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Chapter 11 of 14
针灸甲乙经
Volume 9 of The Systematic Classic of Acupuncture and Moxibustion (Zhen Jiu Jia Yi Jing) primarily discusses disorders affecting the head, chest, hypochondrium, abdomen, lumbar region, and external genitalia caused by external pathogens, internal injuries, and malfunctions of the viscera, bowels, channels, and collateral vessels, with particular emphasis on channel-pattern identification and principles of acupuncture and moxibustion. The entire volume can be understood in twelve chapters, with the core idea being: many localized symptoms, as seen by ancient physicians, were not merely local problems but resulted from reversed flow of visceral and channel qi or deep invasion of external pathogens.
Reading Note: All acupoints and needling methods mentioned below are scholarly records from ancient literature, intended solely for understanding ancient diagnostic reasoning. Readers are strictly forbidden from self-administering needling, bloodletting, or moxibustion.
Huangdi asked: There is a kind of headache that persists for years without resolution — what disease is this? Qibo replied: This is caused by past exposure to severe cold, where the cold qi has penetrated deeply into the bone marrow. The bone marrow communicates with the brain, and the cold qi causes brain qi to flow upward in rebellion, hence the headache, which even extends to toothache.
This chapter classifies headaches into several types:
At the end of the chapter, certain acupoints are listed for different headaches, such as Muchuang (GB 16), Tianchong (GB 9), Fengchi (GB 20), Kongzui (LU 6), and Shangqiu (SP 5).
This chapter distinguishes headaches caused by cold invading the bone marrow, yang qi rebelling upward, jue-reversal of qi flow, true headache, and traumatic static blood, reflecting the principle that "headache should not be treated solely at the head." Particular emphasis is placed on:
The description of "true headache" shares similarities with critical headaches in modern medicine such as subarachnoid hemorrhage, elevated intracranial pressure, intracranial infection, and hypertensive crisis. The ancients' ability to distinguish this from ordinary headaches and their warning of a grave prognosis carries significant clinical value.
However, "severe cold entering the bone marrow" cannot be directly equated with modern etiologies. Chronic headache should prompt investigation for migraine, tension-type headache, cervical spondylosis, intracranial lesions, hypertension, and other conditions. Bloodletting and needling of dangerous sites such as Renying must never be performed independently.
This chapter discusses sudden heart pain, chest bi, cardiac hernia, and intestinal parasitosis.
"Jue heart pain" is classified according to the five viscera:
True heart pain: Hands and feet cyanotic up to the elbows and knees with intense heart pain. The ancients said, "Onset at dawn brings death by dusk; onset at dusk brings death by dawn" — a critical condition.
Other conditions mentioned include:
The description of "true heart pain" bears similarities to conditions requiring emergency intervention, such as acute myocardial infarction, aortic dissection, and severe shock. If severe chest pain, cold sweats, cold extremities, or a sense of impending doom occurs, immediate medical attention is required — not self-treatment.
References to "three worms" and "roundworms" reflect ancient observations of parasites, but diagnosis and deworming require modern medical confirmation. Acupuncture and bloodletting cannot substitute for emergency management.
This chapter focuses on cough. Huangdi asked: Why does the lung cause people to cough? Qibo replied: All five viscera and six bowels can cause coughing, not just the lung.
The mechanism is:
Characteristics of the five visceral coughs:
If the five visceral coughs persist without resolution, they transmit to the six bowels:
The chapter concludes: These coughs "accumulate in the stomach and relate to the lung, " hence patients experience copious phlegm and nasal discharge, facial edema, and reversed qi flow. In treatment, for visceral disease select Shu points, for bowel disease select He points, and for edema select Jing points. The chapter ends by listing points including Pohu (BL 42), Qishe (ST 11), Yixi (BL 45), Futu (LI 18), Tianrong (SI 17), Huagai (CV 20), Danzhong (CV 17), Shenzang (KI 25), Kufang (ST 14), Yunmen (LU 2), Taixi (KI 3), Weidao (GB 28), Taiyuan (LU 9), Chize (LU 5), Tianfu (LU 3), and Dazhong (KI 4).
Chronic cough has complex etiologies; modern medicine also emphasizes looking beyond the lung. Post-nasal drip, gastroesophageal reflux, asthma, and medications can all cause cough. The traditional concept of "accumulating in the stomach and relating to the lung" shares some commonality with gastroesophageal reflux-related cough.
However, not all coughs can be attributed to "visceral transmission. " Persistent cough, hemoptysis, weight loss, or chest pain warrant investigation for infection, tuberculosis, malignancy, and other conditions — traditional theory cannot replace diagnosis.
This chapter discusses chest and hypochondriac fullness and pain caused by liver disease, as well as impaired flow of defensive qi.
When pathogenic qi is in the liver, there may be bilateral hypochondriac pain, cold in the middle, static blood retention, and swollen painful joints. Treatment may include selecting Xingjian (LR 2) to course and drain the hypochondrium, reinforcing Zusanli (ST 36) to warm the stomach, needling the blood vessels to dissipate stasis, and selecting the green vessels behind the ears.
Huangdi asked: When defensive qi stagnates within the vessels, accumulating without movement, causing fullness in the hypochondrium, wheezing, and reversed breath — how should this be managed? Bogao replied:
The chapter lists many points for chest and hypochondriac fullness and pain, including Xuanji (CV 21), Huagai (CV 20), Zigong (CV 19), Yutang (CV 18), Zhongting (CV 16), Lingxu (KI 24), Shenfeng (KI 23), Bulang (KI 22), Qihu (ST 13), Xiongxiang (SP 19), Zhongwan (CV 12), Yuanye (GB 22), Dabao (SP 21), Zhejin (GB 23), Juque (CV 14), Liangmen (ST 21), Qimen (LR 14), Laogong (PC 8), Sanjian (LI 3), Yanggu (SI 5), Taibai (SP 3), Taichong (LR 3), Xiaxi (GB 43), and Yanglingquan (GB 34).
Of particular note: The original text records, "Needling Renying (ST 9), inserting four fen, can unfortunately kill a person, " demonstrating that the ancients recognized certain locations carried fatal risks when needled.
Hypochondriac pain may be a manifestation of hepatobiliary disorders, intercostal neuralgia, pleural disease, muscular strain, or even herpes zoster. Emotional distress can cause chest and hypochondriac oppression, but not all hypochondriac pain can be attributed to liver depression.
"Renying" (ST 9) is located near major cervical vessels and nerves; modern acupuncture has strict anatomical and operational standards for such sites, and ordinary readers must never imitate the ancients' practices.
Huangdi asked: For bitter taste in the mouth, Yanglingquan (GB 34) is selected — what disease presents with bitterness in the mouth? Qibo replied: It is called Dan Dan (gallbladder heat/dan jaundice) . The gallbladder is "the bowels of refined clarity" (zhong jing zhi fu), the liver governs planning, yet decisions depend upon the gallbladder, and the throat is the passageway through which gallbladder qi ascends. When prolonged deliberation and indecision cause gallbladder qi to overflow upward, bitterness in the mouth results. Treatment involves selecting the Mu (front collecting) and Shu (back transport) points of the gallbladder.
This chapter also addresses the relationship between emotional abnormalities and the viscera:
Gallbladder disease manifests as a tendency to sigh, bitter taste in the mouth, vomiting of stagnant fluids, inner unease, ready fright, throat discomfort, and frequent coughing with sputum. According to whether the Foot Shaoyang channel is deficient or excess, moxibustion is used for deficiency, and Yanglingquan (GB 34) for cold and heat patterns.
Pathogenic qi in the gallbladder, with counterflow affecting the stomach: When gallbladder fluid leaks, bitterness in the mouth results; when stomach qi rebels upward, vomiting of bitter fluid results — this is termed "vomiting of bile" (ou dan). Select Zusanli (ST 36) to descend stomach counterflow, and needle the blood collateral of the Foot Shaoyang channel to stem the gallbladder counterflow.
Anxiety, depression, and chronic tension can indeed produce symptoms such as bitter taste, sighing, palpitations, and easy fright, which relate to autonomic nervous function and brain-gut interaction. However, bitter taste can also be caused by hepatobiliary disease, gastroesophageal reflux, oral conditions, etc., and warrants appropriate investigation.
Acupuncture treatment for emotional disorders has some research support, but it cannot replace professional psychiatric and psychological care.
Huangdi asked: When the spleen is diseased, the four limbs become unable to function properly — why is this? Qibo replied: The four limbs require nourishment from the grain-and-water qi of the stomach, but the stomach qi cannot directly reach the channels of the four limbs; it must rely upon the spleen for transformation and transport. When the spleen is diseased, it cannot move fluids for the stomach, the four limbs fail to receive the essence of grain and water, qi and blood progressively weaken, the vessels become blocked, and the sinews, bones, and muscles all lose nourishment — hence the limbs lose their function.
Another question: Why does the spleen not independently govern a season? The answer: The spleen belongs to Earth, resides in the center, and is each season credited with sixteen (eighteen) days at the end of each of the four seasons; it does not exclusively govern a single season. Earth is able to generate the myriad things, modeling the workings of Heaven and Earth, and therefore from the upper to the lower parts of the body — from head to feet — nothing is separate from the nourishment of the spleen.
A further question: The spleen and stomach are connected only by a membrane — why is the spleen able to transport fluids on behalf of the stomach? The answer: The Foot Taiyin Spleen channel traverses the stomach, pertains to the spleen, and connects with the throat; thus the Taiyin is able to convey the qi of the stomach to the three yin channels. The Foot Yangming Stomach channel is the sea of the five viscera and six bowels and sends qi and blood to the three yang channels. It is therefore that the four limbs are able to obtain nourishment.
The chapter ends with the entry: "body heavy and bones painful/chacid, as if not interconnected — select Taibai (SP 3). "
Digestive and absorption disorders, malnutrition, and chronic consumptive diseases can indeed lead to muscle atrophy and weakness of the limbs. However, limb weakness may also result from disorders of the nervous system or muscle tissue itself, such as peripheral neuropathy, myasthenia gravis, or hypokalemia, and cannot be attributed solely to "spleen deficiency."
"The spleen governs the four seasons in succession" is a model of ancient time medicine and Five-Phase correspondence. It has cultural value, but it cannot directly guide modern treatment.
This chapter focuses on abdominal distension, intestinal rumbling, and shortness of breath caused by disorders of the spleen, stomach, and large intestine.
When pathogenic qi resides in the spleen and stomach, it manifests as muscle pain. When yang qi is excessive and yin qi is insufficient, there is stomach heat with rapid hunger; when yang qi is insufficient and yin qi is excessive, there is interior cold with intestinal rumbling and abdominal pain; when both yin and yang are excessive or both are deficient, there is mixed cold and heat. In all cases, ST-36 (Zusanli) may be regulated.
Stomach disease manifests as abdominal distension, pain in the gastric region radiating to both hypochondriac regions, throat discomfort, and inability to ingest food. ST-36 may be selected. Intestinal rumbling like thunder, qi rushing upward to the chest, wheezing, and inability to stand for long indicate pathogenic qi in the large intestine. The source of the Huang membrane (Huangzhi Yuan), ST-37 (Shangjuxu), and ST-36 (Zusanli) may be selected. Large intestine disease manifests as sharp cutting pain in the intestines, audible rumbling in the abdomen, and periumbilical pain after exposure to cold in winter, with inability to stand for long.
At the end of the chapter, numerous acupoint indications are listed, including BL-20 (Pishu), BL-21 (Weishu), BL-22 (Sanjiaoshu), BL-49 (Yishe), BL-50 (Weicang), CV-13 (Shangwan), CV-12 (Zhongwan), CV-10 (Xiawan), ST-25 (Tianshu), LR-13 (Zhangmen), LI-7 (Wenliu), LI-10 (Shousanli), SP-5 (Shangqiu), SP-7 (Lougu), SP-9 (Yinlingquan), ST-36 (Zusanli), GB-39 (Xuanzhong), and BL-56 (Chengjin).
Abdominal distension, intestinal rumbling, abdominal pain, and dyspepsia are commonly seen in functional gastrointestinal disorders, but they may also be caused by ulcers, inflammatory bowel disease, tumors, or intestinal obstruction. Modern medicine has conducted some research on ST-36 and gastrointestinal function, but acupuncture cannot replace etiological diagnosis and treatment.
If there is severe abdominal pain with distension, tenderness on palpation, vomiting, or cessation of flatus and bowel movements, it may be an acute abdomen and requires immediate medical attention.
When pathogenic qi resides in the kidney, it manifests as bone pain and yin bi (yin-type painful obstruction). Yin bi is characterized by the absence of a clearly defined tender point upon palpation, accompanied by abdominal distension, low back pain, difficult defecation, stiffness and pain in the shoulders, back, neck, and nape, and dizziness. KI-1 (Yongquan) and BL-60 (Kunlun) may be selected; if blood stasis is visible in collaterals, they may be needled.
When the lower abdomen pulls the testicles, radiates to the lumbar spine, and rushes upward to the heart and lungs, it indicates pathogenic qi in the small intestine. The small intestine is connected to the testicles, spine, liver, lungs, and heart system. When qi rebels upward, it rushes to the stomach and intestines, steams the liver and lungs, spreads into the chest, and accumulates around the navel. Treatment involves selecting the source of the Huang membrane to disperse pathogenic qi, needling Taiyin to tonify, selecting Jueyin to descend rebellious qi, and selecting ST-39 (Xiajuxu) to eliminate pathogenic qi.
The Yellow Emperor asked about a pulse condition: In winter, the right pulse is deep and firm, while the left pulse is floating and slow. What disease is this? Qi Bo replied: In winter, a deep and firm right pulse conforms to the four seasons; a floating and slow left pulse is contrary to the four seasons, indicating simultaneous disease of the kidney and lung, manifesting as low back pain.
This is followed by a detailed differentiation of various types of low back pain:
At the end of the chapter, acupoint indications are listed, including GV-1 (Changqiang), BL-27 (Xiaochangshu), BL-28 (Pangguangshu), BL-29 (Zhonglushu), BL-52 (Zhishi), BL-53 (Baohuang), BL-54 (Zhibian), ST-30 (Qichong), LR-13 (Zhangmen), GB-25 (Jingmen), LR-2 (Xingjian), SP-9 (Yinlingquan), LR-3 (Taichong), LR-11 (Yinbao), KI-1 (Yongquan), BL-61 (Pushen), BL-40 (Weizhong), and BL-54 (Yinmen).
The causes of low back pain are extremely complex, including muscle strain, lumbar disc herniation, kidney stones, urinary tract infection, and gynecological diseases. Low back pain accompanied by testicular pain and lower abdominal pain requires evaluation for urogenital diseases.
Bloodletting and needling of collaterals are ancient therapeutic methods and must not be self-imitated. Low back pain accompanied by lower limb weakness, bowel or bladder dysfunction, fever, trauma, or unexplained weight loss requires prompt medical attention.
Lower abdominal swelling with pain and inability to urinate indicates pathogenic qi in the sanjiao, with constraint of sanjiao qi transformation. The great collateral of the foot-taiyang channel may be selected, and needling may be applied where blood stasis has formed in collateral networks. If swelling extends to the gastric region, ST-36 (Zusanli) may be selected.
Sanjiao disease manifests as abdominal distension and fullness, with the lower abdomen particularly firm and the inability to urinate. When fluids spill externally, it becomes edema; when retained internally, it becomes distension and fullness. BL-40 (Weizhong) may be selected.
Bladder disease manifests as swelling and pain on one side of the lower abdomen; when pressed, there is a sensation of urinary urgency but inability to void; heat above the eyebrows; or cold between the thighs. Treatment involves needling the lumbar and thigh region until warmth is generated, resulting in recovery.
At the end of the chapter, acupoint indications are listed, including CV-4 (Guanyuan), CV-2 (Qugu), SP-7 (Lougu), LR-2 (Xingjian), LR-10 (Zu wuli), KI-1 (Yongquan), BL-40 (Weizhong), and BL-51 (Chengfu).
Difficulty urinating and lower abdominal distension and pain may be caused by prostatic hyperplasia, urinary tract stones, infection, or neurogenic bladder. Severe urinary retention requires catheterization, and postrenal kidney injury can be life-threatening.
Ancient acupuncture, heat application, and other therapies must be evaluated under standardized medical care and cannot replace modern management.
For internal closure with inability to urinate or defecate, the foot-shaoyin and foot-taiyang channels may be selected; for qi rebellion, the taiyin and yangming channels are selected; for severe reversal, the pulsating points of the taiyin and yangming channels are selected.
When the sanjiao is constrained with inability to urinate or defecate, points such as ST-28 (Shuidao), SJ-3 (Zhongzhu), SP-3 (Taibai), and KI-4 (Dazhong) may be selected.
The simultaneous inability to urinate and defecate is attributed to "constraint" and "internal closure" of sanjiao qi movement. The therapeutic approach is to unblock qi movement and restore ascending and descending.
Simultaneous inability to urinate and defecate may indicate severe intestinal obstruction, neurological disorders, or drug effects, and the cause must be urgently identified. Ancient acupuncture merely reflects the thinking of its time and cannot replace modern management of acute abdomen.
This chapter discusses the needling method of "removing clothing," which refers to needling the joint collateral networks related to the lumbar spine, buttocks, and genitalia. The ancients considered the lumbar spine to be the body's joints, the buttocks to be the support for walking, and the genitalia to be the essential region for reproduction and urination, as well as the pathway of fluids.
Irregular diet and uncontrolled joy and anger cause fluids to flow downward and the water passage to become blocked, resulting indifficulty bending forward and backward, difficulty walking, and even edema of the lower body, with clothing unable to cover the body—hence the name "removing clothing."
The Yellow Emperor asked: There is a condition of urinary retention with urination dozens of times per day—this indicates deficiency. Yet there is also body heat like burning charcoal, obstruction in the neck and chest, rapid and agitated pulse, and wheezing with rebellious qi—this indicates excess. What disease is this? Qi Bo replied: The disease is in the taiyin, with excess in the stomach and involvement of the lungs. It is called "reversal" (jue) and is a fatal condition. The "five excesses" refer to pathogenic excess, and the "two deficiencies" refer to righteous qi deficiency. With external pathogenic excess and internal righteous qi deficiency, neither superficies nor interior, the prognosis is extremely poor.
At the end of the chapter, numerous acupoint indications are listed, including CV-14 (Juque), CV-7 (Yinjiao), KI-11 (Henggu), CV-6 (Qihai), CV-4 (Guanyuan), ST-25 (Tianshu), ST-27 (Daju), SP-8 (Diji), SP-12 (Chongmen), GB-26 (Daismai), SP-5 (Shangqiu), LR-3 (Taichong), LR-1 (Dadun), LR-2 (Xingjian), LR-4 (Zhongfeng), CV-5 (Shimen), KI-8 (Jiaoxin), LR-5 (Ligou), KI-1 (Yongquan), KI-2 (Rangu), KI-6 (Zhaohai), BL-67 (Zhiyin), ST-22 (Guanmen), HT-7 (Shenmen), BL-40 (Weizhong), BL-39 (Weiyang), CV-3 (Zhongji), SP-9 (Yinlingquan), CV-1 (Huiyin), CV-12 (Zhongwan), ST-39 (Xiajuxu), GB-12 (Wangu), ST-37 (Shangjuxu), and SI-2 (Qiangu), covering hernia, enuresis, urinary retention, and yellow-red urine.
Hernia, enuresis, and urinary abnormalities require differentiation between organic and functional causes. Incarcerated hernia, urinary retention, and acute prostatitis may all require emergency treatment. Tension and anxiety can indeed cause frequent urination, but they should not replace evaluation for organic diseases.
The description of "fatal condition" suggests certain critical states, such as high fever, wheezing, rapid and agitated pulse with deficiency, which may correspond to severe infection or shock.
This chapter discusses hemorrhoids and rectal prolapse.
For hemorrhoid pain, BL-2 (Zanzhu) may be selected. For hemorrhoids and perineal disorders, CV-1 (Huiyin) may be selected. The original text mentions that "when hemorrhoids communicate with the genitals, it is fatal," indicating that the ancients recognized the poor prognosis of certain severe perianal and perineal infections or necrosis.
For hemorrhoids with bone-eroding-like pain, SP-5 (Shangqiu) may be selected. For hemorrhoids and perineal pain, BL-58 (Feiyang), BL-40 (Weizhong), BL-51 (Chengfu), and BL-56 (Chengjin) may be selected. For rectal prolapse, ST-30 (Qijie) may be selected.
Hemorrhoids and rectal prolapse are related to the foot-taiyang bladder channel and the perineal channel network. Combining local and distal point selection represents the ancient therapeutic approach.
Hemorrhoids and rectal prolapse require differentiation by type; mild cases may be managed conservatively, while severe cases may require surgery. Blood in the stool must always rule out colorectal tumors and should not be assumed to be merely hemorrhoids. "When hemorrhoids communicate with the genitals, it is fatal" may be an empirical warning about critical conditions such as perianal necrotizing fasciitis.
This content is based on classical Chinese medicine texts and is provided solely for the study of traditional culture. It does not constitute any medical diagnosis, medication, or treatment advice. If you feel unwell, please seek medical attention promptly.
— Compiled by Bu Gua