针灸甲乙经卷五 - 针灸甲乙经

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A-B Classic of Acupuncture and Moxibustion, Volume 5

Overall Paraphrase

This volume focuses on contraindications for acupuncture and moxibustion, the nine needles' forms and classification of needling techniques, contralateral needling (Miu needling), and the fundamental principles of needling practice. It does not discuss specific herbs or formulas but systematically explains the "rules of using needles": when not to needle, how deep to insert, how to treat different constitutions differently, how to grasp tonification and drainage methods, and the rationale behind contralateral point selection.

I. Acupuncture and Moxibustion Contraindications: Seasons, Depth, and Forbidden Points 🌿🩺

Ancient physicians held that the qi of the four seasons resides in specific locations; therefore, the key to moxibustion and needling lies in the selection of appropriate qi points—that is, the crucial aspect of using needles and moxa is precisely selecting the acupoints (pores where meridian qi and blood are infused) corresponding to the current season and disease location.

Spring needling: Suitable for collaterals, Ying-spring points, and between the major channels' flesh divisions. Deep insertion for severe cases, shallow for mild ones.
Summer needling: Suitable for minute collaterals, muscles, and the skin surface, because summer pathogenic qi is still relatively superficial.
Long Summer needling: Suitable for meridian points and between the flesh divisions.
Autumn needling: Suitable for He-sea points, following the shallow needling method of spring; as yang qi begins to withdraw in autumn, selecting He-sea points can drain yang pathogens.
Winter needling: Suitable for Jing-well and Ying-spring points, with deep insertion and needle retention; as yang qi is hidden in winter, deep needling helps regulate yin rebellion and unblock yang qi.

If the wrong seasonal layer is needled—for example, needling summer locations in spring—it may cause chaotic pulse and weakened qi, failure of the disease to resolve, loss of appetite, and shortness of breath. Needling autumn locations in spring may cause tendon spasms, coughing, and easy startling. Needling winter locations in summer may cause shortness of breath and irritability. These contents reflect the ancient understanding of the correspondence between the four seasons, skin-flesh-tendons-vessels-bones, and the viscera.

Before needling, attention must also be paid to lifestyle and emotional contraindications: after severe cold, severe heat, intoxication, overeating, extreme hunger, extreme thirst, extreme anger, extreme fatigue, or sexual activity, needling should not be performed immediately. Those who have traveled long distances by carriage or on foot should rest first and wait until qi and blood have settled before considering needling. The ancients believed that at such times the pulse is chaotic and qi is scattered; if needling is forced, pathogenic qi may sink deeper or qi and blood may become disordered.

Regarding depth levels, the ancients proposed the progressive principle: "When needling bone, do not injure tendon; when needling tendon, do not injure flesh; when needling flesh, do not injure vessels; when needling vessels, do not injure skin; when needling skin, do not injure flesh..." This emphasizes that the needle should reach the disease site without damaging unrelated tissues. The text also records that puncturing the five viscera, major blood vessels, the brain, and other vital areas may cause severe consequences; therefore, a list of forbidden needling points and forbidden moxibustion points is provided, including Shenting (GV 24), the navel (CV 8), Ruzhong (ST 17), Jiuwei (CV 15), Naohu (GV 17), Fengfu (GV 16), and others.

Finally, the principle of "Five Depletions: No Drainage" is presented: when the body has been severely emaciated, after massive blood loss, profuse sweating, severe diarrhea, or recent childbirth with heavy bleeding—in these five conditions, drainage methods must not be applied recklessly. The text further states that "the stomach is the sea of water, grain, qi, and blood," explaining that the body's qi and blood originate from water and grain; the meridians are the great collaterals of the five viscera and six bowels. If needling disrupts their qi, it may harm the patient—even "able to kill the living, but cannot raise the dead."

II. Nine Needles, Nine Needling Methods, Twelve Sectional Needlings, Five Needlings, and Five Pathogens 🪡

The nine needles were designed according to heaven, earth, man, the four seasons, five tones, six pitches, seven stars, eight winds, and nine fields, each with specific forms and functions:

The needle corresponding to heaven: large head with a sharp end, used for heat in the head and body, or for disease of the skin without fixed location.
The yuan needle corresponding to earth: round body with an egg-shaped tip, used for disease located between the flesh divisions.
The needle corresponding to man: shaped like a grain of millet, used for disease of the vessels with qi deficiency requiring tonification.
The feng needle corresponding to the four seasons: used for chronic, fixed diseases of the five viscera.
The pi needle corresponding to the five tones: shaped like a sword blade, used for large abscesses with pus and blood.
The yuanli needle corresponding to the six pitches: sharp as a hair tip with a slightly enlarged body, used for sudden bi (obstruction) syndrome.
The hao needle corresponding to the seven stars: sharp as a mosquito or horsefly beak, used for painful bi in the collaterals.
The chang needle corresponding to the eight winds: seven cun in length, used for deep pathogens and distant bi.
The da needle corresponding to the nine fields: slightly rounded tip, used for edema that does not pass through the joints.

Needling must match the depth of disease: if the disease is shallow and the needling deep, healthy flesh is injured; if the disease is deep and the needling shallow, pathogenic qi is not drained. If the disease is small and the needle large, qi is drained excessively; if the disease is large and the needle small, pathogenic qi is not eliminated.

Subsequently, the nine needling methods are listed: needling meridian shu points, dao needling, meridian needling, collateral needling, fen needling, major drainage needling, mao needling (superficial skin needling), ju needling, and cui needling (fire needling). The twelve sectional needlings include: ou needling (paired needling), bao needling (repeated needling), hui needling (restoring needling), qi needling (uniform needling), yang needling (scattered needling), zhi needling (direct perpendicular needling), shu needling (transport needling), duan needling (short needling), fu needling (superficial needling), yin needling, bang needling (lateral needling), and zan needling (praise needling). The five needlings: ban needling (half needling), baowen needling (leopard-spot needling), guan needling (joint needling), hegu needling (combined valleys needling), and shu needling—correspond respectively to the lungs, heart, liver, spleen, and kidneys. The five pathogen needling methods: yong (abscess) pathogens use the pi needle, major pathogens use the feng needle, minor pathogens use the yuan needle, heat pathogens use the hao needle, and cold pathogens use the hair-thin needle. The common thread of these classifications is selecting different needle instruments and methods according to disease location, nature, and constitution.

III. Miu Needling: Left Disease Treated on the Right, Right Disease on the Left ↔️

Ancient physicians believed that when pathogenic qi enters the collaterals from the skin and hair, if it remains in the great collaterals, it will cross-flow left and right and transmit up and down, producing conditions of "left flowing to right, right flowing to left." In such cases, the disease is not in the regular meridians but in the collateral vessels, and therefore one should not simply needle the affected meridian on the diseased side. Instead, Miu needling should be used—that is, needling the right side for left-sided disease and the left side for right-sided disease.

The distinction between Miu needling and Ju needling is: Ju needling targets diseases of the meridians, while Miu needling targets diseases of the collaterals. The text lists numerous examples of Miu needling for various collateral invasions:

When pathogenic qi attacks the foot Shaoyin collateral, causing sudden heart pain, sudden distension, and fullness in the chest and hypochondrium, one should needle Qianogu (KI 2) to cause bleeding—left disease treated on the right, right disease treated on the left.
When pathogenic qi attacks the hand Shaoyang collateral, causing throat obstruction, curled tongue, dry mouth, and vexation, one should needle the nail corner of the finger—left for right, right for left.
When pathogenic qi attacks the foot Jueyin collateral, causing sudden hernia with severe pain, one should needle the junction of the nail and flesh of the great toe.
When pathogenic qi attacks the foot Taiyang collateral, causing head and neck pain and shoulder pain, one should needle the area of the small toe nail.

These contents constitute the ancient records of cross-lateral point selection for collateral diseases. It must be emphasized that these are classical theoretical principles; specific point selection and techniques must be performed by professional physicians under standardized and safe conditions, and should not be self-imitated.

IV. The Way of Needling: Guarding the Spirit, Guarding the Opportunity, Tonification-Drainage, and Deqi 🧘

Ancient physicians held that the highest level of needling is not merely fixing on specific points, but guarding the spirit and guarding the opportunity. Qi movement comes and goes with favorable and adverse patterns; only by understanding the timing of qi arrival and departure can one "meet it and seize it" to drain, or "follow it and assist it" to tonify.

Principles of Tonification and Drainage: Tonify deficiency, drain excess, eliminate stagnated blood, and reduce pathogenic excess. The tonification method is like a mosquito or horsefly alighting—gentle and retained; the drainage method is like casting off and letting go—causing pathogenic qi to be expelled. The key is not to "strengthen excess and weaken deficiency"—that is, one must not make excess conditions more excessive or deficient conditions more deficient, which would worsen the condition.

Deqi is the sign of effective needling. The ancients described that when Deqi occurs, the "grain qi arrives": after tonification the pulse becomes fuller, after drainage the pulse becomes weaker. The disease may not disappear immediately with the needle, but once the qi mechanism turns, the disease momentum will diminish. To achieve this, the physician must concentrate with full attention, "as if facing a deep abyss, hands as if gripping a tiger," undisturbed by external matters.

V. Beginning and End of the Needling Way: Renying and Pulse Opening, and Yinyang Excess and Deficiency ⚖️

The Beginning and End chapter proposes that by comparing the strength of Renying (carotid pulse location) with that of the Pulse Opening (cun-kou radial pulse), one can determine the excess and deficiency of yin and yang meridians. If the Renying pulse is strong, it indicates disease of the yang meridians; if the Pulse Opening is strong, it indicates disease of the yin meridians. According to the degree of excess, one selects the corresponding meridians and uses "tonify deficiency, drain excess" to rebalance.

The text also discusses threefold needling reaching grain qi: the first needling discharges yang pathogens, the second discharges yin pathogens, and the third causes grain qi to arrive and then stops. "Grain qi arriving" can be understood as healthy qi returning and Deqi occurring beneath the needle.

Needling depth should also be combined with the four seasons and body build: spring qi is in the hair, summer qi in the skin, autumn qi in the flesh divisions, and winter qi in the sinews and bones. Obese people should be needled deeply with retention; thin people should be needled shallowly with quick withdrawal. For disease above, treat below; for disease below, treat above.

VI. Natural Conformity and Contrariety: Individual Differences 🌱

Different constitutions require different needling methods:

Obese people: thick skin, firm flesh, turbid blood, and astringent qi—suitable for deep needling with retention.
Thin people: thin skin, less coloration, clear blood, and slippery qi—suitable for shallow needling with quick withdrawal.
Average people: harmoniously regulated qi and blood—use standard needling methods.
Robust individuals: distinguished between those with firm but relaxed flesh and those with strong, taut sinews—either deep with retention or shallow and quick.
Infants: tender flesh, scanty blood, and weak qi—use hair-thin needles for shallow, quick needling, which may be repeated daily.

There is also conformity and contrariety between body qi and disease qi: if body qi is insufficient but disease qi is excessive, this indicates pathogenic excess requiring urgent drainage; if body qi is excessive but disease qi is insufficient, urgent tonification is appropriate; if both body qi and disease qi are insufficient, this indicates combined yin-yang deficiency, and further needling is inadvisable—otherwise, healthy qi may be further exhausted.

VII. External Inference and Internal Correspondence: Knowing the Interior from the Exterior 🔍

This section emphasizes using surface information to judge the state of internal viscera. For example, observing the skin of the forearm for cold-heat, slippery-astringent quality, and firmness; observing the five colors of the eyes; and palpating blood vessels—from these one can determine the deficiency-excess of the five viscera and cold-heat bi pain. When holding the needle, one must be upright and calm, first clarifying deficiency and excess, then determining speed, slowness, depth, and shallowness. Only thus can one "infer the internal from the external, the external from the internal," achieving clarity of discernment before needling.

🧠 Deep Understanding

Core Theoretical Principles 💡

The core of this volume constitutes the general framework of "needling safety and qi-regulation techniques," which can be summarized into five aspects:

Adaptation to time: The location of qi differs across the four seasons, and needling depth adjusts accordingly.
Adaptation to the individual: Obese, thin, strong, weak, infant, and average individuals all require different needling methods.
Appropriate depth: Disease in the skin, flesh, vessels, sinews, bones, and marrow each corresponds to specific layers; excessive depth injures the interior, while insufficient depth fails to eliminate pathogens.
Rules for tonification and drainage: Based on pulse deficiency-excess and the arrival-departure of qi—meeting and seizing is drainage, following and assisting is tonification.
Safety first: Listing forbidden needling and moxibustion points, the five depletions, and emotional and physical exertion prohibitions, emphasizing "guarding the spirit" rather than blindly deep needling or heavy moxibustion.

These principles collectively form the foundation of the A-B Classic of Acupuncture and Moxibustion as a standardizing document for acupuncture practice—it is not merely a collection of points but a set of operational principles for "how to use needles safely and effectively."

Modern Perspectives 🌟

This material should be viewed from two levels:

Valuable aspects: Its integration of "four seasons—constitution—depth" resonates with modern attention to stimulation intensity, needling layers, and individual differences. The compilation of forbidden needling and moxibustion points reflects that the ancients already recognized anatomical dangers at certain sites, such as major blood vessels, vital organs, and the cranium. The principles of not draining during the five depletions and avoiding needling after extreme anger, intoxication, or overeating align with modern precautions against adverse reactions to acupuncture.
Historical limitations: Ancient anatomical knowledge was limited, and the specific timeframes such as "puncturing a certain organ results in death on a certain day" represent experiential observations or theoretical extrapolations rather than equivalents to modern prognostic judgments. Some points listed as forbidden in ancient times may be used under specific conditions in modern practice with rigorous standards; conversely, some sites not considered forbidden anciently are now known to present risks. Therefore, the contraindication items in this volume serve as documentary evidence of ancient acupuncture safety concepts but should not be directly applied as modern operational standards.

Health and Wellness Insights ⚡

From a non-therapeutic perspective, this volume reminds us to:

Align activities with the seasons: Nourish yang in spring and summer, nourish yin in autumn and winter; align daily activities with seasonal rhythms.
Achieve emotional stability before acting: After extreme anger, fright, intoxication, overeating, extreme hunger, or extreme fatigue, the body's qi and blood have not yet settled—no intense interventions or vigorous activities should be undertaken.
Maintain dietary moderation: The spleen and stomach constitute the sea of water, grain, qi, and blood; regular eating patterns with balanced intake are fundamental to maintaining adequate qi and blood.
Value rest: After long journeys or exhaustion, settle down first and allow mind and body to recover before handling important matters.
Avoid blind pursuit of "depth, intensity, or speed": Whether in health cultivation or skill acquisition, progress comes through gradual development rather than excessive consumption.

These insights are general lifestyle references and do not pertain to any specific disease.

📚 Related Knowledge

Related concepts: Qi points, collaterals/minute collaterals/great collaterals, nutritive and defensive qi and blood, Renying-cun-kou pulse method, five depletions, Miu needling/Ju needling, nine needles, tonification-drainage techniques, grain qi/Deqi, five needlings corresponding to five viscera, four-season needling methods.
Further reading: Huangdi Neijing: Lingshu, Chapters 1 (Nine Needles and Twelve Yuan-Primary) and 7 (Officials' Needles), Chapter on Beginning and End; Suwen, Chapters on Essentials of Needling and Prohibitions of Needling; Nanjing, Difficulty 78 — all are valuable for cross-reference with this volume.

This content is based on classical Chinese medicine texts and is provided solely for traditional cultural study and research. It does not constitute any medical diagnosis, medication, or treatment advice. If unwell, please seek medical attention promptly.