bubble_chart Content

1. Syndrome Differentiation and Channel Differentiation

Acupuncture and moxibustion treatment first requires mastering the relationship between pattern identification and channel differentiation. Pattern identification involves understanding the overall disease, which always manifests related symptoms and signs. These are collectively referred to as "syndrome" or "symptom and sign" in Chinese medicine (the character "症" is a later development; in ancient times, only the character "證" was used. Therefore, the "syndrome" in "symptom and sign" and the "symptom" in "symptom" were not distinguished in ancient times). The term "syndrome" carries the meanings of telling, evidence, and verification; "候" implies signs, observation, and diagnosis. Thus, "syndrome" or "symptom and sign" includes both the symptoms reported by the patient and the signs observed by the physician. Pattern identification is the specific analysis and judgment of these disease manifestations. Syndromes can be "external syndromes" manifested externally or "internal syndromes" occurring within the body. The diagnosis of "internal syndromes" especially requires the use of various examination methods to understand the nature of the disease Bingben. Symptoms and signs manifest in specific locations, with different natures such as cold-heat and deficiency-excess, and occur at different stages of the disease. These aspects—location of disease, nature of disease, and disease course—are the main contents of pattern identification. Channel differentiation, on the other hand, involves identifying the specific location of the disease, as stated in Lingshu-Guanneng: "Observe the pain, its left and right, upper and lower aspects; know its cold and warmth, and which channel it belongs to"; and in Suwen-Pibu Lun: "Differentiate its divisions, left and right, upper and lower, yin-yang locations, and the beginning and end of the disease." Symptoms and signs are classified according to yin-yang meridians, which are divided into upper and lower, hand and foot, and further into left and right sides. The so-called "divisions" refer to analyzing the location of the disease according to the six cutaneous regions of the meridians; "the beginning and end of the disease" refers to distinguishing the six meridians based on the disease's development process. Pattern identification can be said to analyze the body's symptoms and signs using the theory of meridians and collaterals as a framework. External syndromes have identifiable locations; internal syndromes belong to zang-fu organs. Upper purgation differentiation can be further divided into the triple energizer, each focusing on its key aspects to determine the location of disease and mechanism of disease, providing a rational basis for selecting acupoints along the meridians. Pattern identification requires a comprehensive understanding of the body's symptoms and signs. In terms of location, attention should be paid to the differences between upper and lower, left and right; in terms of disease development, attention should be paid to the sequence of changes. One should not focus only on the local area while neglecting the whole, or focus only on the present while ignoring the development process.

2. Treatment and Treating the Root

The term "tip" refers to the extremities, while "root" refers to the fundamental aspects. The concepts of "tip" and "root" are used to analyze the primary and secondary relationships of various phenomena. In acupuncture and moxibustion treatment, understanding the branch and root is essential, primarily to discern the branch and root of the disease. Generally, the initial illness is the root, and subsequent illnesses are the tip; the main symptoms are the root, and the secondary symptoms are the tip; zang-fu organ diseases are the root, while meridian and collateral diseases are the tip; internal diseases are the root, and external contractions are the tip. There is an interactive relationship between the root disease and the tip disease: under normal circumstances, treatment should focus on addressing the root, or both the root and the tip simultaneously, but in special cases, the focus should be on treating the tip. This is the principle of "treating the tip in acute conditions and the root in chronic conditions." Secondly, it is crucial to master the branch and root of acupoint selection. According to the meridian and collateral branch and root theory, the meridian points on the limbs are the root, while those on the head and body are the tip, and the points on the Governor Vessel (GV) are considered the root of all meridian points. This has significant implications in acupoint selection and treatment. For example, in newly emerged excess pattern, one might first select the root points on the limbs and then the tip points on the head and body; for chronic deficiency pattern, one might first select the tip points on the head and body and then the root points on the limbs. Depending on the severity of the condition, treatment may focus on the tip, the root, or both. This is also what Lingshu-Bingben states: "When a disease manifests with excess, treat the root first and then the tip; when a disease manifests with deficiency, treat the tip first and then the root. Carefully assess the severity and adjust accordingly. Mild cases can be treated concurrently, while severe cases require a focused approach." For example, in asthma patients, the root of the disease lies in the lungs, and the tip lies in the chest, back, and upper limbs. If a new common cold presents with symptoms like chills, fever, and headache, these are tip symptoms, and "treating the tip in acute disease" means addressing the chills, fever, and headache first, followed by treating the asthma to achieve "treating the root in chronic disease." The treatment of asthma also involves addressing both the tip and the root. For excess syndromes, draining Chize (LU5) and Yuji (LU10) targets the root points; for deficiency syndromes, moxibustion on Feishu (BL13) and Gaohuangshu (BL43) targets the tip points. For chronic conditions, points on the Governor Vessel (GV) such as Dazhui (GV14) and Tiantu (CV22), as well as points like Qihai (CV6) and Guanyuan (CV4) based on kidney qi theory, are also used, adhering to the principle that "treating disease should focus on the root."

III. Tonifying Deficiency and Draining Excess

"Deficiency" refers to the weakness of the body's healthy qi, while "excess" refers to the predominance of pathogenic qi. The rise and fall of pathogenic and healthy qi determines the deficiency and excess of pathological changes. Deficiency and excess are the two major principles that distinguish the nature of disease in the human body. Tonifying deficiency means supporting the body's healthy qi, enhancing the function of the zang-fu organs, and supplementing the body's yin-yang, qi, and blood to resist disease. Draining excess means expelling pathogenic qi to facilitate the recovery of healthy qi. The "tonifying deficiency" and "draining excess" in acupuncture and moxibustion are achieved by stimulating the body's regulatory functions through the methods of needling and moxibustion, thereby producing the effects of tonification and drainage, and achieving the goal of reinforcing healthy qi and eliminating pathogenic factors. The tonifying method includes "treating deficiency with tonification" and "moxibustion for sinking." Treating deficiency with tonification refers to situations where, in the struggle between pathogenic and healthy qi, if healthy qi is insufficient and becomes the main aspect of the contradiction, the symptoms often manifest as deficiency pattern. For example, severe or prolonged illness, consumption of essential qi, or excessive sweating, vomiting, diarrhea, or major bleeding that injures yang qi and yin fluids can all lead to weakness of healthy qi, reduced function, and symptoms such as pale or sallow complexion, listlessness, fatigue, palpitations, shortness of breath, cold limbs, or heat in the five centers, spontaneous sweating, night sweating, loose stools, incontinence of urine, scant or no tongue coating, and weak pulse. For yang deficiency and qi deficiency, filiform needles are used with the tonifying method and moxibustion to invigorate yang qi; for yin deficiency, filiform needles are used with the tonifying method to nourish yin.

"Moxibustion for sinking" comes from the Lingshu-Jingmai chapter. "Sinking" has two meanings: one refers to the sinking of middle qi, losing its ability to hold; the other refers to a deep and weak pulse, which often indicates qi deficiency pattern or yang qi collapse. For qi deficiency pattern and yang deficiency pattern, moxibustion should be used for treatment. For example, in cases of sudden yang qi collapse, continuous sweating, cold limbs, and faint pulse, points such as Shenque (CV8), Guanyuan (CV4), and Qihai (CV6) should be selected, and large moxa cones should be used for heavy moxibustion to restore yang and stop collapse; for syndromes of middle qi sinking such as prolapse of the rectum or uterus, moxibustion should be applied to points like Baihui (GV20) and Qihai (CV6) to lift the sinking qi. The draining method includes "draining excess when it is abundant," "draining when full," "removing stagnation," and "breaking blood stasis." Draining excess when it is abundant refers to situations where pathogenic qi is hyperactive, such as fever, abdominal distension and fullness with pain and tenderness, chest tightness, dysphoria, even unconsciousness and delirious speech, coarse breathing, profuse phlegm, severe constipation, difficulty urinating, thick and greasy tongue coating, and strong pulse. Treatment should use the draining method, either with filiform needles, bloodletting with a three-edged needle, or heavy tapping with a plum-blossom needle to remove pathogenic factors. When pathogenic factors are removed, healthy qi will stabilize, and the disease will improve. "Draining when full" has the same meaning as "draining excess." "Removing stagnation" refers to qi and blood stagnation, which is treated with bloodletting to activate blood circulation, remove stasis, and unblock collaterals. "Breaking blood stasis" comes from the Suwen‧Yin-Yang Yingxiang Dalun chapter. "Excess" refers to pathogenic excess, such as hyperactivity of pathogenic qi in the blood or toxic stagnation in the blood aspect, leading to blood heat pattern or stasis pattern caused by static blood obstruction. "Breaking" means draining, with the intention of breaking blood stasis, and can be treated with bloodletting methods. IV. Regulating Qi and Regulating Spirit

The therapeutic effect of acupuncture and moxibustion emphasizes the concept of "regulation," collectively referred to as "regulating blood and qi," with the focus being on "regulating qi." Lingshu-Cijie Zhenxie states: "The use of needles is to regulate qi"; it also says: "Without the regulation of fire, it cannot be achieved." This illustrates that both acupuncture and moxibustion aim at "regulation," from regulating local qi and blood to overall qi and blood, to achieve "yin-yang balance." The activity of "qi" is primarily guided by "spirit." Acupuncture can regulate qi to treat the spirit, and fully utilizing the role of the spirit can better regulate qi. Therefore, when treating patients, doctors must first concentrate their thoughts, "focus their spirit, and direct their will to the needle," to achieve the effect of "moving the spirit, and stopping when qi arrives." Qi mainly refers to the purgation qi of the needle, and also refers to the functional changes of the body that occur with the sensation of acupuncture. Regulating qi means regulating the purgation qi of the needle, as well as regulating the qi of the entire body. Treating the spirit includes adjusting the mental states of both the doctor and the patient, and leveraging the initiative of both parties. Wang Bing's annotation on Suwen "The essence of acupuncture must first treat the spirit" says: "Focus the spirit, be still and undisturbed, the essential truth of acupuncture lies here!" This refers to the spirit being settled and qi following. Later, Dou Han-qing wrote in Biao You Fu: "When performing acupuncture, make Benshen (GB13) face upwards before insertion; after insertion, make Benshen (GB13) settle and qi follow. Do not insert the needle if the spirit is not facing upwards, but it can be applied once the spirit is settled." This requires acupuncture to be performed when the patient's spirit is gathered and settled. Once the spirit is settled, qi follows, and on the basis of obtaining qi, methods such as tonifying, purging, and guiding qi are used to regulate qi. Throughout the treatment process, it is essential to observe the changes in the patient's mental state.