The Nine Needles and the Twelve Origin-Points

Huangdi asked Qibo, saying: "I nurture the myriad people, support the common folk, and collect their taxes; I pity their insufficient livelihood and frequent illnesses. I wish to spare them the suffering of taking medicine and the use of stone needles, and instead use fine needles to unblock their channels, harmonize their blood and qi, and bring the movement of qi—its flow, counterflow, exit, and entry—into balance. Let this method be passed down to later generations; it must be clearly established as a rule, so that it endures forever, lasts long without interruption, is easy to use and hard to forget, serving as a guiding principle, divided into sections, distinguishing exterior and interior, and setting beginnings and endings. Let the various needles have fixed shapes, and first compile the 'Needle Classic.' I wish to hear the reasoning behind it." Qibo replied: "Allow me to explain it in order, so that it has a guiding thread, starting from one and ending with nine. Let me speak of its principles! The essential points of the fine needle are easy to speak of but difficult to master. A coarse physician only clings to the physical form, but an enlightened physician can grasp the spirit. Spirit! Spirit! Evil qi lodges at the gateway of the portals. Without seeing the disease, how can one know its root? The subtlety of needling lies in the speed of slowness or haste. A coarse physician only fixates on the joints, but an enlightened physician grasps the timing. The emergence of timing never leaves the interstices of the points. The timing within the interstices of the points is clear, still, and subtle. When evil qi arrives, do not meet it with reducing method; when evil qi departs, do not pursue it with tonifying method. One who understands the law of timing makes not a hair's breadth of error. One who does not understand the law of timing, even holding the needle handle, cannot act in time. Knowing the coming and going of qi, one must grasp its timing. How foolish the coarse physician is! Subtle! Only the enlightened physician can master it. The qi that goes is counterflow, the qi that comes is smooth flow. Clearly knowing counterflow and smooth flow, one can needle correctly without hesitation. Meet evil qi and reduce it—how can it not weaken the evil? Follow proper qi and tonify it—how can it not strengthen the proper? Meeting and reducing, following and tonifying, harmonize with intention, and the principles of needling are complete. Whenever using needling, for deficiency, use tonification to fill; for excess, use reduction to drain; for stagnant blood and old accumulations, use bloodletting to remove; for exuberant evil qi, use reduction to weaken it. The great summary says: 'Slow insertion and quick withdrawal fill proper qi; quick insertion and slow withdrawal weaken evil qi.' Speaking of excess and deficiency, it is as if they exist and as if they do not. Observing before and after, it is as if present and as if absent. For deficiency and excess, it is as if something is gained and as if something is lost. The essential points of deficiency and excess are most subtle in the nine needles. In tonification and reduction, use the needle to operate. For reduction, it is said: one must hold the needle and insert it, then disperse and withdraw, expelling yang qi as the needle comes out, so that evil qi is drained. Press the hole closed and draw the needle out; this is called internal warming, so that blood does not scatter and qi does not exit. For tonification, it is said: follow and go with it, the intention as if nothing is happening. As if walking and as if pressing, as light as a mosquito or gadfly bite, as if pausing and as if turning back. When withdrawing the needle, it is as swift as a snapped string. Let the left hand press the needle hole, the right hand withdraw the needle; proper qi thus lingers, the outer gate is already closed, central qi thus becomes full. Be sure there is no retained blood; if there is, quickly remove it with needling. The method of holding the needle values firmness. Point straight in and needle straight, not deviating left or right. Focus the spirit on the finest hair, concentrate the intention on the patient. Carefully examine the blood vessels, and needling will have no danger. At the moment of needling, one must suspend yang qi, as well as the defensive aspects on both sides. The spirit is focused and does not leave; know the presence or disappearance of the disease qi. The blood vessels lie horizontally at the points; when looking, they are especially clear; when pressing, they are especially firm. The names of the nine needles and their shapes differ. The first is called the arrowhead needle, one cun and six fen long; the second is called the round needle, one cun and six fen long; the third is called the lance needle, three cun and a half long; the fourth is called the lance-point needle, one cun and six fen long; the fifth is called the sword needle, four cun long, two and a half fen wide; the sixth is called the round-sharp needle, one cun and six fen long; the seventh is called the fine needle, three cun and six fen long; the eighth is called the long needle, seven cun long; the ninth is called the large needle, four cun long. The arrowhead needle has a large head and sharp tip, used to drain yang qi; the round needle is shaped like an egg, used to massage between the muscle layers without injuring the muscles, to drain qi from between the muscles; the lance needle has a tip sharp like millet or grain, mainly used to press along the channels without inserting, to guide qi; the lance-point needle has three edges, used to treat stubborn diseases; the sword needle has a tip like a sword blade, used to pierce large abscesses; the round-sharp needle is about the size of a long hair, both round and sharp, slightly larger in the middle shaft, used to treat sudden qi; the fine needle has a tip like a mosquito or gadfly's mouth, slowly inserted, gently retained for a long time to nurture, used to treat painful bi disorder; the long needle is sharp and thin, can treat distant bi disorder; the large needle has a tip like a rod, its end slightly round, used to drain fluid from the joints. The nine needles are thus complete. Qi in the channels: evil qi resides in the upper part, turbid qi in the middle, clear qi in the lower. Therefore, needling into sunken vessels lets evil qi out; needling into the middle vessels lets turbid qi out; needling too deep causes evil qi to sink further, worsening the disease. Thus it is said: 'Skin, flesh, sinews, and vessels each have their fixed places. Each disease has its appropriate treatment. The various needles have different shapes, each suited to its proper condition. Do not make deficiency more deficient or excess more excessive. Injuring what is insufficient and supplementing what is excessive is called aggravating the disease.' Aggravating the disease: taking the five vessels leads to death; taking the three vessels leads to bodily weakness; seizing yin leads to death; seizing yang leads to mania. The harms of needling are thus fully stated. When needling, if qi does not arrive, do not ask about the number of insertions. When qi arrives, withdraw the needle; do not needle again. Each needle has its proper condition; shapes differ, each suited to its place. This is the essential point of needling. When qi arrives, there will be effect; the verification of effect is like wind blowing away clouds, clearly as if seeing the blue sky. The principles of needling are thus complete." Huangdi said: "I wish to hear the places from which the channel qi of the five zang and six fu organs emerges." Qibo said: "Each of the five zang has five shu points, making twenty-five in total; each of the six fu has six shu points, making thirty-six in total; there are twelve channels and fifteen collateral vessels, totaling twenty-seven qi pathways, moving throughout the entire body above and below. The place where channel qi emerges is called the well; where it flows is called the brook; where it pours is called the stream; where it moves is called the river; where it enters is called the sea. The movement of the twenty-seven qi pathways all occurs at the five shu points. Where joints meet, there are three hundred and sixty-five meeting points. Knowing the essential, one can grasp it in one sentence; not knowing the essential, it scatters endlessly. What is called 'joint' is the place where spirit qi travels and emerges, not the skin, flesh, sinews, or bones. Observe the patient's complexion, examine the patient's eyes, and you will know whether proper qi is scattered or restored. Examine the patient's body, listen to their movements, and you will know the condition of evil and proper. The right hand pushes the needle in, the left hand holds and directs it; when qi arrives, withdraw the needle. Whenever using needling, one must first examine the pulse, observe the slowness or urgency of qi, and only then treat. If the qi of the five zang is already exhausted internally, and the needler instead supplements externally, this is called double exhaustion. Double exhaustion inevitably leads to death, and the death is quiet. The healer instead goes against the qi, taking points under the armpit and on the chest. If the qi of the five zang is already exhausted externally, and the needler instead supplements internally, this is called reversed jue. Reversed jue inevitably leads to death, and the death is agitated. The healer instead takes points at the ends of the limbs. The harms of needling: if needling hits the disease but the needle is not withdrawn, it causes leakage of essence qi; if needling hits the disease but the needle is withdrawn too quickly, it causes evil qi to congeal. Leakage of essence qi worsens the disease and weakens the body; congealed evil qi produces abscesses and sores. The five zang have the six fu; the six fu have the twelve yuan-source points. The twelve yuan-source points emerge from the four joints, and the four joints govern the five zang. When the five zang are diseased, one should take the twelve yuan-source points. The twelve yuan-source points are the source from which the five zang receive the qi and flavor of the three hundred and sixty-five joints. When the five zang are diseased, they react at the twelve yuan-source points. Each of the twelve yuan-source points belongs to its corresponding zang or fu. Clearly knowing the yuan-source points, observe their reactions, and you will know the diseases of the five zang. The lesser yin within yang is the lung; its yuan-source point emerges at Taiyuan, with one on the left and one on the right. The greater yang within yang is the heart; its yuan-source point emerges at Daling, with one on the left and one on the right. The lesser yang within yin is the liver; its yuan-source point emerges at Taichong, with one on the left and one on the right. The ultimate yin within yin is the spleen; its yuan-source point emerges at Taibai, with one on the left and one on the right. The greater yin within yin is the kidney; its yuan-source point emerges at Taixi, with one on the left and one on the right. The yuan-source point of the fat emerges at Jiuwei, one point. The yuan-source point of the membrane emerges at Boyang, one point. All these twelve yuan-source points govern the diseases of the five zang and six fu. For distension, take the three yang channels; for undigested diarrhea, take the three yin channels. Now, when the five zang are diseased, it is like a thorn in the body, like dirt, like a knot, like a blockage. Though the thorn has been there long, it can still be removed; though the dirt has been there long, it can still be washed away; though the knot has been there long, it can still be untied; though the blockage has been there long, it can still be cleared. Some say long-standing disease cannot be treated; this is not correct. One skilled in needling treats disease like pulling out a thorn, like washing away dirt, like untying a knot, like clearing a blockage. Though the disease is long-standing, it can still be cured. To say it cannot be treated is to lack skill in technique. Needling various heat diseases is like feeling boiling water with the hand; needling cold diseases is like a person unwilling to walk. For disease with yin aspect and yang evil, take Xialing and Zusanli, needle straight without laziness; when qi descends, stop; if it does not descend, start again. For disease located high and internal, take Yinlingquan; for disease located high and external, take Yanglingquan."