Discussion on the Essentials of Diagnosis and the Termination of Channels

Yellow Emperor asked: What are the essentials of diagnosis? Qi Bo replied: In the first and second months, Heaven’s qi begins to generate, Earth’s qi begins to stir, and the human qi mechanism resides in the liver. In the third and fourth months, Heaven’s qi is clear and bright, Earth’s qi is stable and generative, and the human qi mechanism resides in the spleen. In the fifth and sixth months, Heaven’s qi reaches its peak, Earth’s qi rises high, and the human qi mechanism resides in the head. In the seventh and eighth months, yin qi begins its killing descent, and the human qi mechanism resides in the lung. In the ninth and tenth months, yin qi begins to congeal into ice, Earth’s qi starts to close and store, and the human qi mechanism resides in the heart. In the eleventh and twelfth months, ice layers freeze solid, Earth’s qi is completely sealed, and the human qi mechanism resides in the kidney.

Thus, in spring, needling is applied to the scattered points and the interstices of the muscles and flesh; stop when blood appears. For severe cases, the qi is conducted through the channels; for mild cases, the qi completes one circuit. In summer, needling is applied to the collateral points; stop when blood appears, allowing the pathogenic qi to be entirely dispersed and the needle hole to be closed; pain will inevitably subside. In autumn, needling is applied to the skin, following the grain of the muscles; the method is the same for upper and lower regions, and stop when the complexion changes. In winter, needling is applied to the points and the interstices between bone and flesh; for severe cases, needle deeply and directly; for mild cases, needle shallowly and disperse the stimulation. Each of the four seasons—spring, summer, autumn, and winter—has its appropriate needling sites, and the method should accord with the location of the qi mechanism.

If in spring one needles the sites appropriate for summer, the pulse will become disordered and the qi weak; pathogenic qi will invade the bone marrow, the disease will not heal, the person will have no desire to eat, and there will be qi deficiency and lack of strength. If in spring one needles the sites appropriate for autumn, the sinews and vessels will spasm, the qi will reverse and cycle, causing cough; the disease will not heal, the person will be frequently startled and prone to weeping. If in spring one needles the sites appropriate for winter, pathogenic qi will penetrate deeply and lodge in the internal organs, causing abdominal distention; the disease will not heal, and the person will talk excessively. If in summer one needles the sites appropriate for spring, the disease will not heal, and the person will become languid and weak. If in summer one needles the sites appropriate for autumn, the disease will not heal, and the person will have no desire to speak, with a heart fearful as if about to be seized. If in summer one needles the sites appropriate for winter, the disease will not heal, and the person will have shortness of breath and be prone to anger. If in autumn one needles the sites appropriate for spring, the disease will not heal, and the person will feel a fearful agitation as if about to do something, yet upon rising forgets what it was. If in autumn one needles the sites appropriate for summer, the disease will not heal, and the person will become increasingly lethargic and have many dreams. If in autumn one needles the sites appropriate for winter, the disease will not heal, and the person will frequently experience cold shivering. If in winter one needles the sites appropriate for spring, the disease will not heal, and the person will want to lie down but cannot sleep, and after falling asleep will see abnormal visions. If in winter one needles the sites appropriate for summer, the disease will not heal, and the person will have rebellious qi ascending, causing various bi disorders. If in winter one needles the sites appropriate for autumn, the disease will not heal, and the person will frequently be thirsty.

Whenever needling the chest and abdomen, one must avoid the five viscera. If the heart is needled, death occurs within one day; if the spleen is needled, death occurs within five days; if the kidney is needled, death occurs within seven days; if the lung is needled, death occurs within five days; if the diaphragm is needled, it always damages the middle burner; even if such a condition temporarily heals, death will surely come within a year. The key to avoiding the viscera when needling lies in understanding the principle of compliance and opposition. What is meant by compliance? It means knowing the positions of the diaphragm, spleen, kidney, and so forth, and avoiding them. Not knowing these constitutes opposition. When needling the chest and abdomen, a cloth must be used to wrap and secure the needle body, and then the needle is inserted through a single layer of cloth. If one needling does not cure the disease, another may be performed. During needling, the needle must be held steadily and upright. When needling a swelling, the needle may be shaken; but when needling along the channels, it should not be shaken. This is the rule of needling.

Yellow Emperor said: I wish to hear about the manifestations when the qi of the twelve channels is exhausted. Qi Bo replied: When the qi of the taiyang channel is exhausted, the patient’s eyes turn upward, the back arches rigidly, the hands and feet twitch, the complexion turns white, and the decisive sweat flows; once the sweat appears, death follows. When the qi of the shaoyang channel is exhausted, the patient becomes deaf, all the joints become slack and lax, the eyes stare fixedly without movement as the ocular connection is severed; after the ocular connection is severed, death occurs within one and a half days. Before death, the complexion first appears greenish-white, and then death ensues. When the qi of the yangming channel is exhausted, the patient’s mouth and eyes twitch, they are easily frightened, they speak deliriously, the complexion turns yellow, the pulse in the hands and feet surges vigorously, and the skin becomes numb and insensitive; then death follows. When the qi of the shaoyin channel is exhausted, the patient’s complexion turns black, the teeth appear elongated and covered with grime, the abdomen is distended and blocked, and the qi of the upper and lower body does not communicate; then death follows. When the qi of the taiyin channel is exhausted, the patient’s abdomen is distended and blocked, breathing is impossible, there is frequent belching and vomiting; vomiting causes rebellious qi to ascend, and when qi ascends, the complexion turns red. If the qi does not ascend, then the upper and lower qi do not communicate; when they do not communicate, the complexion turns black and the skin and hair become withered; then death follows. When the qi of the jueyin channel is exhausted, the patient experiences heat in the chest, a dry throat, frequent urination, and mental agitation; in severe cases, the tongue curls back and the testicles retract upward; then death follows. These are the conditions of the exhaustion and decline of the qi of the twelve channels.