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A collection of notes on the topics of classical Chinese, medicine, and traditional culture.
 

Lingshu 1 translation

1

九針十二原

The Nine Needles and Twelve Sources

Line One

(一)黃帝問於岐伯曰:

(二)余子萬民,養百姓,而收租稅。

(三)余哀其不給,而屬有疾病。

)四)余欲勿使被毒藥,無用砭石,欲以微針通其經脈,調其血氣,營其逆順出入之會。

(五)令可傳於後世,必明為之法。

(六)令終而不滅,久而不絕,易用難忘,為之經紀。

(七)異其章,別其表裡,為之終始令各有形,先立針經,願聞其情。

 

1) The Yellow Emperor asked Qí Bó:

2) “I consider the myriad people my own children, I nurture the hundred surnames, and I collect taxes and levies.

3) I am saddened by their lack of provisions and by the fact that they suffer from diseases.

4) I would like to avoid exposing them to toxic medicinals or having lancing stones used on them. Instead, I would like to see subtle needles used to facilitate the free flow in their channels, attune their qi and blood, and keep watch over their flow and counterflow and the meeting points for exiting and entering.

5) To allow me to transmit this information to later generations, I must clearly understand it and turn it into a method [that can be passed on by teaching].

6) To allow to come to the end without ever perishing, to make it last long without being cut off, to make it easy to use and yet difficult to forget,[1] [I must] give guidelines and principles.

7) To make distinct sections and to differentiate the interior from the exterior, to give [the teachings] a beginning and an end, to make each [aspect] tangible, I will first establish a Needling Guideline/Classic. I would like to hear your feelings about this.”

 

Line Two:

(一)岐伯答曰:

(二)臣請推而次之,令有綱紀,始於一,終於九焉。請言其道。

)小針之要,易陳而難入。

(四)粗守形,上守神,神乎神,客在門,未睹其疾,惡知其原。

1) Qí Bó answered:

2) “Your servant is being asked to expand and follow up, to give [the teachings] guidelines and principles, to begin with the One and end with Nine. [Your servant] is being asked to speak about its Dao.

3) The crux of [applying] small needles is easy to expose but difficult to enter.[2]

4) Coarse medicine safeguards the physical shape. Superior medicine safeguards the shén. The shén, oh the shén! If there is an intruder at the gate, before you observe the disease, how can you know its source?

 

Line Three:

(一)刺之微,在速遲。

(二)粗守關,上守機機之動,不離其空。空中之機,清靜而微,其來不可逢,其往不可追。

(三)知機之道者,不可掛以髮不知機道,扣之不發。

(四)知其往來。要與之期,粗之暗乎,妙哉,工獨有之。

(五)往者為逆,來者為順,明知逆順,正行無問。

(六)逆而奪之,惡得無虛?追而濟之,惡得無實?

(七)迎之隨之,以意和之,針道畢矣。

1) The subtlety of needling lies in the speed.

2) Coarse medicine safeguards opening and closing;[3] superior medicine safeguards the trigger mechanism [of qi]. The movement of the trigger mechanism does not go beyond that which is empty.[4] The trigger mechanism in the empty spaces is clear and still and thereby subtle. You must not greet it when it arrives nor chase it when it leaves.

3) Knowing the Dao of this trigger mechanism is not something that you can suspend from a single strand of hair. If you do not know the Dao of this trigger mechanism, you will pin down [the qi] instead of making it effuse.

4) Knowing its comings and goings,[5] you want to give it the perfect timing. How much are coarse practitioners in the dark about this! Marvelous indeed! Only experts[6] possess this skill.

5) Leaving means [moving] counterflow, and arriving means [moving] with the flow. When you clearly know counterflow and flow, you act correctly without any doubt.

6) Seizing it by force when it is moving counterflow, how could you not cause vacuity? Aiding it further as you are chasing it, how could you not cause repletion? [7]

7) In welcoming it and in following it, use your intention to harmonize with it. This concludes the Dao of Needling.[8]

 

Line Four

(一)凡用針者,虛則實之,滿則洩之,宛陳則除之,邪勝則虛之。

(二)大要曰:徐而疾則實,疾而徐則虛。

(三)言實與虛,若有若無;察後與先,若存若亡;為虛與實,若得若失。

1) In all cases of applying needles, when there is vacuity, make it replete; when there is fullness, drain it; when there is circuitousness and staleness, eliminate it; when evil has triumphed, make it vacuous.

2) The Great Guideline states: ‘Proceeding slowly and then quickly results in repletion. Proceeding quickly and then slowly results in vacuity.’

3) Speaking of repletion and vacuity refers to the apparent presence or absence [of qi?]. Observing the before and after refers to the apparent survival or perishing. Making something vacuous or full refers to obtaining or losing it.

 

Line Five

一)虛實之要,九針最妙

(二)補瀉之時,以針為之。

(三)瀉曰必持內之,放而出之。排陽得針,邪氣得洩。按而引針,是謂內溫,血不得散,氣不得出也。

(四)補曰隨之,隨之意若妄之,若行,若按,如蚊虻止,如留,如還,去如弦絕,令左屬右,其氣故止,外門已閉,中氣乃實。

(五)必無留血,急取誅之。

1) For the crux of vacuity and repletion, the nine needles are most marvelous.

2) The [ideal] timing for supplementation and draining is enacted by means of the needle.

3) Draining means this: You must firmly hold [the needle] during insertion and release [your grip] during removal.[9] Push out the yang as you get the needle,[10] and as a result you can drain the evil qi. If you press down [on the hole] as you pull the needle out, this is referred to as “internal warming.”[11] It means that the blood is unable to scatter and the qi is unable exit.

4) Supplementing means that you follow [the qi]. The meaning of “following” is that you [handle the needle] as if in a haphazard way,[12] now moving [the needle], now pressing [on the insertion point], like a mosquito or gadfly landing [ever so lightly], now retaining [the needle], now removing it. Remove [the needle swiftly,] like an arrow released from the bow. Have the left hand support the right hand[13] and the patient’s qi is stopped as a result. When the outside door is already closed, center qi is then made replete.

5) It is essential that no blood is retained [at the insertion point]. Quickly retrieve [the needle] to aggressively remove it.

 

Line Six

)持針之道,堅者為寶,正指直刺,無針左右。

(二)神在秋毫,屬意病者,審視血脈者,刺之無殆。

)方刺之時,必在懸陽,及與兩衛,神屬勿去,知病存亡。

(四)血脈者在腧橫居,視之獨澄,切之獨堅。

1) As for the Dao of grasping the needle, firmness is what makes it a treasure.[14] Align your fingers and pierce straight down, do not needle from the right or the left.

2) Your shén should be as fine as autumn down, with attention fixed only on the patient. When you closely watch the flow of blood in the vessels, piercing them will entail no risk.

3) When you are just about to pierce, you must position yourself at suspending yang and then arrive at the pair of wei defenses.[15] With the shén in focus, do not let it leave,[16] and you will know whether the illness has survived or perished.

4) Concerning the flow of blood in the vessels, at the shù transport points it occupies a horizontal position. Therefore it is singularly transparent when you look at it [there] and singularly firm when you palpate it [there].

 

Line Seven

(一)九針之名,各不同形:一曰鑱針,長一寸六分;二曰員針,長一寸六分;三曰針,長三寸半;四曰鋒針,長一寸六分;五曰鈹針,長四寸,廣二分半;六曰員利針,長一寸六分;七曰毫針,長三寸六分;八曰長針,長七寸;九曰大針,長四寸。

(二)鑱針者,頭大末銳,去瀉陽氣。

(三)員針者,針如卵形,揩摩分間,不得傷肌肉,以瀉分氣。

(四)針者,鋒如黍粟之銳,主按脈勿陷,以致其氣。

(五)鋒針者,刃三隅,以發疾。

(六)鈹針者,末如劍鋒,以取大膿。

(七)員利針者,大如氂,且員且銳,中身微大,以取暴氣。

(八)毫針者,尖如蚊虻喙,靜以徐往,微以久留之而養,以取痛痹。

(九)長針者,鋒利身薄,可以取遠痹。

(十)大針者,尖如梃,其鋒微員,以瀉機關之水也。九針畢矣。

1) The names of the nine needles indicate the particular shape by which they differ from each other: The first one is called chisel needle, and it is 1.6 cùn long. The second one is called rounded needle, and it is [also] 1.6 cùn long. The third one is called spoon needle, and it is 3.5 cùn long. The fourth one is called sharp-edged needle, and it is [again] 1.6 cùn long. The fifth one is called stiletto needle, and it is 4 cùn long and 0.25 cùn wide. The sixth one is called rounded sharp needle, and it is [also] 1.6 cùn long. The seventh is called “autumn down” needle, and it is 3.6 cùn long. The eighth one is called long needle, and it is 7 cùn long. The ninth one is called big needle, and it is 4 cùn long.

2) The chisel needle has a large head with a sharp tip and [is used to] drain away yang qi.

3) The round needle is shaped like an egg [at the tip] and is used to rub in between the divisions [in the flesh]. You cannot damage the flesh with it. It is used to drain qi from the divisions [in the flesh].

4) The spoon needle has a tip that is sharpened like a millet grain. Its main application is pressing on the vessels, but do not allow it to sink into [the vessel itself].[17] You use it to make the qi arrive.

5) The sharp-edged needle has three edges and is used to bring long-term diseases to the surface.

6) The stiletto needle has a tip like the blade of a sword and is used to get rid of major pus.

7) The rounded sharp needle is large like yak hair, both round and sharp, and slightly larger in the center. It is used to get rid of fulminant qì.

8) The filiform needle is pointed like the proboscis of a mosquito. Keep it still to let the qi approach slowly, and it is tiny so you can leave it in for a long time in order to provide nourishment. Use it to get rid of painful impediment.

9) The long needle has a sharp edge and thin body, and can be used to get rid of distant impediment.

10) The large needle has a tip like a club, and its edge is slightly rounded. Use it to drain off the water in the joints. This concludes [my discussion of] the nine needles.

 

Line Eight

(一)夫氣之在脈也,邪氣在上,濁氣在中,清氣在下。

(二)故針陷脈則邪氣出,針中脈則濁氣出,針太深則邪氣反沉,病益。

(三)故曰:皮肉筋脈各有所處,病各有所宜,各不同形,各以任其所宜。

(四)無實無虛,損不足而益有餘,是謂甚病,病益甚。

(五)取五脈者死,取三脈者恇;奪陰者死,奪陽者狂,針害畢矣。

1) Now regarding the presence of qi in the vessels, evil qi is located on top, turbid qi in the middle, and clear qi below.

2) Therefore when you needle the in-caving vessels,[18] evil qi exits as the result. When you needle the vessels in the middle,[19] turbid qi exits as the result. When you needle too deeply, evil qi contrary [to your intention] becomes submerged, and the disease is aggravated.

3) Therefore it is said: ‘The skin, flesh, sinews, and vessels each have their specific locations, and diseases each have their specific appropriate treatments, each [of the Nine Needles] differs in shape, and each is in charge of what it is appropriate for.’

4) Without repletion and without vacuity, if you further take away from what is insufficient or add further to what is already in excess, this is what is called making the illness worse, aggravating the illness even more.

5) When you select the five vessels, death ensues. When you select the three vessels, feebleness ensues.[20] Taking the yīn by force means death.[21] Taking the yáng by force means mania. This concludes [my discussion of] injury from needles.

 

Line Nine

(一)刺之而氣不至,無問其數;刺之而氣至,乃去之,勿復針。

(二)針各有所宜,各不同形,各任其所為。

(三)刺之要,氣至而有效,效之信,若風之吹雲,明乎若見蒼天,刺之道畢矣。

1) When you pierce [the skin with a needle] and yet qì fails to arrive, do not ask about the number[22]; when you pierce and the qì arrives, in that case remove [the needle], and do not needle again.

2) The [nine types of] needles each have specific [conditions] that they are suitable for, each have a different shape, and each are in charge of their specific action.

3) The crux of needling is that when the qì arrives, it is efficacious. The proof of this efficacy is like the wind blowing away the clouds. It is as apparent as when you look at the blue sky. This concludes my discussion of the Dao of Piercing.

 

Line Ten

(一)黃帝曰:願聞五藏六府所出之處。

(二)岐伯曰:五藏五腧,五五二十五腧;六府六腧,六六三十六腧。

(三)經脈十二,絡脈十五,凡二十七氣,以上下,所出為井,所溜為滎,所注為腧,所行為經,所入為合,二十七氣所行,皆在五腧也。

(四)節之交,三百六十五會,知其要者,一言而終,不知其要,流散無窮。

(五)所言節者,神氣之所遊行出入也,非皮肉筋骨也。

1) The Yellow Emperor said: “I would like to hear about the locations where the five zàng organs and six organs emerge.”

2) Qí Bó answered: “The five zàng organs have their five shù transport points [each], to a total of five times five, or twenty-five, shù points. The six organs have their six shù points [each], to a total of six times six, or thirty-six, shù points.

3) There are twelve channel vessels and fifteen network vessels, to a total of twenty-seven [kinds of] qì. Above and below, these exit at the jǐng well points, stream out at the yīng brook points, gush out at the shù stream points, move along at the jīng river points, and enter at the uniting points. The movements of the twenty-seven qi all happens at the five shù transport points.

4) Regarding the interactions at the nodes, there are three hundred and sixty-five assembly points. If you know the crux of this, the entire situation can be explained in a single sentence. If you do not know the crux of this, your comprehension will be scattered to no end.

5) What I mean by nodes is the places where the shén qì exits and enters in its roaming. It is not a reference to skin, flesh, sinews, or bones.

 

Line Eleven

(一)觀其色,察其目,知其散復;一其形,聽其動靜,知其邪正。

(二)右主推之,左持而御之,氣至而去之。

1) Look at [the patient’s] complexion and observe their eyes, and you will know the scattering and returning [of the qì]. Make their physical body one and listen to their movement and stillness, and you will know [the state] of their evil and right [qì].

2) The right is the master and pushes [the needle in]; the left acts as support and drives [the needle]. The qì arrives, and then you remove [the needle].

 

Line Twelve

)凡將用針,必先診脈,視氣之劇易,乃可以治也。

(二)五藏之氣已絕於內,而用針者反實其外,是謂重竭。

(三)重竭必死,其死也靜,治之者,輒反其氣,取腋與膺。

(四)五藏之氣已絕於外,而用針者反實其內,是謂逆厥。

(五)逆厥則必死,其死也躁,治之者,反取四末。

(六)刺之害,中而不去,則精洩;害中而去,則致氣。

(七)精洩則病益甚而恇,致氣則生為癰瘍。

1) In all cases, when you are about to employ needles, you must first diagnose the flow in the vessels and observe the agitation or ease of the qì. Only then can you treat [the patient] by means of [this knowledge].

2) If the qì of the five zàng organs has already expired on the inside and yet your use of needles contrary [to your intentions] makes the patient replete on the outside, this is referred to as doubling the exhaustion.[23]

3) Doubling the exhaustion is bound to lead to death, and this kind of death will be [marked by] stillness. Treating the patient like this means that you have willfully mishandled their qì,[24] by choosing the armpits and chest [as treatment sites].[25]

4) If the qì of the five zàng organs has already expired on the outside and yet your use of needles contrary [to your intentions] makes the patient replete on their inside, this is referred to as counterflow reversal.

5) Counterflow reversal is bound to lead to death, and this kind of death will be one [marked by] agitation. Treating the patient like this means that you have chosen the four branches[26] contrary [to the proper treatment/to your intentions].

6) Regarding injuries from piercing, if you strike the target and then fail to remove the needle, essence drains out as the result. If you fail to strike the target[27] and then remove the needle, you cause the qì to arrive.

7) Draining essence results in even greater aggravation of the illness and in weakness. Causing the qì to arrive results in the formation of abscesses.[28]

 

Line Thirteen

(一)五藏有六府,六府有十二原,十二原出於四關,四關主治五藏。

(二)五藏有疾,當取之十二原。

(三)十二原者,五藏之所以稟三百六十五節氣味也。

(四)五藏有疾也,應出十二原,而原各有所出,明知其原,睹其應,而知五藏之害矣。

1) The five zàng organs have six [associated] organs, and these six organs have twelve sources. The twelve sources exit at the four passes.[29] The four passes rule in the treatment of the five zàng organs.

2) When the five zàng organs are diseased, we ought to select these twelve sources [for treatment].

3) Regarding the twelve sources, these is where the five zàng organs are endowed with the qì and flavor from the three hundred and sixty-five nodes.

4) When there is disease in the five zàng organs, a response exits at the twelve sources. The twelve sources each have locations where they exit. If you clearly know these sources and observe their responses, you will know the harm that is affecting the five zàng organs.

 

Line Fourteen

(一)陽中之少陰,肺也;其原出於太淵,太淵二。

(二)陽中之太陽,心也;其原出於大陵,大陵二。

(三)陰中之少陽,肝也;其原出於太沖,太沖二。

(四)陰中之至陰,脾也;其原出於太白,太白二。

(五)陰中之太陰,腎也;其原出於太溪,太溪二。

(六)膏之原,出於鳩尾,鳩尾一。

(七)肓之原,出於脖胦,脖胦一。

(八)凡此十二原者,主治五藏六府之有疾者也。

(九)脹取三陽,飧洩取三陰。

1) Shàoyīn in the yáng aspect is the lung. Its source exits at tàiyuān (Great Abyss). Tàiyuān consists of two points [on the right and left].

2) Tàiyáng in the yáng aspect is the heart. Its source exits at dàlíng (Supreme Mound). Dàlíng consists of two points.

3) Shàoyáng in the yīn aspect is the liver. Its source exits at tàichōng (Supreme Thoroughfare/Surge). Tàichōng consists of two points.

4) Zhìyīn in the yīn aspect is the spleen. Its source exits at tàibāi (Supreme White). Tàibái consists of two points.

5) Tàiyīn in the yīn aspect is the kidney. Its source exits at tàixī (Supreme Ravine). Tàixī consists of two points.

6) The source of gāo exits at jiūwěi (Turtledove Tail). Jiūwěi is a single point.

7) The source of huāng exits at bóyāng (Navel). Bóyāng is a single point.

8) In all cases, these twelve sources are the ruler in treatment when the five zàng and six organs are diseased.

9) For distention, select the three yáng; for swill diarrhea, select the three yīn.

 

Line Fifteen

(一)今夫五藏之有疾也,譬猶刺也,猶污也,猶結也,猶閉也。

(二)刺雖久,猶可拔也;污雖久,猶可雪也;結雖久,猶可解也;閉雖久,猶可決也。

(三)或言久疾之不可取者,非其說也。

(四)夫善用針者,取其疾也,猶拔刺也,猶雪污也,猶解結也,猶決閉也。疾雖久,猶可畢也。

(五)言不可治者,未得其術也。

1) Now when the five zàng organs have a disease, we can compare this to a thorn, to filth, to a knot, or to an obstruction.

2) Even though the thorn has been there for a long time, we can still pull it out. Even though the filth has been there for a long time, we can still make it white like fresh snow. Even though the knot has been there for a long time, we can still untangle it. Even though the obstruction has been there for a long time, we can still dredge it.

3) The fact that some people say that chronic illness cannot be removed is not persuasive.

4) Now, skill in using needles means removing the patient’s disease, just like pulling out a thorn, cleaning away filth, untangling a knot, or dredging an obstruction. Even though it is chronic, it can still be brought to an end.

5) Those who say that it cannot be treated have not yet attained this art.

 

Line Sixteen

)刺諸熱者,如以手探湯;刺寒清者,如人不欲行。

(二)陰有陽疾者,取之下陵三里,正往無殆,氣下乃止,不下復始也。

(三)疾高而內者,取之陰之陵泉;疾高而外者,取之陽之陵泉也。

1) Needling the various heat conditions is like testing boiling water with one’s hand. Needling clear cold conditions is like a person who does not want to leave.[30]

2) When there is a yáng disease in yīn,[31] select [zú]sānlǐ.[32]  Address the problem straight on, without hesitation, and do not stop until the qì has descended. If it fails to descend, start again.

3) If the disease is high in the body and on the inside, select yīnlíngquán. If the disease is high in the body and on the outside, select yánglíngquán.

 

[1] According to a comment by Zhang Zhicong 張志聰, quoted in the Lingshu Shi 靈樞識, this phrase can be explained as follows: “Understanding its organizing principles makes it easy to use. Grasping its heart makes it difficult to forget (明其理則易用。持於心則難忘).”

[2] According to a comment by Zhang Jiebin quoted in the Lingshu Shi, “‘Easy to expose’ means that the standard rules are easy to calculate. ‘Difficult to enter’ means that the subtleties are hard to attain (易陳者常法易計也。難入者精微難及也).”

[3] Read literally, means mountain passes, narrow spaces that things have to pass through, which can be opened or shut, and from there by implication the closures themselves, in the sense of “barriers.” Here, the term might refer to either the locations of passages that can be opened or closed, or the mechanism of opening and closing. It can possibly also be interpreted in the narrower sense of joints, or more broadly as the problem of restricted flow in the extremities. Looking at early illustrations of acupuncture prohibitions (such as the ten illustrations for prohibited points in pregnancy found in the Ishimpo 醫心方, it appears that less sophisticated practitioners in fact might have tended to concentrate on the extremities in their treatments.

[4] Based on the Shuowen definition of as “apertures,” ( 竅也),  the term appears to refer here to the points directly, to the fact that detecting vacuity and repletion is as simple as knowing where the points are (the standard classical term for acumoxa points, after all does mean “holes”), and that you can determine or affect the qi dynamic from these points of emptiness, cavities, or holes.

[5] I.e., be aware of whether the qi is arriving or leaving.

[6] The Jiayijing 甲乙經 has (“superior”) here instead of (“expert”). Given the similarity between these two characters, it is quite possible that is a scribal error. In either case, the meaning is obvious.

[7] In the minds of most commentators, “counterflow” describes a situation when the qi is moving towards you, while “going with the flow” refers to the qi moving away from you. In any case, the line seems to say that we must not act hastily to force the coming and going of the qi but instead cultivate a state of 清淨 (“clear and still”) to know the perfect timing for the most subtle of actions.

[8] While bi can also mean “to ensnare,” I interpret it here as “to conclude” and read 針道 as the title of a text or section of the chapter based on a very similar line at the end of the exposition on the Nine Needles.

[9] According to the traditional understanding of this line in commentaries, this means that you insert the needle quickly and decisively but remove it gently and slowly while moving it around to leave a generous hole for the repletion evil to exit.

[10] The meaning of this phrase is unclear to me. According to the commentary, yang refers to the superficial layer of the skin and this is a reference to making a large hole for the needle to facilitate the expulsion of evil qi.

[11] According to the commentary, this describes a situation where the practitioner mistakenly pushes on the needling hole, thereby closing it up and causing blood and qi to be congested on the inside.

[12] Note that the character (“haphazard”) is in the Jiayijing 甲乙經 replaced with the character “forgetful.” In either case, the meaning is similar, that the practitioner needles without a clear rational plan and intention but responds to the qi from an irrational plane of consciousness.

[13] The standard reading of this phrase is that the left hand is used to push down on the insertion point immediately after the right hand has removed the needle, to prevent qi from escaping on the one hand, and blood from accumulating on the other.

[14] One commentator compares the firm hand to the strength of a crouching tiger. Historically, some commentators have claimed that (treasure) is a mistake for (repletion). Nevertheless the fact that the JIayijing also has here strongly suggests that we need to read it as such.

[15] My translation obviously requires a lengthy explanation. Most likely, this line is fairly corrupted and therefore quite difficult to reconstruct. As such, it has been the subject of much scholarly debate for centuries.

The commentary from the Lingshushi 靈樞識 states: 甲乙必作心。衛作衡。張云:懸、猶言舉也。陽、神氣也。凡刺之時必先舉神氣為主故曰懸陽。兩衛者衛氣在陽肌表之衛也。脾氣在陰臟腑之衛也。二者皆神氣所居。不可傷犯。凡用針者首宜顧此故曰兩衛。In the Jiayijing, the character “must” is replaced with “heart”, and the character “defense” is replaced with “balance beam, arm of a steelyard,” and from there “equilibrium.” In that case the first phrase could be interpreted as: “When you are just about to pierce, the heart is at the level of suspended yang and reaches a state of equilibrium by conjoining the two (??). According to Zhang [Jiebin] however, “suspend” should be interpreted as “to raise up.” He explains yang as referring to shen qi 神氣 and reads the line as “Whenever you pierce, you must first focus on lifting up the shen qi.” He further explains the “pair of qi” 兩氣 as referring to the yang aspect of wei qi, which means the defense in the fleshy exterior, and the yin or zangfu aspect of wei qi, which means the spleen qi. These two are where the shen qi resides, and these must not be injured. Therefore it is of primary importance whenever you employ needles that you pay attention to this dimension of the two defenses.

[16] I tend to read this as referring to the practitioner’s shen, but it could of course also refer to the patient’s shén, in the sense that you must preserve it instead of losing it. Based on that, you can diagnose whether the disease has left and treatment been successful. This is the reading suggested by modern commentaries. I have purposely left it open to both possibilities in my translation.

[17] I.e. you do not allow it to penetrate into the skin.

[18] According to the 靈樞識 commentary and most modern commentaries, “this refers to the sunken vessels on the head, since they are clearly sunken into the bone. …These are the opposite of 陽明合mentioned below.” On a more literal level, though, we can interpret as “from the top down,” as is suggested by the Shuowen definition as 𠄟. In that case it would simply mean to needle from the head down. Yet another commentary tradition interprets the phrase as simply referring to all acupuncture points, as most of the xue (“holes”) are, after all, found in indentations in the body.

[19] According to some commentators, this is a reference to yangminghe 陽明合, or in other words, zusanli 足三里.

[20] For information on what the “five vessels” and “three vessels” means, see Lingshu 3. Most  commonly, this is interpreted as referring to the five yīn vessels associated with the five zàng organs and to the three yáng vessels, respectively.

[21] The Jiayijing here has “reversal” (Wiseman) or “inversion” (Hood) instead of “death”.

[22] I.e., do not ask how many times it may be appropriate to needle that particular patient or how many points you should use, because you should needle as many times as necessary until you can feel that the qì has arrived.

[23] The clinical reasoning behind this line is that the physician is here erroneously supplementing yáng further even though the patient is already suffering from a yīn vacuity, thereby further aggravating the superabundance of yáng at the cost of yīn. The opposite reason applies to the following situation where an existing vacuity on the outside, or in other words in the yáng aspect of the body, is further aggravated by erroneous supplementing of yīn.

[24] My reading of fǎn here is based on the similar phrase in the following line. Alternatively, the word could here also be interpreted as “reversing the direction of the qì flow.”

[25] According to Zhang Jiebin’s commentary, the armpits and chest are the place where the channels of the zang organs emerge. If qi has already expired on the inside and yet you lead the qi to the outside, you thereby compound the problem.

[26] 四末: This expression refers to the four extremities. According to Zhang Jiebin’s commentary, “the four branches are the root of all the yang. When qi has expired on the outside and yet you choose the root, you cause yin qi to arrive there and cause yang to cave in even further” 四末為諸陽之本。氣於外而取其本,則陰氣至而陽愈陷矣。

[27] An almost identical line in the chapter on Heat and Cold Disease (寒熱病) has 不中而去 (“If you have failed to strike the harm and remove the needle…”), which makes perhaps more sense, since the entire line 12.6 refers to two needling mistakes and their pathological results.

[28] Following commentary tradition, I read 癰癢 as a textual error for 癰疽.

[29] According to commentary tradition, the “four passes” (sì guān 四關) refer to the elbows and knees, in the sense that the various shù points (well, brook, source, stream, river, and uniting points) of each channel are all located on the distal parts of the arms and legs without passing the elbows and knees.

[30] According to the commentary this describes a person who is reluctant to set out on a journey and leave behind his or her loved ones.

[31] I.e., in the yīn aspect of the body, or in other words, when a yáng evil is affecting the zàng organs on the inside.

[32] Xiàlíng 下陵 (Lower Mound) is an alternate name for zúsānlǐ.