Sudden Chest Pain and You Suspect Heart Disease — What Should You Do? Headache That Painkillers Can’t Touch for 20 Years, Shoulder Pain and Stomach Pain — When Is the Best Time to Treat Them? Doctor Luo Dalun Presents Doctor Ni Haixia’s Lecture on the Huang Di Nei Jing: Closing the Ba Zheng Shen Ming Lun and Opening the Li He Zhen Xie Lun — the Superior Doctor Treats Illness Before It Begins, Reduce with the Square and Reinforce with the Round, Form and Spirit, Waiting for the Qi Before Inserting the Needle, and Drawing Out Stagnant Blood with Cupping

Patient search terms: sudden tight pain in the chest / I suspect I have heart disease / what tests should I do for an uncomfortable heart? / a headache that painkillers cannot touch after many years / when is the best time to needle shoulder pain? / what medicine should I take for stomach pain? / how do the reinforcing and reducing methods of acupuncture actually work? / what should I do about stagnant blood in my body? / is a summer cold the same as a winter cold? / why does Chinese medicine say a doctor should not ask too many questions? / what can pulse reading reveal about illness?

Corresponding medical names: Su Wen · Ba Zheng Shen Ming Lun (On the Eight Directions and the Spirit of Brightness, the twenty-sixth chapter), closing section: the pulses of the four seasons (a winter pulse felt in summer is pathological — noting the season at the pulse is enough) · xu xie (external evil qi) and zheng xie (illness arising from within) · the superior doctor treats illness in the sprout, the inferior doctor treats illness once formed; Su Wen · Li He Zhen Xie Lun (On Separation, Union and True Evil Qi, the twenty-seventh chapter): evil entering from outside (the twelve channels, exterior patterns) · the twenty-eight mansions and the channels (when heaven is cold and frozen the channel waters congeal — cold congeals blood and makes stasis; when hot, the channel waters boil over) · the cun kou pulse (large — the pathogen has come; small — the illness retreats) · the debate between classical formulas (jing fang) and the formulas of the Warm Disease school · reducing must use the square (insert on the inhale, twist on the inhale, withdraw on the exhale; Green Dragon Swings Its Tail widens the needle hole; all acute severe pain is excess) · reinforcing must use the round (insert on the exhale, twist on the inhale, withdraw on the inhale, press the hole shut at once; in the old days lift the skin before inserting) · form and spirit (read complexion and pulse together / shen hu shen, er bu wen — spirit is focus; the fewer questions, the better the doctor) · the insufficient are reinforced (numbness, soreness, dull pain, long illness — deficiency; when qi arrives the skin turns pink, blue means blood stasis) · waiting for the qi to insert the needle (needle only when the illness qi arrives / if you treat too early or too late the qi and blood are spent and the illness cannot be reached / the one who knows the machine does not hang it on a hair) · in excess, drain the child; in deficiency, reinforce the mother · blood patterns and stagnant blood — cupping (cupping the limbs draws out stasis faster than medicine; stasis in the internal organs needs a prescription) · the normal pulse (in men the right pulse is larger than the left, in women the left larger than the right — the left is blood, the right is qi) · the three sections and nine positions (Jiaosun SJ20 / in front of the ear — Shaoyang / Renying ST9 — Yangming; the head and face pulse must match the speed of the hands and feet)

Opening: it is so hot — how can a person get a cold pattern?

At the very start of this lecture, Doctor Ni Haixia is still closing out the tail of the Ba Zheng Shen Ming Lun — which carries the idea that runs through the entire Huang Di Nei Jing: human beings are shaped by heaven and earth. To judge cold and heat, he says, there is a very simple way of thinking:

💬 Note from Doctor Ni: When it is cold and you get a cold pattern, when it is hot and you get a hot pattern — that is the normal course of things. The reverse is when the illness is heavier — it is terribly hot out, and yet the person catches a cold pattern; or it is terribly cold, and the person catches a hot pattern. Neither fits the season; both go against the qi of heaven. When that happens, the illness tends to be more severe.

But when you treat a patient, do you really have to calculate the phases of the moon so finely? No, says Doctor Ni — noticing the four seasons when you take the pulse is quite enough:

💬 Note from Doctor Ni: When you treat, you do not need to think about all those external things. Someone comes to you for treatment. It is summer — you know it is hot enough to kill you. You touch his pulse and it is a winter pulse — pathological! In winter, touch it and it is a winter pulse — that is normal. In summer, how can the pulse be so full and red (flooding, hong da)? That is pathological. It is that simple. And you do not need to run outside at night and look at the moon, checking for the full moon — it is not that fine. Basically, when you work with me in the clinic, I feel the pulse: it is summer now, and this man is showing a winter pulse — I already know his condition. That is all the four seasons require.

Xu xie and zheng xie: evil from outside, and illness from within

Next the Yellow Emperor asks about the difference between xu xie and zheng xie. Doctor Ni cracks it open with one sentence:

💬 Note from Doctor Ni: Among the eight directions and the eight vacuous influences — xu xie (true evil) is evil qi that comes from outside. Zheng xie is illness the person generates himself, illness that comes out from within. Xu xie comes from outside. If you exert yourself and sweat — you sweat from hard physical labor and then get hit by wind — because you were using all your strength, the strike is very slight. The superior doctor (shang gong) goes to the sprout — when the illness first starts, at the moment it erupts, he treats it. The inferior doctor (xia gong) goes to what has already formed — he waits until the illness is fully formed, and only then treats it.

The superior doctor treats illness before it begins: a cold costs four dollars, and no money is still no problem

This passage is full of human warmth. Doctor Ni says this is the principle of the Huang Di Nei Jing — but patients do not understand it:

💬 Note from Doctor Ni: Patients do not understand. The patient thinks, “I don’t have much money,” and even when he has a little illness he will not spend the money to come, and only comes when he cannot bear it anymore. Then should you scold the patient — “You are making me an inferior doctor”? That will not do either — he simply does not understand. So you tell him: from now on, the moment you have the smallest complaint, come right away — it is cheap! In my clinic I keep one rule: for an ordinary visit, if I have not yet written a prescription, I still charge a fee. But for a cold, I charge four dollars. Why? To encourage people — the moment they catch a cold, come to me. And some people have no money; they know the rule, and they bring their children anyway — I help them all the same. So as doctors, we must have this heart of a parent.

Then he told a story he has remembered his whole life:

💬 Note from Doctor Ni: There was once a doctoral student, a mainland Chinese studying here. He came on a Saturday with his little child, who had a cold and fever. He said, “Doctor Ni, I have no money. I am studying, I am working part-time, I have no money. The child has a fever — what should I do?” Do I treat him or not? Of course I treat him. One prescription and it was done. Treating illness does not always have to be about collecting money — this was the very beginning of the illness. And that man, now with his PhD and a good job, tells everyone: I will always remember what he did for me. But I never once thought, “How will you repay me?” — you asked, and I believed you.

Western medicine is the “inferior doctor”: by the time the disease shows itself, the person is gone

“The superior doctor treats illness before it begins; the inferior doctor treats illness once it has formed.” Doctor Ni says this sentence might as well be describing Western medicine:

💬 Note from Doctor Ni: Western medicine is the inferior doctor — it waits until the disease erupts and only then treats. That is far too slow. When you have just the first symptom, Western medicine does not think you are sick, because all the test numbers look fine. We have had cases like this: the space center had two engineers, one 39, one 41, both PhDs in high-tech physics, developing space physics there. The three of them were close friends — the third one ran to me in terror, because both of the others had died, often within less than a month of each other.

The 39-year-old’s story, Doctor Ni tells as though he had lived it himself:

💬 Note from Doctor Ni: One morning the 39-year-old felt a pain in his heart, a tight dull pain. He went to the hospital and told the doctor, “I believe I have heart disease.” The doctor looked at him — well, what a neurotic reaction. But since you mention it, I’ll check you anyway; it’s money either way. So they ran an EKG, a stress test, all of it. “Your heart looks great. Go home.” He drove home. That night the pain grew stronger, and it would not stop. He drove himself back to the emergency room. In America, calling an ambulance costs you $1,500 — they are afraid you’ll call for nothing — so he drove himself. He walked in, and his face had changed color. They rushed him onto the EKG table — the test confirmed: he really is having a heart attack. And the patient lay there on the EKG machine and stopped breathing, dying right in front of the doctor. The other one, the same story, died the same way.

So how does Chinese emergency medicine handle this? Doctor Ni says:

💬 Note from Doctor Ni: In Chinese emergency medicine, at the moment of the attack, we first take the pain away. Then you can go have your tests if you want — do you need them? No. That machine is useless.

Page 225: reducing must use the square — reduce when qi is at its fullest

The Yellow Emperor asks: I have heard of many reinforcing and reducing methods, but I do not understand the true meaning of the classics. Qi Bo’s answer is the most central passage in acupuncture — reducing must use the square, reinforcing must use the round:

💬 Note from Doctor Ni: Reducing must use the square — fang, because it is when qi is at its fullest (qi fang sheng ye). Seize the moment when qi is at its strongest and reduce. By the moon, it is the full moon. By the time of day, it is when the weather is warm. By the person, it is when the patient has settled down and is still, calm and composed (qi ding shen xian). That is the time we insert: xi er nei zhen — insert as the patient begins to inhale and the breath sinks, because on the inhale the qi is rushing inward; then twist the needle on the inhale — turning the needle is how you perform the reducing technique; and when the patient exhales, the needle truly comes out. Why? Because reducing is meant to let the qi out. On the inhale the qi goes inward; you have made a hole, and the qi leaks out through it — that is exactly what we want, to drain qi. So insert on the inhale, twist on the inhale, withdraw on the exhale, letting more qi escape — this is the strongest reducing technique in needling.

And there is an enhanced version of reducing:

💬 Note from Doctor Ni: You do not just make a hole and leave it. We have reinforcing techniques — for example, the Green Dragon Swings Its Tail (cang long bai wei): rock the needle hole wide, come out slowly, slowly; or shake the needle and pull it out — all of these widen the hole. These are strong reducing methods. So you need to know when to reduce — the simplest diagnosis: we only reduce excess. Every pain — acute pain, violent pain, strong pain — all of it is excess.

Reinforcing must use the round: insert on the exhale, press the hole the instant you withdraw

The reinforcing technique is exactly the opposite of reducing:

💬 Note from Doctor Ni: Reinforcing must use the round — yuan, the movement must shift. When you needle, avoid the blood — do not drive straight into a vessel; strike beside the vessel, because the blood lies deeper, and you truly must go deeper. In the old days we had no needle tube — just a needle in the hand. Doing reinforcing was fun: lift the skin, pinch the skin up, puh — drive it in. Because when you lift it, the qi is pinched shut inside; gently strike into the skin layer first, then insert to the heart of the point on the exhale. The skin must be lifted before striking. Nowadays, with the needle tube, you tap it in — once the skin is lifted it is hard to tap — so with the tube we do not use that technique. The reinforcing and reducing techniques are exact opposites: reducing inserts on the inhale and withdraws on the exhale; reinforcing inserts on the exhale — the qi is dispersing outward, so when you go in, the qi cannot escape; twist on the inhale; after completing the reinforcing, wait for the inhale and let the inhale suck the needle out — on the inhale the qi is moving into the body, and at that moment you withdraw the needle and press the hole shut immediately. Reducing is different: after withdrawing, wait a few seconds, then press the hole.

Form and spirit: a doctor who only feels the pulse and never looks at the patient has form but no spirit

On page 226, the Yellow Emperor asks about “form and spirit” — what is form, what is spirit? Doctor Ni says this is a concept they will use again and again:

💬 Note from Doctor Ni: Form — you do not ask the patient a single question, you do not notice that the patient’s face has already turned black, you just sit there and say, “I don’t want to look. Let me feel your pulse.” That is form without spirit. Spirit requires reading complexion and pulse together — your eyes must look at the patient. And what is spirit? Shen hu shen, er bu wen — when you use spirit to see a patient, you are focused; when you are truly focused, you do not even hear your wife calling you to dinner. So you must first make it clear to your wife — it is better if she is not in the clinic. We will come back to form and spirit; I will analyze it thoroughly so that you learn it. Even if you cannot, I will teach you until you can.

How do you judge whether a doctor has “spirit”? Doctor Ni gives a very practical standard — and incidentally explains why this “spirit” is so hard to teach:

💬 Note from Doctor Ni: When the patient tells you his story and the illness is settled in two or three sentences — that is using spirit. Look at doctors this way: the fewer questions a doctor asks, the better the doctor. A doctor whose questions miss the point entirely, questions that have nothing to do with anything — that is a poor doctor. Some doctors feel your pulse, look at you, and after you have told them your condition, they ask, “How many brothers and sisters do you have?” — you came to him for your illness, and he asks about your siblings; that alone tells you whether this doctor has spirit. Is it hard? You cannot see it, you cannot touch it — Chinese medicine is philosophy after all, and philosophy is metaphysical; it is not something an instrument can show. So making people grasp it is harder; I will find many good ways for you to understand.

The Li He Zhen Xie Lun: illness that enters from outside mostly lives in the channels

Next we enter the Li He Zhen Xie Lun — the twenty-seventh chapter of the Huang Di Nei Jing. This chapter is about evil qi entering the body from outside:

💬 Note from Doctor Ni: Illness on the twelve channels and meridians is mostly exterior pattern, entering from outside — sometimes you sprain and injure a channel, sometimes it is cold damage, a cold, a fever, injuring the channels — all entering from outside. When the evil of heaven and earth enters the body, we call it xie — evil. In the old days some people studying Chinese medicine said: look at this Chinese medicine, that character “xie” (evil) is so off-putting, it makes me not believe it. You are wrong! When you truly read through it, this character is the only good one to use. Why? Once you name the disease, once you go check for every kind of virus, you are worse off — you have looked too fine. Is there any need to look so fine? No. It does more harm than good.

What trouble does splitting diseases too finely bring? Doctor Ni gives an example from his own clinical practice:

💬 Note from Doctor Ni: We treated a 50-year-old man with liver cancer and cured him. But he went and had a PET scan, which showed a small tumor still in the liver, possibly cancer. He panicked and started shaking. Have you ever considered that this little lump might never trouble you for 50 or 100 years? It is harmless. Why dig it out? Western medicine has dozens of diseases — it does not believe in its own premise; its worldview is: there is no healthy person on earth. If you are not taking medicine, that seems strange to them. And once they find something, they insist it must be treated — and what do they treat it with? They tell you to take aspirin — useless, because they have no medicine left; they will find some way to finish you off. So if you enjoy being slaughtered, go to the hospital and be slaughtered.

The twenty-eight mansions and the channels: when heaven is cold and frozen, the blood congeals

On page 229, Qi Bo uses heaven and earth as a metaphor — the twenty-eight mansions, mountains and rivers, and the human channels:

💬 Note from Doctor Ni: In heaven and earth there is the motion of the twenty-eight mansions. On the earth there are rivers and mountains. In the person there are the channels. The channels are the great rivers — like the Yangtze and the Yellow River, great waterways; and there are smaller streams. When heaven and earth are mild and warm, the channel waters are calm. When heaven is cold and frozen, the channel waters congeal (jing shui ning qi). When it is cold, the qi inside the channels freezes solid — cold is what creates stagnant blood. People worry that a blood clot will float back to the heart and cause heart disease, or travel to the brain and cause a cerebral embolism — but they never think that this blood clot is simply heaven cold and earth frozen, the channels too cold. So you take blood-thinning drugs — have you thought about the aftermath? The blood cannot be too thin, or the vessels rupture. So indeed there is no blockage — but your vessel has burst, blood spills out, and there is cerebral hemorrhage. That is not good.

The reverse — too much heat — is also a problem:

💬 Note from Doctor Ni: When a person catches too much heat from heaven and earth, the channel waters boil over (jing shui fei yi) — too hot, and it overflows. If it is too hot, the channels fill to the brim, the peaks surge up, and the channel waters swell and heave. When the illness evil enters the channels, cold congeals the blood — this is cold and heat, and it concerns our diagnosis and our prescriptions, because our prescriptions contain many warming herbs. In great summer heat, the qi turns turbid; hot qi rises upward, and because of the great heat the illness evil can run into the body, just as wind blows across the mountains and rivers outside — these are all things that happen when the evil of heaven and earth outside enters the body and attacks a person.

The cun kou pulse: a big pulse means the pathogen has come; a small pulse means the illness is retreating

How do you read the rise and fall of an illness from the pulse? Doctor Ni explains the cun kou pulse:

💬 Note from Doctor Ni: The pulse at the cun kou — sometimes you can read it there, sometimes big, sometimes small. When the pulse is too big, it means the evil has come, the illness has arrived, and the body is resisting it. A small pulse means the body is well, the illness is recovering. So if a patient has a big pulse and you treat him, and after the medicine the pulse calms down, the pace slows — when you use classical formulas (jing fang), it changes in an instant — sometimes in three hours, sometimes overnight it has changed. If you use the ordinary formulas of the Warm Disease school, it will not change. Sometimes a formula seems to work very well on the surface, but in truth the root of the illness has not been removed — the root stays.

The insufficient are reinforced: numbness, soreness, dull aching — all deficiency

How do you choose between reinforcing and reducing? Page 230 says it plainly:

💬 Note from Doctor Ni: The insufficient are reinforced (bu zu zhe bu zhi). When the patient shows insufficiency in the channels — numbness, soreness, dull aching — the illness has lasted a long time, the pain has lasted long: long illness is deficiency (jiu bing wei xu). All of these call for the reinforcing technique. That is how the differentiation of excess and deficiency begins. When reinforcing, first stroke and follow the channel (men er xun zhi), cut and scatter (qie er san zhi), push and press (tui er an zhi), pluck and rouse (tan er nu zhi) — that is, first massage the area where you will insert; where there is a vessel, cut it aside with your fingers and push it away; grasp the skin, pinch it up, and then insert.

Once the needle is in, how do you know “the qi has arrived”? Doctor Ni teaches a method you can see with your own eyes:

💬 Note from Doctor Ni: When qi arrives, you can see the skin turn pink — truly, it turns into a pink patch. The stronger the qi that comes, the larger the pink patch; the weaker the qi, the smaller the patch. Healthy, strong people have large qi. If the needle goes in and you fuss around and there is hardly any qi — just a little around the hole — then the body is very deficient. So generally when you needle someone, on the back or beside the hands and feet, a ring of pink around the needle hole — that is qi arriving; qi arrival is visible. If what appears around the needle is blue, you hit a blood vessel, there is stasis inside — that is not qi arriving, that is blood stagnation; you struck wrong. We want qi to arrive (qi zhi), never blood stagnation (xue zhi). When qi arrives, it is like a noble guest coming to your house — you must receive him well. Bu zhi ri mu — do not watch the sun, do not watch the clock; the arrival of qi is the standard. When the qi has arrived and then calms, wait for the inhale and withdraw the needle, so the qi does not leak out, then push the gate shut (tui he qi men) and let the spirit and qi stay — that is the reinforcing technique. So reinforcing and reducing are simple: insert on the exhale, withdraw on the inhale — that is reinforcing; the reverse is reducing.

Waiting for the qi before needling: come when it hurts, and the needle lands true

The Yellow Emperor asks what “waiting for the qi” (hou qi) means. Doctor Ni says it is the shared secret of both acupuncture and herbal medicine: insert the needle when the illness qi arrives, and the effect is best:

💬 Note from Doctor Ni: The patient says his shoulder hurts. I ask: does it hurt right now? “No.” — Bad timing. You have come to me, but right now the qi has not arrived; the illness qi is not here. Come to me next time when it hurts — no appointment needed, just walk in. Same for headaches. In the beginning I did not understand this. A headache — well, it is not hurting now, but we needled anyway. We saw his pain followed the gallbladder channel, and we inserted accordingly — the effect was not very good. Later we changed the method: wait until it hurts, then come.

Then he told the classic case that made his name — the wife with a 25-year headache:

💬 Note from Doctor Ni: This wife had a headache for 25 years. She took painkillers and they could not stop it; she would bang her head against the wall. She took one painkiller a day — not just one pill: that medicine damages the liver, so she had to take another medicine to patch the liver; the liver-patching medicine damages the kidneys, so she had to take another to patch the kidneys; the kidney-patching medicine damages the spleen, so she had to take another one for that — her whole body was like a patchwork quilt. The actual painkiller was one pill, but the aftermath was enormous, and she had eaten it for over twenty years. She came in one morning. I asked: does it hurt right now? “No.” — Go home! She said, “You’re kicking me out?” Yes! Right now you do not hurt. You came for treatment but you had already taken your painkiller. Remember: come when it hurts. The patient went home. That very afternoon she burst back in — the headache had erupted! I said good, lie down on the bed — that is the moment of treatment (shi zhi zhi zhi). When the illness erupts, that is when treatment is needed. One needling — the pain was gone. I said: you do not need to come tomorrow; come again when the pain returns. Three days later the pain came back, and she came again. She said: the pain has come, but only 20 percent — after more than twenty years of headache, 80 percent was gone, only 20 percent left. I needled her once more, and from that day the headache was cured. She never came back.

Internal medicine works the same way — timing is everything. He gave the stomach example:

💬 Note from Doctor Ni: Take a patient with a stomach ulcer — stomach disease, xin xia pi (stuffiness below the heart). Five patterns, very simple: whatever prescription I write will match the pattern. But he eats it and it does not get better. After a week with no improvement — wrong, I’m getting angry. We knew the formula was correct; it was still that formula. So I put a packet of the powder in his pocket: take it when the stomach hurts. If it does not hurt, the body does not need it. One dose, and it was done — of course we made a lot less money, but this is virtue; we are not in it for the money. He usually ate his three meals on schedule, and at that hour it did not hurt; but that night it hurt even in his sleep — one dose, and it never hurt again. You see, the formula is right, but we must also match the timing — the timing must be right. So from now on, all of you practicing classical formulas, becoming superior doctors — you will all make plenty of money, because you cure too fast. And you will feel good too, because your patient turnover is fast — if you see the same patient for two years and he is still coming back to you, that is not good; new patients constantly arriving, that is good.

Miss the window and it is gone: if you treat too early or too late, the illness cannot be reached

On page 232, Qi Bo speaks of the importance of timing, and Doctor Ni gives a wonderfully vivid comparison:

💬 Note from Doctor Ni: Ruo xian ruo hou zhe, xue qi yi jin, qi bing bu ke xia — if you treat too early or too late, the qi and blood are spent, and the illness cannot be reached; the moment has slipped away. Zhi ji dao zhe bu ke gua yi fa, bu zhi ji zhe kou zhi bu fa — like drawing a bowstring and not releasing. We know to treat at the instant the moment arrives. Take the stomach patient I just mentioned — we knew he needed that formula, but I could not keep a prescription in my hand waiting for his attack. If he does not flare up for eight hours, do you follow him around for eight hours? Your wife will divorce you for sure — why would you stay with the patient? So you put the medicine in his pocket and tell him what to do. Some patients only need to hear an old physician speak like this and they are already better before the medicine goes down. So there are many methods — do not be too rigid. When treating illness, you must not be too rigid. The same for acupuncture, the same for herbs.

What are reinforcing and reducing for? Stagnant blood must be let out

On page 233, the Yellow Emperor asks what the purpose of reinforcing and reducing is:

💬 Note from Doctor Ni: Reinforcing and reducing are for expelling evil and expelling blood — that is what we do them for. In excess, drain the child (shi ze xie qi zi); in deficiency, reinforce the mother (xu ze bu qi mu). And when you meet a blood pattern — stagnant blood blocking the way — remember, the stagnant blood must be let out, release the blood. This stagnant blood is not only in the gaohuang (the deep region between heart and diaphragm); in the legs, on the body from injuries, sprained ankles — all of it, draw it out with cupping (huo guan). The blood must go; the stagnant blood must go. If the stasis is in the limbs — say, a sprained ankle — cupping the blood out is absolutely faster than taking medicine. Why would you not cup, and instead prescribe bitter herbs to swallow? But if the stasis is in the internal organs, of course you cannot do without a prescription — it depends on where the blood is. Later, when we discuss blood patterns, we will see that we can know there is stasis in the body, and which symptoms reveal it.

What is a normal person? Men: right larger than left. Women: left larger than right.

The Yellow Emperor asks again: when illness evil and the person’s upright qi grapple inside the channels, and the pulse does not seem to change — how do you read that? Doctor Ni says you must first know what “normal” is:

💬 Note from Doctor Ni: What is a normal person (chang ren)? In a man, the right pulse is larger than the left pulse. In a woman, the left pulse is larger than the right. That is the normal state. Why? The left is blood; the right is qi. A man’s qi is more vigorous, a woman’s blood is more vigorous. So man-right-large, woman-left-large — that is the norm. If the upright qi and evil grapple in the channels and the pulse does not change, from this we can still detect it.

Closing: the three sections and nine positions — cannot feel the wrist, feel the head

The last short passage covers the three sections and nine positions (san bu jiu hou) — what to do when you cannot find the pulse at the wrist:

💬 Note from Doctor Ni: If we cannot find the pulse at the hand, check the three sections and nine positions — Jiaosun SJ20, and in front of the ear, both are Shaoyang; here is the Renying ST9 pulse of Yangming. In the three sections and nine positions, the pulse of the head and face must beat at the same speed as the pulse of the hands and feet. If the speeds differ, or it is now big now small, we know this channel has a problem. So sometimes you simply cannot feel the pulse at the wrist. That is why it is said: he who does not know the three sections cannot distinguish yin from yang, cannot separate heaven from earth (bu zhi san bu zhe, yin yang bu bie, tian di bu fen). So we must know the three sections and nine positions.

What to take away

Season beats finesse. You do not need to chart the phases of the moon — feel a winter pulse in summer, or a summer pulse in winter, and you already know the illness goes against the season and runs heavy.
Catch the sprout. The superior doctor treats the very beginning of illness; that is why Doctor Ni charged four dollars for a cold and treated penniless children for free — a parent’s heart. Western medicine, waiting for the disease to show itself, is the “inferior doctor.”
Reduce with the square, reinforce with the round. Reducing: insert on the inhale, twist on the inhale, withdraw on the exhale, widen the hole — for excess, and all sharp, violent pain is excess. Reinforcing: insert on the exhale, twist on the inhale, withdraw on the inhale, press the hole shut at once — for deficiency: numbness, soreness, dull ache, long illness.
Wait for the qi. Needle only when the illness is present: come when the shoulder hurts, take the powder when the stomach hurts. Treat too early or too late and the moment is lost.
Cold makes blood congeal; heat makes it boil. Stagnant blood from cold is the root of many clots — and blood-thinning drugs have their own aftermath: ruptured vessels. Let stasis out with cupping on the limbs; prescribe for stasis in the organs.
Know the normal. Man’s right pulse larger than left, woman’s left larger than right — the left is blood, the right is qi. And when the wrist will not speak, the head will: the three sections and nine positions must beat in step.

Compiled from Doctor Ni Haixia’s Ren Ji (Human Records) lecture series on the Huang Di Nei Jing (Lecture 36)