This Chapter is mainly based on《Ling Shu Chapter 10》.

《靈樞經脈第十》

雷公問于黃帝曰﹕禁服之言﹐凡刺之理﹐經脈為始﹐營其所行﹐知其度量﹐內次五藏﹐外別六腑。願盡聞其道。黃帝曰﹕人始生﹐先成精﹐精成而腦髓生﹐骨為干﹐筋為剛﹐肉為牆﹐皮膚堅而毛髮長﹐谷入于胃﹐脈道以通﹐血氣乃行。雷公曰﹕願卒聞經脈之始生。黃帝曰﹕經脈者﹐所以能決死生﹐處百病﹐調虛實﹐不可不通也。

《Ling Shu Chapter 10》

Le Gong asked Huangdi: Ling Shu Chapter 48 (Jinfu) states that the theory of meridians is the most important foundation in acupuncture. Meridians run all over the body, transferring Qi/Blood, connecting Zang-Fu organs. Can you tell me all about it?

Huangdi answered: The life of a man begins with the combination of the sperm of a man and the ovum of a woman, after that the marrow of brain is developed, then muscles, tendons, skin and skin hair all develop, finally the body is formed. Once the water and food get into the stomach, the meridians start to work to transfer Qi and Blood.

Le Gong said: I want to know all about meridians at once.

Huangdi answered: A doctor should know the theory of meridians in order to know the condition; prognosis of all kind of diseases, and how to regulate excess or deficiency of diseases.

2-1: The Lung Meridian of Hand-Taiyin

肺手太陰之脈﹐起于中焦, 下絡大腸﹐還循胃口﹐上膈屬肺﹐從肺系橫出腋下﹐下循臑內﹐行少陰心主之前﹐下肘中﹐循臂內上骨下廉﹐入寸口﹐上魚﹐循魚際﹐出大指之端﹔其支者﹐從腕後﹐直出次指內廉﹐出其端。

The Lung Meridian of Hand-Taiyin starts from the middle-Jiao, and runs downward to connect with the Large Intestine. It then winds back to the upper orifice of stomach, passes through the diaphragm, and connects with the Lung, its pertaining organ. From the Lung system, it comes out transversely right below the armpit, descending along the medial aspect of the upper arm in front of the Heart Meridian of Hand-Shaoyin, going downward to the elbows, then continues to Cunkou (the radial artery at the wrist) along the anterior border of the radial side of the medial aspect of the forearm. It further goes along the radial side of the thenar eminence and then ends at the medial side of the tip of the thumb. The branch from the wrist goes to the radial side of the tip of the index finger.

是動則病肺脹滿﹐膨膨而喘咳﹐缺盆中痛﹐甚則交兩手而瞀﹐此為臂厥。   

是主肺所生病者﹐咳﹐上氣喘喝﹐煩心胸滿﹐臑臂內前廉痛厥﹐掌中熱。氣盛有余則肩臂痛風﹐汗出﹐小便數而欠。氣虛則肩背痛寒，少氣不足以息﹐溺色變。

The pathological manifestations of Lung Meridian are a sensation of fullness in the chest, asthmatic cough, and pain in the supraclavicular fossa. The patient comes with the hand crossed on the chest and blurry vision when the case is severe; a case called Arm-Jue syndrome.

The points from the Lung Meridian can be used for the disorder of Lung. The pathological manifestations of the Lung organ affecting the Lung Meridian are cough, wheezy asthma, anxiety, sensation of fullness in the chest, pain on the anterior border of the medial aspect of the arm, and hot sensation of the palm.

If there is an excess-Qi condition of the Meridian, the pathological manifestations are pain of the shoulders and arms, sweating, and frequent urination and yawning.

If there is a deficiency-Qi condition of the Meridian, the pathological manifestations are pain and cold sensation of the shoulders and upper back, shortness of breath, and a change in the color of the urine.

為此諸病﹐盛則瀉之﹐虛則補之﹐熱則疾之﹐寒則留之﹐陷下則灸之﹐不盛不虛以經取之。盛者寸口大三倍于人迎﹐虛則寸口反小于人迎也。

The principle of treatment for the above dysfunction is to reduce if the meridian is an excess condition, reinforce if it is in a deficient condition, retain the needle if it is a cold syndrome, puncture and quickly withdraw the needle if it is a heat syndrome, apply moxibustion if the location of the acupoint shows an indentation, puncture (only) the disordered Meridian when the pulse of Cunkou (radial artery) and Renying (carotid artery) are even.

The pulse of Cunkou will be four times stronger than Renying in the excess condition of the Lung Meridian. The pulse of Cunkou will be weaker than Renying in the deficient condition of the Lung Meridian.

【Comment】

(1) The Significance of Distribution of Meridian

1-1: One of the important characteristics of Chinese Medicine is that the human body is considered as an organic whole. Every part of the body (upper and lower, inside and outside, left and right) connects with each other. The theoretical basis of this is from the theory of Meridians, especially in its distribution. Through the Meridian system, every part of the body connects together. In another words, without the theory of Meridians, Traditional Chinese Medicine would not be complete.

1-2: Because the Meridians connect the outside of the body with the internal organs, stimulating or puncturing the outside of the body (acupoints of the meridians) can treat diseases of the internal organs.

1-3: Furthermore, through the distribution of the Lung Meridian, the Lung organ has a particular relationship with certain parts outside the body. For example, the Lung meridian “goes continuously to Cunkou (the radial artery at the wrist) along the anterior border of the radial side on the medial aspect of the forearm… ends at the medial side of the tip of the thumb.”

         This means one can (only) treat diseases of the Lung by puncturing those parts of the body (acupoints on the Lung meridian); this statement corresponds with the statement about the Five Shu points of the Lung in 《Ling Shu Chapter 2》.  The same principle of selecting acupoints applies to treating diseases of other Zang-Fu organs.

Figure 2-2-1 Relationship of Lung Meridian and the Outside of the Body (Acupoints)

(2) The Significance of Symptoms Due to the Disorder of the Lung Meridian

2-1: “The pathological manifestations of Lung Meridian are a sensation of fullness in the chest, asthmatic cough, and pain in the supraclavicular fossa. The patient comes with the arms crossed on the chest and blurry vision when the case is severe; a case called Arm-Jue syndrome.”  This group of symptoms is crucial for differentiating the Lung Meridian, because it is typical to the disorder of the Lung meridian.

Although the differentiation of meridians is mainly based on pulse diagnosis in 《Ling Shu》 (Renying and Cunkou pulses) a new practitioner will find it very difficult to practice.  There will be more discussion of this in the next chapter, but these groups of symptoms will help a new practitioner during the first stages of clinic.  A disorder of each Meridian has its own group of symptoms which help differentiate the meridian. The symptoms are very important to an acupuncturist, comparable to the importance of reports from the laboratory to a medical doctor. Without the group of symptoms, it is difficult make a correct differentiation of the Meridian in clinic.

The correct differentiation of Meridians is the precondition that ensures the proper selection of acupoints and the proper needling technique. It is absolute that an acupuncturist should memorize all the groups of symptoms due to a meridian disorder.

Yet in acupuncture practice today, acupuncturists rarely differentiate the meridian according to these particular groups of symptoms.

2-2:“The points of the Lung Meridian can be used for the disorder of the Lung.” This statement also states clearly that acupoints treating Lung dysfunctions are from the Lung Meridian only.  The acupoints are the Five Shu points of the Lung according to 《Ling Shu Chapter 2》. This is the theoretical basis for understanding the characteristics of the Five-Shu points that will be discussed later in this book.

(3) Significance of Symptoms Due to a Lung Disorder Affecting the Lung Meridian

It is very difficult to learn the differentiation of Five Zang-organs, because it is mainly based on diagnosis of the facial complexion and pulse, as depicted in 《Huangdi Neijing》, and only《Su Wen Chapter 22》,   and《Ling Shu》Chapter 2 and 8 record the symptoms due to a dysfunction of each Zang-Fu organ.

Because Zang and Fu organs are considered the root of Meridians, any Zang or Fu organ dysfunction will affect its related Meridian.

For example, “The pathological manifestations of the Lung organ affecting the Lung Meridian are cough, wheezy asthma, anxiety, sensation of fullness in the chest, pain on the anterior border of the medial aspect of the arm, and hot sensation of the palm.”

This group of symptoms is due to the dysfunction of the Lung affecting the Lung Meridian.

The symptoms due to the disorder of organs affecting Meridians will certainly help identify which organ has a disorder. Through this way of differentiation, we will gradually learn and master the skill of diagnosis through facial complexion and pulse.

(4) Significance of Symptoms due to Excess or Deficiency of the Lung Meridian

“If there is an excess-Qi condition of the Meridian, the pathological manifestations are pain of the shoulders and arms, sweating, and frequent urination and yawning.

If there is a deficiency-Qi condition of the Meridian, the pathological manifestations are pain and cold sensation of the shoulders and upper back, shortness of breath, and a change in the color of the urine.”

The typical symptoms due to a disorder of the Lung meridian such as “sensation of fullness in the chest, asthmatic cough, and pain in the supraclavicular fossa” appears in either an excess or deficient condition of the Lung Meridian.

Excess or deficiency of the Meridian is usually determined by pulse diagnosis of Cunkou and Renying. But symptoms also help to verify whether the Meridian is in a state of excess or deficiency.

The Meridians of the Lung, Large Intestine, and Stomach have different groups of symptoms relating with the excess and the deficiency of the meridian.

(5) The typical symptoms due to a disorder of the Lung meridian are also the indications for acupoints of the Lung Meridian.

5-1: According to 《Su Wen Chapter 59》, acupoints are where the Qi and Blood from the Meridians gather near the surface of the body; there is no doubt that acupoints represent the Meridian.

Furthermore, a certain group of acupoints is related with a particular Meridian. For example, Lung Meridian has 22 acupoints (bilaterally). They represent the condition of the Lung Meridian. If the Lung Meridian is in excess, all of the 22 acupoints are also in excess. Puncturing any one of these acupoints is puncturing the Lung Meridian; therefore, the indications for these acupoints are the symptoms due to the dysfunction of the Lung meridian. LU 1 can be used for “a sensation of fullness in the chest, asthmatic cough, and pain in the supraclavicular fossa.” The same is with LU9 and LU 11. In other words, every point of the Lung Meridian has the same indications as the symptoms for the dysfunction of the Lung Meridian. Thus, it can be concluded that symptoms for a dysfunction of a meridian are indications for acupoints of that meridian.

5-2: Furthermore, 《Ling Shu Chapter 1》states that “there are twenty five points for diseases of the Five-Zang organs, thirty six points for diseases of the Six-Fu organs.” And then in 《Ling Shu Chapter 2》, it clearly states that only LU 5, LU 8, LU 9, LU 10, and LU 11 are related with the Lung. 《Ling Shu Chapter 2》: “The Qi/Blood of Lung  emerges at LU 11, it is located at the medial side of the tip of the thumb, and is called “Jing” , it relates with “wood” in the five elements correspondence. The Qi/Blood flows in LU 10 which is located at the thenar eminence of the hand, and it is called “Ying”. The Qi/Blood fills at LU 9, it is located about 1 cun above LU 10; the depression at the radial side of wrist, and is called “Shu”. The Qi/Blood passes LU 8 which is located where the Cunkou pulse is, and is called “Jin”. The Qi/Blood enters LU 5 which is located on the cubital crease, on the radial side of the tendon of m.biceps brachii, near the radial artery, and is called “He”. These are the Five Shu points of Hand-Taiyin.”

It is very clear that the discussion of acupoint indications in 《Huangdi Neijing》 refers to the relationship of a Meridian and its acupoints, and the relationship of acupoints and its pertaining Zang-Fu organs.

《《Ling Shu Chapter 1》states, “For one who understands the theory of acupoint in Ling Shu, the indications of acupoints become easy to learn and remember, otherwise one is lost in  acupoint indications.”  (《靈樞九針十二原第一》﹕知其要者，一言而終，不知其要，流散無窮。)

Unfortunately, when it comes to indications of points, the later generations of acupuncturists diverge from the theory of 《Huangdi Neijing》, and focus on clinical experiences of some doctors or interpretations of the meaning of acupoint names instead.

For example, in《Bian Que’s Dragon Acupuncture Canon 》 (AD 1295), it states that “the acupoints of K 6 and SJ 7 were very effective for treating constipation.” (《扁鵲神應針灸玉龍經》﹕“大便閉塞不能通﹐照海分明在足中﹐更把支溝來瀉動﹐方知醫士有神功 。”) There is absolutely no theory about the application of these points for constipation; it is only based on “clinical experience”.   Another example is acupoint H 7. This acupoint is often used for mental disorders just because of the meaning of its name.

Misunderstanding the indications of acupoints has distorted the indications of acupoints. In either teaching or practice, there are only few so-called important indications selected from few so-called important acupoints used today. Due to this misunderstanding, less than 20% of the 361 available acupoints are being used in the clinic nowadays.  Divergence from the relationship of Meridian and its acupoints and the relationship of the acupoints and its pertaining Zang-Fu organs has directly resulted in the disastrous emergence of extra-ordinary points and the so-called magic points.

(6)) Principles of Acupuncture Treatment for Disorder of the Meridian

6-1; “Reducing for excess condition, reinforce for a deficient condition.”The pulse of Cunkou will be four times stronger than Renying in an excess condition of the Lung Meridian. The pulse of Cunkou will be weaker than Renying in a deficient condition of the Lung Meridian.””

Furthermore, according to the theory of Yin/Yang balance, excess or deficiency condition are always relative. For example, if the Lung Meridian has an excess condition, the Large Intestine Meridian, which is internally-externally related with the Lung Meridian, must be in a relatively deficient condition. Therefore, if the Lung Meridian has an excess condition, the acupuncture treatment is not only to reduce the Lung Meridian but also to reinforce the Large Intestine Meridian. This is a very crucial point regarding how to regulate a disordered Meridian, and is also a realistic application of the theory of Yin/Yang balance in acupuncture treatment. More discussion of this is in Section 1 “Renying and Cunkou Pulse”

It is clear that reducing or reinforcing the disordered Meridian by applying different techniques method on the acupoints. In other words, reducing or reinforcing is accomplished by acupuncture techniques, an acupoint itself does not have the function to reduce or reinforce. If you reinforce a point, the point will respond to the reinforcement. If you reduce a point, it will respond to the reduction. Acupoints are only receivers.

A disordered Meridian is either in excess or deficiency. ““Reducing if it is an excess condition, reinforcing if it is a deficient condition” is the most important principle of treatment for a dysfunction of the Meridian.

 “Reduce in an excess condition, reinforce in a deficient condition …” is repeated twelve times in 《Ling Shu Chapter 10 》. The unusual number amount of statements in this chapter of《Ling Shu 》indicates how important this principle is. Yet in most of acupuncture textbooks, such an important principle is left out.

6-2: “Retaining the needle if it is a cold syndrome, puncture and quickly withdraw the needle if it is a heat syndrome.”

To determine if the needle should be retained for a long duration or a short duration depends on whether the Meridian dysfunction is a cold or hot syndrome. But this is only a general principle of acupuncture technique. The time to withdraw the needle is the time the purpose of treatment is reached. How do we evaluate the results of treatment? How long do the needles have to be retained in each treatment?  Section 5 “Acupuncture Technique” will cover this.

6-3: “Apply moxibustion if the location of the acupoint shows an indentation.” This is the principle of applying moxibustion for a disorder of the Meridian.

In 《Ling Shu Chapter 48》, it states that “the indentation of the Meridian means coldness of the blood, thus moxibustion is needed.”More discussion on moxibustion will be presented in Section 5, “Acupuncture Technique”.

6-4: “Puncture the Meridian in a disorder only if the pulse of Cunkou and Renying are even.”  Under what condition will the disorder of the Meridian have an even Cunkou and Renying pulse?  In 《Ling Shu Chapter 9》, it was states “puncture a Meridian in a disorder only if there is not an imbalance of Yin/Yang involved.” (《靈樞終始第九》﹕“故陰陽不相移﹐虛實不相傾﹐取之于經。”)

 《Su Wen Chapter 27》 states, “the imbalance of Yin/Yang is due to the imbalance of  Ying-Qi and Wei-Qi in the Meridian. However, this is not related with disorders of the Meridian due to pathogenic-qi attack from the outside.”  This means the Cunkou and Renying pulse are used only for the diagnosis of disorders of a Meridian due to the imbalance of Yin/Yang, and not for disorders due to pathogenic-qi attacking from the outside.  In other words, if a disorder of the Meridian is due to outside pathogenic-qi the Cunkou and Renying pulse are even.

Additionally, as we already know, after determining the excess or deficiency of a Meridian through Cunkou and Renying pulse diagnosis, we need to reduce or reinforce the disordered meridian and its related Yin or Yang Meridian as well. In contrast, if the Meridian is in a disorder due to an outside pathogenic-qi, we should puncture only the disordered Meridian.

(7) Renying and Cunkou Pulse Diagnosis.

 “The pulse of Cunkou will be four times stronger than Renying in the excess condition of the Lung Meridian. The pulse of Cunkou will be weaker than Renying in the deficient condition of Lung Meridian.

7-1: What does it mean when it says the pulse is "four times stronger" or "weaker"?

It describes the strength of palpation of the pulses at the two pulse locations. More discussion on this subject refers to Section 1, “Renying and Cunkou Pulse."

7-2: In 《Ling Shu Chapter 9》, it states that “if the pulse of Cunkou is four times stronger than the pulse of Renying, the disordered Meridian is Foot Taiyin; if the pulse of Cunkou is four times stronger than the pulse of Renying, and the pulse shows restlessness, the disordered Meridian is Hand-Taiyin.”

This means that in a disorder of the Lung Meridian, the pulse will have another different characteristic in addition to the strength of the pulse. That characteristic is the flow of Qi/Blood in the Meridian showing restlessness. Because in 《Ling Shu Chapter 9》 this characteristic was mentioned, so in 《Ling Shu Chapter 10》 it is not repeated again.  It is common for Ling Shu to omit repetitive sayings.  Therefore, although《Ling Shu Chapter 10》only states that “The pulse of Cunkou will be four times stronger than Renying in the excess condition of the Lung Meridian…” the pulse will also show restlessness.

7-3: 《》states the palpation strength of the pulse shows deficiency of the Lung Meridian when Cunkou is weaker than Renying.

However, on further examination of 《Ling Shu Chapter 9》, a weaker Cunkou pulse relative to the Renying pulse appears in any of the six Yin Meridian deficiency conditions. So how can we distinguish which Meridian deficiency? We depend on the symptoms due to the disorder of the Lung Meridian.  Therefore, the differentiation of the Meridian depends on both symptoms and pulse.

An acupuncturist determines the disordered Meridian based on the symptoms of the disorder of the Meridian first, and then determines if it is an excess or deficient condition by the comparison of the pulse of Cunkou and Renying. An acupuncturist will have more experience towards palpation of the pulse through clinical cases.

7-4: An excess or deficient condition of a meridian depends on the Renying and Cunkou pulse diagnosis, and the reinforcing or reducing technique used is also based on the result of diagnosis. Pulse diagnosis is essential in acupuncture treatment, however, in most acupuncture textbooks today diagnosis using the Renying and Cunkou pulse are left out. Checking all the acupuncture classic books written after 《Ling Shu》, one may be surprised to find that none of the acupuncturists practiced according to 《Ling Shu》 because the Renying and Cunkou pulse diagnosis is not used.

Though some acupuncturists today still claim they regulate the Meridian in clinical practice, they in fact do not and can not. How can we determine the excess or deficiency of a Meridian without Renying and Cunkou pulse diagnosis? How can we apply the reinforcing or reducing technique if we do not know if the Meridian is in excess or deficiency? The answer here is clear.

The distribution, symptoms, pulse, and principles of treatment of Meridians recorded in 《Ling Shu Chapter 10》are the foundations of Meridian theory.