Beginning and End

The principles of acupuncture ultimately return to the law of beginning and end. Understanding the meaning of beginning and end, taking the five viscera as the guiding principle, the relationship of yin and yang is established. The yin channels govern the five viscera; the yang channels govern the six bowels. The yang channels receive qi from the extremities of the limbs; the yin channels receive qi from the five viscera. Therefore, the reducing method uses the technique of meeting, and the reinforcing method uses the technique of following. Knowing meeting and following enables one to harmonize qi. The method of harmonizing qi requires understanding yin and yang. The five viscera belong to yin; the six bowels belong to yang. These principles should be transmitted to later generations, solemnized by swearing an oath with blood. Those who respect them will prosper; those who slight them will perish. Those who do not follow the correct Way and act with selfish intent will surely suffer the calamity of an early death.

Reverently adhering to the Heavenly Way, let me speak of "beginning and end." Beginning and end take the channels and vessels as the guiding principle. Examining the pulse at the radial artery (cunkou) and the carotid artery (renying) reveals the excess and deficiency, balance and imbalance of yin and yang; the pattern of the Heavenly Way is all here. What is called a healthy person is one who does not become ill. In such a person, the pulses at cunkou and renying correspond to the four seasons, rise and fall in mutual accord, the six channel pulses show no knotted or agitated patterns, and the cold and warmth of the body's root and tip can protect each other. The physical form, flesh, blood, and qi must all be mutually balanced; this is what is called a healthy person. In a person with scant qi, the pulses at both cunkou and renying are weak, and they do not correspond to the cun and chi pulses. In this case, both yin and yang are insufficient. If yang is supplemented, yin qi will be exhausted; if yin is reduced, yang qi will be lost. In such a situation, one can use sweet-tasting medicinals to nourish, but one should not administer large doses of medicine, nor use moxibustion. If the condition does not improve and reducing technique is used, it will ruin the qi of the five viscera.

When the renying pulse is one time larger than the cunkou pulse, the disease is in the foot-shaoyang channel; if it is one time larger and agitated, the disease is in the hand-shaoyang channel. When the renying pulse is two times larger than the cunkou pulse, the disease is in the foot-taiyang channel; if it is two times larger and agitated, the disease is in the hand-taiyang channel. When the renying pulse is three times larger than the cunkou pulse, the disease is in the foot-yangming channel; if it is three times larger and agitated, the disease is in the hand-yangming channel. When the renying pulse is four times larger than the cunkou pulse, and is also large and rapid, it is called "overflowing yang." Overflowing yang is a condition where yang qi overflows externally and is repelled outward. When the cunkou pulse is one time larger than the renying pulse, the disease is in the foot-jueyin channel; if it is one time larger and agitated, the disease is in the hand-jueyin channel. When the cunkou pulse is two times larger than the renying pulse, the disease is in the foot-shaoyin channel; if it is two times larger and agitated, the disease is in the hand-shaoyin channel. When the cunkou pulse is three times larger than the renying pulse, the disease is in the foot-taiyin channel; if it is three times larger and agitated, the disease is in the hand-taiyin channel. When the cunkou pulse is four times larger than the renying pulse, and is also large and rapid, it is called "overflowing yin." Overflowing yin is a condition where yin qi overflows internally and is closed within. When there is internal closure and no passage, the person will die and cannot be saved. When both the renying and cunkou pulses are four times larger than normal, it is called "guange" (barrier and repulsion). The appearance of guange indicates that death is near.

When the renying pulse is one time larger, reduce the foot-shaoyang channel and supplement the foot-jueyin channel, using a technique of two reductions and one supplementation, needling once daily. One must examine the pulse to verify, slowly select the points, and stop only when the upper qi is harmonized. When the renying pulse is two times larger, reduce the foot-taiyang channel and supplement the foot-shaoyin channel, using a technique of two reductions and one supplementation, needling once every two days. One must examine the pulse to verify, slowly select the points, and stop only when the upper qi is harmonized. When the renying pulse is three times larger, reduce the foot-yangming channel and supplement the foot-taiyin channel, using a technique of two reductions and one supplementation, needling twice daily. One must examine the pulse to verify, slowly select the points, and stop only when the upper qi is harmonized. When the cunkou pulse is one time larger, reduce the foot-jueyin channel and supplement the foot-shaoyang channel, using a technique of two supplementations and one reduction, needling once daily. One must examine the pulse to verify, slowly select the points, and stop only when the upper qi is harmonized. When the cunkou pulse is two times larger, reduce the foot-shaoyin channel and supplement the foot-taiyang channel, using a technique of two supplementations and one reduction, needling once every two days. One must examine the pulse to verify, slowly select the points, and stop only when the upper qi is harmonized. When the cunkou pulse is three times larger, reduce the foot-taiyin channel and supplement the foot-yangming channel, using a technique of two supplementations and one reduction, needling twice daily. One must examine the pulse to verify, slowly select the points, and stop only when the upper qi is harmonized. The reason for needling twice daily is that the foot-taiyang and foot-yangming channels govern the stomach, and the grain qi in the stomach is very abundant, so needling can be done twice daily. When both the renying and cunkou pulses are three times larger than normal, it is called "both yin and yang overflowing." If this is not cleared, the blood vessels will become obstructed, qi will have no place to move, and it will overflow and stagnate within the body, causing internal injury to the five viscera. If moxibustion is used in this case, it will transform into other diseases.

In all principles of acupuncture, stop when the qi is harmonized. Supplement yin and reduce yang, so that the voice and complexion are enhanced and manifested, and the ears and eyes become clear and sharp. If this principle is violated, the blood and qi will not circulate. What is meant by "qi arrives and there is effect" is that when reducing technique is used, the pulse becomes weak. The sign of weakness is that although the pulse size is as before, it is no longer firm; if the pulse remains firm as before, even if temporarily felt to be the same, the pathogenic factor has not been removed. When supplementing technique is used, the pulse becomes full. The sign of fullness is that the pulse size is as before and even firmer; if the pulse is as before but not firm, even if temporarily felt comfortable, the pathogenic factor has not been removed. Therefore, supplementing makes the pulse full, and reducing makes the pulse weak. Although pain does not immediately disappear with the needle, the disease will surely decline. One must first thoroughly understand the diseases governed by the twelve channels before one can transmit the principles of "beginning and end." Therefore, yin and yang do not mutually transfer, and deficiency and excess do not mutually encroach; treatment should then take the corresponding channel.

In all categories of needling, there are three needle insertions until the grain qi arrives. If pathogenic qi improperly combines with upright qi, yin and yang are misplaced, inverse and normal are reversed, floating and sinking are in abnormal positions, the qi of the four seasons do not correspond, and the pathogenic factor lingers and scatters, all require needling to remove it. Therefore, the first insertion expels yang pathogenic factors, the second insertion expels yin pathogenic factors, and the third insertion brings the grain qi. When the grain qi arrives, stop needling. What is meant by the arrival of grain qi is that after supplementing, the pulse becomes full; after reducing, the pulse becomes weak; therefore, one knows that the grain qi has arrived. If only the pathogenic factors are removed, and yin and yang are not yet harmonized, the disease is already known to be curable. Therefore it is said: Supplementing makes the pulse full, reducing makes the pulse weak; although pain does not immediately disappear with the needle, the disease will surely decline.

When yin qi is abundant and yang qi is deficient, first supplement yang qi, then reduce yin qi to harmonize. When yin is deficient and yang is abundant, first supplement yin qi, then reduce yang qi to harmonize.

The three channels pulse on the large toe; one must carefully examine their deficiency and excess. If deficiency is mistakenly treated with reduction, this is called "double deficiency." Double deficiency will worsen the disease. In all needling of these areas, press with the finger; if the pulse beats forcefully and rapidly, quickly apply reducing technique; if the pulse is weak and slow, apply supplementing technique. Violating this principle will worsen the disease. Among these pulsing channels, the foot-yangming is above, the foot-jueyin is in the middle, and the foot-shaoyin is below.

For points on the chest and breast, needle so as to hit the chest and breast; for points on the back, needle so as to hit the back. When the shoulder and upper arm areas are weak, take points above. For double tongue disease, use a stiletto needle to pierce the pillar-like sinew under the tongue. When the hand is bent and cannot straighten, the disease is in the sinews; when the hand is straight and cannot bend, the disease is in the bones. If the disease is in the bones, treat the bones; if the disease is in the sinews, treat the sinews.

Supplementing is appropriate when the pulse shows one area of relative excess; needle deeply, and after withdrawing the needle, slowly press the point to fully expel the pathogenic qi. Reducing is appropriate when the pulse shows one area of relative deficiency; needle shallowly to nourish the blood vessels, and after withdrawing the needle, quickly press the point to prevent pathogenic qi from entering. When pathogenic qi arrives, the pulse is urgent and rapid; when grain qi arrives, the pulse is relaxed and calm. When the pulse is firm, needle deeply to drain the pathogenic qi; when the pulse is weak, needle shallowly so that essence qi is not leaked out, to nourish the blood vessels, and only expel the pathogenic qi.

In needling various painful diseases, the patient's pulse is always firm. Therefore it is said: Above the waist, the hand-taiyin and hand-yangming channels govern; below the waist, the foot-taiyin and foot-yangming channels govern.

For diseases in the upper part, select points in the lower part; for diseases in the lower part, select points in the upper part; for diseases in the head, select points in the foot; for diseases in the waist, select points in the popliteal fossa. When disease arises in the head, the head feels heavy; when it arises in the hand, the arm feels heavy; when it arises in the foot, the foot feels heavy. In treating disease, first needle the site where the disease originates.

The qi of spring resides in the fine body hair, the qi of summer in the skin, the qi of autumn in the intermuscular spaces, and the qi of winter in the sinews and bones. When needling these diseases, establish the needling standards according to the season. Thus, when needling obese people, use the standards of autumn and winter; when needling thin people, use the standards of spring and summer.

Painful disease is yin; pain that cannot be located by pressing with the hand is yin and requires deep needling. Disease in the upper part is yang. Disease in the lower part is yin. Itching is yang and requires shallow needling. When disease first arises from the yin aspect, treat the yin aspect first, then the yang aspect; when disease first arises from the yang aspect, treat the yang aspect first, then the yin aspect.

When needling heat reversal disease, retaining the needle instead causes the disease to turn cold; when needling cold reversal disease, retaining the needle instead causes the disease to turn hot. When needling heat reversal disease, use two yin channel needlings and one yang channel needling; when needling cold reversal disease, use two yang channel needlings and one yin channel needling. What is meant by "two yin" is needling the yin channels twice; "one yang" is needling the yang channels once.

In chronic disease, pathogenic qi has penetrated deeply. When needling such disease, needle deeply and retain the needle for a long time, then needle again every other day. First, it is necessary to regulate the left and right, remove stasis in the blood vessels, and then the principles of needling are complete.

In all methods of needling, one must observe the patient's physique and complexion. If the physical flesh is not emaciated, but qi is scant and the pulse is agitated, with manic reversal, then the collateral needling method must be used. In this way, scattered qi can be gathered, and stagnant qi can be dispersed.

Dwell in deep quietude and observe the comings and goings of the spirit. Shut doors and windows to keep the ethereal soul and corporeal soul from scattering. Focus the mind single-mindedly, concentrate the spirit, and do not listen to human voices, so as to gather essence qi. One must single-mindedly concentrate the intention on the needle. Needle shallowly and retain the needle, or needle slightly and superficially, to divert the patient's spirit, stopping only when qi arrives. In men, direct inward; in women, direct outward. Firmly repel pathogenic qi, not allowing it to emerge; cautiously guard the upright qi, not allowing it to enter. This is called "obtaining qi."

All needling prohibitions: Do not needle immediately after sexual intercourse, and do not have sexual intercourse immediately after needling; do not needle when intoxicated, and do not drink alcohol after needling; do not needle right after anger, and do not become angry after needling; do not needle right after exertion, and do not exert oneself after needling; do not needle right after a full meal, and do not eat a full meal after needling; do not needle when hungry, and do not become hungry after needling; do not needle when thirsty, and do not become thirsty after needling; when encountering great fright or great fear, first calm the spirit before needling. If the patient came by carriage, let them lie down and rest for about the time of one meal before needling. If they came on foot, let them sit and rest for about the time it takes to walk ten li before needling. In all these twelve prohibitions, if the patient's pulse is chaotic, spirit qi is scattered, construction and defense qi and blood are disordered, and channel qi does not flow in proper sequence, and if needling is performed under such conditions, then yang disease will enter the yin aspect, yin disease will emerge into the yang aspect, and pathogenic qi will be generated anew. Coarse physicians pay no attention to these matters; this is called harming the body, leading to physical weakness, consumption of brain and marrow, failure of fluids to transform, and loss of nourishment from the five flavors. This is called "loss of qi."

Symptoms when the foot taiyang channel qi is exhausted: eyes turn upward, opisthotonos, four limbs twitch, complexion turns white. When the skin qi is exhausted, sweating of exhaustion occurs; once such sweating appears, death follows. Symptoms when the foot shaoyang channel qi is exhausted: deafness, all joints become lax, and the eye-connecting channel qi is exhausted. After the eye-connecting channel qi is exhausted, death occurs in one and a half days. Near death, the complexion is greenish-white, then death ensues. Symptoms when the foot yangming channel qi is exhausted: twitching of the mouth and eyes, tendency to fright, delirious speech, complexion turns yellow. When the qi of its upper and lower channels is exuberant but does not move, death follows. Symptoms when the foot shaoyin channel qi is exhausted: complexion turns black, teeth appear elongated with adherent grime, abdominal distension and obstruction, upper and lower body not communicating, then death follows. Symptoms when the foot jueyin channel qi is exhausted: heat in the chest, dry throat, frequent urination, vexation, and in severe cases, the tongue curls up and the testicles retract, then death follows. Symptoms when the foot taiyin channel qi is exhausted: abdominal distension and obstruction, inability to breathe, belching, tendency to vomit; vomiting leads to qi counterflow, and qi counterflow causes the complexion to turn red; if there is no qi counterflow, then upper and lower body do not communicate, and when they do not communicate, the complexion turns black, the skin and body hair become withered and scorched, then death follows.