Plain Discourse: Bone Void Discourse, Chapter Sixty

A Vernacular Study of Huangdi Neijing · Suwen · Bone Void Discourse, Chapter Sixty

Overall Paraphrase

I. Wind Pathogen Pathogenesis and Acupuncture Principles 💨

The Yellow Emperor asked: I have heard that "wind" is the initiating factor of many diseases. How should one grasp the treatment when using acupuncture?

Qi Bo replied: When wind pathogen invades from the outside, it causes aversion to cold with shivering (chills and trembling), sweating, headache, heavy body sensations, and aversion to cold. For treatment, one may select Fengfu (GV-16, a Du meridian point at the nape, approximately one cun directly above the midpoint of the posterior hairline), harmonizing yin and yang: use the supplementing method when righteous qi is insufficient, and the reducing method when pathogenic qi is excessive.

II. Acupuncture and Moxibustion Sites for Wind Diseases and Pain Syndromes 🌿

• Severe wind causing neck pain: puncture Fengfu (GV-16). Fengfu is located at the upper vertebral prominence.
• Severe wind with sweating: moxibustion at Yixi (BL-45, a Bladder meridian point on the back, approximately 3 cun lateral to the lower border of the spinous process of the 6th thoracic vertebra). When locating the point, press on the area and ask the patient to say "Yixi"; if there is a responsive sensation under the fingers, this is the point.
• Aversion to wind: puncture the medial end of the eyebrow (near Cuanzhu, BL-2).
• Stiff neck (wry neck from sleeping): select the point between the transverse bones of the shoulder (clavicle).
• Lower back and spine feeling broken, with limited mobility: have the patient extend their arms, align with the elbow level, and apply moxibustion at Jizhong (GV-6, midpoint of the spine).
• Hypochondriac collateral vessels pulling with lower abdominal distension and pain: puncture Yixi (BL-45).
• Low back pain with inability to turn or move sideways, with urgent pulling sensation in the genitals and testes: puncture Baliao (the eight liao points in the sacral region) as well as the painful area.
• Rat fistula (a condition similar to scrofula ulcerating into a fistula) accompanied by chills and fever: puncture Hanfu (the lateral bone interspace of the knee). When selecting points on the lateral aspect above the knee, have the patient assume a bowing posture; when selecting points on the sole of the foot, have the patient assume a kneeling position.

III. Pathways and Pathologies of the Ren, Chong, and Du Vessels 🩺

Ren Vessel (Conception Vessel): Originates below the point Zhongji (CV-3), ascends to the pubic hair margin, travels along the interior of the abdomen upward past Guanyuan (CV-4), reaching the throat, then ascends to the chin, follows the face, and enters the eyes.
Pathologies of the Ren Vessel: In men, it can manifest as internal binding of seven types of hernia (various ancient hernia and lower abdominal pain conditions); in women, abnormal vaginal discharge and abdominal masses (accumulations and conglomerations).

Chong Vessel (Thoroughfare Vessel): Originates at Qijie (near Qichong, ST-30), travels parallel with the foot-shaoyin meridian, ascends flanking the umbilicus, and disperses in the chest.
Pathologies of the Chong Vessel: Manifests as rebellion of qi with urgent internal sensations (qi rising counterflow, abdominal urgency).

Du Vessel (Governing Vessel) pathologies: Manifest as stiff spine with opisthotonos (rigid back, bowing backward like a stretched bow).
The pathway of the Du Vessel is relatively complex: It originates below the lower abdomen, in the center of the pelvis. In women, it connects with the Tingkong (urethral orifice); its collateral vessels course along the external genitalia, converging at the perineum, then wrap around the perineum. A branch circles the buttocks, joining with the collaterals of the foot-shaoyin and foot-taiyang meridians. The foot-shaoyin meridian ascends along the posterior border of the medial thigh, pierces through the spine, and connects with the kidneys; it arises with the foot-taiyang meridian at the inner canthus, ascends across the forehead and converges at the vertex, enters and connects with the brain, then emerges and descends along the nape, travels along the medial border of the scapulae flanking the spine down to the lumbar region, enters along the fleshy part of the spine, and connects with the kidneys. In men, it courses along the penis down to the perineum, same as in women.
There is another branch ascending directly from the lower abdomen: it pierces through the center of the umbilicus, ascends through the heart, enters the throat, ascends to the chin, encircles the lips, and ascends to connect with the central region below both eyes.
When the Du Vessel manifests the above pathologies, one may see qi surging upward from the lower abdomen striking the heart with pain, difficulty with urination and defecation — this is called Chong hernia; in women: infertility, difficult urination, hemorrhoids, enuresis, and dry throat.
When the disease lies in the Du Vessel, treat the Du Vessel; select points on the bone (historically understood as above the pubic symphysis or near Qugu, CV-2). For severe cases, select the nutritive region below the umbilicus.

IV. Needling Treatment for Knee Pathologies and Bony Landmarks 🦴

• Knee joint mobility impairment, able to extend but not flex: treat Jian (the pivot structure).
• Knee pain when sitting: treat Ji (the mechanism/fulcrum).
• Knee hot and weak like unfolding when standing: treat Haiguan (the knee joint space).
• Knee pain extending to the great toe: treat Guo (popliteal fossa).
• Knee pain when sitting as if something is hidden inside: treat Guan (the upper aspect of the popliteal region).
• Knee pain with inability to flex and extend: treat the medial aspect of the back.
• Pain in the lower leg with shinbone feeling broken: treat Zhongyu Liao points on the yangming meridian.
• If pain is prominent elsewhere: treat the Ying-Spring points of the taiyang and shaoyin meridians.
• Tibial soreness and weakness, inability to stand for long: treat the luo-connecting point of the shaoyang meridian, located five cun above the lateral malleolus.

Bony landmark names are as follows:

V. Water Points, Bone Voids, and Marrow Voids 💧

Distribution of the fifty-seven points for treating water disease:

• Five rows above the sacrum/coccyx, five points in each row;
• Two rows above Futu (ST-32 area), five points in each row; one row on the left and one on the right, five points in each row;
• One row above each malleolus, six points in each row.

Marrow voids (bone apertures observed by the ancients) are located at:

• Three divisions behind the back of the head, below the sharp bone at the cranium;
• One at the base of the gums;
• One below the double bone in the middle of the nape;
• One at the upper void of the spinal column, located above Fengfu;
• The lower void of the spinal column, beneath the tailbone;
• Several marrow voids on the face flanking the nose;
• Bone voids below the mouth directly opposite both shoulders;
• Voids of both scapulae at the lateral border of the scapulae;
• The void of the arm bones on the lateral aspect of the arm, between the two bones four cun from the wrist;
• The upper void of the thigh bone on the lateral thigh, ascending to four cun above the knee;
• The void of the tibia at the upper end of the accessory bone;
• The void at the junction of the thigh bones in the pubic hair, below the pulsating artery;
• The void of the tailbone behind the hip bone, at a distance of four cun.
  Flat bones have permeating textures without obvious marrow voids; marrow exchange does not rely on apertures.

VI. Moxibustion Method for Chills and Fever 🔥

The ancients' method of moxibustion for chills and fever diseases — applying moxibustion sequentially to the following sites:
First: moxibustion at Dazhui (GV-14) at the nape, with the number of cones equal to the patient's age; second: moxibustion at Juegu (the sacrococcygeal region), also with the number of cones equal to the patient's age; observe the depressed areas of the back shu points and apply moxibustion; the depressed area on the shoulder when raising the arm; between the two hypochondriac regions; at the end of the absolute bone above the lateral malleolus; between the small toe and the second toe; at the depressed pulsating area of the calf; posterior to the lateral malleolus; at the site above the supraclavicular fossa that is hard and painful like a sinew upon pressure; at the depressed area in the middle of the sternum; below the wrist bundle bone; at Guanyuan three cun below the umbilicus; at the pulsating artery at the pubic hair margin; at the region three cun below the knee between the muscle divisions; at the dorsalis pedis artery area of the foot-yangming meridian; at the top of the head.
Apply three cones at the site of a dog bite, and follow the method for treating dog bite disease.
In total, twenty-nine sites are moxibusted (some say nineteen, possibly due to differences in counting symmetric left-right points). Food stagnation diseases may also be treated with moxibustion; if not cured, one must examine which meridian has exuberant yang qi, repeatedly puncture its shu points, and combine with herbal treatment.

All the specific acupuncture and moxibustion sites mentioned above are descriptions from the original classical text and are provided purely for traditional cultural study. Do not attempt these procedures on your own.

🧠 Deep Understanding

Core Principles and Methods 💡

1. Wind as the origin of hundred diseases — harmonizing yin and yang as the general principle for treating wind
   This chapter opens with "wind entering from outside," holding that wind pathogen is the vanguard of many externally contracted diseases. When wind pathogen attacks the exterior, it first affects defensive yang, manifesting as chills with shivering, sweating, headache, heavy body, and aversion to cold — similar to exterior pattern symptoms. The treatment emphasizes "harmonizing yin and yang, supplementing what is insufficient, reducing what is excessive," reflecting the Neijing's consistent principle of "supplement for deficiency, reduce for excess."

2. Bone voids and body surface localization thinking
   "Bone voids" can be understood as apertures and spaces in the skeletal structure — an early observation of bone anatomy by the ancients. The chapter extensively records the locations of marrow voids and bone voids, using these as localization references for acupuncture and moxibustion, demonstrating that the ancients had already noted the relationship between body surface landmarks and deep structures, showing early anatomical awareness.

3. Pathways and pathologies of the eight extraordinary vessels
   This chapter provides a relatively complete description of the pathways and pathologies of the Ren Vessel, Chong Vessel, and Du Vessel, making it an important chapter on extraordinary vessel theory in the Neijing. The Ren Vessel governs yin and relates to menstruation, vaginal discharge, pregnancy, and childbirth in women; the Chong Vessel is the sea of blood, with pathologies manifesting as rebellious qi and internal urgency; the Du Vessel governs yang and superintends all yang meridians, with pathologies manifesting as stiff spine with opisthotonos, Chong hernia, infertility, urinary retention, and hemorrhoids. Later eight extraordinary vessel pattern differentiation and acupuncture point selection largely originate from this text.

4. Combining knee regional pattern differentiation with local anatomy
   The chapter links different knee pain presentations to bony landmarks such as "Jian, Ji, Haiguan, Guo, and Guan," then selects points by meridian, embodying an approach that combines "pain as point" and "point selection along meridians."

5. Empirical medical characteristics of the moxibustion method for chills and fever
   The moxibustion points cover the head, nape, back, chest, abdomen, and four limbs, and proposes "using the year age as the number of cones," suggesting individualization. However, this set of moxibustion methods belongs to the ancient empirical system and lacks evidence from modern evidence-based medicine and should be viewed rationally.

Modern Perspectives 🌟

• Wind pathogen and exterior patterns: The chapter's "chills with shivering, sweating, headache, heavy body, aversion to cold" bears resemblance to the early symptoms of externally contracted diseases today. The theory of wind pathogen causing disease can be understood as the ancients' generalization of how environmental factors trigger illness, and should not be equated with modern pathogenic microorganism theory.

• Bone voids and anatomy: The ancients' observations of apertures and spaces in bones have rough correspondence with today's anatomical concepts of bone foramina, nutrient foramina, and marrow cavities, but the localization is vague and lacks systematic precision. The statement that flat bones have "no marrow voids" is also inaccurate — flat bones do have nutrient foramina and marrow spaces.

• Eight extraordinary vessels: The pathways of the Ren, Chong, and Du vessels partially overlap with modern anatomy of nerves, blood vessels, and the genitourinary system. For example, the Du Vessel ascends along the spine into the brain, roughly parallel to the central nervous system's location. However, meridians cannot currently be equated with any single known anatomical structure and should be regarded as the ancients' functional model.

• Boundaries of moxibustion: The moxibustion methods for chills and fever, and moxibustion at dog bite sites, belong to ancient empiricism and cannot replace modern medical management. Especially after a dog bite, one should immediately wash and disinfect the wound and receive rabies vaccination, rather than relying on moxibustion.

Health Cultivation Insights ⚡

• Pay attention to avoiding wind and keeping warm, especially the nape, lower back, and knees; avoid sweat exposure to wind.
• Maintain regular daily routines, avoid prolonged sitting or standing and excessive fatigue, and protect the lower back and knees.
• Maintain emotional balance, avoiding qi machine rebellion surging upward.
• If neck pain, low back pain, knee pain, lower abdominal masses, urinary abnormalities, or dry throat occur, seek medical attention promptly rather than self-applying acupuncture or moxibustion from classical texts.

📚 Related Knowledge

• Related concepts: Fengfu, Dazhui, Ren Vessel, Chong Vessel, Du Vessel, eight extraordinary vessels, bone voids, marrow voids, moxibustion cone counts, pain as point, Ying-Spring points, Shu points.
• Further reading: Suwen · Feng Lun (Discussion on Wind), Lingshu · Jingmai (Meridian Pathways), Nanjing · Ershiba Nan, Zhenjiu Jiayi Jing Volume III.

This content is based on classical Chinese medicine texts and is provided solely for traditional cultural learning and study. It does not constitute any medical diagnosis, medication, or treatment advice. Please consult a healthcare professional promptly if you feel unwell.
— Buguā