N.V.N. Edition. Translated from the French by Edward S. Garbacz, MD With Additional Commentary by Sean Christiaan Marshall, D. Ac.

Transcription

1 Nguyen Van Nghi Tran Viet Dzung Christine Recours-Nguyen huangdi neijing LINGSHU Volume II Books IV and V N.V.N. Edition Translated from the French by Edward S. Garbacz, MD With Additional Commentary by Sean Christiaan Marshall, D. Ac. Jung Tao School of Classical Chinese Medicine Rough Draft For JTS Students Only

2 7. Understanding the meaning of the Dao of Acupuncture is like becoming liberated from doubt, like awakening from a drunken state, like coming clearly out of a sleep. In contrast, those who do not understand the Dao remain mute before their patient; and mistakenly understanding, sufficiently enough, the cause of the evolution of the disease, he gropes along in the darkness in order to attempt discovering a solution.... Ma Yuan Tai Tang dynasty ( A.D.) 2 Rough Draft For JTS Students Only

3 no 8/9. INTRODUCTION We complete, finally, Volume II of the Lingshu which has demanded of us a sum of efforts and comprehension of several years. It was initially planned to split this work up into two volumes, but the abundance of commentaries has lead us to publish it in three works. This very old book, this cult book, has been subject over the centuries to numerous translations, transcriptions, discussions and analyses. There exists then inevitable archaisms and inherent linguistic difficulties in the evolution of the language, unrecognizable social and literary habits, customs/habits/type, climate, the pathology and philosophy of this time. We must appreciate the exact measure, placing it constantly in the context of the era; we must nullify the traps of what is left unsaid, allusions, hierarchical terms, obscure analogies and maxim phrases. In this manner, up to the present, none of the modern translations of the Lingshu, also deserving fut-elle, have statisfied us. One demands on the part of the translator to be an eminent historian and literary sinologist, and, above all, a grounded/grassroots/practical acupuncturist de terrain, rich in his own experience and an acupuncturist of culture/knowledge saturated with the great Chinese medical classics. Indeed, our work is not perfect; it presents/sets out again more or less, of uncertainties; most certainly we hope that physicians of the next generation will be able to improve it. But present-day physicians will be able to draw interesting teachings on the pathophysiology and therapeutics of Acupuncture/Moxabustion, to fill the gaps, to perfect the practice of acupuncture and to be urged to carry out research work according to the criteria of modern science, entirely respecting Daoist mind/ spirit/ thinking. 3 Rough Draft For JTS Students Only

4 This 2nd volume consists of Books IV and V. Book IV consists of 7 chapters and develops various themes: 10. _ Etiology, classification, therapeutics and prognostics of the extravagant and capricious syndromes of certain diseases of Yin and Yang nature (Yin Madnesses and Yang Madnesses). _ Diseases of Heat etiology and treatment: hemiplegia, quadriplegia, cutaneous pain, facial edema, limb spasms, ostealgia, deafness, bruxism, headaches, epistaxis, etc. _ Diseases of Afflux etiology and treatment: 9 types of cardialgia, 9 types of headache, deafness and buzzing, spinal pain, lumbalgias, gonalgias, nuchal pain, tonsillitis, epistaxis, disorders of behavior, disorders of diuresis, abdominal pains, limb flaccidity, etc. _ Erratic pain and cyclic pain and the therapeutic techniques of Top-Bottom and Left/Right-Right/Left. _ Singular diseases and treatment: yawning, hiccups, grief, trembling from cold, eructations, sneezing, muscular laxity, passage of tears, sialorrhea, sighing, tinnitus, biting the tongue.... Book V consists of 20 chapters and concerns the following studies: _ Attitudes of the sage: men of state and physicians. Favorable and unfavorable problems of Yin and Yang and problems of attachment to life and fear of death. _ Fundamental characteristics of the energy: ^6 Energies, Jing (quintessence), Qi (energy), Xin (interstitial liquids), Ye (viscous liquids), Xue (blood) and Mai (vessels). _ Studies of the 4 Seas and their transmittable points: Sea of Cereal Water, Sea of the Jingmai, Sea of Energy and Sea of Marrow. _ Five disorders of the energy and unfavorable phenomena of Yin and Yang. Method of conduction of the energy (Dao Qi). _ Etiology, classification, diagnosis and therapy of the intumescences. _ Five facial zones (Wu Guan) and the constant principles of examination of the complexions/colors. _ Treatment according to the build of the individual. _ Blood stasis and treatment. _ Properties of the pure and impure energy of the human organism. _ Solar and lunar movements in the determination of emptiness and fullness, growth and decline, of Yin and Yang. _ Acupuncture and the evolution of the disease according to the chains of production and destruction of the law of the 5 Movements. _ Analysis of the different types of dreams and treatment. _ Conformity of the energy of the body with that of the day divided into 4 seasonal periods and therapeutic principles of the Wu Shu (5 Shu antique points). _ Mechanism of triggering of disease as a function of the state of the musculoskeletal and epidermo-dermal systems. _ Favorable and unfavorable states of the 5 organs/6 bowels as a function of anatomic aspects (morphology, disposition...). _ Basic principles of medical reasoning of Acupuncture and Moxabustion Rough Draft For JTS Students Only

5 In this way, present-day acupuncture physicians saturated with scientific knowledge must work out of these ancient texts, knowing how with respect the archaic and magical aspects which saturate ipso facto Chinese thought of more than 3000 years beforehand and in drawing from new elements in order to, paradoxically, modernize the practice of their art. Scientific thinking and fundamental Chinese thinking are not contradictory. They are the perfect representation of the duality of the world. They are like Yin and Yang; they are at once opposed, indivisible and complementary. To possess these two modes of thought, these two types of medical knowledge, is to pose, more than every other, a serene, critical and universal look at medicine. The reading of the Lingshu remains one of the first acts to accomplish in order to reach there. Marseille, November 5, Rough Draft For JTS Students Only

6 no 12/13. Book IV Book IV consists of 7 chapters: Chapter 22: Yin Madness and Yang Madness (Dian Kuang) Chapter 23: Diseases of Heat (Re Bing) Chapter 24: Diseases of Afflux (Jue Bing) Chapter 25: Causes of Disease (Bing Ben) Chapter 26: Various Diseases (Za Bing) Chapter 27: Erratic and Cyclic Pains (Zhou Bi) Chapter 28: Oral Questions (Kou Wen) 6 Rough Draft For JTS Students Only

7 no 14/15. CHAPTER XXII Yin Madnesses and Yang Madnesses (Dian Kuang) Chapter 22 of the Lingshu is devoted to the study of the Yin-Madnesses and the Yang-Madnesses (Dian Kuang). Pathological approaches to these illnesses are grouped together in several phases from which the syndromes are classified and treated according to the principle of choice of the channels as a function of the 4 seasons. The causes of Calm Madnesses and Agitated Madnesses are not beyond the scope of sadness, chagrin, fear, fright, worry, excessive joy, orientation of the essential energy toward insufficiency, digestive disturbance... and treatment must be based on deep analysis of the syndromes. This chapter of the Lingshu does not deal with mental disorders. The term Dian Kuang does not in any way signify manic-depressive psychoses, but madnesses in the sense of designating the excessive and capricious prodromes of some illnesses of Yin nature and Yang nature and, particularly, illnesses called Contrary Afflux (Jue Ni). This chapter consists of 22 paragraphs. 7 Rough Draft For JTS Students Only

8 PARAGRAPH 1 The ocular angle split toward the external part of the cheekbone is Wai Zi (external canthus of the eye), and the angle directed toward the side of the nose, Wei Zi (internal canthus of the eye). The upper eyelid belongs to Wai Zi, and the lower eyelid, to Nei Zi. EXPLANATIONS AND COMMENTARIES 16. I - Zhang Shi explains: The energy of Taiyin controls the maintenance of the canthii of the eyes, that of Taiyang involves the upper eyelid and that of the Yangming, the lower eyelid. Therefore, to speak of the upper eyelid belonging to Wai Zi and the lower eyelid belonging to Nei Zi is to speak of the energy of Taiyang and Yangming also controlling the canthii of the eye. The Hand Taiyin (Lu) responds to Heaven and Foot Taiyin (Bl), to Earth. Taiyang controls the opening (of the eye) and Yangming, the closing. The energy of Heaven and that of Earth lights the day and darkens the night. Such is the response of man to day and night, to the opening and closing, of Heaven and Earth. During one respiration, the opening and closing are intended to respond to the expiratory movement, inspiratory movement and the clepsydra. Is the energy of opening and that of closing are not evident, Yin energy and Yang energy are without distinction, Shen (mental) and Chi (will) lose their connection in growing dark, and transform into Dian Kuang (Yin Madnesses and Yang Madnesses). This is why treatment of these illnesses especially consists of needling the points of the Taiyang, Taiyin and Yangming channels of the foot and hand. II - Ma Shi clarifies: Paragraph 1 demonstrates the external energetic morphology of the eye because the eyes are the sites of manifestaion of the Jing Shen (pure energy and mental) of the organs and bowels and because examination of the Shen at the level of the eyes constitutes the first diagnostic action in the illnesses called Yin Madnesses/Yang Madnesses. III - N.V.N.: The external energetic morphology of the eye can be diagrammed in the following fashion: Rough Draft For JTS Students Only

9 Figure 1: Energetic morphology of the eye. PARAGRAPH 2 At its start, the Dian illness (Yin Madnesses) manifests by the following signs: _ sadness _ feeling of heaviness of the head and headaches _ gaze fixed toward the top and redness of the eyes. At a more advanced degree: _ anxiety, restlessness Examine well Tian Ding (1) and needle the points belonging to the Taiyang, Yangming and Taiyin; stop treatment as soon as the complexion changes. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: The Dian illnesses (Yin Madnesses) and Kuang illnesses (Yang Madnesses) are due to an obstruction of the Yin and Yang energy of the bottom, causing an afflux toward the top. Shaoyin is a priori (innate) Water-Fire and Taiyin is a posteriori (acquired) Earth.... The Water-Fire energy of Heaven and Earth must be balanced above and down below; the opposite is synonymous with illness. 1. Frontal area (forehead). 9 Rough Draft For JTS Students Only

10 The Jing (quintessence) of Water is the Chi (will) and the Jing of Fire is the Shen 18. (mental). When the Shen and Chi are not at ease, they manifest as sadness. Fixed upward gaze and redness of the eyes are phenomena due to an afflux of the energy of the heart. Anxiety, restlessness is the result of the contrary flow (afflux- Jue Ni) of the energy encroaching on Taiyang and Yangming and also on Jueyin (XB). To examine Tian Ding is to observe the complexion (Heaven) located in the inter-eyebrow space. The upper half of the body is Yang and is controlled by the Hand Taiyin (Lu) and Hand Yangming (LI). This is why needling these two channels permits purifying the energy of this part of the body; and needling the Hand Taiyang (SI) permits cooling the Jueyin (XB) to suppress the anxiety. The heart controls the blood. As a result, during needling, the change in color of the blood (complexion) is a sign attesting that the Shen Qi (mental energy) is purified, the determining condition of cure of the Dian illnesses (Calm Madnesses). II - Ma Shi clarifies: From this paragraph to Paragraph 8, study is centered on the classification of the Dian illnesses whose beginning signs are demonstrated in Paragraphs 2, 3 and 4. The Hand Taiyang (SI), Hand Yangming (LI) and Hand Taiyin (Lu) are the 3 specific channels in the treatment of the beginning signs of the Dian illnesses (Yin Madnesses). III - N.V.N.: The points of these 3 channels recommended by Zhang Jing Yue ( A.D.) are: 1 - Hand Taiyang (SI): _ Zhizheng (SI 7), Luo point (needle depth 0.3 cun, moxa 3 times) and Xiaohai (SI 8), He point (needle depth 0.2 cun, moxa 3 times) 2 - Hand Yangming (St): _ Pianli (LI 6), Luo point (needle depth 0.5 cun, moxa 3 times) and Wenliu (LI 7), Xi point (needle depth 0.3 cun, moxa 3 times). 3 - Hand Taiyin (Lu): _ Taiyuan (Lu 9), Luo point (needle depth 0.2 cun, moxa 3 times) and Lieque (Lu 7), Luo point (needle depth 0.2 cun, moxa 7 times). PARAGRAPH At its start, the Dian illness (Yin madnesses) manifests by such signs as: _ deviation of the mouth and moaning _ dyspnea _ palpitations and fear. Examine the Hand Yangming (LI) and Hand Taiyang (SI) and needle the left side if the right side is tense or the right side if the left is tense; stop treatment as soon as the complexion changes. 10 Rough Draft For JTS Students Only

11 EXPLANATIONS AND COMMENTARIES I - Ma Shi explains: With deviation of the mouth accompanied by moaning or dyspnea, palpitations and fear... one must needle the Hand Yanging (LI) and Hand Taiyang (SI). The tension is not pathologic if it is bilateral; it becomes so when it manifests on a single side. This is why one needles the side opposite the affected side and interrupts the needling upon change of the complexion. II - Zhang Shi states: This paragraph demonstrates the mechanism of obstruction/afflux of the energy, causing disturbances of opening and closing, determinant factors of the Dian illnesses. Tears, cries and fear originate from disturbances of the energy of Taiyang. Dyspnea is due to the impurity of the energy of Yangming. Yet, the energy of Taiyang governs opening and that of Yangming, closing. This is why the above-cited pathologic signs originate from these two channels. Ma Men Zung states: The Hand Taiyang (SI) constitutes the external system of the heart and the Hand Yangming (LI), the external system of the lung. As a result, tears and fear originate from the heart and dyspnea, from the lung. Tears, anxiety, dyspnea therefore result from the impurity of the energy of the opening and closing. In this case, the illness localizing at the exterior goes to reach the interior. (2) III - N.V.N.: The notions of closing-opening-hinge have been many a time demonstrated and described in our works since Their complete assimilation permits the appreciation of the permanent mobility of the energy of the 3 Yang, Taiyang, Shaoyang, Yangming, from which all energetic pathology result. PARAGRAPH At its start, the Dian illness (Yin madnesses) manifest in the first place by stiffness of the body, then by spinal pain. Needle the Foot Taiyang (Bl), Foot Yangming (St), Foot Taiyin (Sp) and Hand Taiyang (SI); interrupt the needling as soon as the complexion changes. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: Stiffness of the body results from the obstuction/afflux of the energy at the level of the Taiyang (Water-Cold). Root. 2. The explanation of Ma Men Zung justifies treatment according to the technique called Summit- 11 Rough Draft For JTS Students Only

12 Spinal pain comes from the encroachment of the cold energy on Earth. This is why one must needle the Foot Taiyang (Bl), Foot Yangming (St) and Foot Taiyin (Sp). According to Liang Zhen: The previous 3 paragraphs (2, 3, 4) only broach the starting phase of Jue Ni (Obstruction/Contrary Afflux) at the level of the Taiyin, Taiyang and Yangming channels, that is to say, at the level of the energetic layers and not the anatomic layers. The illnesses still within the energetic layers can easily be purified and dispersed. They become incurable from their penetration into the anatomic layers. As a result, the Dian illnesses localizing in the bones, muscles... are usually fatal. (3) The good physician treats the prodromes, while the poor physician waits until illnesses are declared before applying therapy. II - N.V.N.: a - Translations into Western language have completely changed the spirit of the text. Here, it concerns stiffness of the body with spinal pain due to an obstruction/afflux of the energy and not epilepsy (!). b - The points recommended by Zhang Jing Yue are: 1 - Foot Taiyang (Bl): Weizhong (Bl 40), Feiyang (Bl 58), Pushen (Bl 61) and Jinmen (Bl 63). 2 - Foot Yangming (St): Sanli (St 36) and Jiexi (St 41). 3 - Foot Taiyin (Sp): Yinbai (Sp 1) and Gongsun (Sp 4). 4 - Hand Yangming (LI): Pianli (LI 6) and Wenliu (LI 7). PARAGRAPH 5 In the struggle against the Dian illnesses, the physician is advised to be at the bedside of the patient often in order to observe the evolution of the disease and determine the channel to needle. 21. During the crisis, one must carefully study the channel affected and practice bleeding. The blood conserved in a gourd will coagulate by the next crisis; if not, apply 20 moxas to the coccyx. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: This paragraph shows the therapy of the Dian iillnesses according to the principle of distinction of the water energy and fire energy, of the energy of Heaven and energy of Earth. The Fire of Taiyang is the Sun. The Water of Taiyin is the Earth. During bleeding to diagnostic and therapeutic ends, it is recommended to conserve the blood in a container made of the skin of gourd and observe the phenoenon of coagulation. Coagulation of blood comes from the passage of the energy of the afflux toward the Hand Taiyin (Lu) and Hand Taiyang (SI) conforming to the sensitivity of the energy of the Taiyang within the natural world. Dian Kuang. 3. This phrase corroborates our opinion on the misinterpretation of the old translation of the term 12 Rough Draft For JTS Students Only

13 In contrast, non-coagulation results from the deep penetration of the energy of the afflux into Earth-Water. This is why one must apply 20 moxas to Changqiang (GV 1). The Neijing said: When the vessels are retained at the bottom, one must apply moxabustion. In our case, the illness is maintained at the level of 2 channels, Foot Taiyang (Bl) and Foot Taiyin (Sp). One must then apply moxabustion at the level of the coccyx, site of reunion of the 3 vessels: Taiyang (Bl), Taiyin (Sp) and Dumai (GV), Figure 2: Changqiang (GV 1): reunion-meeting point of the 4 vessels (CV, GV, Taiyang, Taiyin). PARAGRAPH Dian of the bones (Gu Dian) is an ailment deeply reaching the bones and marrows. The clinical signs are: _ blockage and swelling of the Shu (kinetic) points and of the areas of distribution of the flesh, etc... _ weight loss _ sweating and anxiety _ frothy vomiting _ flowing out of the energy toward the bottom. The illness is incurable. 13 Rough Draft For JTS Students Only

14 EXPLANATION AND COMMENTARIES Zhang Shi explains: Here, it concerns illness of the Foot Shaoyin (Ki) contaminating the Hand Shaoyin (He). Frothy vomiting is due to the ascent of the energy toward the top, rising up to the exterior. The kidney is the source organ of the production of the vital energy. The energy flowing out toward the bottom belongs to the Shaoyin. Therefore, one witnesses a phenomenon of concomitant escape of Yin and Yang, from the bottom and top. The illness is therefore incurable and the text does not propose treatment. This paragraph and the following two deal with material illnesses (having form: Xing), that is to say, illnesses at the level of the bones and muscles. This is why one does not speak of Yin and Yang of Tai (Yang) and of Shao (Yin). PARAGRAPH 7 Dian of the muscles (Jin Dian) is an ailment which deeply reaches the muscles and is characterized by such signs as: _ asthenia _ spasm _ rapid and changing (Da) pulse. It is advised to needle Dazhu (Bl 11) belonging to the great vesselchannel of the neck. If these signs are accompanied by frothy vomiting and flowing out of the energy toward the bottom, the illness is incurable. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: The pulse is always changing (Da) in Jin Dian. 23. The Foot Taiyang (Bl) maintains the muscles in water. This is why one needles Danzhu (Bl 11), located in the 1st intercostal space, 1.5 cun to the side of the 1st dorsal vertebral apophysis, to 0.5 cun depth and apply 7 moxas. Vomiting and flowing out of the energy toward the bottom... denotes that illnesses of the organs/bowels are material illnesses having escape of the energy as a consequence. II - N.V.N.: Danzhu (Bl 11), reunion point of the bones is not only specific on the treatment of bony ailments, but also in the treatment of neuro-psychiatric illnesses, particularly psychasthenia. 14 Rough Draft For JTS Students Only

15 Figure 3: Dazhu (Bl 11): reunion-meeting point of 3 vessels: Foot Taiyang, Hand Taiyang, Hand Shaoyang. PARAGRAPH 8 Dian of the vessels (Mai Dian) is characterized by a sudden fall. The vessels at the level of the 4 limbs are edematous and lax and the pulse is full. One must urgently practice bleeding by acupuncture. 24. If the pulse is not full, one must perform moxabustion at the Taiyang located at the neck, at Daimai (GB 26), 3 cun from the lumbar vertebrae and at the dorsal Shu points of the region of the distribution of the flesh. If these signs are accompanied by frothy vomiting and flowing out of the energy toward the bottom, the illness is curable. 15 Rough Draft For JTS Students Only

16 EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: The Jingmai play the role of softening the tendons and bones and insures joint movements. Therefore, the individual affected by Dian Illnesses falls down. The 12 Jingmai manifest at the Jing, Ying... points of the hands and feet. This is why, when they are affected by the Dian illness, they are swollen and slack. In this case, one must perform bleeding by acupuncture. If concerns the illness retained at the bottom, at the Foot Taiyang (Bl); it is advised to apply moxabustion at the point of the Foot Taiyang (Bl) of the cervical region. The Daimai (vessel of the belt) starts at Zhangmen (Li 13), at the level of the false ribs, arrives at the point of the same name, Daimai (GB 26), encircles the body and links the Jingmai of this region, among which is the Foot Taiyang (Bl). The point Daimai (GB 26) is located 3 cun below the tip of the 11th rib. II - N.V.N.: a - We can cite Zhang Jing Yue: Treatment of this illness (Mai Dian), when the vessels are edematous and slack, consists of needling to bleed them. In the opposite case, one must apply moxas to the points Tianzhu (Bl 10) and Dazhu (Bl 11) of the Foot Taiyang (Bl), Daimai (GB 26) of the Foot Shaoyang (GB) and to the points located in the small valleys (Xi) and valleys (Gu) at the level of the swollen and slack regions. According to the book entitled Classification, Diagnosis and Treatment, the flowing out of the energy toward the bottom implies an escaping of the energy of the kidney. This Emptiness- Escaping of the energy is fatal. b - The Daimai (belt channel), starting at Zhangmen (Li 13), is an important notion to retain. (Figure 4) 25. Figure 4: Point of beginning of the Dumai (belt channel). 16 Rough Draft For JTS Students Only

17 PARAGRAPH 9 The rapid evolution of Dian (Yin madness) illness, like that of Kuang (Yang madness), is fatal, therefore incurable. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: Fullness of Yin is the origin of the Dian illness, and that of Yang, the Kuang illness. The speed of the manifestation of Dian, like that of Kuang, originates from the concomitant disturbances of Yin and Yang; the illness is then grave. Clinically, one must always recall that Zhong Yin and Zhong Yang phenomena (concomitance or juxtaposition of Yin and Yang) are fatal. II - N.V.N.: Since 1969, with Chamfrault, we had translated Dian and Kuang as Yin Madness and Yang Madness (conforming to the explanation of Zhang Shi). Recall that the term manic-depressive psychosis does not designate Dian and Kuang which are two distinct illnesses. PARAGRAPH Kuang (Yang madness) illness starts first with sadness, then forgetfulness, anger and fear. Everthing comes from preoccupation and hunger. Treatment consists of needling the Hand Taiyin (Lu) and Hand Yangming (LI) until the change of color of the blood and also the Foot Taiyin (Sp) and Foot Yangming (St). EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: From this paragraph, the study is centered on Kuang illnesses organized into emptiness and fullness types.... first with sadness because the illness is secondary to the insufficiency of the kidney.... then forgetfulness and fear because the Shen-Chi (mental/will) is in emptiness.... anger comes from the emptiness of the liver with afflux of Yang (of the liver). Liver-Wood and Shen-Chi are created by the kidney. This Kuang illness always originates, on the one hand, from a state of mind in the grip of obsession qui anxiety or disturbance until moral suffering, and, other the hand, from a state of starvation. Worries, sadness... injure the lung and hunger slows the production of Cereal Jing (Gu Jing), hence insufficiency of the Jing of the Kidney. In this case, the insufficiency of Yin causes the fullness of Yang, determining factor of Kuang. One must needle in dispersion the Hand Taiyin (Lu) and Hand Yangming (LI) to combat 17 Rough Draft For JTS Students Only

18 blood stasis and exterminate the afflux phenomenon. The two channels, Foot Taiyin (Sp) and Foot Yangming (St), must be needled in tonification to augment the production of the Cereal Jing with the goal of maintaining the energy of the kidney. In the majority of cases, the Dian illnesses are due to the fullness of Yin, and the Kuang illnesses, to the emptiness of Yin. Bian Que (alias Qin Yue Ren-500 A.D.) said: The concomitance of Yin (Zhong Yin) manifests by Dian, and the comcomitance of Yang, by Kuang. These phenomena of concomitance are due to the emptiness of Yin with fullness of Yang or from the emptiness of Yang with fullness of Yin.. This means to say that if Yin is in emptiness, Yang is in fullness; one then must disperse Yang and tonify Yin. In pratice, one must always recall that the Jing Qi (Yin Quintessence) is produced by the Yangming (St) and that the Yang Qi (Yang energy) has its source in Yin. Such is one of the aspects of the reciprocal relationship of Yin and Yang. Understanding the antagonistic and complementary aspects of these 2 phenomena (Yin and Yang) permits advancing onto the true path of medicine. 27. II - N.V.N.: We recall again the teaching of Zhang Jing Yue: The insufficiency of Shen (Mental) is the cause of anxiety; preoccupation and disturbance of the Hun (vegetative soul) cause immoderate ambitions. The Jing (quintessence) then is found in shortage. Chi (will) in a disturbed state is the cause of forgetfulness. Invasion of the energy of the liver on the spleen causes anger and fits of rage. The insufficiency of blood is the cause of fear. All these signs originate from anxiety and hunger, which injures the energy of the organs. It is then advised to needle: _ Taiyuan (Lu 9) and Lieque (Lu 7) of the Hand Taiyin (Lu) _ Pianli (LI 6) and Wenliu (LI 7) of the Hand Yangming (LI) _ Yinbai (Sp 1) and Gongsun (Sp 4) of the Foot Taiyin (Sp) _ Sanli (St 36) and Jiexi (St 41) of the Foot Yangming (St) and leave the needles in place until the change of the complexion. PARAGRAPH 11 In the Kuang illness starting with such signs as _ insomnia and anorexia _ self-satisfaction and certainty of being skillful, intelligent and noble _ screaming and insults _ agitation day and night, one must needle the Hand Yangming (LI), Hand Taiyang (SI) and Hand Taiyin (Lu). Moreover, one must examine the sublingual area of the neck and the Hand Shaoyin (He) in order to perform needling in the event of fullness. 18 Rough Draft For JTS Students Only

19 EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: This paragraph shows the Kuang illness caused by fullness of the energy of the heart. Fullness of Yin energy causes hypersomnia, and fullness of Yang energy, insomnia. During penetration of cereal energy into the stomach, Jing Qi (quintessence) reaches the heart. When the energy is in fullness, the individual does not feel the sensation of hunger. The heart is sovereign organ. When the energy of the heart is in emptiness, the individual experiences the feeling of inferiority and thinks he is poverty-stricken, and, in the event of fullness of the energy of the heart, the individual is proud and arrogant and believes he is worthy and magnanimous. Screaming and insults originate from the fullness of Yangming. Fire-Heart in a state of fullness invades Fall-Metal. The lung is comparable to an umbrella covering the heart. When the fire rises up toward the top, the energy of Heaven becomes impure. This is why one must needle the Hand Taiyang (SI) to disperse the fullness of Fire-Heart and needle the Hand Yangming (LI) and Hand Taiyin (Lu) to cool and calm the illness, thereby reducing the invasive movement and revolt of the energy. This illness is of Shen Qi (mental) origin and not from Xue Mai (blood vessels) origin. One must examine well the sublingual area of the neck and bleed the Xue Mai of the heart in the event of fullness. In this way, therapeutically, in illnesses of the Shen Qi (psyche/mind), one must treat the bowel to purify the organ because the bowel is Yang responding to the energy. In contrast, if the illness of Shen Qi reaches the Xue Mai, one must treat the Luomai of the corresponding organ. II - Ma Shi clarifies: The previous paragraph demonstrates the precursor signs of Yang madnesses, and this one describes the beginning signs. III - N.V.N.: According to Zhang Jing Yue, 1 - The points used concerning the Hand Yangming, Hand Taiyang and Hand Taiyin channels are cited in the previous paragraphs. 2 - the sublingual area of the neck designates the point Lianquan (CV 23). (4) 3 - The points of the Hand Shaoyin are Shenmen (He 7) and Shaochong (He 9). PARAGRAPH 12 Kuang characterized by: _ logorrhea (5) _ fear _ groundless laughter _ obsession with music and singing 29. _ erring ways, bad habits is due to fright. One must needle the Hand Yangming (LI), Hand Taiyang (SI) and Hand Taiyin (Lu). 4. This point has a vessel which goes to the base of the tongue. 5. Pathologically incoherent, repetitious speech; incessant or compulsive talkativeness. 19 Rough Draft For JTS Students Only

20 EXPLANATIONS AND COMMENTARIES Zhang Shi explains: Here, Kuang illness first manifests at the kidney, then reaches the heart, triggering fear. Yin in an empty state and Yang in a full state becomes indicated by logorrhea and panic. The classics stated: Fullness of the enery of the heart becomes characterized by logorrhea, and emptiness, by sadness. In the event of fullness, Xin-Chi (heart-will) is compressed. This is why the individual likes to sing and listen to music to become calm. The combined disturbances of Shen and Chi direct the individual to run aimlessly. Treatment consists of needling the Hand Taiyang (SI) to purify the heart in a state of fullness and the Hand Yangming (LI) and Hand Taiyin (Lu) to maintain the kidney in a state of emptiness. PARAGRAPH 13 Kuang characterized by _ visual and auditory hallucinations _ and screaming is due to the loss of the energy. One must needle the Hand Taiyang (SI), Hand Yangming (LI), Hand Taiyin (Lu) and Foot Taiyin (Sp) and the 2 sides of the chin. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: Here, Kuang is due to the insufficiency of the energy of the kidney causing the emptiness of the energy of the heart. Above and down below, Fire (heart) energy and Water (kidney) energy support one another and become tempered. This is why the insufficiency of the kidney energy provokes the emptiness of the heart with appearance of the above-cited signs. It is recommended to needle the points of the Hand Taiyang (SI), Hand Taiyin (Lu) and Hand Yangming (LI) to purify hallucinations and to tonify Foot Taiyin (Sp) and Foot Yangming (St) to augment the production of the cereal energy (Gu Qi) because the 5 organs need the energy of Yangming to develop their functions. 30. The kidney is a water organ. It receives the Jing Qi (pure energy; quintessence) of the 5 organs (Figure 5). The energy (6) forms from Jing (quintessence). This classic has mentioned: The energy of the stomach ascends toward the top and projects into the lung. One part of this energy, via the pharyngeal route, rises up toward the head. On the one hand, it becomes exteriorized at the orifices (5 sense organs) and, on the other hand, it reaches the 2 sides of the chin up to the head. Here, our masters of old did not speak of the Foot Yangming (St), but mentioned the 2 sides of the chin to designate the facial portion of the Foot Yangming linked to the Shangjiao (UJ) and Zhongjiao (MJ). 6. Here, this indicates essential or vital energy. 20 Rough Draft For JTS Students Only

21 II - N.V.N.: The explanation of Zhang Shi allows us to understand the important role of reception of the Jing of the 5 organs at the level of the kidney (Figure 5). Figure 5: Kidney: receptor organ of the Jing of the organs. 21 Rough Draft For JTS Students Only

22 PARAGRAPH Kuang manifesting by such signs as: _ bulimia _ visual hallucinations _ silent laughing come from elation. One must needle first the Foot Taiyin (Sp), Foot Taiyang (Bl) and Foot Yangming (St) and then secondly the Hand Taiyin (Lu), Hand Taiyang (SI) and Hand Yangming (LI). EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: 1 - Excessive joy injures the Xin (heart) and Chi (will) causing the Xu Kuang (Kuang in a state of emptiness). Bulimia is due to emptiness of the energy of the heart and visual hallucinations, to the emptiness of Shen Qi (mental energy). 2 - During penetration of nutritional energy into the stomach, the impure energy reaches the heart. This is why one must first tonify the Foot Taiyin (Sp) and Foot Yangming (St) to maintain the Jing (quintessence) of the heart and the Foot Taiyang (Bl) to activate the production of organic liquid in order to temper the Shen Qi; then secondly needle the Hand Taiyang (SI) and Hand Yangming (LI) to disseminate the Kuang syndrome. 3 - In illnesses caused by the Foot Shaoyin (Ki), one must first needle the channels of the foot, and in the illnesses caused by the Hand Shaoyin (He), one must do the opposite. This is a marvelously effective method to reestablish the exchange of the energy of the top and bottom. II - N.V.N.: We have also noted in the Nanjing: During escaping of Yang, the individual perceives demons, and during escaping of Yin, vision is disturbed. PARAGRAPH 15 If Kuang is not as serious as in the previous case, it is advised to needle the 2 Ququan (Li 8) (left and right) at the side of an artery. If they are in fullness, one must make them bleed by acupuncture and cure is virtually instantaneous. If this is not the case, one must apply 20 moxas to the coccyx. 22 Rough Draft For JTS Students Only

23 EXPLANATIONS AND COMMENTARIES 32. Zhang Shi explains: Here it concerns a general study of Kuang during its first manifestations, being able to be cured by needling the point Ququan (Li 8). In summary, the Kuang illness originates from emptiness or fullness of the energy of the heart. In contrast, if it is due to the emptiness or fullness of the energy of the kidney, Water reaches Wood then arrives at Fire. This is why, at the starting phase of the Kuang illness without signs of sadness, fear, anger, visual hallucinations... cure can be obtained on the field by needling the poing Ququan (Li 8) because the disturbance manifests at the level of the energy of the liver without touching the Shen Qi. If cure is slowed, the application of 20 moxas to the coccyx is recommended to eliminate the pathogenic energy of the liver by the lower route. PARAGRAPH 16 as In Feng Ni (contrary afflux of wind) manifesting by such signs _ sudden edema of the 4 limbs _ trembling with cold _ anxiety during hunger _ displeasure during satiety one must needle the Hand Taiyin (Lu) and its external and internal relationships, the Foot Shaoyin (Ki) and Foot Yangming (St). If the individual feels cold in the muscles, one must needle the Ying-stream points, and if he feels cold in the bones, the Jing-well and Jingriver points. EXPLANATIONS AND COMMENTARIES Zhang Shi explains: Jue (afflux) is a massive arrival of energy, triggering factor of the Dian illness. 1 - The kidney is a water organ and wind is a force susceptible to displace the mass of water in the form of waves. As a result, Feng Ni (contrary afflux of wind) implies a massive attack of wind provoking a contrary flow (afflux/jue Ni) of the water energy of the Foot Shaoyin (Ki), hence sudden edema of the 4 limbs with shivers. 2 -Wind injures kidney water and causes emptiness of the heart energy (according ot he inhibitory law of the 5 movements). This is why the subject is anxious and annoyed when hungry. If perverse Wind-Wood injures the Center-Earth (spleen and stomach), the individual is usually agitated and angered when his appetite is satisfied To needle the system of external-internal, Yin-Yang relationship of the Hand Taiyin (Lu) is to liberate the perverse wind, and to needle the Foot Shaoyin (Ki) and Foot Yangming (St) is to harmonize the contrary afflux (Ni), thereby warming up the cooled energy. 23 Rough Draft For JTS Students Only

24 4 - To speak of cold of the flesh is to explain that the cold energy has reached the dermal system. Therefore, one must needle the Ying-Fire points in order to warm up the flesh and muscles conforming to the principle according to which Earth (spleen) governs heat and fire (heart) maintains Earth. The term cold in the bones implies that the perverse energy is still found within the water organ (kidney). One then must needle the Jing-well point to disperse (7) the perverse energy. 5 - Chu Ma Rong has said: To needle the external and internal realationship of the Hand Taiyin (Lu) is to perform a provoked sweat, as is made by Herba Ephedrae (Ma Huang), with the purpose of aerating the sweat glands, associated with Semen Armeniaca amarae (Xingren) to maintain Lung-Metal, because the aeration permits the energy of the interior to diffuse to the exterior. PARAGRAPH 17 In Jue Ni (contrary afflux) with such signs as: _ cold feet _ sensation of bursting of the thorax _ lancinating pain of the abdomen _ annoyance and anorexia _ large or small, steady or rapid pulse, if the body is hot, one must needle the Foot Shaoyin (Ki) if the body is cool, one must needle the Foot Yangming (St). In the event of coolness, one must tonify, and in the event of heat, one must disperse. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: This paragraph explains contrary afflux (Jue Ni) of the energy of the Foot Shaoyin (Ki). 1 - The kidney organ sends out a large vessel which exteriorizes at the point Qijie (other name Qichong-St 30). This vessel descends, runs alongside the inner thigh, arrives at the knee, reaches the internal malleolus and penetrates into the sole of the foot. For this reason, at the time of the contrary afflux of the energy of the kidney, the soles of the feet are icy cold. 2 - Sensation of bursting of the thorax... is due to a gathering of the energy which, from the abdomen, affluxes toward the heart and thorax The basic substance of the blood vessels come from the kidney.... The large or small, regular or rapid pulse results from the engorgement of the Jingmai following an contrary afflux of the energy of the kidney. 7. According to the Mother-Son rules. 24 Rough Draft For JTS Students Only

25 4 - The kidney is the source organ of the vital energy. The body is warm because the phenomenon called fullness-contrary afflux intervenes; one must disperse Foot Shaoyin (Ki). In contrast, the body is cold because the phenomenon called emptiness-contrary afflux intervenes; one must tonify Foot Yangming (St) to maintain the Jing (quintessence) of the kidney organ. 5 - The previous Paragraph 16 demonstrated the syndrome of afflux of external origin (Jue); this one deals with the syndrome of afflux of internal origin. These affluxes are the primary causes of the Dian illnesses. This is why the treatment of the Jue syndromes (afflux) constitutes a preventive method of these illnesses called Yin Madnesses (Dian). II - N.V.N.: 1 - Regarding the choice of points, Zhang Jing Yue recommends: _ Yongquan (Ki 1) and Rangu (Ki 2) of the Foot Shaoyin (Ki) and _ Lidui (St 45) and Neiting (St 44) of the Foot Yangming (St). These points are specific in the treatment of Jue Ni (contrary afflux). 2 - The large vessel (cited above by Zhang Shi), which exteriorizes at the point Qichong (St 30) and reaches the inner thigh to the sole of the foot, is the descending branch of the Chongmai (Firgure 6). Figure 6: Formation of the descending branch of the Chongmai. 25 Rough Draft For JTS Students Only

26 PARAGRAPH In Jue Ni (contrary afflux) characterized by such signs as: _ swelling and abdominal fullness _ boborygmi _ thoracic fullness with respiratory difficulty, one must needle the sub-thoracic points, at the two hypochondria, at the place where the cough responds to pressure of the hand, and the dorsal Shu (Bei Shu) points at the place where the patient experiences relief with the pressure of the fingers. EXPLANATIONS AND COMMENTARIES I - Zhang Shi instructs: This paragrph explains the illness caused by Jue Ni at the level of Taiyin and Yangming. Swelling and abdominal fullness indicate Jue Ni at the level of the Foot Taiyin (Sp) and Foot Yangming (St). Boborygmi indicates the presence of Jue Ni at the level of the Hand Yangming (LI). Thoracic fullness with difficulty breathing explains the evolution of Jue Ni toward the Hand Taiyin (Lu). The points located at the two hypochondria are none other than Zhongfu (Lu 1) and Yunmen (Lu 2) of the Hand Taiyin (Lu). II - N.V.N.: The sub-thoracic points mentioned, at the two hypochondria, do not belong to the Hand Taiyin (Lu) but to the Foot Jueyin (Li). According to Zhang Jing Yue, it concerns Zhangmen (Li 13) and Qimen (Li 14). Ma Shi also had spoken of these. Zhangmen (Li 13) is located below the tip of the 11th rib. This is the Mu point of the spleen and reunion point of the energy of the organs. The Nanjing states: The energy of the 5 organs reunites at Zhangmen (Li 13). Ailments of the organs are treated with this point. The Dacheng adds: This point treats boborygmi, swelling/abdominal fullness.... Qimen (Li 14) is located 3.5 cun to the side of Juque (CV 14), in the 6th intercostal space (Figure 7). 26 Rough Draft For JTS Students Only

27 36. Figure 7: Localization of Zhangmen (Li 13), Qimen (Li 14), Dabao (Sp 21) and Riyue (GB 24). PARAGRAPH 19 When the interior is obstructed, the illness manifests by oligoanuria. One must needle the Foot Taiyang (Bl) and Foot Shaoyin (Ki), as well as the point at the coccyx, with long needles. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: In this paragraph, the energy of Jue Ni does not gather at the top, but at the bottom, hence oligo-anuria. One must needle the Foot Shaoyin (Ki) and Foot Taiyang (Bl) and the point located at the coccyx in order to disseminate the afflux, thereby favoring diuresis. 27 Rough Draft For JTS Students Only

28 II - N.V.N.: 37. The points favoring diuresis recommended by Zhang Jing Yue are: _ Yongquan (Ki 1) and Jiaoxin (Ki 8) of the Foot Shaoyin (Ki) and _ Weizhong (Bl 40), Feiyang (Bl 58), Pushen (Bl 61), Jinmen (Bl 63) of Foot Taiyang (Bl). The point located at the coccyx is Changqiang (GV 1). (8) PARAGRAPH 20 In the Jue Ni syndromes, one must needle the Taiyin and Jueyin. In serious cases, it is advised to add the Shaoyin and Yangming. EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: This paragraph justifies the treatment of the Jue Ni syndromes. Because, when the energy of the afflux of the energy of the Foot Shaoyin (Ki) arrives in abundance at the heart to trigger the Dian Kuang (Yin Madnesses and Yang Madnesses), one must needle the Jueyin because the water energy maintains Liver-Wood and, from there, it reaches Heart-Fire. This is why, at the start of the illness, one must needle Ququan (Li 8) (9). If the case is serious, one must disperse the Foot Shaoyin (Ki). II - Ma Shi states: In the Jue Ni syndromes, it is advised to needle Foot Taiyin (Sp) and Foot Jueyin (Li). In serious cases, add Foot Shaoyin (Ki) and Foot Yangming (St) (Ex: Fuliu- Ki 7, Jiexi- St 41, etc.). PARAGRAPH 21 In syndromes of insufficiency of the energy characterized by such signs as: _ chills _ shortness of breath and cracked voice _ arthralgia _ sensation of heaviness of the body _ fatigue of the limbs with trouble moving, one must tonify the Foot Shaoyin (Ki). 8. All of these points are described in MTC- NVN Edition. 9. Ququan (Li 8) is the He point of the Foot Jueyin (Li) which responds to water. 28 Rough Draft For JTS Students Only

29 EXPLANATIONS AND COMMENTARIES 38. I - Zhang Shi explains: This paragraph concerns the insufficiency syndrome of the energy of the Foot Shaoyin (Ki), determining factor of the triggering of the illness called Xu Ni (Emptiness-Contrary Afflux). The heart governs speech and the lung, the voice. But they become manifest due to the active energy (Dong Qi) (10) of the kidney. As a result, in the insufficiency of the energy of the kidney, speech is no longer possesses its connected nature (11). In this case, it is advised to urgently tonify the Foot Shaoyin (Ki), that is to say, the root energy (source energy). II - N.V.N.: According to Zhang Jing Yue, this illness is due to emptiness of the Jing (quintessence) of the kidney, causing a contrary flow (Jue Ni), hence the necessity to tonify the Foot Shaoyin (Ki). PARAGRAPH 22 Short respiration is synonymous with a more or less prolonged suspension of respiration (apnea). It is gasping for breath with poorer effort. One must tonify the Foot Shaoyin (Ki) and bleed the Xue Luo (blood capillaries). EXPLANATIONS AND COMMENTARIES I - Zhang Shi explains: This paragraph justifies the reascent of the energy in a state of loss, susceptible to triggering the syndrome called Emptiness-Yang Madnesses (Xu Kuang), while the previous one demonstrates the syndrome of loss of the energy of the Foot Shaoyin (Ki), that is to say, the syndrome of insufficiency of the energy located down below. Short respiration originates from the energy in a state of insufficiency down below with encroachment on the top. Thus, one must tonify the Foot Shaoyin (Ki) and bleed the Xue Luo. II - N.V.N.: Paragraph 22 and the previous one concern the emptiness of the energy. One does not tonify the Hand Taiyin (Lu) (mother of energy) but the Foot Shaoyin (Ki) ( source of the energy) because Yang has its origin in Yin and energy is created from Jing (quintessence). Therefore, the search for the root of the illness represents a primary phase in Oriental medicine, necessary before any therapy. 10. The active energy is a very mobile, very dynamic energy which, at every moment, changes direction. 11. Difficulty forming sentences. 29 Rough Draft For JTS Students Only

30 39. CHAPTER XXIII Diseases of Heat (Re Bing) (1) Chapter 23 is devoted to the diseases of heat: classification and description of diseases, therapy and prognosis. The methods of needling of the different forms of the diseases of heat and their contraindications are clearly set forth. The description of the diseases of heat at the level of the different anatomic layers (skin, flesh, muscles, blood and vessels, tendons and bones) is based on the principles of the 5 Movements at the level of the channels (liver, heart, spleen, lung and kidney) in order to determine the therapeutic rules by acupuncture, The 59 energetic anti-heat points are mentioned. This chapter consists of 28 paragraphs. PARAGRAPH 1 In the syndrome Tian Ku (hemiplegia) (1), characterized by a painful paralysis of half of the body, without change in language and without disturbance of will (Chi), the disease is localized in the demarcation of the flesh (epidermo-dermal system); one must employ great needling in order to tonify the essential energy in a state of insufficiency and to disperse the perverse energy in a state of excess. 1. In any event, Re Bing cannot be translated as febrile diseases. 30 Rough Draft For JTS Students Only

31 EXPLANATIONS AND COMMENTARIES 40. I - Zhang Shi explains: Chapter 23 studies the diseases of heat of three different etiologies: _ exogenous etiology, caused by an infiltration of Wind-Cold _ endogenous etiology, following a syndrome of heat at the level of the 5 organs _ mixed etiology, resulting from simultaneous disequilibrium of the interior and exterior, of Yin and Yang, of the essential energy and perverse energy. Paragraph 1 concerns the disease of heat of external origin. Here, perverse Wind-Cold infiltrates into half of the body. Ying (nutritive) energy and Wei (defensive) energy grow weak, the source energy escapes and the perverse energy inserts itself alone, triggering Tian Ku (hemiplegia), with disturbance of motility and pain. The heart governs speech, and the kidney, Chi (will). Therefore, absence of change in language and disturbance of will indicates that the interior is intact and that the perverse energy is localized only at the exterior. One must then use the great needling method (Ju Zhen) to tonify the essential energy and disperse the perverse energy. II - N.V.N.: _ Regarding Tian Ku (hemiplegia), complementary studies are developed in the Suwen (Chapters 3 ( Relationship of the Vital Energy with that of Heaven ), 7 ( Special Study on Yin and Yang ), 42 ( Dissertation on Wind ), 48 ( Dissertation on the Great Singularities ), 75 ( Discourse on the Illustrious Teaching ) and 77 ( Analysis of the 5 Errors ) - N.V.N. Edition). _ Great Needling cannot be translated as a large needle because it concerns here an acupuncture technique opposite to that called needling in opposition (Mu Zhen) (see Suwen, Ch. 63 ( Disocurse on Needling on the Opposite Side ). One can therefore not correctly translate Oriental medical classics like the Neijing without being an acupuncturist. The Great Needling used in the treatment of hemiplegia of external origin consists of needling points of the side affected to reestablish the circulation of the Jingluo and harmonize the blood and energy. PARAGRAPH 2 In Fei (quadriplegia), the paralysis of the 4 limbs is not painful. If the Chi (will) is not totally altered and if the voice is not very 41. weak, the disease is curable. In contrast, it is incurable if there is anarthria. This disease first starts at Yang, then it reaches Yin. One must first treat Yang and secondly, Yin. The needling done on Yang must be superficial. 31 Rough Draft For JTS Students Only