo (energetic capillaries) shenmen (he 7)

no 518/519.

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CHAPTER

XXI

diseases of Cold and heat (han re Bing)

Chapter 21 is devoted to the classification and therapy of diseases caused by cold and heat. Cold and heat are two types of energies of antagonistic nature. Cold responds to yin, and heat, to yang. When cold and heat are oriented toward fullness, yin and yang lose their equilibrium. The causes of the orientation of the two energies toward fullness, causing afflux of heat and cold, and the therapeutic rules of these ailments are explicitly demonstrated. The choice of points of the “4 Seasons” called “Wu shu” (five energetic or “shu” Antique points), the relationship of the energy of the 5 organs with the external layers of the body (skin, flesh, muscles and bones) and the associated methods of utilization of yin and yang channels in the treatment of sweating are also presented. This chapter consists of 24 paragraphs. Ma Shi states: “Chapters 19, 20 and 21 form a series. As a result, Huangdi’s questions and Qi Bo’s answers are not mentioned. These 3 chapters have been formed in this manner to call attention to the diseases located in the organs, in the bowels and in the channels”. Chapter 21 describes the pathological manifestations of yin and yang channels grouped together under the title “diseases of Cold and heat” (han re Bing), that is to say, “of yin and yang”.

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PARAGRAPH 1 Attack of the skin by cold and heat manifest by such signs as: _ cutaneous pain (the individual cannot grow his braid longer) _ dryness of body and head hair 520. _ absence of sweating. Needle the luo of the 3rd yang ( 1 ) and tonify the Hand Taiyin (Lu). EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The illness is located at the skin. Therefore, the individual’s hair cannot grow longer. The lung exteriorizes at the nose. When the lung is affected, the nose is dry. This ailment is due to the fixation of perverse energy in the cutaneous layer and localization of the illness in the energetic areas belonging to taiyin (Lu) and taiyang (Bl). Sweating favors cure. In the case of absence of sweating, it is necessary to disperse the luo of the bladder (Feiyang- Bl 58) to favor perspiration and tonify the taiyin (Lu) to nourish the source of production of the organic liquid.” II - N.V.N.: In regard to the tonification of Hand Taiyin (Lu), Ma Shi proposes Lieque (Lu 7) and Zhang Shi recommends Yuji (Lu 10) and Taiyuan (Lu 9). In effect, _ Lieque (Lu 7), luo point of the lung channel, is linked to the yuan point of the large intestine, _ Yuji (Lu 10) and Taiyuan (Lu 9), ying and yuan points of the lung channel, are utilized in tonification, but also in dispersion. In practice, these sudorific points are used according to the clinical manifestations (emptiness or fullness).

PARAGRAPH 2 Attack of the flesh (dermis) by cold and heat manifest by the following signs: _ dermalgia _ dryness of the body and head hair _ dryness of the lips _ absence of sweating. Needle

the luo of the 3rd yang (Bl) and tonify the Foot Taiyin (Sp).

1. Designates taiyang (Bl).

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EXPLANATIONS AND COMMENTARIES

521.

I - Zhang Shi explains: “The energy and blood circulating outside the vessels maintain the skin, temper the flesh and nourish the hair system. In the event of disturbance, the body hair and head hair dry out. The spleen governs the flesh (dermal system) and exteriorizes at the mouth. In the event of disturbance, the mouth and lips are dry. The cold and heat are retained within the dermis obstructing the sweat glands routes. This is why, in the event of absence of sweating, it is advised to disperse the luo point of the 3rd yang (Foot Taiyang- Bl) to eliminate blood stasis at the level of the Xue luo (blood capillaries) and tonify the Foot Taiyin (Sp) to favor sweating.” II - N.V.N.: After dispersion of the luo point (Feiyang- Bl 58) of the Foot Taiyang (Bl), tonification must be done on the field of the Foot Taiyin (Sp). This procedure constitutes the technique of “sudorification” during treatment of the illness of cold and heat localized in the dermal system. According to Zhang jing Jue, Dadu (Sp 2) and Taibai (Sp 3) of the spleen channel have a very efficacious sudorific action.

PARAGRAPH 3 Attack of the bones by cold and heat manifest by the following signs: _ agitation _ continuous sweating. If the teeth are not dried out, it is advised to needle the luo of the channel located at the internal surface of the thigh (Foot Shaoyin- Ki). If they are dried out, the illness is incurable and the clinical signs are those of Gu Jue (illness of bones caused by afflux of cold).

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “Attack of the bones by cold and heat is an illness of the energy of the Foot Shaoyin (Ki). “Agitation” is the sign revealing yin in trouble . 522. The shaoyin (Ki) is the source of procreative energy (sheng qi) whose escape signals continuous sweating (hypersudation). The fact that the “teeth are not completely dried out” gives evidence of the persistence of the original energy. In this case, it is necesary to needle the luo point of the Foot Shaoyin (Ki) to eliminate the perverse energy. In contrast, if the “teeth are dried out”, the illness is incurable. In this ailment of the energy of the shaoyin (Ki), the confrontation of the perverse energy and essential energy is the origin of the illness of cold and heat. Gu Jue is a disease belonging to the kidney organ whose energy, once effected, triggers a flow in the wrong direction (afflux).” II - N.V.N.: The luo point of the Foot Shaoyin (Ki) is Dazhong (Ki 4) where a vessel leaves from toward the Foot Taiyang (Bl). This point is located at the postero-internal part of the heel on the calcaneus between two ligaments.

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Zhang jing Yue states: “When the yin energy “flies” toward the top, the individual is anxious and tormented. In disorders of the yin energy, the organic liquid escapes, hence continuous sweating. Teeth are part of the bony system; non-drying out of the teeth gives evidence of the sufficiency of yin energy; the illness is always curable. One must needle Dazhong (Ki 4), luo point of the kidney. In the opposite case, the illness is fatal. In Gu Jue, one notes not only drying out of the teeth, but also of the nails.”

PARAGRAPH 4 In Gu Bi (obstruction of the energy of the bones), the joints are blocked and painful, sweating is very abundant and the “heart” is anxious. One must needle in tonification the jing point of the 3rd yang.

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: 523. “This paragraph presents the illness of Gu Bi and its treatment. Blockage and joint pains, abundant sweating and anxiety are signs attesting that the kidney governs the bones and vessels which communicate with the lung and heart and spread into the thorax (2) (Figure 72). It is advised to tonify Kunlun (Bl 60), jing-river point of the Foot Taiyang (Bl= 3rd yang), because the Foot Taiyang (Bl) and Foot Shaoyin (Ki) constitute the “external-internal, yin-yang” system of relationship.” II - N.V.N.: Kunlun (Bl 60), jing (river- fire) point of the Foot Taiyang (Bl) is located 0.5 cun behind the external malleolus in a crease above the calcaneus. According to Tongren, this point must be needled to a depth of 0.3 cun. Needling this point during pregnancy risks provoking abortion. Zhang jing Yue states: “Gu Bi is an illness localizing in the yin part. Hypersudation and anxiety are also from ailments localizing in the yin part. Consequently, when the yin Source is in insufficiency, perverse energy is retained in the interior. In Chapter 20 (“The Five Perverse”) of this same classic, Paragraph 4, the text states: “Perverse energy localized in the kidney is the origin of bone pain and of the illness yin Bi (obstruction of yin). It is therefore recommended to needle Yongquan (Ki 1) and Kunlun (Ki 60)”. As a result, the Gu Bi described in this chapter is the same ailment as that cited in the previous chapter.”

2. Conforming to the laws of the 5 movements.

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Figure 72 Energetic liason of the kidney with the lung and heart. 524.

PARAGRAPH 5 An injury with strong hemorrhage or a direct attack of wind (Zhongfeng) and cold (Zhonghan) or also a serious fall... causes laxity of the limbs with inability to move. This ailment bears the name Ti Duo (immovable body). One must needle San Jie Jiao (three reunions-meetings) ( 3 ) , located below the umbilicus.

San Jie Jiao is a point of reunion of 3 vessels: yangming (St), taiyin (Sp) and renmai (CV), located 3 cun below the umbilicus. This point is none other than guan yuan (CV 4). EXPLANATIONS AND COMMENTARIES Zhang Shi explains: “Paragraphs 1, 2 and 3 of this chapter are devoted to the attack of the skin, flesh and bones by cold and heat, that is to say, the illness of the energy of the 3 yin. As for Paragraph 5, it involves the change in blood and energy at the level of the epidermo-dermal system whose display must be appreciated at the level of taiyin and yangming, conforming to the mutual relationship of yin and yang, of the blood and energy. 3. See the classification of “Meeting-reunion” points in M.T.C. - N.V.N. Edition.

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“An injury with abundant hemorrhage...” denotes “injury” of the blood and “aggression of wind...”, explains that of the ying (nutritive) and wei (defensive) energies. The energy heats up the body, and blood, humidifies it. The body is immovable because the blood and energy are “injured”. blood and energy, which maintain the muscles and warm up the flesh, are produced by the yangming from Cereal jing (nutritive energy). Chongmai and renmai (CV) spread them to the cutaneous system. This is why one must needle guanyuan (CV 4) in order to activate the source-movements of the blood and energy at San Jie Jiao, that is to say, at the point of reunion-Meeting of the yangming, taiyin and renmai (CV) (4).

PARAGRAPH 6 1. In Jue Bi (Obstruction/Afflux) , the energy affluxes toward the top, up to the abdomen. One must needle the luo point of the yin channel or of the yang channel related to this ailment. In other words, one must carefully discern the channel affected in order to disperse it if it concerns the yang channel, and tonify it if it concerns the yin channel. 525.

2. The artery at each side of the neck is renying (carotid). The point renying (St 9) , located on the anterior border of the sternocleidomastoid muscle, belongs to the Foot Yangming (St). Behind this muscle is the point Futu (LI 18) , belonging to the Hand Yangming (LI). To the side of this muscle is found the point Tianyou (SJ 16) , belonging to the Hand Shaoyang (SJ). Still further behind is Tianzhu (Bl 10) , belonging to the Foot Taiyang (Bl). Below the axillary fold (on the external side of the brachial biceps) is the point Tianfu (Lu 3) , belonging to the Hand Taiyin (Lu).

EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “This paragraph defines Jue Bi (Blockage/Afflux) and its treatment. Jue Bi is due to an “obstruction/pain” (algoparesthesia) located at the lower part of the body (lower limbs), causing an afflux of energy of the 3 yang toward the abdomen without reaching the cephalic region. This is why, to disperse the yang channel is to eliminate the afflux of the energy, and to tonify the yin channel is to incite yin to produce yang.” II - Ma Shi instructs: “In “Bi” disease (algoparesthesia/obstruction) causing an afflux of energy toward the top, up to the abdomen, it is necessary to needle the luo of the yin channel and the luo of the yang channel. At the yang channel, one must apply the technique of dispersion, and at the yin channel, the technique of tonification. Moreover, according to the site of the illness (at the upper or lower limb), one adds one of the following “windows of heaven” points: _ renying (St 9), located 1.5 cun from the upper edge of the thyroid cartilage in front of the sternocleidomastoid muscle. This point is intended to explore, in global fashion, the energetic 4. guanyuan (CV 4) is also the site of arrival of the Chongmai.

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state of the 5 organs. Needling must not exceed 0.4 cun depth. _ Futu (LI 18), located 3 cun outside the upper border of the thyroid cartilage between the two fascia of the sternocleidomastoid muscle. The needling must not exceed 0.3 cun depth. _ Tianyou (SJ 16), located behind Futu (LI 18). Needling is to 0.5 cun depth; the needle is left in place during 3 expirations. It is recommended not to tonify it. _ Tianzhu (Bl 10), located behind Tianyou (SJ 16). Needling is to a depth of 0.3 cun and the needle left in place for no longer than 3 expirations. _ Tianfu (Lu 3), located on the brachial artery, 3 cun beneath the anterior end of the axillary fold. This artery is directed toward the hand, hence the name Bi taiyin which responds to the Hand Taiyin (Lu)”. 526.

III - N.V.N.: This paragraph justifies the therapeutic action of the luo points and the points called “windows of heaven” in the treatment of Jue Bi (obstruction-afflux). Zhang jing Yue states: “Afflux (Jue) starting at the 4 limbs is always associated with the “Bi” phenomenon (obstruction). This afflux ascends up to the abdomen. This is why one must needle gongshun (Sp 4), luo point of the Foot Taiyin (Sp), and Fenglong (St 40), luo point of the Foot Yangming (St), to recuperate the energy of the 4 limbs. In all cases, one must carefully discern the localization of the illness in order to disperse the Foot Yangming (St), often in fullness, and to tonify the Foot Taiyin (Sp), often in emptiness.”

PARAGRAPH 7 origin

Afflux of perverse yang at the level of the yang channels is the of headache and thoracic fullness with difficulty breathing. One must needle renying (St 9).

EXPLANATIONS AND COMMENTARIES Zhang Shi explains: “This paragraph 7 and the 4 others following are devoted to the study of jue ni (flow in the wrong way/afflux). Each case of jue ni possesses a particular system of classification. The treatment must therefore be done as a function of the channel effected. In this paragraph, the headache is of “yangming” origin. The contrary flow of the energy of yangming reaches up to the abdomen, without being able to reach renying (St 9), to ascend to the head, hence headache. Because the energetic afflux occurs at the zhongjiao (middle jiao), the thorax is found in a state of fullness, hence respiratory difficulties. Therefore, in this case of headache with thoracic fullness and difficulty breathing, one must needle renying (St 9) to make the energy circulate.

PARAGRAPH 8 In sudden aphonia following an afflux of the energy, one must needle the point Futu (LI 18) and bleed the root of the tongue.

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EXPLANATIONS AND COMMENTARIES

527.

Zhang Shi explains: “metal governs the voice and the heart, speech. The Hand Yangming (LI) governs the energy and belongs to metal. This is why the afflux of the energy of yangming toward the bottom causes stiffness of the tongue. One must needle Futu (LI 18) and bleed the “root of the tongue”. here, “root of the tongue” designates the point Fengfu (GV 16), belonging to Dumai (GV). Needling is to a depth of 0.3 cun; moxabustion is strictly forbidden at the risk of provoking mutism.”

PARAGRAPH 9 In sudden deafness with decreased visual acuity, one must needle Tianyou (SJ 16).

EXPLANATIONS AND COMMENTARIES Zhang Shi explains: “The Hand Shaoyang (SJ) penetrates into the ear and arrives at the external tip of the eyebrow. In the event of afflux of the Foot Shaoyang (GB), stagnation takes place above, at the level of the Hand Shaoyang (SJ), hence severe deafness and disturbance of visual acuity. One must needle Tianyou (SJ 16).”

PARAGRAPH 10 In spasm and severe convulsions or in sudden vertigo with difficulty walking, it is necessary to needle Tianzhu (Bl 10) .

EXPLANATIONS AND COMMENTARIES Zhang Shi explains: “The Foot Taiyang (Bl) controls the muscles. This is why violent spasms, sudden convulsive fits and vertigo always brings about difficulty walking. The Foot Taiyang (Bl) starts at the point jingming (Bl 1), located at the internal canthus of the eye. Obstruction of the energy of this channel is the cause of these clinical manifestations; one must needle Tianzhu (Bl 10).”

PARAGRAPH 11

528.

Severe polydispsia (Bao Dan) is due to an afflux of energy which occurs in the interior. In this case, the liver and lung confront one other and blood leaks from the nose and mouth (epistaxis and hematemesis); one must needle Tianfu (Lu 3) .

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EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “Bao Dan” designates a great thirst which occurs violently. The liver contains a vessel which is directed to the lung. By this path, its energy affluxes violently toward the lung. It is said that it is a question of a confrontation of liver and lung. The lung governs energy, and the liver, blood. The afflux of the energy takes place then in the interior; as a result, blood collects and overflows toward the top, hence epistaxis. The lung is also the source of production of water. During its confrontation, the production of water is slowed, hence great thirst. Needling Tianfu (Lu 3) is intended to aid the energy in circulating in order to curb the afflux phenomenon. The term Bao Dan (violent manifestation of the energy) designates the Jue (afflux) syndrome. This is why the word Bao (violent, sudden) is used in the various paragraphs above.” II - Ma Shi clarifies: “Bao Dan (great thirst) manifests in the course of a great heat with afflux of the energy from the interior (of the organism). here, the phenomenon of afflux originates from the confrontation of the liver and lung, that is to say, from “2 fires”, responsible for choatic circulation, hence epistaxis and hematemesis.”

PARAGRAPH 12 The “5 Great windows” cited in the previous paragraphs are grouped under the name Tian You Wu Bu (group of 5 Great windows of heaven).

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This phrase is the conclusion of the 5 preceding paragraphs. The energetic points used make up part of the group Tian You (window of heaven- SJ 16). Therefore, when our masters of the past used one of these points, they resorted to all the points of the same group, as in phytotherapy we name the magistral formula as a function of the principal component.” II - Zhang Shi states: “The word You means window. The elders compared certain points of the region of the head and neck to “windows” of the great palace because these points are intended to aerate the energy. When afflux of the energy occurs below, the jingmai of the cephalic region are obstructed, hence diminution of visual and auditory acuity. Clinical manifestations such as sudden aphonia, violent convulsive fits, vertigo... originate from the afflux of energy of the 3 yang from below upward. • Question: In Chapter 2 (“Origin of the shu-antique points”) of this classic, during the study of the jingmai, the 6 channels of the 3 yang of the foot and hand are considered in their group, while in this Chapter 21, only the Hand Yangming (LI), Hand Shaoyang (SJ), Foot Yangming (St) and Foot Taiyang (Bl) are used to determine the Dai You (Great windows). Why? • response: The energy of taiyang originates from the water of the bladder; that of the shaoyang takes

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its source from the level of Ministerial fire of Mingmen and that of yangming is created at the level of the stomach bowel, dependent on zhongjiao (middle jiao). In the study of the jingmai, the 6 channels of the the foot and hand constitute the basic components, and in the study of the 2 energies, one envisions the 3 yin and 3 yang. Hand Yangming (LI) and Hand Taiyin (Lu) form one “external-internal, yin-yang” system of relationship controlling the energetic circulation. The study of the group of these components (Foot Taiyang, Hand Shaoyang, hand and Foot Yangming) permit establishment of the system of Wu Dai You (5 Great windows) (Figure 73)”. 530.

Figure 73: “Five Great windows of heaven” (Tian You Wu Bu). III - N.V.N.: The French-German version of this difficult passage (Paragraph 12) does not conform at all to the thinking of the text. A loyal translation must be the work of clinicians perfectly integrating the two medicines, Oriental and Western, in order to grasp the importance of this group of points called “Great windows of heaven”, one of the fundamental basis of the daily practice of acupuncture. Yet, the study of these energetic points forms part of the education program of Acupuncture/Moxabustion in Europe since 1971 (5). 5. See M.T.C. - N.V.N. Edition - 1971 and 1984.

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PARAGRAPH 13 The Hand Yangming (LI) possesses a vessel which penetrates into the lower maxilla and branches to the teeth. The point of penetration is called Daying (St 5) . In dental pains of the lower maxilla, one must needle the Hand Yangming. In the event of fear of cold ( 6 ) , one must tonify it, and in the event of absence of fear of the cold, one must disperse it. 531.

The Foot Taiyang (Bl) possesses a vessel which penetrates into the malar bone and branches into the teeth, and the point which connects to the teeth is Jiaosun (SJ 20) . Therefore, in dental pains of the upper maxilla, one must needle the region near the nose and upper maxilla. During attack, this vessel is in a state of fullness; one must disperse it, and in the event of emptiness, one must tonify it. This technique constitutes what one calls “needling outside the nose”. EXPLANATIONS AND COMMENTARIES

I - Zhang Shi explains: “1. The previous paragraphs justify the passage of the energy of the 3 yang at the level of Dai You (Great windows), while this one defines the Loumai as little vessels of communication in accord with the adage: “When the great vessels end, the little vessels begin... like a string of pearls without linking.” In other words, the energy manifests at Dai You and spreads outside the channels via the qi Jie (paths of emergence or diffusion of the energy) (7). As for the energy circulating within the channels, it passes to another channel via the route of the luomai; in the interior as at the exterior, this circulation is perpetual. 2. The Hand Yangming (LI) has a vessel which penetrates into the point Daying (St 5) and infiltrates into the lower maxilla and root of the teeth. Therefore, the energy of Hand Yangming (LI) communicates with that of the Foot Yangming (St) via the luomai. For this reason, when the lower maxilla is affected, one must needle the Hand Yangming (LI). 3. The Foot Taiyang (Bl) has a vessel which penetrates into the malar bone and from there it reaches the point Jiaosun (SJ 20), belonging to the Hand Shaoyang (SJ). At the level of the face, the energy of the Hand Taiyang (SI) has a vessel which directly

reaches the Foot Taiyang (Bl). As a result, it also communicates with that of the Hand Shaoyang (SJ). This is why, it is necessary to needle the side of nose and the front of the maxilla, that is to say, the luomai of taiyang, when the lower maxilla is affected.” II - Ma Shi states: “The original text uses the term Bi yangming to designate the Hand Yangming (LI) because the word “Bi” designates the arm. The Hand Yangming (LI) arrives at Quepen (supraclavicular fossa), reaches the points Tianding (SI 17) and Futu (LI 18), crosses the cheekbone, penetrates into the root of the teeth, goes around the upper lip, crosses opposite channel at the point renzhong (GV 26), located at the upper part of the naso-labial groove under the nose, goes back up toward the base of the opposite root, to the points heliao (LI 19) and yingxiang (LI 20), to unite with the Foot Yangming (St). A vessel leaves from the point Futu (LI 18) toward Daiying (St 5), belonging to the Foot yangming, to penetrate deeply into the lower maxilla. For this reason, in the event of dental pain 6. This must mean “fear of cold drinks”. 7. qichong (St 30).

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of the lower maxilla, one must needle the points of the Hand Yangming (LI), such as Shangyang (LI 1), Erjian (LI 2), Sanjian (LI 3), hegu (LI 4)..., which all have a sedative action on dental pain. These points are needled in dispersion in the event of fullness and in tonification in the event of emptiness. The Foot Taiyang (Bl) also possesses a vessel which penetrates into the malar bone and branches into the teeth. This vessel is connected to the Hand Shaoyang (SJ), whose point of penetration is Jiaosun (SJ 20) (8). In the case of dental pain of the upper maxilla, the path of the Foot Yangming (St) is affected; one must needle Juliao (St 3), Dicang (St 4), heliao (LI 19), yingxiang (LI 20)... .” (Figure 74) III - N.V.N.: This paragraph deals with dental pain. (Figure 74)

Figure 74: Connection of Jiaosun (SJ 20) with the upper maxilla and that of Daying (St 5) with the lower maxilla.

8. See classification of “Meeting-reunion” points in M.T.C. - N.V.N. Edition.

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PARAGRAPH 14

533.

The Foot Yangming (St) possesses a vessel which ascends to the base of the nose to join the internal canthus of the eye. The point of penetration is Huanlu (GB 5) , where little vessels leave from to the mouth and from the mouth, they link to the “root of the eye”. One must analyze the disease well before needling according to the technique of dispersion in the event of excess and tonification in event of insufficiency. The opposite treatment worsens the disease. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “The previous paragraph and this one shows the well-organized trajectories of the 3 yang channels. The energy of the 3 yang goes toward the top, exteriorizes at Dai You (Great windows), circulates following the Hand Yangming (LI), Foot Shaoyang (GB), Foot Yangming (St) and Foot Taiyang (Bl) and forms, in this way, the routes of connection (Luo) of the 6 channels of foot and hand. The Hand Taiyang (SI) has a vessel which penetrates into the nose and face; the point of penetration is Huanlu (GB 5), belonging to the Foot Shaoyang (GB). As a result, the energy of the Hand Taiyang (SI) circulates according to the path of the luo (branch) in order to link up to the Foot Shaoyang (GB) which brings it toward the mouth and eyes. One must therefore diagnose the illness well before needling. If the illness is located at the taiyang (SI) with excess of the luo (branch) and insufficiency of the shaoyang (GB), one must disperse the energy in excess and tonify the energy in insufficiency; the opposite worsens the illness. • Question: The Foot Yangming (St) and Hand Yangming (LI) have a mutual relationship; this is the Natural Dao. But how do you explain the union of the taiyang (Bl) with the shaoyang (GB)? • Answer: The energy of taiyang and that of shaoyang have their ”fire-water” source from the natural world. In comparing them to the “Two Principles” (Er ni), one distinguishes “4 Aspects” (si Zang) (9). This is why: _ at the 1st and 2nd month, taiyang and shaoyang govern the energy. _ at the 5th and 6th month, taiyang and shaoyang also govern the energy. These phenomena bear the name “reciprocal unions”. 534. _ here, the word yangming implies the sense of union of 2 yang, factor of the creation of light (Ming). For this reason, the energy of yangming governs the 3rd and 4th month (Lunar). The Dao of yin-yang is profound! Their transmutations are perpetual. If we grasp the meaning of the reason for the mutation, the problem of yin and yang is no longer discussed.”

II - On this subject, Zhang Shi also cites the “Question-Answer” of Zhou Ge Hong (281-341 A.D.): “Question: The energy of taiyang “opens” to the exterior and governs the skin and hair; that of yangming governs the dermis and sweat gland system, and that of shaoyang governs the “hinge” 9. The “2 Principles” and “4 Aspects” are terms used in the I jing (Book of Changes) to study the principles of change/mutation.

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regions, the hips and ribs. But here, the study is centered on the energy of the 3 yang in being uniquely based on the routes of the channels directed toward the top to exteriorize at the level of the head and face. Why? Answer: here, it is the routes of ascent/descent and entering/exiting which are studied. The yin energy and yang energy enter and exit... . If the skin and hair are attacked by cold or heat, one must needle the Taiyang and taiyin. If it is the flesh and muscles that are affected, one must needle the upper portion of the 3 yang because of the existence of the ascending/descending movements. When perverse energy attacks the facial region, it progresses to the bottom via the yangming; if it attacks the cervical region, it descend via the taiyang; if it attacks the region of the cheek, it evolves toward the bottom via the shaoyang. The energy of the 2nd yang circulates within the region located between the muscles and epidermo-dermal system. This is why perverse energy attacks yang (external) in the first place, then reaches the channels that are the paths of communication of interior/exterior, ascent/descent, entering/exiting in constant movement. When these movements are hampered or slowed, the circulatory system is thrown out of order.”

III - N.V.N.: The evolutive phases of yin and yang in the course of the 4 seasons and the formation of the yangming and jueyin are meticulously studied by Zhang jing Yue (1563-1640 A.D.): “The 1st, 2nd and 3rd months (Lunar) respond to yang in yang. This is the phase of birth/growth of yang; the yang energy progresses toward the front at the left side and toward the back at the right side... . The 4th, 5th and 6th months respond to yin in yang. This is the phase of progressive decline of yang and the birth/growth of yin... . During the year, the yang energy gathers together at the Chen (V) and si (VI) months. This phenomenon bears the name “reunion of 2 yang at the front” (Figure 75), nicknamed “yangming”, a word implying the sense of maximum amplitude of yang energy. 535. The 7th, 8th and 9th months respond to yin in yin. This is the phase of progression of yin; the 7th month is the period of birth of yin. The energy progresses toward the front at the right side and toward the back at the left side... . The 10th, 11th and 12th months respond to yang in yin. This is the phase of progressive decline of yin and progressive appearance of yang... . During the year, the yin energy unites to the Xu (XI) and Hai (XII) months. This phenomenon bears the name “reunion of 2 yin at the back” (Figure 75), nicknamed “jueyin”, a word implying the sense of maximal amplitude of yin energy.” This is the method of overall calculation of the excessive state and insufficient state of yin and yang during the year.

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Figure 75: reunion of the 2 yang called “yangming”. reunion of the 2 yin called “jueyin”.

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PARAGRAPH 15

536.

The Foot Taiyang (Bl) possesses a vessel which reaches the nucha and penetrates into the brain, where it joins with the “root of the eyes” (ophthalmic area). In the case of pronounced headache (encephalgia) and acute ophthalmalgia, one must needle the point Yuzhen (Bl 9) located above the 2 tendons of the nucha. This point contains a vessel that penetrates deeply into the brain and exteriorizes at the level of the yangqiao and yinqiao, where the yang energy enters into the yin and the yin energy exits from the yang. When the yang energy turns toward excess, it provokes opening of the eyes (insomnia), and when the yin energy turns toward excess, it causes closure of the eyes (hypersomnia). EXPLANATIONS AND COMENTARIES I - Zhang Shi explains: “This paragraph justifies use of the point Yuzhen (Bl 9) in the treatment of headache and eye pain on the one hand, and on the other hand, the existence of the point jingming (Bl 1), site of reunion of the yinqiao and yangqiao, that is to say, site of causality of insomnia and hypersomnia. reaching the occipital region, the Foot Taiyang (Bl) sends a vessel off into the brain; the point of penetration is called Yuzhen (Bl 9), and the area of arrival of the energy of taiyang bears the name “root of the eyes” (ophthalmic area). The entire ocular system depends on this root, and all headaches and eye pain of cerebral origin are treated by this point. The site of penetration of this vessel into the brain is also the area where the yinqiao and yangqiao end. It is therefore the site of reunion of yin and yang of the entire organism. The entering of the energy of the yangqiao into the yinqiao and the exiting of the energy of the yinqiao by way of the yangqiao is affected at the level of the point jingming (Bl 1), located at the internal canthus of the eye. When the yang energy is in excess at this level, it brings about the opening of the eyes (insomnia), and when the yin energy is in excess, it provokes closure of the eyes (hypersomnia).

II - N.V.N.: This paragraph explains the relationship of the ocular organs with the brain. Because: _ a vessel leaves from Yuzhen (Bl 9) which penetrates into the ophhalmic area of the brain, and from there, it unites with the internal canthus of the eye, where jingming (Bl 1) occurs, point of “reunion-meeting” (10) of 4 vessels: Hand Taiyang (SI), Foot Taiyang (Bl), yinqiao and yangqiao (Figure 76). _ the external occipital protuberance is the site of terminal gathering of the two curious vessels, yinqiao and yangqiao. _ Yuzhen (Bl 9), located at the supero-external border of the of the external occipital protuberance, has a therapeutic action evident on headache and eye pain with sensation of having bulging eyes and dimunition of visual acuity.

10. This group of points is described in M.T.C. - N.V.N. Edition.

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537.

Figure 76: The “root of the eyes” (ophthalmic zone) and its connections

PARAGRAPH 16 In afflux of heat (re Jue) , one must needle the points of the Foot Taiyin (Sp) and Foot Shaoyin (Ki) and leave the needles in place a long time (11). In afflux of the cold (han Jue) , one must needle the points of the Foot Yangming (St) and Foot Shaoyang (GB) and leave the needles in place a long time ( 1 2 ) .

11, 12. In some modern versions of the Lingshu, shaoyin (Ki) and shaoyang (GB) had been erroneously reversed. See commentaries of Zhang Shi above.

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EXPLANATIONS AND COMMENTARIES

538.

Zhang Shi explains: “Afflux of cold and afflux of heat originate from the disharmony of yin and yang. When this disequilibrium is located at the exterior, it causes illness of cold or heat at the level of the skin and flesh. But when it is located in the interior, at the yin Root and yang Root, it is at the origin of the afflux of the cold or of heat.. Chapter 45 (“Essay on Afflux”- Jue lun) of the Suwen states: The insufficiency of yang energy of the bottom causes the afflux of cold, and the insufficiency of yin energy at the bottom is responsible for the afflux of heat. Because the afflux of heat is due to the domination of the energy of the 3 yang of the foot, one must tonify the yin part, that is to say, to needle the points belonging to the Foot Taiyin (Sp) and Foot Shaoyin (Ki) and leave the needles in place a long time until the appearance of the “cold” energy at the level of the needling. The afflux of cold originates from the victory of the energy of the 3 yin of the foot. It is necessary to tonify the yang part of the foot, that is to say, to needle the points belonging to the yangming (St) and shaoyang (GB) and allow the needles to remain in place a long time until the appearance of the “heat” energy at the level of the needling.”

PARAGRAPH 17 In tongue protrusion, with salivation and anxiety, one must needle the Foot Shaoyin (Ki).

EXPLANATION AND COMMENTARIES I - Zhang Shi explains: “The protrusion of the tongue follows a laxity of the lingual muscles. This paragraph justifies the disharmony of yin and yang, of top and bottom. Because, at the top, shaoyin (He) is found and is the Imperial fire which commands, and at the bottom is the “water Organ”. The energy of water below and that of fire above enter into exchange. In the event of insufficiency of the kidney, “water” energy does not succeed in reaching fire-heart, hence loosening of the lingual muscles. This is why it is necessary to needle the Foot Shaoyin (Ki) to reestablish the connection of these two organs.”

II - N.V.N.: relaxation of the lingual muscles with salivation is a syndrome associated with the insufficiency of kidney yin in the inablity to temper heart-fire. This is why it is necessary to needle kidney yin. (Figure 77) Zhang jing Yue clarifies: “This Paragraph 17 and the following two deal with the syndromes of Cold and heat. Protrusion of the tongue, with diarrhea and anxiety, is due to the loss of the energetic receptive function of kidney yin. One must tonify it.” 539.

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Figure 77: Etio-pathophysiology of protrusion of the tongue.

PARAGRAPH 18 In trembling from cold with clicking of the teeth, absence of sweating, abdominal bloating and anxiety, one must needle the point of the Hand Taiyin (Lu).

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “Trembling from cold, clicking of the teeth...” are due to insuficiency of essential energy. This is why one must tonify the Hand Taiyin (Lu). II - Zhang Shi clarifies: “This paragraph demonstratess the disharmony of yin and yang in the interior and at the exterior. According to the Neijing, “The yang energy associated with yin transforms into sweat...”because superficial and exterior are yang, and deep and interior are yin. The yin-Ye (organic liquid) (13) of the interior depend on the yang energy of the exterior to be excreted in the form of sweat. One must then needle the Hand Taiyin (Lu) to ventilate the energy at the level of the skin, in order to activate the circulation of the organic liquid, because the Hand Taiyin (Lu) controls the formation and spreading of the organic liquid of the entire body.” 13. Precisely, the word “Ye” signifies “viscous liquid”.

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III - N.V.N.: The previous paragraph shows the principle of “Top-Bottom”, while this one studies that of “interior-exterior”. These principles constitute the paths of “Ascent/Descent” and “EntryExit” of yin and yang. As a result, the words “Cold” and “heat” are employed in this chapter to explain the states of disequilibrium of yin and yang in order to recommend appropriate treatment.

PARAGRAPH 19 In the syndrome of emptiness, one must needle at the moment of departure of the energy, and in the syndrome of fullness, at the moment of the arrival of the energy.

EXPLANATINS AND COMMENTARIES I - Ma Shi explains “This paragraph explains the tecnhniques of tonification and dispersion. In emptiness, one tonifies the energy in orienting the needle in the direction of the energy, and in fullness, dispersion is performed in orienting the needle in the direction opposite to the circulation.” II - Zhang Shi describes: “Emptiness” implies the sense of insufficiency of essential energy, and “fullness”, the sense of fullness of perverse energy. In other words, the fullness of perverse energy always causes the emptiness of the essential energy.” III - N.V.N.: Tonification and dispersion constitute the two fundamental gears of the practice of acupuncture and moxabustion. Tonification has for a goal activating the vital functions of the organism, of intensifying mental and physical tonus in light of restoring force and vigor, indispensible in the struggle of life. Dispersion has the objective of neutralizing the perverse energies, of expelling them in light of establishing physiologic equilibrium. In all likelihood, it acts to reinforce the defense mechanism of the organism. 541. Tonification and dispersion work toward harmonizing the functioning of the organism. Tonification is indicated in the event of emptiness, and dispersion, in the event of fullness. Besides the techniques of tonification and dispersion mentionned in this paragraph, still others are also considered clinically: 1. Technique based on speed at the instant of implantation of the needle: a) Tonification: _ stick the needle in well, slowly _ slightly turn the needle _ at the instant of needle withdrawal, observe a little pause when it arrives just under the skin _ remove the needle rapidly. b) Dispersion: _ push well the needle in rapidly _ turn rapidly _ remove slowly.

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the

2. Technique based on the characteristics of the movements transmitted to needle: a) Tonification: _ transmit rotatory movements to the needle in counter-clockwise direction (turned left) b) Dispersion: _ transmit clockwise rotatory movements (turned right) to the needle.

3. Technique based on the nature of propulsion/thrust and retropulsion/ reverse thrust of the energy: a) Tonification: _ After obtaining the flow of energy (deqi), continue to transmit to the needle strong advancing and weak retreating movements, first in the superficial, then deep, layer. b) Dispersion: _ The is the reverse process. It consists of transmitting weak thrusting movements and strong reverse thrusting movements to the needle, first in the deep, then the superficial, layer. 4. Technique based on closing and opening the energetic point: a) Tonification: At the instant of retreat of the needle, _ rapidly remove the needle _ close off the energetic point by pressing on the opening of the puncture site. This act is intended to prevent the escape of the energy. b) Dispersion: _ enlarge the orifice of the needling site by stirring the needle in every direction. This maneuver is intended to facilitate the expulsion of the perverse energy. 542.

5. Technique based on the respiratory movements of the patient: a) Tonification: _ insert the needle in well, upon expiration _ remove it upon inspiration. b) Dispersion: _ insert the needle in well, upon inspiration _ remove it upon expiration. 6. Technique combining inspiration and expiration: This consists of transmitting rotatory movements to the needle in two directions, clockwise and counter-clockwise. It is indicated in disputed cases where it is impossible to discern the emptiness or fullness and in particular cases characterized by the coexistence of emptiness and fullness.

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PARAGRAPH 20 In spring, needle the luomai; in summer, the dermal and sudorific points; in fall, the points belonging to qi Kou; in winter, the jing and shu points. Needle the luomai to treat ailments of the skin. Needle dermal and sudorific points to treat ailments of the flesh. Needle points responding to qi Kou to treat neuromuscular ailments. Needle the jing

and shu

points to treat osteo-medullary ailments.

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “This paragraph presents the method of needling according to the “4 Seasons”. In spring, it is advised to puncture the luomai because luo points treat cutaneous ailments, like Ligou (Li 5), luo point of the jueyin (Li). (14) In summer, it is advised to needle the points of the flesh because these treat dermal ailments, like the points belonging to the heart and small intestine. In fall, it is advised to needle the points belonging to qi Kou (radial pulse) because these treat neuromuscular ailments. In winter, it is advised to needle the jing and shu points because these points treat osteomedullary ailments, like Fuliu (Ki 7) and Taixi (Ki 3) of the Foot Shaoyin (Ki) II - Zhang Shi specifies: 543. “This paragraph describes the different layers of the body responding to the 4 seasons, because the blood and energy of the living being circulates in accord with the “entry/exit” movements of yin and yang of the natural world. This is why: _ in spring, one needles the luo points, and in summer the points of the flesh because, during spring and summer, the energy circulates from the interior toward the exterior (from yin toward yang). _ in fall, one needles the points belonging to qi Kou, and in winter, the jing and shu points because, during fall and winter, the energy circulates from the exterior toward the interior (from yang toward yin). These paths of entering and exiting respond to the circulation of the blood and energy of the human being and to the climatic movements of the 4 seasons.” III - N.V.N.: The choice of points responding to spring and summer have been explained in Chapter 19 (“Energies of the 4 Seasons”- si She qi) of this classic. As for the points used during fall and winter, here is the explanation of Zhang jing Yue: a) The phrase “In fall, one needles the points responding to qi Kou” implies the sense of needling the points of the Hand Taiyin (Lu) which respond to the energy of metal-Fall circulating 14. This luo point (Li 5) is specific in the treatment of vulvar and scrotal pruritis.

at the level of qi Kou (right radial pulse). Qi kou, being the site of “Great reunion of the Vessels”,

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these points can treat neuromuscular ailments. b) The phrase “In winter, one needles the jing shu points...” does not mean that it involves the jing (4th shu antique) and shu (3rd shu antique) points, but the energetic points (shu, in movement) having a relationship to the energy of the organ.” The latter analysis of Zhang jing Yue is based on the words jing (channel) and shu (energetic point). For our part, we lean toward the explanation of Ma Shi (see above).

PARAGRAPH 21 The energy of the 5 organs exteriorizes at the level of 5 regions: _ region of F u t u _ region of the calf _ region of the back _ region of the Back shu points _ and region of the nucha. When abscess (anthrax) manifests in one of these regions, death is inevitable.

EXPLANATIONS AND COMMENTARIES

544.

I - Ma Shi explains: “This paragraph points out the seriousness of abscesses localized in one of the 5 regions cited above. The 5 organs, although internal, are in relation to the entire body, particularly with the following 5 regions: 1. region of Futu (St 32), point belonging to the Foot Yangming (St), 6 cun above the knee. 2. region of the calf, where the point Chenjin (also zhicheng- Bl 56) is found, a point prohibited from being needled; moxa 3 times. 3. Median back region, where the Dumai (GV) is found. 4. region of the Back shu points, like Feishu (Bl 13), to the side of and below the 3rd thoracic vertebrae, Pishu (Bl 20), to the side and below the 11th dorsal vertebra, etc. 5.. region of the nucha, belonging to Dumai (GV) and taiyang (Bl).” II - Zhang Shi comments: “heaven and earth are not responsible for these abscesses. They originate only from the accumulation of blood and energy. The previous paragraphs study the localization of perverse energy within the different layers of the body: skin, flesh, muscles, bones...; while this one shows the relationship of the 5 organs with the 5 regions. A simple modification of the factor “energy/blood” of one of these regions is sufficient for the abscess to form. For us, it is a matter here of the phenomena called “yin in yang” and “yang in yin”. The abscess can be of “wind-Cold” origin coming from the exterior or can following an internal perturbation of psycho-affective origin. They can also originate from a digestive disturbance or a disequilibrium of ying (nutritive energy) or wei (defensive energy). In all cases, yin and yang lose their connection, hence the confrontation of “2 heats” with pyogenic formation. Sometimes, these abscesses manifest on the arms and are fatal; sometimes they manifest on the back or nucha and are incurable. Therefore, one must determine the benign or malignant nature of these abscesses and the emptiness and fullness of the essential energy to evaluate the

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prognosis of life or death. If these abscesses are of exogenous etiology, the good physician treats the skin first, then the flesh and muscles. If it is a question of abscesses of endogenous origin, one evacuates the “stagnant” energy toward the cutaneous system, avoiding that it not become inflammatory. In other words, in the beginning phase, the abscesses of these 5 regions are curable, and in the evoultive phase, toward pyogenic formation, they are incurable.” 545.

PARAGRAPH 22 In illnesses starting on the arm, one must needle first the points of the Hand Yangming (LI) and Hand Taiyin (Lu) to facilitate sweating In illnesses beginning on the head, one must first needle the points of the Foot Taiyang (Bl) to favor sweating. In illnesses first affecting the legs, one must first needle the points of the Foot Yangming (St) to facilitate sweating.

EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “1. The arm is the region of passage of the Hand Yangming (LI) and Hand Taiyin (Lu). This is why, in illnesses localizing on the arm, one needles the points of these two channels to facilitate sweating to evacuate the perverse energy via the route of the sweat glands. 2. The nucha is the site of passage of the Foot Taiyang (Bl). In the ailments localizing at the head and nucha, one needles the points on this channels to facilitate sweating to disseminate the perverse energy via the sweat gland route. 3. The antero-external region of the leg is the site of passage of the Foot Yangming (St). In ailments of the leg, one needles the points on this channel to favor sweating to evacuate the perverse energy via the sweat gland route.”

II - Zhang Shi describes: “This paragraph concerns the top and bottom of the body, certain places of which govern yin and yang. 1. The upper half of the body is controlled by the Hand Taiyin (Lu) and Hand Yangming (LI). As a result, when the illness starts on the arm, it is necessary first to needle the points of these two channels to facilitate sweating. 2. The energy of the Foot Taiyang (Bl) coming from the bladder exteriorize at the neck, nucha and head. In illnesses starting on the head, it is first necessary to needle the points of this channel, located in this region, to aid in sweating. 3. The lower half of the body is controlled by the Foot Taiyin (Sp) and Foot Yangming (St). In illnesses starting on the leg, it is first necessary to needle the points of these two channels, located in this region, to favor sweating. The term “...starting on” implies that the illness begins at the bottom; but when it affects the entire bottom, it reaches the top and vice versa. 546. The term “...first” implies that yin and yang of the foot and hand have regions which govern them. But the energy of the 3 yin and that of the 3 yang do not remain immobile; their movements of “ascent/descent”, “entering and exiting” are reciprocal and perpetual, always

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connecting them together.” III - N.V.N.: This paragraph justifies the importance of the choice of channels in the practice of acupuncture and moxabustion. 1. The Hand Taiyin (Lu) and Hand Yangming (LI) are specific in the treatment of ailments of the upper limbs. 2. The Foot Taiyang (Bl) is specific in the treatment of ailments of the head. 3. The Foot Yangming (St) is specific in the treatment of ailments of the lower limbs.

PARAGRAPH 23 Needling the Hand Taiyin (Lu) can provoke sweating. Needling the Foot Yangming (St) can also provoke sweating. This is why, during needling of the yin channel, if the sweating is too abundant, one must stop it by needling the yang channel; and during the needling of the yang channel, if the sweating is excessive, one must stop it by needling the yin channel. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: “Sweat is the yin Ye (organic liquid) originating from “cereal” metabolism at the level of yangming (St). The taiyin (Lu) is the “master” of the energy. Its energy circulates within the external area of the body and brings with it the liquid substance in order to spread it within the organism. This distribution of organic liquid harmonizes the transformation of the energy. As a result, the Hand Taiyin (Lu) can provoke sweating. similarly, since sweat excreted by the sweat glands comes from the liquid substance metabolized at the level of the stomach, the Foot Yangming (St) can also provoke sweating. But the organic liquid needs the energy to circulate and the energy needs the organic liquid to permeate the organism and moisten the skin and hair. This is why, during the needling of the yin channel, if the sweating is excessive, one can curb it by needling the yang channel and vice versa, because yang is a substance which consolidates the external part of the yin and yin is a substance which consolidates the internal part of the yang,” 547.

II - N.V.N.: According to Zhang jing Yue, Yuji (Lu 10) and Taiyuan (Lu 9) of the Hand Taiyin (Lu) and Neijing (St 44) and Xiangu (St 43) of the Foot Yangming (St) can be used either in tonification (sweating effect) or in dispersion (anti-sweating effect). During tonification of the Hand Taiyin (Lu), the sweating is excessive because yin is “victorious”. In that case, one must tonify the Foot Yangming (St) to stop it. similarly, if dispersion of the Hand Taiyin (Lu) brings with it too abundant a sweating, one must stop it by dispersion of the Foot Yangming (St). Chapter 21 is therefore fundamental to the practice of sweating provoked with the therapeutic goal of the diseases of Cold and heat following disequilibrium of yin and yang”(15). 15. See “Therapeutic Rules” in M.T.C. - N.V.N. Edition

PARAGRAPH 24

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The non-withdrawal of the needle at the instant of the arrival of the energy is a danger to needling because it risks provoking secretion of the jing (essence) energy. similarly, withdrawal of the needle without attaining the energy is a determining factor of the return of the perverse energy. The secretion of the jing energy worsens the illness, and the return of the perverse energy causes the formation of abscesses. EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: “In this paragraph, needling is intended to disperse fullness. When it reaches the region of the illness, not removing the needle risks provoking escape of the jing (essence) energy, worsening the illness and weakening the patient. If the needling has still not reached the illness, the needle must be placed pemanently to disperse it. The opposite can cause the return of the perverse energy and formation of abscesses. In summary, this paragraph explains the technique of dispersion used in cases of fullness.”

II - Zhang Shi desrcibes: 548. “Chapter 21 explains yin and yang, Cold and heat caused by the emptiness of the essential energy and by the fullness of the perverse energy. The last paragraph advises physicians to respect the rules of removal and placement of the

needle permanently to avoid the serious complications called “Fullness-Fullness, EmptinessEmptiness”.”

III - N.V.N.: Chapter 21 justifies the specificity of the points used in acupuncture and moxabustion: _ sudorific and anti-sudorific points _ activator points of the movements of blood and energy _ unobstructing points called “windows of heaven” _ “reunion-Meeting” points _ specific points used in the afflux of heat _ specific points used in the treatment of protrusion of the tongue with continuous salivation _ points used according to the “4 Seasons” _ specific points in the treatment of abscesses (anthrax) localized in the 5 regions of the body _ specific points in the treatment of illnesses beginning on the arm, head and leg.

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549/550.

Introduction ....................................................................................................... Book I Chapter 1: “9 Needles” and “12 Yuan” (Jiu Zhen Shi Er Yuan) ................................................... Chapter 2: Origin of the Shu-Antique points (Ben Shu) ......................................................................... Chapter 3: Explanations of the “Little Needles” (Xiao Zhen Jie) ................................................................ Chapter 4: Pathological Forms of the Attack of the Organs and Bowels by Perverse energy (Xieqi Zang Fu Bing Xing).............................................. Chapter 5: Origin and Gatherng (Gen Jie) ........................................................................... Chapter 6: Longevity and Brevity - Hard and Soft (Tu Yao Gong Ru) ........................................................... Chapter 7: Use of the Needles (Guan Zhen) .................................................................... Book

Book

II Chapter 8:

Origin of the Mental (Ben Shen) ...................................................................... Chapter 9: Beginning and Ending (Zhong Zhui) ................................................................... Chapter 10: Vessels-Channels (Jing Mai) ........................................................................ III Chapter 11: Distinct Channels (Jing Bie) ......................................................................... Chapter 12: River Ways (Jing Shui) ...................................................................... Chapter 13: Tendinomuscular Channels (Jing Jin) ......................................................................... Chapter 14: Measurement of the Bones (Gu Duo) ........................................................................... Chapter 15: Fifty Rong (Wu Shi Rong) ................................................................ Chapter 16: Nutritive Energy (Ying Qi) .......................................................................... Chapter 17: Measurement of the Vessels (Mai Duo) ......................................................................... Chapter 18: Production and Reunion of Ying and Wei (Ying Wei Sheng Hui) .................................................... Chapter 19: Energies of the 4 Seasons (Si She Qi) ........................................................................ Chapter 20: The Five Perverse (Wu Xie) ........................................................................... Chapter 21: Diseases of Cold and Heat (Han Re Bing) ................................................................

Table of Contents .......................................................................................

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11 17 53 93 103 151 175 195

219 239 283

365 389 405 445 455 461 467 477 493 511 519 549

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