This chapter is based on 《Su Wen》Chapter 50, 51, 61; 《Ling Shu》Chapter 2,9,19.
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The purpose of this Chapter is to discuss the depth to needle an acupoint during the four seasons and needling diseases of the skin, muscle, tendon and bone. |
6-1: The Depth of Needling a Disease of the Skin, Muscle, Tendon and Bone
《素問刺要論篇第五十》
黃帝問曰﹕願聞刺要。歧伯對曰﹕病有浮沉﹐刺有淺深﹐各至其理﹐無過其道。
《Su Wen Chapter 50》
Needle depth should correspond with the location of the disease.
《素問刺齊論篇第五十一》
黃帝問曰﹕願聞刺淺深之分。歧伯對曰﹕刺骨無傷筋﹔刺筋無傷肉﹔刺肉無傷脈﹔刺脈無傷皮﹔刺皮無傷肉﹔刺肉無傷筋﹔刺筋無傷骨。
《Su Wen Chapter 51》
Huangdi asked: Can you say the principle of how deep or how shallow to needle?
Qibo answered: One who is needling the bone should not injure the tendon; one who is needling the tendon should not injure the muscle; one who is needling the muscle should not injure the vessel; one who is needling the vessel should not injure the skin; one who is needling the skin should not injure the muscle; one who is needling the muscle should not injure the tendon; one who is needling the tendon should not injure the bone.
帝曰﹕余未知其所謂﹐願聞其解。歧伯曰﹕刺骨無傷筋者﹐針至筋而去﹐不及骨也﹔刺筋無傷肉者﹐至肉而去﹐不及筋也﹔刺肉無傷脈者﹐至脈而去﹐不及肉也﹔刺脈無傷皮者﹐至皮而去﹐不及脈也。所謂刺皮無傷肉者﹐病在皮中﹐針入皮中﹐無傷肉也﹔刺肉無傷筋者﹐過肉中筋也﹔刺筋無傷骨者﹐過筋中骨也。此之謂反也。
Huangdi asked: Can you explain to me?
Qibo answered: “One who is needling the bone should not injure the tendon” means that one should not stop and withdraw the needle on the level of the tendon before the needle reaches the bone. (It will injure the tendon);
One who is needling the tendon should not injure the muscle” means that one should not stop and withdraw the needle on the level of the muscle before the needle reaches the tendon;
One who is needling the muscle should not injure the vessel” means that one should not stop and withdraw the needle on the level of the vessel before the needle reaches the muscle;
One who is needling the vessel should not injure the skin” means that one should not stop and withdraw the needle on the level of the skin before the needle reaches the vessel;
One who is needling the skin should not injure the muscle” means that one should needle on the skin to treat the skin disease, and should not needle deeply to injure the muscles;
One who is needling the muscle should not injure the tendon” means that one should needle on the level of the muscle, and not needle deeply to injure the tendon;
One who is needling the tendon should not injure the bone” means that one should needle on the level of the tendon, and should not needle deeply to injure the bone.
If one needles more shallow or deeper than appropriate, there will be bad consequences.
【Comment】
“Needle depth should correspond with the location of the disease” is the basic and most important principle regarding needling depth. 《Ling Shu Chapter 1》has a similar statement. In other words, to treat a skin, muscle, tendon or bone disease, the tip of the needle must reach the location of the disease, needling more shallow or deeper than appropriate can cause further injury.
Application of the nine needles also embodies this principle. The first type of needle for example; when one applies the first needle to treat a skin disease, one will not injure the muscle because of the shortness of the needle.
Guided by this principle, any acupuncturist that treats a disease of the skin, muscle, tendon, or bone will have the same corresponding depth of needling.
6-2: The Depth of Needling an Acupoint in Four Seasons
《靈樞四時氣第十九》
黃帝問于歧伯曰﹕夫四時之氣﹐各不同形﹐百病之起﹐皆有所生﹐灸刺之道﹐何者為定﹖歧伯答曰﹕四時之氣﹐各有所在﹐灸刺之道﹐得氣穴為定。故春取經﹐血脈分肉之間﹐甚者深刺之﹐間者淺刺之。夏取盛經孫絡﹐取分間絕皮膚。秋取經輸﹐邪在府﹐取之合。冬取井滎﹐必深以留之。
《Ling Shu Chapter 19》
Huangdi asked: The Qi of four seasons have different forms. (The Qi of a season indicates the dominating-Qi for that season; for example, the dominating-Qi in spring is the Wood element.) The cause of each disease is different as well. What is the key regarding acupuncture technique?
Qibo answered: The Qi of four seasons affect the Qi of man; the key to acupuncture technique is to know the exact depth of the Qi-point during the different seasons.
During spring, the Qi is in the meridian, the Qi-point is located between the collateral and the muscle, needling deeper within this range is for a more severe disease and more shallow is for a disease that is less severe.
During summer, the Qi is in the superficial collateral, the Qi-point is located under the skin.
During autumn, the Qi-point is the “Jin” and “Shu” points (two of the Five Shu points), and the “He” point is used if the pathological-Qi attacks the Fu organs.
During winter, the Qi-point is the “Jing” and “Ying” points, these points are to be needled deeply and retained.
《素問水熱穴論篇第六十一》
帝曰﹕春取絡脈分肉﹐何也﹖歧伯曰﹕春者木始治﹐肝氣始生﹔肝氣急﹐其風疾﹐經脈常深﹐其氣少﹐不能深入﹐故取絡脈分肉間。
帝曰﹕夏取盛經分腠﹐何也﹖歧伯曰﹕夏者﹐火始治﹐心氣始長﹔脈瘦氣弱﹐陽氣留溢﹐熱熏分腠﹐內至于經﹐故取盛經分腠。絕膚而病去者﹐邪居淺也。所謂盛經者﹐陽脈也。
帝曰﹕秋取經輸﹐何也﹖歧伯曰﹕秋者﹐金始治﹐肺將收殺﹐陽氣在合﹐陰氣初勝﹔濕氣及體﹐陰氣未盛﹐未能深入﹐故取輸以瀉陰邪﹐取合以虛陽邪。陽氣始衰﹐故取于合。
帝曰﹕冬取井滎﹐何也﹖歧伯曰﹕冬者水始治﹐腎方閉﹐陽氣衰少﹐陰氣堅盛﹐巨陽伏沉﹐陽脈乃去﹐故取井以下陰逆﹐取滎以實陽氣。故曰﹕“冬取井滎﹐春不鼽衄”﹐此之謂也。
《Su Wen Chapter 61》
Huangdi asked: Why is Qi-point located between the collateral and muscle during spring.
Qibo answered: During spring, the Wood element becomes the dominating-Qi, and the Liver becomes the dominating-Zang organ. The Wind is blowing (the function of the Liver of transporting Qi and blood in the meridian) and the Qi and blood in the meridian begins to flow outside. However, because the meridian is located in the deeper layer, the Qi-point is located between the collateral and the muscle.
Huangdi asked: Why is Qi-point located under the skin during summer.
Qibo answered: During summer, the Fire becomes the dominating-Qi, and the Heart becomes the dominating-Zang organ. The Qi and blood of a meridian is abundant, and overflows to the superficial collateral and skin, therefore the Qi-point is located under the skin. One should penetrate the skin to remove the pathological-Qi. The superficial collaterals are called the “Yang meridians”.
Huangdi asked: Why are the Qi-points “Jin” and “Shu” during autumn?
Qibo answered: During autumn, the Metal becomes the dominating-Qi, and the Lung becomes the dominating-Zang organ. At this time, yin-Qi becomes stronger than the yang-Qi, which begins to decline, yet the yin-Qi has not entered inside the body, therefore needling the “Shu” point reduces the yin pathological-Qi, and needling the “He” points reduces the yang pathological-Qi.
Huangdi asked: Why are the Qi-points “Jing” and “Ying” during winter.
Qibo answered: During winter, the Water becomes the dominating-Qi, and the Kidney becomes the dominating-Zang organ. At this time, the yang-Qi begins to decline and yin-Qi begins to increase. The Qi and blood of the meridian transfers from yang to yin (the Qi and blood moves from the outside of the body to the inside), therefore needling the “Jing” point reduces the yin excess, and needling the “Ying” reinforces the yang-Qi.
《靈輸本輸第二》
春取絡脈諸滎大經分肉之間﹐甚者深取﹐間者淺取之﹔夏取諸輸孫絡肌肉皮膚之上﹔秋取諸合﹐余如春法。冬取諸井諸輸之分﹐欲深而留之 。此四時之序﹐氣之所處﹐病之所舍﹐針之所宜。
《Ling Shu Chapter 2》
During spring, the Qi is in the meridian, the Qi-point is located between the collateral and the muscle, needling deeper within this range is for a more severe disease and more shallow is for a disease that is less severe.
During summer, the Qi is in the superficial collateral; the Qi-point is located under the skin, select the “Shu” points. (The original passage states the Qi-point is located above the skin, collateral and muscle. But according to the《Ling Shu Chapter 1》, “the acupoint of the Meridian is not located on the skin, muscle, tendon and bone” and “the location of each acupoint is in a depression that may be found between the muscles, beside the tendons, below the skin and above the bone”. Therefore we made this modification by referring to other chapters in regarding the location of the Qi-point).
During autumn, select the “He” points, other rules as stated for spring also apply.
During winter, the Qi is located in the deeper layer of the body; one should needle the “Jing” points deeply and retain the needle.
The Qi-points of the four seasons are the places where diseases dwell and the depths of needling.
《靈樞終始第九》
春氣在毫毛﹐夏氣在皮膚﹐秋氣在分肉﹐冬氣在筋骨﹐刺此者各以其時為齊。故刺肥人者﹐以秋冬之齊﹔刺瘦人者﹐以春夏之齊。
《Ling Shu Chapter 9》
During spring, the Qi is in the hair. During summer, the Qi is in the skin. During autumn, the Qi is between the muscles. During winter, the Qi is in the tendons and bones. The depth of needling should be in accord with the season.
Thus, the depth of needling for an overweight person should be similar to the depth of needling a point during autumn and winter and the depth of needling a point for a thin person should be similar to the depth of needling during spring and summer.
【Comment】
The above chapters from 《Huangdi Neijing》discuss one of the very important acupuncture technique principles, which is that the depth of needling an acupoint is in accord with the season. 《Su Wen Chapter 25》states, “the creation of man depends on the Qi of the heaven and earth, and the law of life corresponds with the four seasons.” Thus, revealing the intimate connection between the human body and nature.
《Ling Shu Chapter 19》states, “The Qi of four seasons affects the Qi of man”, and then 《Su Wen Chapter 61》 further discusses how different seasons can affect the Qi of man. An example of one of its passage is the following: “During spring, Wood becomes the dominating-Qi, and the Liver becomes the dominating-Zang organ…and the Qi and blood in a meridian begins to flow to the outside… because the meridian is located within deeper layer of the body, therefore the Qi-point is located between the collateral and muscle.”
《Su Wen Chapter 64》has a similar statement 《Su Wen Chapter 61》has regarding how different seasons can affect the Qi. (《素問四時刺逆從論第六十四》﹕是故春氣在經脈﹐夏氣在孫絡﹐長夏氣在肌肉﹐秋氣在皮膚﹐冬氣在骨髓中。帝曰﹕願聞其故。歧伯曰﹕春者﹐天氣始開﹐地氣始泄﹐凍解冰釋﹐水行始通﹐故人氣在脈。夏者﹐經滿氣溢﹐入孫絡受血﹐皮膚充實。長夏者﹐經絡皆盛﹐內溢肌中。秋者﹐天氣始收﹐腠理閉塞﹐皮膚引急。冬者蓋藏﹐血氣在中﹐內著骨髓﹐通于五藏。是故邪氣者﹐常隨四時之氣血而入客也﹐至其變化﹐不可為度﹐然必從其經氣﹐辟除其邪﹐除其邪則亂氣不生。) It is clear that the Qi of seasons affect the Qi of man, and according to《Ling Shu Chapter 16》the Qi of man is the Qi and blood of the meridian.
《Su Wen Chapter 59》states, “acupoints are emanated and formed by the Qi/Blood of the Meridian.” This indicates that the acupoint is represents the meridian. Thus, since the Qi goes up and down within the body during different seasons, the Qi and blood of acupoints will have the same effect.
The location of Qi and blood in an acupoint is located in the Qi-point. The Qi-point represents both the superficial location of a point and the depth of Qi and blood of a point during a season. From the aspect of Qi and blood, Qi-point is the essence of an acupoint.
Figure 5-6-1 Difference between a Superficial Location of an Acupoint and Qi-point
《Ling Shu Chapter 2》 says that “the Qi-point of four seasons is the dwelling place for the disease and the depth for needling an acupoint.” And 《Ling Shu Chapter 19》states, “the key to acupuncture technique is to know the exact depth of a Qi-point during different seasons.” Therefore, one who needles an acupoint to regulate the meridian and to dispel pathological-Qi has to know the place where the Qi-point dwells during the different seasons and decide the depth of needling. It is a crucial point in acupuncture technique. Furthermore, an acupuncturist who does not know the Qi-point not only cannot regulate the meridian, but also can cause injury to the body. In《Su Wen Chapter 16》and 《Su Wen Chapter 64》 there are detailed discussions regarding this issue. For more discussion, refer to the section “Acupuncture Malpractice”.
However, the discussions regarding the Qi-point in 《Huangdi Neijing》are spread out in different chapters, and some parts even seem to contradict each other. Researchers of 《Huangdi Neijing》in the past years gave their explanations of the Qi-point during different seasons without doing much comparison or analysis. In fact, the depth to needle for acupuncturist in the past generations is very general. Thus, the depth of needling for an overweight person should be similar to the depth of needling a point during autumn and winter and the depth of needling a point for a thin person should be similar to the depth of needling during spring and summer. They don’t have a clear idea where the exact location of the Qi-point is during the different seasons, and as a consequence, they miss the Qi-point.
In the following points, we will discuss all of the above-mentioned chapters in《Huangdi Neijing》, and find the Qi-point during the four seasons.
(1) The Qi-point during summer is synonymous to the depth of needling the point during summer.
Figure 5-6-2 Different Chapters Regarding the Qi-point in the Summer
《Ling Shu Chapter 19》 states, “During summer, the Qi of man is in the superficial collateral; the Qi-point is located below the skin.” 《Ling Shu Chapter 21》 has similar a statement in regards to needling the Qi-point during summer. (《靈樞寒熱病第二十一》“夏取分腠”) 《Su Wen Chapter 61》states, “During summer, the Fire (one of five elements) becomes the dominating-Qi, and the Heart becomes the dominating-Zang organ. The Qi and blood of meridian is abundant and overflows to the superficial collateral and skin, therefore the Qi-point is located below the skin. One should penetrate the skin to remove the pathological-Qi.”《Ling Shu Chapter 2》states, “During summer, the Qi of man is in the superficial collateral, the Qi-point is located below the skin, select the “Shu” points.” All these chapters indicate that the Qi-point during summer is located below the skin. One needs to insert the needle just through the skin, and should not go any deeper.
Figure 5-6-3 Location of the Qi-point and Needling Method in the summer
