Puncture Nodes and True Evil

Yellow Emperor asked Qi Bo, saying: I have heard that needling has five kinds of "defenses" (methods of needling). What are they specifically? Qi Bo said: Indeed there are five defenses: the first is called Shaking off Dust, the second is called Dispelling Obscurity, the third is called Removing Nails, the fourth is called Stripping off Clothes, and the fifth is called Resolving Confusion. Yellow Emperor said: Master, you speak of the five defenses, but I still do not understand their meaning. Qi Bo said: Shaking off Dust is needling the external channels to remove disease from the yang channels; Dispelling Obscurity is needling the Shu points of the fu organs to remove disease from the six fu organs; Removing Nails is needling the collateral vessels of the joints and four limbs; Stripping off Clothes is needling the extraordinary points of all the yang channels generally; Resolving Confusion is fully understanding the harmonization of yin and yang, using supplementation or drainage to manage excess and deficiency, causing yin and yang to balance and transfer mutually. Yellow Emperor said: In the needling methods, when it speaks of Shaking off Dust, Master says it is needling the external channels and removing yang disease. I do not understand what this means and wish to hear your full explanation. Qi Bo said: Shaking off Dust refers to a severe uprising of yang qi, filling the chest, leading to chest fullness and rebellious qi, heaving shoulders in breathing, great pathogenic qi ascending rebelliously, wheezing with sound, unable to sit or lie still, the patient abhors dust and smoke, even to the point of being unable to breathe normally. The reason I call it Shaking off Dust is that this needling method is swifter than shaking off dust. Yellow Emperor said: Good. Then how are the points selected? Qi Bo said: Select Tianrong point. Yellow Emperor said: If the patient has coughing, rebellious qi, chest fullness, and pain, how are the points selected then? Qi Bo said: Select Lianquan point. Yellow Emperor said: Are there fixed rules for needling these points? Qi Bo said: When needling Tianrong point, the depth should not exceed one cun; when needling Lianquan point, stop when the blood color changes. Yellow Emperor said: Excellent indeed.

Yellow Emperor said: In the needling methods, when it speaks of Dispelling Obscurity, I do not understand its meaning. Dispelling Obscurity refers to the ears not hearing and the eyes not seeing, yet Master says it is needling the Shu points of the fu organs to remove disease from the fu organs. Which Shu point has such an effect? I wish to hear you explain the principle behind it. Qi Bo said: This question is truly marvelous! This is the great essential of needling, the ultimate of needling technique, belonging to the category of the divine, which is difficult to express fully through speech or writings. The reason I call it Dispelling Obscurity is that this needling method is swifter than dispelling ignorance. Yellow Emperor said: Good. I wish to hear your full explanation. Qi Bo said: When needling this disease, it must be done at midday. Needle the Tinggong point, making the needling sensation reach the pupil of the eye, and let the sound enter the ear; this is its Shu point. Yellow Emperor said: Good. What is meant by "the sound is heard in the ear"? Qi Bo said: When needling, press firmly with the hand on both nostrils of the patient, then quickly make the patient hold their breath; thus there will inevitably be a response under the needle. Yellow Emperor said: Good. This is what is called seeing and selecting the correct point without using the eyes, reaching the state of divine mutual correspondence.

Yellow Emperor said: In the needling methods, when it speaks of Removing Nails, Master says it is needling the collateral vessels of the joints and four limbs. I wish to hear your explanation. Qi Bo said: The lower back and spine are the great joints of the human body; the four limbs and shin bones are what humans use for walking and running; the penis and testicles are crucial parts of the body, manifestations of essence, and also the pathway for the movement of fluids. Therefore, if diet is immoderate, and joy and anger are untimely, fluids overflow within the body, flowing downward and stagnating in the testicles, causing the blood pathways to be blocked, swelling day by day without stopping, making it inconvenient to bend or stretch, and impossible to walk or run. This disease is like having water accumulation, neither rising nor descending, requiring the use of a stone needle or a metal needle to puncture and drain it, because the body cannot hide it, and it often cannot be covered, hence it is named "Removing Nails." Yellow Emperor said: Good.

Yellow Emperor said: In the needling methods, when it speaks of Stripping off Clothes, Master says it is needling the extraordinary points of all the yang channels generally, without a fixed location. I wish to hear your explanation. Qi Bo said: This is because yang qi is in excess, while yin qi is insufficient. Yin qi insufficiency generates internal heat, and yang qi excess generates external heat; internal and external heat mutually contend, becoming as hot as holding a burning coal. The patient fears wearing cotton clothes, cannot bear to have others approach the body, and cannot approach the bed or mat. The interstices and striae are blocked, so there is no sweating; the tongue is parched and dry, the lips withered, the muscles dry and increasingly desiccated, and the patient cannot distinguish good from bad food or drink. Yellow Emperor said: Good. Then how are the points selected for treatment? Qi Bo said: Select Tianfu point and Dazhu point, needling each three times; then needle Zhonglü Shu to remove the heat pathogen; then supplement the Foot Taiyin channel and the Hand Taiyin channel to stop sweating. When the heat recedes and sweating stops, it is faster than stripping off clothes. Yellow Emperor said: Good.

Yellow Emperor said: In the needling methods, when it speaks of Resolving Confusion, Master says it is fully understanding the harmonization of yin and yang, using supplementation or drainage to manage excess and deficiency, causing yin and yang to balance and transfer mutually. Then how is confusion resolved? Qi Bo said: When a great wind pathogen enters the body, the blood vessels become partially weak, with the weak manifesting as deficiency and the strong manifesting as excess. The body is unbalanced in lightness and heaviness, tilting, leaning forward, not knowing east from west, north from south. The symptoms rise and fall, alternate repeatedly, and are topsy-turvy without constancy, more severe than ordinary confusion. Yellow Emperor said: Good. Then how are the points selected for treatment? Qi Bo said: Drain the excess, supplement the deficiency, causing yin and yang to return to balance. Using the needle in this way is swifter than resolving confusion. Yellow Emperor said: Good. Please record these and store them in the Chamber of the Orchid of the Spirit, and do not take them out carelessly.

Yellow Emperor said: I have heard that needling deals with five kinds of pathogenic qi. What are the five pathogens? Qi Bo said: Disease may have abscesses, may have great expansion, may have small contraction, may have heat, may have cold. These are the five pathogens. Yellow Emperor said: What are the methods of needling the five pathogens? Qi Bo said: In general, the methods of needling the five pathogens are no more than five categories. Heat disease must be eliminated, swelling and gathering must be dispersed, cold bi must be warmed and supplemented, the small must be boosted with yang, the great must be removed. Allow me to explain the specific methods. Whenever needling an abscess pathogen, do not confront its peak; alter the routine and comply with the disease nature. When there is no pus, change the pathway and handle it differently, causing the pathogen to leave its location, not allowing it to settle, and thus it will disperse. Wherever the yin and yang channels pass through the abscess site, select their Shu points and use drainage. Whenever needling a great pathogen, make it smaller day by day, draining its excess, and it will become more deficient. Quickly open its pathway, needle the pathogen, carefully observe the muscles, do not let it return to its original state, needling the intermuscular spaces of the yang channels. Whenever needling a small pathogen, make it larger day by day, supplement its deficiency, and there will be no harm. Observe where the pathogen resides, meet it at its boundary and needle, causing the qi from far and near to arrive, so the pathogen cannot invade outward and move, and thus it will dissipate on its own, needling the intermuscular spaces. Whenever needling a heat pathogen, cause the pathogen to disperse and retreat, as if wandering away without returning, and the disease will be cured. Open the pathways, clear the gates and doors, allowing the pathogen to be expelled, and the disease will heal. Whenever needling a cold pathogen, make it warm day by day, insert the needle slowly and withdraw it slowly, guiding its spirit qi. Once the gates and doors are closed, qi does not dissipate, deficiency and excess become harmonized, and true qi can be preserved. Yellow Emperor said: What needles are used? Qi Bo said: For needling an abscess pathogen, use the pi needle; for needling a great pathogen, use the feng needle; for needling a small pathogen, use the yuanli needle; for needling a heat pathogen, use the cai needle; for needling a cold pathogen, use the hao needle.

Allow me to explain the theory of resolving binding. The human body corresponds to heaven and earth and harmonizes with the four seasons; because humans participate in the space between heaven and earth, binding can be resolved. Beneath the ground there are damp marshes, and above them grow reeds and rushes—this is the basis for judging the relative amounts of form and qi. Yin and yang are like cold and heat: when it is hot, rain moistens above, the root and stem have little fluid, human yang qi is on the exterior, the skin is relaxed, the interstices are open and draining, blood and qi are reduced, sweat is profusely discharged, and the skin is moist. When it is cold, the ground freezes and water turns to ice, human yang qi is in the interior, the skin is dense, the interstices are closed, no sweat is produced, blood and qi are abundant and strong, and the muscles are firm and rough. At such a time, one skilled in moving water cannot walk on ice, one skilled in digging earth cannot move frozen ground, and one skilled in using needles cannot treat reversal of the four limbs, because the blood vessels are congealed, firm, and not flowing, and cannot be made supple immediately. Therefore, one who moves water must wait until the weather is warm, the ice melts, and the frozen earth thaws, so that water can flow and the earth can be dug. The human blood vessels are likewise. When treating reversal, one must first warm and harmonize the channels with hot compresses, using the palms, axillae, elbows, feet, neck, and back to harmonize, causing the fire qi to flow freely, so that the blood vessels can move. Then observe the condition: if the pulse is moist, needle to make it balanced; if the pulse is firm and tense, pierce to disperse it; when evil qi descends, stop. This is what is called the method of resolving binding.

The key to using needles lies in regulating qi. Qi accumulates in the stomach to regulate and circulate the nutritive and defensive qi, each moving along its own pathway. The ancestral qi remains in the sea of qi; its lower portion pours into the qi street; its upper portion travels through the respiratory passage. Therefore, when reversal is in the feet, the ancestral qi cannot descend, and the blood in the vessels becomes stagnant and stops; if one does not first harmonize with fire moxibustion, no effect can be obtained. One who uses needles must first observe the deficiency and excess of the channels and collateral vessels, press and palpate with the hands, stroke and probe, press and tap, look for the response and the place that jumps, and only then insert the needle to treat. When the six channels are harmonized, this is called not being ill; even if there is illness, it will heal itself. If one channel is upper part excessive and lower part deficient and not flowing, there must be a transverse collateral that is full and abundant, pressing upon the great channel and causing it to be blocked; observe this and drain it—this is what is called resolving binding. When the upper part is cold and the lower part hot, first needle the taiyang channel of the neck, retain the needle for a long time, after needling, apply hot compresses to the neck and shoulder blades, causing heat qi to descend and harmonize before stopping—this is what is called the method of pushing upward. When the upper part is hot and the lower part cold, observe the deficient vessels and take points where they sink in the channels and collaterals, causing qi to descend before stopping—this is what is called the method of pulling downward. When the whole body is greatly hot, with mania and seeing, hearing, and speaking wildly, observe the foot yangming channel and its great collateral vessels to take points; for deficiency, supplement; for blood excess and surplus, drain. Have the patient lie supine, stand at the head, and with the four fingers of both hands press on either side of the carotid artery, hold for a long time, then roll the fingers and press, pushing down into the supraclavicular fossa; repeat as before, stopping when the heat recedes—this is what is called the method of pushing and dispersing.

Huangdi said: One single channel can produce several tens of diseases—some painful, some abscesses, some hot, some cold, some itchy, some impediment, some numbness with loss of sensation—changes without end. What is the reason for this? Qibo said: These all arise from evil qi. Huangdi said: I have heard that qi has true qi, righteous qi, and evil qi. What is called true qi? Qibo said: True qi is what is received from heaven, and it combines with grain qi to nourish the entire body. Righteous qi is normal wind that comes from one direction; it is neither substantial wind nor empty wind. Evil qi is the thief-like wind of emptiness that harms the human body; it enters the body deeply and cannot be removed by itself. When righteous wind enters the body superficially and combines with righteous qi, it will disperse by itself, because its qi comes weakly and cannot overcome true qi, so it disperses by itself.

When the evil of emptiness invades the human body, it causes a person to shiver with chills, the fine hairs stand up, and the interstices open. The evil enters deeply, and when it binds internally with the bone, it forms bone impediment; when it binds with the sinews, it forms sinew contraction; when it binds within the vessels, it causes blood vessel blockage; if it does not flow freely, it forms abscesses and swellings. When it binds with the muscles and does battle with the defensive qi, if yang qi prevails, there is heat; if yin qi prevails, there is cold. Cold causes true qi to leave; when true qi leaves, there is deficiency of righteous qi; when righteous qi is deficient, cold binds between the layers of skin. When the evil disperses outward, the interstices open, the fine hairs move, and the evil comes and goes in movement, then itching arises. If the evil stays and does not leave, it forms impediment. When defensive qi cannot move, there is numbness with loss of sensation. If the evil of emptiness attacks one side of the body partially, enters deeply, and dwells within the nutritive and defensive, the nutritive and defensive qi gradually declines, true qi leaves, and the evil alone remains and lingers, then hemiplegia develops. If the evil is more superficial, there is pain on the affected side. When the evil of emptiness enters the body deeply, cold and heat do battle with each other, remain long in the body and attach themselves; if cold overcomes heat, it causes bone joint pain and muscle withering; if heat overcomes cold, it causes the muscles to rot and form pus, which then damages the bone internally; when the bone is damaged, it forms bone erosion. When evil attacks the sinews and vessels, it causes the sinews to bend and not be able to extend; if the evil stays among the sinews and cannot be dispersed, it forms sinew tumors. When evil has something it binds to, qi returns and gathers there, defensive qi stays and cannot return, fluids remain for a long time, merge with the evil, and form intestinal tumors. For those with a long course, it takes several years to form; when pressed with the hand it is soft—this is because the evil has already bound, qi has returned and gathered, fluids have remained, and then being further attacked by evil, the binding increases day by day, accumulating continuously, and forms chronic tumors. When pressed with the hand it is hard—this is because the evil has bound somewhere, entered deeply into the bone, qi attaches itself to the bone, bone and qi combine, and increase day by day, forming bone abscess. When evil has bound somewhere and stays in the muscle, ancestral qi returns and gathers there; the evil stays and does not leave; if there is heat, it transforms into pus; if there is no heat, it forms muscle abscess. These several kinds of evil have no fixed place of onset, yet they have fixed names.