Is Acupuncture Safe? Can a Needle Hit an Organ? — Doctor Luo Dalun Presents Doctor Ni Haixia’s Twentieth Lecture on the Huang Di Nei Jing: the Essentials of Diagnosis and the Termination of the Channels

Patient search terms: is acupuncture safe? / can a needle hit an internal organ? / taking the pulse / why did my pulse suddenly get bigger? / how can I tell if I am anemic? / lots of blue veins on my arms / dull, dark face / afraid of cold in winter / how to do acupuncture in spring / how to do acupuncture in summer / a child who sleepwalks / a child who is afraid of the dark and hides in the closet / talks too much, hyperactive / does not want to talk, no energy / swollen hand, sprained ankle / do I have to take my clothes off for acupuncture? / can you needle through clothes?

Corresponding medical names: Su Wen · Yu Ban Lun Yao (On the Essentials of the Jade Tablet, chapter fifteen) · the complexion runs toward one side: chong yang (double yang) and chong yin (double yin) as contrary (ni) patterns · yin shi (yin excess) when yang leaves the liver · fat is yin, lean meat is yang, the skin is yang · bo mai bi bi, han re zhi jiao (a throbbing pulse with numbness and inability to walk, at the junction of cold and heat) · mai gu wei xiao qi (an isolated pulse means the qi is being consumed) · xu xie wei duo xue (deficient diarrhea means the blood is being seized) · gu wei ni, xu wei cong (the isolated is contrary, the deficient is following) · the Guan bar is yang, the Chi is yin · mai du chen yu cun kou (pulse sinking only at the Cun mouth — yin qi consumed) · mai du chen yu chi (pulse sinking only at the Chi — yang qi declined) · gu yin gu yang zhi mai (the isolated yin and isolated yang pulses) · kou mai (the scallion-stalk pulse, hollow from loss of blood) · chi nei qing jin (green veins on the inner forearm — anemia) · wei bu hua xue (the stomach cannot transform blood) · treating a replete pulse into a deficient one as a sign of recovery · Su Wen · Zhen Yao Jing Zhong Lun (On the Essentials of Diagnosis and the Termination of the Channels, chapter sixteen) · in the first and second months the human qi dwells in the liver, in the third and fourth in the spleen, in the fifth and sixth in the head, in the seventh and eighth in the lung, in the ninth and tenth in the heart, in the eleventh and twelfth in the kidney · tian qi shi fang, di qi shi fa (the weather qi begins to open, the earth qi begins to rise) · shallow needling in spring and summer, deep needling in autumn and winter · needling as in the summer division in spring makes one lose appetite and become short of qi · needling as in the autumn division in spring makes one startle and weep · needling as in the winter division in spring lets the pathogen lodge and causes distension · tai guo (excess) produces movement, bu ji (insufficiency) produces stillness · shen, hun and po (the spirit, the ethereal soul and the corporeal soul) · the po governs stillness, the hun governs movement · whenever needling the chest and abdomen one must avoid the five organs (fan ci xiong fu, bi bi wu zang) · hitting the spleen brings death in five days, the kidney in seven, the lung in five · injuring the diaphragm means death within a year (zhong ge zhe shang zhong, yi sui bi si) · xie ci (oblique needling) · the back-shu points (bei shu xue) · duan ci (short needling, front-and-back paired needling between the ribs) · qi zhu ma (riding the bamboo horse) · locating points with laser pointers · needling through cloth (ge bu ci) · yao zhen (rocking the needle to drain qi) · never rock the needle when needling the channels (ci jing wu yao) · Shangqiu (SP5) penetrating through to Qiuxu (GB40)

Opening scene: the direction your complexion runs hides the secret of life and death

This lecture opens where the last one left off, still reading the complexion. Doctor Ni first asks everyone to remember a question of direction: which way the color on the face runs is a matter of good fortune or disaster.

💬 Note from Doctor Ni: When you look at the complexion, the liver side is liver-green. This green keeps running toward the right, and the yang keeps being added on top, and added again — this is chong yang, double yang, yang on top of yang. If it runs from the right toward the left, the lung channel grows whiter and whiter, leaning toward the yin side — this is chong yin, double yin. Adding yin on top of yin, or adding yang on top of yang — both are contrary patterns (ni), both are bad. So yin and yang must be balanced. You cannot nourish yang on top of yang; that keeps pushing it outward.

In one sentence: when the complexion keeps running to extremes in the same direction, that is contrary; balance of yin and yang is the correct road.

When yang runs away, yin piles up into stone — why must yin and yang be balanced?

Afraid that no one would understand, Doctor Ni used the liver as an example:

💬 Note from Doctor Ni: Take the liver. The liver has yang inside it and yin inside it, and yin and yang are in a balanced state. If the yang goes outward, then inside the liver there is no more yang, and the yin accumulates inside. Accumulate for a long time and it becomes replete — that is yin shi, yin excess, and this is dangerous. So yin and yang must be balanced.

Then he gave the most intuitive example on the body itself — fat and lean meat:

💬 Note from Doctor Ni: The fat on your body is yin, the lean meat is yang. The fat seems to wrap the lean meat, and outside there is another layer, the skin, and the skin is yang. So yin and yang, yin and yang, keep wrapping around each other, and that is how layer after layer forms. This is the state of balance — only in balance can it form like this.

At this point Doctor Ni dropped a single line: what the qi heng (extraordinary) and kui du (assessing) chapters talk about is nothing more than the balance of yin and yang — the kui du and qi heng of the previous lecture on the Yu Ban Lun Yao is being finished right here.

Did your pulse suddenly get bigger? Don’t panic — you may simply be short of blood

In paragraph 111, the classic says: “A throbbing pulse (bo mai) with numbness and inability to walk (bi bi), at the junction of cold and heat; an isolated pulse (mai gu) means the qi is being consumed; deficient diarrhea (xu xie) means the blood is being seized; the isolated is contrary (gu wei ni), the deficient is following (xu wei cong).” Doctor Ni said: this brings us back to the pulse.

💬 Note from Doctor Ni: Back to pulse diagnosis. At the Guan bar you have the Cun pulse, and this is the Chi pulse — the Guan is yang, the Chi is yin, that is the basic idea. The yin pulse grows smaller and smaller, the yang pulse grows bigger and bigger until it touches the surface of the skin — that means the yang is about to come out. There is yang inside to begin with; the yang inside the viscera wants to go outward. Yang is kinetic energy; its vitality keeps streaming outward. This is the bo mai, the throbbing pulse — the junction of cold and heat. When the pulse moves with very great force, because yang governs the four limbs, governs the muscles, governs the joints, when the yang goes outward the four limbs will end up unable to move — hand and foot paralysis.

Then he explained what happens when an external pathogen enters — how the yang comes out to fight:

💬 Note from Doctor Ni: The biao (exterior) of the yin-yang exterior-interior pairing. When we are attacked by an external pathogenic influence, the yang of the viscera comes out to resist it. If you have healthy yang, then the skin already has yang on it from the start, enough to withstand changes in the environment and invading viruses — then there is no disease. When the yang on the surface cannot resist the invading pathogen, the yang inside the body automatically comes out to fight it — and during the fight you get a state of cold-heat contention: win and you feel heat, lose and you feel cold.

Then the two kinds of “pulse sinking only in one place”:

💬 Note from Doctor Ni: Mai du chen yu cun kou — you can only feel the pulse at the Cun mouth, the Chi pulse is gone. This means the yin qi has already been consumed. Conversely, if the pulse sinks only at the Chi, it means the yang qi has declined, because the yin pulse has become too large. When the yin pulse is over-distended, this is called a solitary pulse (gu mai).

When the blood is insufficient, the pulse actually gets bigger — this is the place where beginners misjudge most easily:

💬 Note from Doctor Ni: If the vessel is hollow inside, the blood is not enough. When the blood is insufficient — and here is the funny thing about people — you get the opposite of what you expect. Normally, when something is insufficient the pulse would get smaller. Wrong. When it is insufficient the pulse gets bigger, exactly the reverse, because the inside is empty. When it is empty, the pulse enlarges; you press down and it feels like an empty rush — the middle is hollow. Later we will also cover the kou mai — the kou mai is the hollow pulse, and it represents loss of blood. When the blood is insufficient, the pulse form becomes very large.

There is an even simpler way to check for anemia — look at the arm:

💬 Note from Doctor Ni: We often look at the inner forearm (chi nei), the section from Guan to Chi. If you see many green veins along the chi nei, this is anemia. And look at the complexion: the face should carry a little yellow, the stomach-qi. If you cannot see any stomach-qi and the face is rather dark — this means the stomach’s nutritive function is failing. Food and drink enter the stomach, but the stomach cannot yet transform them into blood — and in this condition there will always be a sign of insufficient blood.

A solitary pulse is dangerous, a deficient pulse is easy to treat — turn a replete pulse into a deficient one and the disease is about to be cured

“Gu wei ni, xu wei cong” — the isolated is contrary, the deficient is following. Doctor Ni took these six characters apart:

💬 Note from Doctor Ni: A solitary yin pulse or a solitary yang pulse — both are dangerous. In the solitary yang pulse the yin is gone; in the solitary yin pulse the yang is gone. These are diseases that are hard to treat, the heavier kind. If you only feel a deficient pulse, a deficient pulse is very easy to treat. Why is it deficient? Because inside there is nothing — the inside is empty, that is the deficient pulse. A replete pulse is comparatively harder.

And he offered the most reassuring rule seen in the clinic:

💬 Note from Doctor Ni: Suppose the patient originally had a replete pulse, a serious disease. You treat him and turn the replete pulse into a deficient pulse — excellent. Before a patient returns from illness to normal, he always presents a deficient pattern, a purely deficient pattern — this is something we all see in the clinic. When you have removed the disease, the person is very weak; give him some nourishment and he will be fine. It is like your car: originally it was broken, and you fixed it. After it is fixed the car still will not run — the gasoline has not been added, the oil has not been poured, the radiator has not been filled. Give it some nourishment, and it starts to move.

Where does the human qi live in each of the twelve months? — the Essentials of Diagnosis and the Termination of the Channels

The Yellow Emperor asks: where lie the essentials of diagnosis and treatment? How do you grasp the key? Qi Bo’s answer begins with a “map of the human qi” for the twelve months:

💬 Note from Doctor Ni: In the first and second months, tian qi shi fang (the weather qi begins to open), di qi shi fa (the earth qi begins to rise), and the human qi dwells in the liver — in the first and second lunar months the yang begins to stir, the earth’s yin begins to rise, and at this time we speak of the liver. In the third and fourth months, tian qi zheng fang (the weather qi is fully open), di qi ding fa (the earth qi rises steadily), and the human qi dwells in the spleen — the heavenly yang has begun to turn, the earth qi rises slowly from below, and at this time the qi of a person gathers at the spleen. In the fifth and sixth months the weather qi is at its fullest, the earth qi rises very high, and the human qi dwells in the head. In the seventh and eighth months the yin begins its killing, begins its harvesting, and the human qi dwells in the lung. In the ninth and tenth months the yin begins to freeze, the weather turns cold, and the human qi dwells in the heart. In the eleventh and twelfth months the cold qi and the yin qi of the earth merge — the place of yin and cold, and this is the kidney.

People must follow the solar terms. Doctor Ni compared us with the animals, and told it with great vividness:

💬 Note from Doctor Ni: Many animals, like the bear, hibernate in winter — because it is very cold, and by hibernating they minimize the energy their bodies consume. This is all according to the nature of animals between heaven and earth. You must trust the nature of animals; they will follow the seasons. If we humans do not follow the seasons — yet all the animals do. They are very clever: when something feels wrong they hide and hibernate, they stop eating, dig a place and sleep, and they still live. In the end, the animals have no mansions and no heating, yet they are not frozen to death in winter — while we humans freeze to death on the streets. How embarrassing! Learn from the bear, learn from the snake.

How to needle in spring and summer, how in winter — depth follows the qi

After the twelve-month map, Qi Bo explains the needling method of the four seasons:

💬 Note from Doctor Ni: When you fall ill in spring, the weather and earth qi have just begun to shift; the disease sits at the junction of the skin and the muscles, and shallow needling with a little bleeding is enough. In severe cases it will transmit to the viscera — in the first and second months that is the liver, in the third and fourth the spleen. When you fall ill in summer, needle the collateral vessels (luo mai), needle the even finer places — the sun luo, the fine collaterals, are very subtle; let a little blood out at the extremities and it is done. Because when the qi is at its reigning time, a person’s qi, like the qi of heaven and earth, makes it hard for pathogens to enter the body at all — they all stay on the surface of the skin.

The principle of diagnosis and treatment, Doctor Ni compressed into one sentence:

💬 Note from Doctor Ni: The meaning of diagnosis is to tell you: when we treat or diagnose, do not go too far and do not fall short. If the disease is very shallow, we needle very shallowly, not too deep. In spring and summer needle comparatively shallow; in autumn and winter needle comparatively deep — in spring and summer the yang slowly moves to the surface of the skin; in autumn it moves from the surface slowly down to the bone, so when the weather is cold you may insert the needle down beside the bone. In autumn, needle the skin following its grain (xun li), even into the gaps of the skin’s interstices (cou li), and withdraw the needle when the complexion and spirit return to normal. In winter the cold qi is heavy and the disease sits deeper, so the needles all go into the back-shu points on the back — the back-shu points are the main targets. In severe disease the needle must go deep; in shallow disease it must go shallow. That is the principle of treatment.

What kind of spectacle do you get from needling in the wrong season? — Excess and insufficiency

The classic continues: spring, summer, autumn and winter each have what they should be needled at — the method follows where the qi resides. What happens if you needle the wrong place? Doctor Ni drew a picture to explain:

💬 Note from Doctor Ni: The bone in the middle is winter. Beside the bone are the sinews, and the sinews are spring. Summer is the blood vessels. In spring the needle should go down to the sinews. If you go down to the blood vessels instead and do not reach the sinews — not deep enough, bu ji, insufficiency — the disease will not be cured, and moreover the qi will become disordered. The moment the needle goes in, the patient’s qi begins to stir. If the depth is insufficient, the first thing affected is the upright qi: you wound the upright qi, the pathogenic qi is not removed, the qi becomes chaotic, and the pathogen takes advantage of the chaos to enter. It will cause the person to lose appetite, to breathe shallowly, to be short of qi.

And going too deep is just as bad:

💬 Note from Doctor Ni: Chun ci qiu fen — needling as deep as the autumn division in spring. In autumn and winter the needle goes down to the bone; in spring, if you insert it too deep — tai guo, excess — it will frighten the patient, and make him prone to weeping. Chun ci dong fen — needling as deep as the winter division in spring: too deep, down to the bone, and the pathogen lodges within (xie qi zhe cang), the viscera will not recover, and there will be distension inside.

So how do you tell them apart? Doctor Ni gives the most practical diagnostic key:

💬 Note from Doctor Ni: There is a simplest way to distinguish them — excess and insufficiency (tai guo and bu ji). The symptoms produced by insufficiency are all stillness: the person does not speak, is taciturn, speaks little, does not much want to talk, does not want to do anything, has completely lost the will to fight. What excess produces is movement: a person whose emotions were calm becomes agitated, high-pitched, talks a great deal, keeps moving, cannot stop moving. This is something the Huang Di Nei Jing takes very seriously.

The sleepwalking child, the child who hides in the closet — is the hun moving, or is the po still?

From “movement and stillness” Doctor Ni moved to the shen, hun and po — and this passage is especially fascinating:

💬 Note from Doctor Ni: The heart stores the shen (spirit). Shen divides into yin and yang — a prescription has its yang part and its yin part. What divides to the yin side is called the po (corporeal soul); what divides to the yang side is called the hun (ethereal soul). Shen, hun and po are the same thing; all three come out of the shen. The po governs stillness; the hun governs movement. A child gets up at night and sleepwalks — right? And you will also notice something strange about children: in broad daylight they do not like to run outside and play with other children; they like to hide in the closet, close the door, and enjoy the darkness. This is why we distinguish these things. When we know whether the disease lies in the hun or in the po, we know whether to use yin medicine or yang medicine — where the disease sits on the yin-yang scale.

And he closed the point:

💬 Note from Doctor Ni: All diagnosis is that complex, yet the main thing is to distinguish yin and yang. A person who talks a great deal is yang; a person who does not want to talk is yin. A person who is agitated, keeps moving, cannot stop — yang; a person who is taciturn, does not want to do anything, has completely lost the will to fight — yin. That is the simple distinction. In real clinical needling you will not be so punctilious about spring, summer, autumn and winter. The ancients were extremely precise about it, because the needles of their time were thick. Our needles today are fine filiform needles — gauge 32, gauge 3; the finer the needle, the better. When a fine needle goes in and comes out, you see no blood. Just remember the great principle: shallow in spring and summer, deep in autumn and winter. That is enough.

What is needling most afraid of? — whenever needling the chest and abdomen, avoid the five organs

On page 116, the classic says: “Whenever needling the chest and abdomen, you must avoid the five organs.” Doctor Ni said this is a life-preserving rule:

💬 Note from Doctor Ni: When you needle the chest, the back, or the abdomen, you must keep clear of the five organs. Do not put on a show and sink a needle straight into the heart — that is no good; hitting the lung is no good either. That is why we have oblique needling (xie ci); we do not needle straight in. Hit the heart and the person dies within a day. Hit the spleen and he dies in five days. Hit the kidney and he dies in seven days. Hit the lung and he dies in five days. And if you strike the diaphragm — that is injuring the middle; even if the disease is cured, death comes within a year. So when we needle, we must always avoid the viscera. When needling the lung, always insert obliquely. From the navel down, below the fourteenth vertebra, only there do we needle straight in — because the viscera are already behind us; straight needling is no problem. Above that, use oblique needling left and right as much as possible, do not go too deep, and absolutely do not touch an organ.

Where is the diaphragm, and why use it as the standard?

💬 Note from Doctor Ni: The diaphragm (ge) is the horizontal membrane. The chest cavity comes down, and from the navel to the lower abdomen lies the region of the heart, spleen and bones. The diaphragm sits here — the place that separates the heart, the lung, the liver and the spleen — and this is what we use as the standard. What the classic calls “following” (cong) means measuring between the diaphragm and the spleen and stomach — that is our measuring standard. For example, when examining the heart: above the heart there is the pericardial wall and the sternum protecting it, and you must insert the needle through the gap beside a rib. If you go straight in from the front and hit the heart, that is bad.

How did the ancients needle near the heart through the sternum? — short needling and riding the bamboo horse

How do you pair front and back on the chest and back? Doctor Ni explained the ancient “short needling” (duan ci):

💬 Note from Doctor Ni: There is a needling method we call duan ci, short needling, done in the gaps between the ribs. Say there is heart pain — the pain is here, and the patient sits here. The ancients kept their measurements, imagining in the mind the position directly behind, front and back corresponding. Then one needle in the front, one needle on the side, and it penetrates right through. If you say “I hurt here,” you press your hand here, find the symmetrically opposite place behind, and insert one needle in front and one behind. Generally we do not pass through the ribs — if you pass through the ribs very deeply and reach the viscera, only then do you touch the lung or the heart. That is the front-and-back method, short needling.

What if you cannot locate the back point? The ancients and the moderns each have their trick:

💬 Note from Doctor Ni: In the past some people used qi zhu ma — riding a bamboo horse. You straddle a bamboo pole, hang a string with a weight, and use it to find the point — you cannot miss. Today, take two laser pointers and put them at the sides, line the beams up so they just touch, have the patient stand in the middle; wherever it hurts, aim here, and you have found the back point. Is that not a good method? Light can find the point. Then, as long as the chest cavity is open, insert the needle and it is done — but you must not hit that line. Why do we use short needling? A very short needle, and that is all. These two, yin and yang: the back is yang, the front is yin. Insert once, and yin and yang are connected — Chinese medicine is about the balance of yin and yang.

What if it is cold when you needle? — turn on the heating, and never needle through clothes

In ancient times, when it was cold, needling had its own customs:

💬 Note from Doctor Ni: When needling the chest and abdomen, generally you do not need to take off too many clothes. If the weather is too cold, do not have the patient strip; cover the body with a cloth — in the past they really did insert needles through a cloth. That is what “ge bu ci” (needling through cloth) means. But you modern people must never needle through clothes — in the United States, if you needle a patient through his clothes, he will sue you! So rather than that, turn on the heating in the room. We have these tools now; we can change the environment. When the weather is cold you must keep warm, yet for needling the clothes must open — in cold weather we turn on the heating, and after the heating is on we insert the needles. The ancients could not even imagine heating, and the north was extremely cold. So do not stupidly follow the book and needle through a cloth just because it says “needle through cloth.”

Closing: be solemn when needling, and know when to rock the needle

Finally, Doctor Ni gave two small pieces of advice about needling. The first — your attitude must be proper:

💬 Note from Doctor Ni: When we test needles, we must be solemn. No grinning and joking — if you grin and joke, the needle will not go in properly; your hand will tremble.

The second — the art of rocking the needle:

💬 Note from Doctor Ni: When there is swelling, rock the needle. Say my hand is swollen, swollen big, sprained. Insert the needle into the swollen place, and when you withdraw it, rock it. Rocking the needle drains the qi — it unloads the pathogen. Especially when we use a fine needle to rock. In the past they used very thick needles and rocked them — that would certainly cause heavy bleeding; that is going too far. Rocking the needle is for swollen conditions. But ci jing wu yao — when you know you are on an acupuncture point of a channel, you must not rock it. That is the great rule of needling. So we needle swollen places: the hand is swollen, insert the needle and rock the hole wide; the ankle joint is swollen, Shangqiu (SP5) penetrating through to Qiuxu (GB40), rock the hole wide as you go through — all of that is fine.

From the direction of the complexion, to the size of the pulse separating deficiency and repletion; from the twelve-month journey of the human qi, to the depth of needling in the four seasons; from the movement of the hun and the stillness of the po, to the life-and-death rule of avoiding the five organs — this lecture has laid out “the essentials of diagnosis and treatment” completely. Just as Doctor Ni said: all diagnosis is that complex, yet in the end it comes down to distinguishing yin from yang.

Based on Doctor Ni Haixia’s Ren Ji (Human Records) lecture series on the Huang Di Nei Jing (Twentieth lecture)