Mastering the Nine Needles: Acupuncture’s Art of Tonification and Reduction

Emperor Huang inquired, “I am eager to hear your exposition on the Nine Needles and the principles of tonification and reduction for treating deficiency and excess conditions.” Qi Bo replied, “For deficiency syndromes, tonification is the key. When the needle is inserted, a sensation of warmth should be felt, as this indicates the replenishment of vital energy. Conversely, for excess conditions, reduction is the way to go. A sensation of coolness under the needle signifies the dissipation of pathogenic factors. When blood stasis has lingered for a long time, the method of bloodletting should be employed to eliminate the stagnant blood. In treating excess conditions with reduction techniques, one should avoid pressing the needle hole after withdrawing the needle, allowing the pathogenic factors to escape. The phrase ‘slow withdrawal and quick closure lead to a solidifying effect’ means that the needle should be withdrawn slowly, and the hole should be promptly closed to retain the vital energy. On the other hand, ‘quick withdrawal and slow closure lead to an emptying effect’ implies that the needle should be withdrawn rapidly, and the hole should not be immediately closed, facilitating the expulsion of pathogenic factors. The basis for determining whether a condition is excess or deficiency lies in the amount of coolness or warmth felt under the needle when the Qi arrives. The term ‘as if there, yet not there’ describes the swift yet imperceptible arrival of the meridian Qi after the needle is inserted. ‘Careful examination of the sequence’ refers to discerning the progression of the disease. For deficiency conditions, tonification is applied; for excess conditions, reduction is used. A physician must adhere to this principle in treating diseases. If a physician fails to grasp this accurately, they will deviate from the correct therapeutic principles. The crux of tonification and reduction lies in the skillful application of the Nine Needles, as each needle has its unique characteristics and is suitable for different conditions. The timing of tonification and reduction should be coordinated with the arrival and departure of Qi: when Qi arrives, it is considered open and can be reduced; when Qi departs, it is considered closed and can be tonified. The Nine Needles have different names and shapes, and their tonifying and reducing effects should be fully utilized according to the treatment needs.

For excess conditions, reduction is necessary. The needle should be left in place after insertion, and it can be withdrawn once a distinct sensation of coolness is felt under the needle. For deficiency conditions, the goal is to tonify the Qi. The needle can be withdrawn once a noticeable sensation of warmth is felt under the needle. When the meridian Qi has arrived, one should guard it carefully and not lose it, nor change the technique. To determine the depth of needling, one must first ascertain whether the disease is internal or external. Although there is a distinction between shallow and deep needling, the method of waiting for Qi is the same. When manipulating the needle, one should be as cautious as if facing a deep abyss, lest they fall. When holding the needle, one should be as firm as if grasping a tiger. The mind should not be distracted by other matters; one should focus intently on the patient and not look around. The needling technique must be correct, straight, and not crooked. After inserting the needle, one must closely observe the patient’s eyes to control their mental activity and ensure the smooth flow of Qi. The Sanli point is located three transverse fingers below the outer side of the knee. The Fusang point is on the top of the foot, easily seen when the knee is raised. The Ju Xu point is in the recess of the outer side of the lower leg when the foot is flexed. The Xia Lian point is below the recess of the outer side of the lower leg.

Emperor Huang said, “I have heard that the Nine Needles correspond to the heavens, earth, four seasons, and the Yin and Yang. Please elaborate on this principle so that it may be passed down through the ages as a constant method for treating diseases.” Qi Bo replied, “Heaven, earth, humans, the four seasons, the five tones, the six laws, the seven stars, the eight winds, and the nine fields—all these correspond to the human body. The shapes of the needles are also made according to the different conditions they are designed to treat, hence the name Nine Needles. The human skin is on the outside, protecting the entire body, corresponding to heaven. The muscles are soft and quiet, like the earth bearing all things. The meridians correspond to the human body itself. The tendons bind the whole body, with different functions in different parts, just as the climate varies in the four seasons. The human voice corresponds to the five tones. The Yin and Yang energies of the human viscera are coordinated like the six laws with their measured pitches. The arrangement of human teeth and facial features is like the stars in the sky. The human breath is like the wind in nature. The nine orifices and 365 collaterals of the human body are distributed throughout, like the rivers and streams on the earth, crisscrossing and irrigating the nine fields. Therefore, among the Nine Needles, the first needle (Jing Needle) is used for the skin, the second needle (Yuan Needle) for the flesh, the third needle (Ti Needle) for the meridians, the fourth needle (Feng Needle) for the tendons, the fifth needle (Pi Needle) for the bones, the sixth needle (Yuan Li Needle) for harmonizing Yin and Yang, the seventh needle (Mao Needle) for replenishing essence and Qi, the eighth needle (Chang Needle) for expelling wind evils, and the ninth needle (Da Needle) for unblocking the nine orifices and removing pathogenic factors from the 365 joints of the body. This is what is meant by different needles having different functions and indications. The human heart’s aspirations correspond to the eight winds. The flow of human Qi corresponds to the movement of the weather. The five sounds of human hair, teeth, ears, and eyes correspond to the five tones and six laws. The flow of Yin and Yang meridians in the human body corresponds to the rivers and streams on the earth. The liver’s essence and Qi are connected to the two eyes, which also belong to the nine orifices. Therefore, the liver and eyes correspond to the number nine.