灵枢经·九针十二原 Nine Needles and the Twelve Source Points

Huangdi asked Qibo, saying: 'I care for the myriad people as my children, nurturing the common folk and collecting their taxes and levies. Yet I grieve that they lack sufficiency and so fall prey to illness. I wish to spare them from being subjected to poisonous medicines and from the use of stone needles, and instead to use the fine needle to open through their channels, to regulate their qi and blood, and to govern the confluences where these flow contrary to or in accord with their proper course, entering and emerging. I wish this to be transmitted to later generations, and it must therefore be set forth with a clear method, so that it may come to an end without being extinguished, endure long without being severed, be easy to use yet not easily forgotten. Let it be given order and system, let its sections be distinguished, its exterior and interior differentiated, and let it be given a beginning and an end. Let each part have its proper form, and let a Canon of Needling first be established. I wish to hear its particulars.'

Qibo replied: 'Allow your servant to set these forth in proper sequence, so that they may have order and system, beginning with one and ending with nine. Let me speak of their principles. The essentials of the fine needle are easy to state but difficult to master. The unskilled practitioner holds fast to the outward form; the superior practitioner holds fast to the spirit. How subtle is the spirit — the invading evil lodges at the gate! Without first perceiving the illness, how can one know its origin? The subtlety of needling lies in its timing — whether swift or slow. The unskilled practitioner holds fast to the joints and bony landmarks; the superior practitioner holds fast to the pivotal moment. The movement of this pivot never departs from the aperture. Within the aperture the pivot is pure, still, and subtle — one cannot meet it as it comes, nor pursue it as it goes. One who understands the way of the pivot will not be off by so much as a hair's breadth; one who does not understand the way of the pivot, though he presses upon it, will not release it. To know its coming and going, one must engage it at the precise moment. How obscure this is to the unskilled — how marvelous! — and it is the skilled practitioner alone who possesses it. What departs is called contrary; what arrives is called compliant. Once one clearly knows the contrary and the compliant, one may proceed directly without hesitation. If one meets the qi head-on and seizes it, how can this fail to create deficiency? If one follows behind and reinforces it, how can this fail to create excess? Whether meeting it or following it, one harmonizes it through the intention of the mind — and the way of the needle is then complete.'

In general, in the use of the needle: where there is deficiency, one fills it; where there is fullness, one drains it; where there is stagnant old blood, one removes it; where evil qi prevails, one depletes it. The great essential is this: to insert slowly and withdraw swiftly produces repletion; to insert swiftly and withdraw slowly produces depletion. In speaking of repletion and depletion, the sensation is as though something were present, as though nothing were there. One examines what comes after and what comes before, as though something remained, as though it had vanished. In bringing about depletion and repletion, it is as though one had grasped something, as though one had lost it.

Of the essentials of depletion and repletion, the nine needles are the most marvelous, and the timing of supplementation and drainage is accomplished through the needle. In drainage, one must grasp the needle firmly and insert it, then release and withdraw it; as the yang is dispersed the needle is felt to loosen, and the evil qi is thereby drained. If instead one presses down and draws the needle out, this is called 'warming within' — the blood cannot disperse, and the qi cannot be released. In supplementation, one follows the qi again and again, applying the mind as though heedlessly, now moving, now pressing, alighting as lightly as a mosquito or gadfly, lingering as though staying and returning, withdrawing the needle as abruptly as a snapped bowstring, causing the left hand to press where the right hand withdraws, so that the qi is thereby retained. Once the outer gate is closed, the qi within becomes replete, and there must be no lingering blood — if there is, one must quickly remove it.

The way of holding the needle: firmness is its treasure. Point the finger straight and puncture directly, without slanting the needle to the left or right. Let the spirit be fixed on the finest hair's tip, and fasten the mind upon the patient. Only after carefully examining the blood vessels may one needle without danger. At the moment of needling, one's attention must rest upon the 'suspended yang' and its two guardian points. Keep the spirit fastened there without wavering, so as to know whether the disease is present or gone. Where the blood vessels lie crosswise over the transport points, on inspection they alone appear clear and distinct, and on palpation they alone feel firm.

The names of the nine needles, each differing in form: the first is called the chan needle, one cun six fen in length (a cun being a proportional unit of body measurement, and a fen one-tenth of a cun); the second is called the yuan needle, one cun six fen in length; the third is called the di needle, three cun and a half in length; the fourth is called the feng needle, one cun six fen in length; the fifth is called the pi needle, four cun in length and two fen and a half in width; the sixth is called the yuanli needle, one cun six fen in length; the seventh is called the hao needle, three cun six fen in length; the eighth is called the chang needle, seven cun in length; the ninth is called the da needle, four cun in length. The chan needle has a large head and a sharp point, and is used to drain the yang qi. The yuan needle is shaped like an egg, and is rubbed between the intervals of the flesh without injuring the muscles, so as to drain the qi of the interstices. The di needle has a tip as sharp as a millet grain, and its chief use is to press upon the vessel without letting it sink in, so as to bring the qi to arrive. The feng needle has a three-sided blade, and is used to release stubborn and chronic disease. The pi needle has a tip like the edge of a sword, and is used to remove large accumulations of pus. The yuanli needle is as thick as a horsehair, both round and sharp, slightly thicker toward the middle of its shaft, and is used to draw out sudden and violent qi. The hao needle has a tip as fine as the proboscis of a mosquito or gadfly; it is inserted quietly and slowly, and retained gently for a long while so as to nourish the qi, and is used to treat painful impediment. The chang needle is sharp-edged and thin in body, and can be used to treat impediment lodged deep within. The da needle has a tip like a stick, its point slightly rounded, and is used to drain water accumulated at the joints. Thus the nine needles are complete.

Now, as for the qi within the vessels: evil qi lodges above, turbid qi lodges in the middle, and clear qi lodges below. Thus if one needles the sunken vessel, the evil qi is expelled; if one needles the middle of the vessel, the turbid qi is expelled; but if one needles too deeply, the evil qi is instead driven further down, and the disease worsens. Hence it is said: the skin, flesh, sinews, and vessels each have their proper location, and each disease has its proper treatment. Since the nine needles each differ in form, each should be employed according to what is proper to it — one should neither create excess nor deficiency. To further diminish what is already insufficient, or to further augment what is already in excess, is called aggravating the disease. When disease is thereby aggravated, drawing qi from the vessels of all five viscera causes death, and drawing qi from the vessels of three of the viscera causes debility. To rob a patient of yin causes death; to rob a patient of yang causes derangement — such are the harms of reckless needling, now fully stated.

When one needles and the qi does not arrive, do not count the number of insertions. When one needles and the qi arrives, then withdraw the needle, and do not needle again. Each needle has that to which it is suited, each differing in form, each employed according to its proper place — this is the essential of needling. When the qi arrives there is efficacy, and the sign of this efficacy is as when the wind blows the clouds away, leaving the blue sky clearly visible — and the way of needling is thus complete.

Huangdi said: 'I wish to hear of the places from which the qi of the five viscera and six bowels emerges.' Qibo said: 'The five viscera each have five transport points, five times five making twenty-five transport points in all; the six bowels each have six transport points, six times six making thirty-six transport points in all. There are twelve channel vessels and fifteen network vessels, making in all twenty-seven qi that travel up and down the body. The point where the qi emerges is called the well point; where it flows is called the spring point; where it pours in is called the stream point; where it travels is called the river point; and where it enters is called the sea point. The travels of these twenty-seven qi all take place among these five transport points.'

The junctures of the joints number three hundred and sixty-five confluences in all. One who knows the essential of this may sum it up in a single phrase; one who does not know the essential will be scattered and adrift without end. What is meant by 'joints' here are the places where the spirit qi travels, emerges, and enters — they are not merely the skin, flesh, sinews, and bones.

Observe the patient's complexion, examine the eyes, and thereby know whether the spirit is scattered or restored. Steady the patient's posture, attend to his movement and stillness, and thereby know whether the qi is evil or upright. The right hand governs the advancing of the needle, the left hand holds and guides it; once the qi arrives, withdraw the needle.

Whenever one is about to use the needle, one must first diagnose the pulse, observe whether the qi's condition is severe or mild, and only then may one proceed to treat. If the qi of the five viscera has already been cut off within, and the practitioner instead reinforces the exterior, this is called 'redoubled exhaustion.' Redoubled exhaustion must result in death, and such a death is quiet and still. Yet the practitioner who does this instead reverses the qi still further, by needling the armpit and chest. If the qi of the five viscera has already been cut off in the exterior, and the practitioner instead reinforces the interior, this is called 'contrary reversal.' Contrary reversal must also result in death, and such a death is agitated and restless. Yet the practitioner who does this instead needles the four extremities.

In needling, if harm reaches the interior and the needle is not withdrawn, the essence is thereby leaked away; if harm reaches the interior and the needle is promptly withdrawn, the qi is thereby brought to arrive. If the essence is leaked away, the disease grows more severe and the patient becomes debilitated; if the qi is brought to arrive in this manner, welling-abscesses and sores may result.

The five viscera are matched with the six bowels, and the six bowels have twelve source points. These twelve source points emerge at the four joints of the limbs, and the four joints govern the treatment of the five viscera. When the five viscera fall ill, one should select points among the twelve source points, for these twelve source points are the means by which the five viscera receive the qi and flavor of the three hundred and sixty-five joints of the body. When the five viscera fall ill, this will manifest at the twelve source points, and each of the twelve source points has its own place of emergence. By clearly knowing these source points and observing their responses, one may know the harm done to the five viscera. Within yang, the lesser yin is the lung, whose source point emerges at Taiyuan — there being two Taiyuan points. Within yang, the greater yang is the heart, whose source point emerges at Daling — there being two Daling points. Within yin, the lesser yang is the liver, whose source point emerges at Taichong — there being two Taichong points. Within yin, the utmost yin is the spleen, whose source point emerges at Taibai — there being two Taibai points. Within yin, the greater yin is the kidney, whose source point emerges at Taixi — there being two Taixi points. The source point of the fat membranes emerges at Jiuwei, there being one Jiuwei point. The source point of the vital membranes emerges at Boyang, there being one Boyang point. All these twelve source points govern the treatment of illnesses of the five viscera and six bowels.

For distention, select points among the three yang; for diarrhea with undigested food, select points among the three yin.

Now, when the five viscera fall ill, it is like being pierced by a thorn, like being stained by filth, like being tied in a knot, like being blocked and obstructed. Though the thorn has been embedded long, it can still be drawn out; though the stain has lingered long, it can still be washed clean; though the knot has been tied long, it can still be untied; though the obstruction has persisted long, it can still be cleared. Some say that long-standing illness cannot be treated — this is not a correct teaching. Now, one who is skilled in the use of the needle, in removing illness, does so as one draws out a thorn, as one washes away a stain, as one unties a knot, as one clears an obstruction. Though the illness be long-standing, it can still be brought to an end. To say that it cannot be treated is simply to have not yet mastered the technique.

In needling for various heat conditions, one should withdraw the needle as swiftly as if testing scalding water with the hand; in needling for cold conditions, one should linger as if a person were reluctant to walk. When there is a yang-type illness within the yin, select the point Xiaxiling — that is, Zusanli; proceed directly and without hesitation, and stop once the qi descends; if it does not descend, begin again. When the illness is located high in the body but affects the interior, select the point Yinlingquan; when the illness is located high in the body but affects the exterior, select the point Yanglingquan.