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Chapter 10 of 10
难经
Question: The medical classics say, "For deficiency, use supplementation; for excess, use draining; for neither deficiency nor excess, treat the affected channel itself." What does this mean?
Answer: For deficiency, one should supplement the mother organ/channel; for excess, one should drain the child organ/channel. In cases of mixed deficiency and excess, one should first supplement the mother, then drain the child. As for "neither deficient nor excessive, take from the channel itself," this means the disease arises from the channel itself, not from external pathogens invading other channels, so one should select points on that channel for treatment.
Question: In spring and summer, needling should be shallow; in autumn and winter, needling should be deep. Why?
Answer: In spring and summer, yang qi resides above, and the body's qi movement also tends upward, so needling should be shallow. In autumn and winter, yang qi resides below, and the body's qi movement also tends downward, so needling should be deep.
Question: In spring and summer, one should draw forth one yin beneath the needle; in autumn and winter, one should push one yang into the depth beneath the needle. What does this mean?
Answer: In spring and summer, the climate is warm; to draw forth one yin, one first inserts the needle deeply to the depth of the liver and kidneys, and after obtaining qi, draws the yin qi upward. In autumn and winter, the climate is cold; to deliver one yang, one first inserts the needle shallowly, floating at the depth of the heart and lungs, and after obtaining qi, pushes the yang qi deep inward. This is why in spring and summer one must bring forth one yin, and in autumn and winter one must deliver one yang.
Question: The medical classics say, "When needling the nutritive qi, do not injure the defensive qi; when needling the defensive qi, do not injure the nutritive qi." What does this mean?
Answer: When needling the yang layer (defensive layer), use a flat, transverse insertion. When needling the yin layer (nutritive layer), first press the selected Ying-Spring or Shu-Stream points with the left hand to disperse the local defensive qi before inserting the needle. This is what is meant by needling the nutritive without injuring the defensive, and needling the defensive without injuring the nutritive.
Question: The medical classics say, "One who can master the qi of Ying-Sui (meeting and following) can regulate the qi movement; the key to regulating qi lies in yin and yang." What does this mean?
Answer: "Ying-Sui" refers to understanding the circulation of nutritive and defensive qi (nutritive qi moves within the vessels, defensive qi moves outside the vessels) and the direction of channel flow. Selecting points according to the opposing or following direction of the channel's flow is called Ying-Sui. Regulating qi must grasp yin and yang, which means understanding whether the disease is internal or external, superficial or deep, and adjusting according to yin-yang attributes. Hence it is said that the key to regulating qi lies in yin and yang.
Question: The Jing-Well points are located in areas where the flesh is thin and shallow, and qi is scanty, insufficient for applying manipulation techniques. What should be done when needing to needle a Jing-Well point?
Answer: Jing-Well points belong to Wood, and Ying-Spring points belong to Fire. Fire is the child of Wood. When one should needle a Jing-Well point, one may instead drain the Ying-Spring point. Thus the medical classics say, "Supplementation cannot be used as draining, and draining cannot be used as supplementation," referring to this principle.
Question: The medical classics say, "In spring, needle the Jing-Well points; in summer, needle the Ying-Spring points; in late summer, needle the Shu-Stream points; in autumn, needle the Jing-River points; in winter, needle the He-Sea points." Why?
Answer: In spring, one needles the Jing-Well points because the pathogen resides in the liver. In summer, one needles the Ying-Spring points because the pathogen resides in the heart. In late summer, one needles the Shu-Stream points because the pathogen resides in the spleen. In autumn, one needles the Jing-River points because the pathogen resides in the lungs. In winter, one needles the He-Sea points because the pathogen resides in the kidneys.
Question: The liver, heart, spleen, lungs, and kidneys correspond to spring, summer, autumn, and winter. Why?
Answer: When the five zang organs become diseased, manifestations often appear in multiple aspects, including the five colors, five odors, five flavors, five sounds, and five fluids. For example, in liver disease: a greenish complexion belongs to the liver, a rank odor belongs to the liver, a preference for sour foods belongs to the liver, a tendency to shout belongs to the liver, and a tendency to weep belongs to the liver. The related manifestations are numerous and cannot all be described. The four seasons have fixed rhythms and correspond to the five zang organs. The subtlety of acupuncture lies in its extreme fineness, as delicate as the tip of an autumn hair.
Question: The medical classics say, "When the East is excessive and the West is deficient, use the method of draining the South and supplementing the North." What does this mean?
Answer: Metal, Wood, Water, Fire, and Earth should mutually restrain and maintain balance. The East belongs to Wood, and the West belongs to Metal. When Wood tends toward excess, Metal should restrain it; when Fire tends toward excess, Water should restrain it; when Earth tends toward excess, Wood should restrain it; when Metal tends toward excess, Fire should restrain it; when Water tends toward excess, Earth should restrain it. The East belongs to the liver, so we know the liver is excessive; the West belongs to the lungs, so we know the lungs are deficient. Drain the Fire of the South and supplement the Water of the North. The Fire of the South is the child of Wood; the Water of the North is the mother of Wood. Water overcomes Fire. The child can make the mother become excessive, and the mother can make the child become deficient. Thus, draining Fire and supplementing Water is to avoid relying solely on Metal to restrain Wood. The medical classics say: "If one cannot treat that which is deficient, why ask about anything else?" This refers to this principle.
Note: The phrase "so that Metal is not used alone to restrain Wood" is one of the more difficult passages in the Nanjing. It roughly means that since the lungs are already deficient, one cannot rely solely on Lung Metal to restrain Liver Wood; instead, one should restore balance indirectly by draining Heart Fire and supplementing Kidney Water. This is presented here purely as traditional theoretical study.
Question: What is meant by supplementation and draining? When supplementing, from where is qi taken? When draining, to where is qi directed?
Answer: When supplementing, qi is taken from the defensive layer; when draining, qi is directed to the nutritive layer. If yang qi is insufficient and yin qi is excessive, one should first supplement yang, then drain yin. If yin qi is insufficient and yang qi is excessive, one should first supplement yin, then drain yang. Allowing the nutritive and defensive qi to circulate freely is the key.
Question: The medical classics say, "The superior physician treats disease before it manifests; the mediocre physician treats disease after it has already manifested." What does this mean?
Answer: "Treating disease before it manifests" means that upon seeing liver disease, one knows the liver disease will transmit to the spleen, so one first strengthens the spleen qi to prevent the spleen from being attacked by the liver pathogen. Hence it is called treating disease before it manifests. The mediocre physician, upon seeing liver disease, does not understand that it will transmit and change, and only treats the liver single-mindedly. Hence it is called treating disease after it has manifested.
Question: Needling methods involve both supplementation and draining. What does this mean?
Answer: The techniques of supplementation and draining do not necessarily require coordinating with breathing during needle insertion and withdrawal. A physician who truly masters needling values the left hand; one who does not, trusts only the right hand. When needling, first press the intended Ying-Spring or Shu-Stream point with the left hand, flick the point to make the local area fill, and press with the fingernail to make an indentation. When qi arrives like the pulsation of an artery, then insert the needle accordingly. After obtaining qi, pushing the needle deeper constitutes supplementation; after obtaining qi, shaking the needle and withdrawing it outward constitutes draining. If qi is not obtained, the needle position should be adjusted—for men, toward the exterior; for women, toward the interior. If qi still cannot be obtained, the ancients considered the condition critical and difficult to treat.
Question: The medical classics say, "Meeting the channel qi and seizing it—how could this not make it deficient? Following the channel qi and supplementing it—how could this not make it excessive? Deficiency and excess: as if obtained, as if lost; excess and deficiency: as if present, as if absent." What does this mean?
Answer: "Meeting and seizing" means draining its child point; "following and supplementing" means supplementing its mother point. For example, in heart disease, draining the Shu-Stream point of the Pericardium Channel is meeting and seizing; supplementing the Jing-Well point of the Pericardium Channel is following and supplementing. As for "excess and deficiency," this refers to the firmness or softness of the needling sensation beneath the needle. When the qi arrives with firmness, it is "obtained"; when it is soft and empty, it is "lost." Hence the phrase "as if obtained, as if lost."
Question: The medical classics say, "Having seen [qi], then enter; having seen [qi], then withdraw." What does this mean?
Answer: "Having seen [qi], then enter; having seen [qi], then withdraw" means that the left hand first awaits the arrival of channel qi before inserting the needle; after insertion, one waits until the qi has subsided before withdrawing the needle. This is what is meant.
Question: The medical classics say, "Do not make excess more excessive or deficiency more deficient; do not harm the insufficient and supplement the excessive." Does this refer to the Cunkou pulse? Or does the disease itself have deficiency and excess? How should one supplement or drain?
Answer: This refers to the disease, not the Cunkou pulse. The disease itself has deficiency and excess. For example, if the liver is excessive and the lungs are deficient—the liver belongs to Wood, the lungs belong to Metal, and Metal and Wood should mutually restrain each other—one should know to use Metal to restrain Wood. Suppose the lungs are excessive and the liver is deficient, and the patient has slight shortness of breath. If when needling, one does not supplement the liver but instead further strengthens the lungs, this is "making excess more excessive and deficiency more deficient," harming the insufficient and supplementing the excessive. This is the harm caused by mediocre physicians.
These thirteen questions concentrate on the core principles of acupuncture treatment, which can be summarized as follows:
Supplementing Mother, Draining Child 💡
Questions 69, 73, 79, and 75 repeatedly apply the five-phase generating and controlling relationships. For deficiency, supplement the mother; for excess, drain the child—this is an important approach in classical acupuncture supplementation and draining. For example, Jing-Well points belong to Wood, Ying-Spring points belong to Fire, and Fire is the child of Wood, so draining a Jing-Well point can be substituted by draining the Ying-Spring point.
Seasonal Needling and the Position of Body Yang Qi 🍂
Questions 70 and 74 explain that needling depth and the selection of Five-Shu points should correspond to the seasons. In spring and summer, yang qi resides above and on the surface, so shallow needling is appropriate; in autumn and winter, yang qi resides below and in the interior, so deep needling is appropriate. This embodies the holistic view that "humans correspond to Heaven and Earth."
Nutritive-Defensive Depth and Needling Precision 🩺
Questions 71 and 76 emphasize distinguishing between the nutritive layer and the defensive layer during needling. Supplementation takes qi from the defensive layer; draining directs qi toward the nutritive layer. When needling the defensive, use flat insertion; when needling the nutritive, first press to disperse qi, avoiding mutual injury.
Ying-Sui Qi Regulation and Yin-Yang 💨
Question 72 points out that the root of regulating qi lies in distinguishing yin and yang and understanding internal/external, superficial/deep. Ying-Sui is not simply a technique but requires understanding the circulation of nutritive and defensive qi and the flow direction of the channels.
Treating Disease Before It Manifests and Organ Transmission 🌿
Question 77 is the classic expression of the Chinese medicine concept of "treating disease before it manifests." Upon seeing liver disease, one knows the liver pathogen will transmit to the spleen, so the spleen should be strengthened first to prevent disease transmission. This reflects a holistic view and preventive thinking.
Obtaining Qi and Supplementation/Draining Manipulation 🔥
Questions 78 and 80 emphasize using the left hand to await qi, and that after obtaining qi, pushing deeper constitutes supplementation and drawing outward constitutes draining. Obtaining qi is an important marker of needling effect. Question 81 cautions against "making excess more excessive and deficiency more deficient," avoiding incorrect treatment that worsens the condition.
These contents belong to the classical acupuncture theoretical system and possess significant historical and cultural value.
Related Concepts:
Five-Shu Points (Jing-Well, Ying-Spring, Shu-Stream, Jing-River, He-Sea), Mother-Child Supplementation and Draining, Ying-Sui Supplementation and Draining, Nutritive and Defensive Qi, Obtaining Qi, Treating Disease Before It Manifests, Five-Phase Generating and Controlling, Seasonal Needling Methods, Excess-Excess and Deficiency-Deficiency
Further Reading:
Miraculous Pivot (Lingshu), Chapters "Nine Needles and Twelve Source-Points," "Original Pivots (Benshu)," "Beginning and End (Zhongshi)"; Plain Questions (Suwen), Chapters "On the Essentials of Needling," "On Regulating the Spirit by the Four Seasons"; Essentials from the Golden Cabinet (Jingui Yaolue), "Pulse, Syndromes, and Treatment of Viscera and Channels in Succession"
This content is based on classical Chinese medical texts and is provided solely for traditional cultural study and reflection. It does not constitute any medical diagnosis, medication, or treatment advice. If you feel unwell, please seek medical attention promptly.
— Pugua (Bu Gua)