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Chapter 19 of 81
黄帝内经·灵枢
Huangdi asked Qi Bo: The qi of the four seasons manifest differently, and the occurrence of various diseases each has its root cause. What, then, should serve as the guiding principle for moxibustion and needling? Qi Bo replied: The qi of the four seasons each has its specific location. The fundamental principle of moxibustion and needling lies in accurately locating the corresponding qi points (acupoints where channel qi enters and exits).
For malarial fevers presenting with fever but no sweating, needle the fifty-nine acupuncture points for treating heat conditions. For wind-edema with skin swelling, needle the fifty-seven points for treating water conditions, and also prick the superficial blood collaterals of the skin to drain stagnant blood as much as possible. For sun-shi (diarrhea with undigested food), tonify the points on the upper aspect of the three yin channels and Yinlingquan (SP9), retaining the needles for a prolonged period until warmth radiates to the affected area. For turning cramp (muscle spasms), treat the yang aspect if it occurs on the yang side, and treat the yin aspect if it occurs on the yin side, all using rapid needling technique.
For simple edema (primary water retention disease characterized by swelling): First, insert a pi needle (an ancient needling instrument) three cun below Huan Valley, then insert a tubular needle to repeatedly aspirate, draining the fluid completely; if drainage is slow, the patient may become agitated; if drainage is smooth, the patient tends to be calmer. Then firmly bind the local area, needle every other day until the water is fully drained. Concurrently, administer herbs that unblock stagnation and promote diuresis; during needling sessions, only herbal decoctions may be taken. When taking herbs, do not eat; when eating, do not take herbs. For one hundred and thirty-five days, avoid all inappropriate foods.
For prolonged bi disorder (arthralgia characterized by dampness predominance with heavy, numb limbs) that does not heal over time, or persistent cold that does not subside, urgently needle Zusanli (ST36). For intestinal dysfunction, also select Zusanli (ST36), using reducing method for excess patterns and reinforcing method for deficiency patterns. For li feng (leprosy-type conditions), needle the swollen areas, then press with a sharp needle to expel noxious qi, continuing until the swelling subsides; the patient should eat only suitable foods and avoid miscellaneous foods.
Large Intestine disease: Frequent rumbling in the abdomen, qi rushing upward to the chest, wheezing with inability to stand for long—the pathogen is in the large intestine. Needle Huang zhi Yuan (approximately the Qihai area), Shangjuxu (ST37), and Zusanli (ST36).
Small Intestine disease: The lower abdomen draws the testicles, connects with the lower back and spine, and rushes upward to the heart—the pathogen is in the small intestine. Because the small intestine connects with the testicles, links to the spine, penetrates the liver and lungs, and connects to the heart system; when qi is exuberant, it rebels upward, rushing the stomach and intestines, steaming the liver, dispersing into the fatty membranes, and binding at the navel. Therefore, select Huang Yuan to disperse the pathogen, needle the Taiyin channel as assistance, select the Jueyin channel to descend rebellious qi, select Xiajuxu (ST39) to remove pathogens from the small intestine, and then harmonize along the channels traversed.
Gallbladder disease: Frequent vomiting of bitter fluid, prolonged sighing, feelings of fear and restlessness as if someone is about to arrest one—the pathogen is in the gallbladder, with stomach qi rebelling upward. When gallbladder fluid leaks out, there is bitterness in the mouth; when stomach qi rebels upward, there is vomiting of bitter fluid—hence the term "ou dan" (biliary vomiting). Select Zusanli (ST36) to descend stomach qi, needle the blood collaterals of the Shaoyang channel to arrest gallbladder rebellion, and then regulate deficiency and excess to dispel the pathogen.
Stomach duct disease: Inability to ingest food, blockage and obstruction in the chest and diaphragm—the pathogen is in the stomach duct. Needle above the upper opening (Shangwan) to suppress rebellious qi, and needle below the lower opening (Xiawan) to disperse pathogenic qi.
San Jiao (Triple Burner) disease: Distension, pain, and swelling in the lower abdomen with difficult urination—the pathogen involves dysfunction of the San Jiao's constraining functions. Select the great collateral of the Foot Taiyang channel, observe areas where collateral vessels and Jueyin minute collaterals show blood stasis, and prick to release blood; if the swelling extends to the stomach duct, additionally match Zusanli (ST36).
Diagnosis and prognosis: Observing the complexion and the eyes reveals the dispersion and restoration of righteous qi; examining the color of the eyes determines the presence and disappearance of the pathological condition. Observe the patient's physical movements, and palpate the Qikou (radial pulse) and Renying (carotid pulse). If the pulse is firm, large, and slippery, the condition is worsening; if the pulse is soft, the condition will recede; if all channels are replete and full, recovery may be expected in about three days. Qikou monitors yin; Renying monitors yang.
"Locating the qi point is the key" — the crux of seasonal needling.
This chapter correlates the qi of the four seasons with the distribution of qi and blood in the human body's channels and collaterals: spring selects channels and intermuscular septa, summer selects minute collaterals, autumn selects Jing and Shu points, winter selects Jing (well) and Xing (spring) points. This demonstrates that the ancients did not fixedly assign specific points for specific diseases; rather, they emphasized that treatment must conform to the depth of qi and blood and the state of the visceral organs according to the season.
The point-selection principle of "He points govern the fu organs."
For diseases of the six fu organs—large intestine, small intestine, stomach, gallbladder, and San Jiao—multiple references cite Zusanli (ST36), Shangjuxu (ST37), and Xiajuxu (ST39) as He points or lower He points. This embodies the consistent Lingshu principle that "He points treat the fu organs," with fu organ disorders being addressed primarily through the stomach channel and corresponding lower He points.
Tonifying deficiency and reducing excess run throughout.
For example, "If the intestines are not functioning well, select Zusanli; when replete, reduce; when deficient, tonify" clearly states that the same point can be treated with different techniques depending on the deficiency or excess pattern. This reflects the core TCM principle of "restoring balance" in acupuncture.
Integration of channel pattern differentiation with visceral localization.
Small intestine disease involves the testicles, lower back and spine, and heart system; gallbladder disease manifests as bitter taste, bilious vomiting, and fear; San Jiao disease presents as lower abdominal swelling and urinary difficulty. The ancients attributed symptoms to channels and visceral organs, then selected points along those channels.
Combined color diagnosis, eye examination, and pulse palpation for prognosis.
The closing passage of this chapter uses changes in complexion, eye color, and Qikou/Renying pulses as the basis for determining disease progression or regression, embodying the holistic diagnostic view that "what is within necessarily manifests without."
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 you experience discomfort, please consult a healthcare professional promptly. — Bu Gua