素问·缪刺论 Treatise on Crossed Needling

Huangdi asked: I have heard of crossed needling but have not grasped its meaning—what is meant by crossed needling? Qibo replied: When a pathogen lodges in the body, it must first reside in the skin and hair; if it lingers there without departing, it enters and resides in the grandchild vessels; if it lingers there without departing, it enters and resides in the network vessels; if it lingers there without departing, it enters and resides in the channel vessels, connecting inwardly with the five viscera and dispersing into the intestines and stomach, so that yin and yang are both affected and the five viscera are thereby injured. This is the sequence by which a pathogen enters from the skin and hair to reach its utmost in the five viscera; in such a case one treats the channels. Now, if a pathogen lodges in the skin and hair and enters to reside in the grandchild network vessels, lingering there without departing, it becomes blocked and fails to pass through; unable to enter the channels, it overflows into the great network vessels and gives rise to unusual diseases. When a pathogen lodges in the great network vessels, it pours from the left to the right, from the right to the left, above and below, left and right, interfering with the channels and spreading to the four extremities; its qi has no fixed location and does not enter the channel transport points—this is called crossed needling. Huangdi asked: I wish to hear of crossed needling—of taking the right to treat the left, and the left to treat the right. How is this done, and how does it differ from great needling? Qibo said: When a pathogen lodges in the channel, if the left is abundant, the right will be diseased; if the right is abundant, the left will be diseased—there are also cases where it shifts, where the pain on the left has not yet ceased before the vessel on the right first becomes diseased. In such cases, one must apply great needling, striking precisely the channel, not the network vessel. Thus in network-vessel disease, the pain occurs at a place crossed from the affected channel—hence it is called crossed needling.

Huangdi asked: I wish to hear how crossed needling is performed, and how the points are selected. Qibo said: When a pathogen lodges in the network vessel of the foot lesser yin, it causes sudden heart pain and abrupt distension, with fullness extending through the chest and rib-sides, without any palpable accumulation. Needle in front of the Rangu point to let blood, and after about the time it takes to eat a meal, it will cease. If it does not cease, take the right side for a left-side ailment, or the left for a right-side ailment. If the disease is newly arisen, it will resolve within five days.

When a pathogen lodges in the network vessel of the hand lesser yang, it causes throat blockage and a curled tongue, dry mouth, and vexation of the heart, with pain along the outer border of the arm such that the hand cannot reach the head. Needle above the nail of the ring finger, about the width of a leek leaf from its tip, one prick on each hand. In the robust, it resolves at once; in the elderly, it takes a little while. Take the right for the left, the left for the right; this, being a recently arisen disease, resolves within a few days.

When a pathogen lodges in the network vessel of the foot reverting yin, it causes sudden hernial pain of great severity. Needle above the nail of the big toe, at the junction with the flesh, one prick on each side. In males it resolves at once; in females it takes a little while. Take the right for the left, the left for the right.

When a pathogen lodges in the network vessel of the foot greater yang, it causes pain in the head, neck, and shoulder. Needle above the nail of the little toe, at the junction with the flesh, one prick on each side; it resolves at once. If it does not resolve, needle three times below the outer ankle. Take the right for the left, the left for the right; it resolves after about the time it takes to eat a meal.

When a pathogen lodges in the network vessel of the hand yang brightness, it causes fullness of qi, panting in the chest, with the rib-sides supported and heat in the chest. Needle above the nail of the index finger, about the width of a leek leaf from its tip, one prick on each side. Take the right for the left, the left for the right; it resolves after about the time it takes to eat a meal.

When a pathogen lodges between the forearm and palm so that it cannot be bent, needle behind the wrist; first press with the finger where it is painful, then needle there, using the waxing and waning of the moon to determine the number of pricks: on the first day of the moon's waxing, one prick; on the second day, two pricks; up to the fifteenth day, fifteen pricks; on the sixteenth day, fourteen pricks, and so on decreasing. When a pathogen lodges in the foot yang springing vessel, it causes eye pain beginning from the inner canthus. Needle about half a cun below the outer ankle, two pricks on each side; needle the right for the left, the left for the right; it resolves after about the time it takes to walk ten li. When a person has fallen or been thrown down, so that malign blood remains within, with fullness and distension in the abdomen and inability to relieve oneself, first give a purgative medicine to disperse it. If this fall has injured the reverting yin vessel above and the lesser yin network vessel below, needle below the inner ankle, at the blood vessel in front of Rangu, to let out blood; needle also the pulsing vessel atop the instep. If this does not resolve it, needle above the cluster of hairs near the great toe, one prick on each side; once blood appears, it resolves at once. Needle the right for the left, the left for the right. For one prone to sorrow, fright, and unhappiness, needle according to the method just given.

When a pathogen lodges in the network vessel of the hand yang brightness, it causes deafness, so that at times no sound is heard. Needle above the nail of the index finger, about the width of a leek leaf from its tip, one prick on each side; hearing is restored at once. If it does not resolve, needle at the junction of the middle finger's nail with the flesh, and hearing is restored at once. In cases where hearing was never present at all, needling is of no avail. For those in whom wind arises within the ear, needle in the same manner as above, the right for the left, the left for the right.

In all cases of painful obstruction that comes and goes without fixed location, needle wherever the pain occurs in the spaces between the flesh, using the waxing and waning of the moon to determine the number of pricks. In wielding the needle, follow the abundance or decline of the qi to determine the number of pricks; if the needling exceeds the proper count of days, qi will be lost; if it falls short of the count, the qi will not be drained. Needle the right for the left, the left for the right; when the disease resolves, stop. If it does not resolve, needle again according to the method: on the first day of the moon's waxing, one prick; the second day, two pricks, gradually increasing; up to the fifteenth day, fifteen pricks; the sixteenth day, fourteen pricks, gradually decreasing.

When a pathogen lodges in the channel of the foot yang brightness, it causes nosebleed and cold in the upper teeth. Needle at the junction of the second toe's nail with the flesh, one prick on each side. Needle the right for the left, the left for the right.

When a pathogen lodges in the network vessel of the foot lesser yang, it causes rib-side pain with inability to breathe freely, coughing, and sweating. Needle at the junction of the fourth toe's nail with the flesh, one prick on each side; the inability to breathe resolves at once, and the sweating stops at once. For coughing, keep warmly clothed and take food and drink, and it will resolve within a day. Needle the right for the left, the left for the right; the disease resolves at once. If it does not resolve, needle again according to the method.

When a pathogen lodges in the network vessel of the foot lesser yin, it causes throat pain such that food cannot be taken in, with causeless irritability and a tendency to anger, with qi rushing up to the diaphragm. Needle the vessel at the center of the sole, three pricks on each side, six pricks in all; it resolves at once. Needle the right for the left, the left for the right. When there is swelling within the throat such that food cannot be taken in, and when at times saliva cannot even be spat out, needle in front of Rangu to let out blood, and it resolves at once. Needle the right for the left, the left for the right.

When a pathogen lodges in the network vessel of the foot greater yin, it causes lower back pain radiating into the lower abdomen and pulling at the flank, so that one cannot bend backward or breathe freely. Needle at the juncture of the lower back and sacrum, above the two muscles beside the spine—this is the lumbar transport point—using the waxing and waning of the moon to determine the number of pricks; upon withdrawing the needle it resolves at once. Needle the right for the left, the left for the right.

When a pathogen lodges in the network vessel of the foot greater yang, it causes spasm and tightness of the back, radiating pain into the rib-sides. Needle beginning from the nape, counting down the vertebrae alongside the spine; press firmly, and wherever the response to pressure feels like pain, needle to the side of it, three pricks; it resolves at once.

When a pathogen lodges in the network vessel of the foot lesser yang, it causes pain lodging in the hip joint, so that the thigh cannot be raised. Needle the hip joint with a fine needle; if there is cold, retain the needle for a long while, using the waxing and waning of the moon to determine the number of pricks; it resolves at once.

In treating the various channels, if needling their points of passage produces no effect on the disease, then apply crossed needling. For deafness, needle the hand yang brightness; if it does not resolve, needle the connecting vessel that emerges in front of the ear. For dental caries, needle the hand yang brightness; if it does not resolve, needle the vessel that enters the teeth, and it resolves at once. When a pathogen lodges among the five viscera, the disease manifests as pain that pulls along the vessel, coming and going intermittently. Observe where the disease is and apply crossed needling at the nails of the hands and feet; observe the vessel, and let out its blood, needling once every other day; if one needling does not resolve it, five needlings will. When the crossed disease is transmitted to affect the upper teeth, causing cold pain in the teeth and lips, observe the vessel with blood on the back of the hand and remove it; at the foot yang brightness, needle at the nail of the second toe with a great prick, and at the hand, needle above the nail of the index finger, one prick on each; it resolves at once. Take the left for the right, the right for the left.

When a pathogen lodges in the network vessels of the hand and foot lesser yin, the hand and foot greater yin, and the foot yang brightness—these five network vessels all converge within the ear and connect above with the left corner of the head. When all five network vessels are exhausted, it causes all the vessels of the body to stir while the body itself has no awareness; its appearance is like that of a corpse, and it is therefore also called corpse reversal. Needle the inner side of the big toe's nail, about the width of a leek leaf from its tip; afterward needle the center of the sole; then needle above the nail of the middle toe, one prick each. Afterward needle the inner side of the thumb's nail, about the width of a leek leaf from its tip; then needle the heart-governing vessel and the tip of the pisiform bone at the lesser yin, one prick each; it resolves at once. If it does not resolve, use a bamboo tube to blow into both ears, shave a square inch of hair at the left corner, burn and grind it, and have the patient drink it down with a cup of fine wine; for one unable to drink, pour it in—it resolves at once.

In general, the method of needling is: first observe the channel vessels, press and follow along them, examine whether there is deficiency or excess, and regulate accordingly. Where the channel is not in harmony, needle the channel itself; where there is pain but the channel is not diseased, apply crossed needling; and observing wherever there are blood network vessels in the skin regions, remove them entirely. This is the method of crossed needling.