The Art of Acupuncture: Mastering the Principles of ‘Zhong Shi’

The principle of acupuncture lies entirely within the concept of “zhong shi” (终始, “beginning and end”). To accurately understand the meaning of “zhong shi,” one must take the five viscera as the framework to determine the relationship between yin and yang meridians. Yin meridians are primarily associated with the five viscera, while yang meridians are mainly linked to the six fu organs. Yang meridians receive the qi (vital energy) that flows through the limbs, and yin meridians receive the qi that circulates within the five viscera. Therefore, when using the drainage method for acupuncture treatment, one should “ying er shou zhi” (迎而守之, “meet and guard it”), and when using the tonification method, one should “sui er ji zhi” (随而济之, “follow and aid it”). Mastering the essence of meeting and following for tonification and drainage can harmonize the pulse qi (vital energy). The key to harmonizing the pulse qi lies in understanding the laws of yin and yang, with the five viscera being yin and the six fu organs being yang. If these principles are to be passed on to future generations, they should be taught with a blood oath, and only in this way can they be promoted and expanded. If they are not valued, these principles will gradually disappear, and if they are not followed, they will lead to heavenly disasters.

Prudently follow the principles of the rise and fall of yin and yang in the universe to grasp the meaning of acupuncture’s “zhong shi.” The so-called “zhong shi” refers to using the twelve meridians as the framework, examining the cun kou (寸口, “cun kou pulse”) and ren ying (人迎, “ren ying pulse”) to understand the deficiency, excess, and balance of yin and yang in the human body. In this way, one can roughly grasp the laws of the rise and fall of yin and yang. The so-called “ping ren” (平人, “healthy person”) is someone who is usually disease – free. The pulse at the cun kou and ren ying of a healthy person is in harmony with the changes of yin and yang in the four seasons, and the pulse qi also corresponds up and down, coming and going continuously. The six meridians’ pulses have neither the phenomena of being knotted and insufficient nor the signs of being rapid and excessive. The internal organs and the extremities can coordinate with each other during the changes of cold and warmth in the four seasons, and the form, flesh, and blood qi can also be in harmony. This is the state of a healthy person.

People with shortness of breath will show weak pulses at both the cun kou and ren ying, which are not proportional to the cun and chi (尺, “chi pulse”) pulses of both hands. This condition is a sign of deficiency in both yin and yang. In treatment, tonifying yang will lead to the exhaustion of yin qi, and draining yin will cause the leakage of yang qi. Therefore, only tonifying agents with a sweet and slow effect can be used for regulation. If the condition does not heal, quick – acting drugs can be taken. For such diseases, moxibustion should never be used. If the drainage method is used because it cannot produce quick effects, the essence and qi of the five viscera will be damaged.

If the ren ying pulse is twice as large as the cun kou pulse, the disease is in the foot shaoyang gallbladder meridian. If it is twice as large and also shows signs of restlessness, the disease is in the hand shaoyang sanjiao meridian. If the ren ying pulse is three times larger than the cun kou pulse, the disease is in the foot taiyang bladder meridian. If it is three times larger and also has restlessness, the disease is in the hand taiyang small intestine meridian. If the ren ying pulse is four times larger than the cun kou pulse and the pulse is both large and rapid, it is called “yi yang” (溢阳, “overflowing yang”). Overflowing yang occurs because the six yang meridians are extremely full and cannot interact with yin qi, hence it is called “wai ge” (外格, “external barrier”).

If the cun kou pulse is twice as large as the ren ying pulse, the disease is in the foot jueyin liver meridian. If it is twice as large and also has restlessness, the disease is in the hand jueyin pericardium meridian. If the cun kou pulse is three times larger than the ren ying pulse, the disease is in the foot shao yin kidney meridian. If it is three times larger and also has restlessness, the disease is in the hand shao yin heart meridian. If the cun kou pulse is four times larger than the ren ying pulse and the pulse is both large and rapid, it is called “yi yin” (溢阴, “overflowing yin”). Overflowing yin occurs because the six yin meridians are extremely full and cannot interact with yang qi, hence it is called “nei guan” (内关, “internal barrier”). Internal barrier is a fatal condition where yin and yang are cut off from each other. If both the ren ying and cun kou pulses are more than four times larger than usual, it is called “guan ge” (关格, “barrier”). When the pulse of guan ge appears, the person is close to death.

If the ren ying pulse is twice as large as the cun kou pulse, one should drain the foot shaoyang gallbladder meridian and tonify the foot jueyin liver meridian. Using the method of two drains and one tonification, acupuncture should be performed once a day. During the treatment, one must still palpate the ren ying and cun kou pulses to assess the progression of the disease. If there are signs of restlessness, points on the upper part of the body should be selected until the pulse qi is harmonized and then acupuncture can be stopped. If the ren ying pulse is three times larger than the cun kou pulse, one should drain the foot taiyang bladder meridian and tonify the foot shao yin kidney meridian. Using the method of two drains and one tonification, acupuncture should be performed every two days. During the treatment, one should still palpate the ren ying and cun kou pulses to assess the progression of the disease. If there are signs of restlessness, points on the upper part of the body should be selected until the pulse qi is harmonized and then acupuncture can be stopped. If the ren ying pulse is four times larger than the cun kou pulse, one should drain the foot yangming stomach meridian and tonify the foot taiyin spleen meridian. Using the method of two drains and one tonification, acupuncture should be performed twice a day. During the treatment, one should still palpate the ren ying and cun kou pulses to assess the progression of the disease. If there are signs of restlessness, points on the upper part of the body should be selected until the pulse qi is harmonized and then acupuncture can be stopped.

If the cun kou pulse is twice as large as the ren ying pulse, one should drain the foot jueyin liver meridian and tonify the foot shaoyang gallbladder meridian. Using the method of two drains and one tonification, acupuncture should be performed once a day. During the treatment, one should still palpate the cun kou and ren ying pulses to assess the progression of the disease. If there are signs of restlessness, points on the upper part of the body should be selected until the pulse qi is harmonized and then acupuncture can be stopped. If the cun kou pulse is three times larger than the ren ying pulse, one should drain the foot shao yin kidney meridian and tonify the foot taiyang bladder meridian. Using the method of two drains and one tonification, acupuncture should be performed every two days. During the treatment, one should still palpate the cun kou and ren ying pulses to assess the progression of the disease. If there are signs of restlessness, points on the upper part of the body should be selected until the pulse qi is harmonized and then acupuncture can be stopped. If the cun kou pulse is four times larger than the ren ying pulse, one should drain the foot taiyin spleen meridian and tonify the foot yangming stomach meridian. Using the method of two drains and one tonification, acupuncture should be performed twice a day. During the treatment, one should still palpate the cun kou and ren ying pulses to assess the progression of the disease. If there are signs of restlessness, points on the upper part of the body should be selected until the pulse qi is harmonized and then acupuncture can be stopped. Why is acupuncture performed twice a day? Because the taiyang meridian is in charge of the stomach, and when the grain qi is abundant, people have more qi and blood, so acupuncture can be performed twice a day.

When the pulse at the Ren Ying (人迎, rén yíng) and Cun Kou (寸口, cùn kǒu) points is more than three times larger than normal, it is referred to as “Yin-Yang Ju Yi” (阴阳俱溢, yīn yáng jù yì), meaning both Yin and Yang energies are overflowing. Such a condition, if not properly addressed, can lead to blockage of the blood vessels, preventing the free flow of Qi and blood, causing it to overflow into the flesh and potentially damaging the internal organs. If moxibustion is wrongly applied in this situation, it could cause further transformations and trigger other ailments.

Generally speaking, acupuncture aims to restore the balance of Yin and Yang. “Bu Yin, Xie Yang” (补阴泄阳, bǔ yīn xiè yáng) refers to nourishing the deficient Qi of the five organs while expelling the harmful external influences (the “liu yin” 六淫, liù yín), allowing the individual to regain clear voice, vitality, and sharp senses. If the Yin is depleted and Yang is replenished, however, it could disrupt the normal flow of Qi and blood.

When we say that acupuncture “obtains Qi,” we mean that after using expelling techniques (Xie Fa, 泻法, xiè fǎ), the condition shifts from excess to deficiency. Although the pulse may remain the same size, it becomes softer and weaker. If the pulse remains strong, even though the patient feels some relief, the disease has not been entirely resolved. On the other hand, if a deficiency is treated with supplementation (Bu Fa, 补法, bǔ fǎ), the condition shifts from deficiency to excess. The pulse may remain the same size but will feel stronger and firmer. If after acupuncture the pulse remains large but weak, the patient may feel better temporarily, yet the disease persists. Thus, it is essential to accurately apply supplementation and expulsion techniques to restore proper Qi balance, alleviate symptoms, and improve the overall condition, even though healing may take time.

Before using acupuncture, it is important to understand the mechanism of the twelve meridians. Each meridian has its fixed route and an assigned relationship with the organs. The principles of nourishing deficiencies and expelling excess cannot be interchanged, and the acupuncture points should be selected according to the meridian involved.

For diseases suitable for acupuncture, the “San Ci Fa” (三刺法, sān cì fǎ) method should be used. This involves three types of needling to ensure the flow of the body’s vital energy (Gu Qi, 谷气, gǔ qì). The first needling targets the skin to expel external Yang evils; the second targets the muscles to expel internal Yin evils; and the third targets the flesh to allow the flow of vital energy, ensuring that once the Qi is gathered, the needle can be removed. The term “Gu Qi” refers to the sensation of restored vital energy after supplementation or the expulsion of pathogenic influences after depletion.

For diseases related to excessive Yin, Yang supplementation should be performed first, followed by the expulsion of Yin evils to balance the excess and deficiency. Conversely, if the Yang is excessive and the Yin is deficient, the Yin should be supplemented first, followed by the expulsion of Yang evils.

The three major pulses of the foot Yangming (足阳明经, zú yáng míng jīng), foot Jueyin (足厥阴经, zú jué yīn jīng), and foot Shaoyin (足少阴经, zú shǎo yīn jīng) all converge between the big toe and the second toe. Acupuncturists should observe the pulse’s quality at these sites to determine whether the disease is due to excess or deficiency. If deficiency is mistakenly treated with expulsion, it leads to a deeper deficiency, worsening the disease. To treat such conditions, the pulse should first be palpated. If the pulse is strong and rapid, expulsion methods should be applied immediately; if the pulse is weak and slow, supplementation should be used. Using the wrong method could worsen the disease.

Regarding the meridians of the lower limbs, the foot Yangming Meridian is located on the top of the foot, the foot Jueyin Meridian is on the inner side, and the foot Shaoyin Meridian is located on the bottom.

For diseases of Yin meridians, acupuncture should be applied to points on the chest; for Yang meridians, points on the back should be targeted. If a patient experiences a “heavy tongue” (舌重, shé zhòng), where a swelling forms under the tongue resembling a small tongue, use a fine needle to pierce the base of the tongue to expel the stagnant blood. If a person’s fingers cannot straighten (indicating tendon issues), the condition pertains to muscles; if they cannot bend (indicating bone issues), the condition relates to bones. Therefore, diseases of the bones should be treated with bone acupuncture, and muscle conditions should be treated with tendon acupuncture.

When applying acupuncture for supplementation or expulsion, special attention must be paid: If the pulse is firm and strong, deep needling should be used to release the excess, with no immediate pressure on the needle site afterward, allowing the evil Qi to be expelled fully. If the pulse is weak, shallow needling should be used to nourish the meridian while rapidly pressing the needle hole to prevent further invasion of the evil Qi. When the pulse is strong and the Qi is excessive, deep needling will expel the evil; when the pulse is weak, shallow needling should protect the vital energy while expelling only the harmful Qi. Most pain-related conditions require deep needling, as the pulse in such cases tends to be firm and strong.

So what do we make of it? For ailments above the waist, target the acupoints on 手太阴 (shǒu tàiyīn) and 手阳明 (shǒu yángmíng) meridians. For conditions below the waist, use the points on 足太阴 (zú tàiyīn) and 足阳明 (zú yángmíng) meridians. For upper body ailments, target lower body points, and vice versa. Headaches? Foot points. Foot ailments? Popliteal fossa points. Always begin by locating the earliest onset point of the illness before needling.

Seasonal Illnesses: Spring’s邪气 (xiéqì) affects body hair, summer hits the skin, autumn targets muscles, and winter invades tendons and bones. Adjust the depth of needling based on the seasons—deeper in autumn and winter, and shallower in spring and summer.

Pain Management: Patients with疼痛 (téngtòng, pain) often have阴症 (yīn zhèng, yin syndrome). For undefined pain points, use deep needling. Upper body ailments are阳症 (yáng zhèng), while lower body ones are阴症. Itching indicates邪气 in the skin (阳症), requiring shallow needling.

Symptomatic Needling:

• For阴经 (yīn jīng) originated illnesses, treat阴经 first, then阳经.
• For阳经 (yáng jīng) originated illnesses, treat阳经 first, then阴经.

Treating热厥 (rè jué, heat collapse) and寒厥 (hán jué, cold collapse):

• 留针 (liú zhēn, retain needle) to turn heat to cold or cold to heat.
• For热厥,刺阴经 (cì yīn jīng) twice and阳经 once.
• For寒厥,刺阳经 twice and阴经 once.

Chronic Diseases: Deep needle retention for long durations, and re-needling every other day. Identify邪气偏盛 (xiéqì biānshèng, dominant pathogenic qi) to balance it and remove blood stasis.

Pre-Needling Examination: Evaluate the patient’s physical and元气 (yuán qì, vitality) condition. If only元气 is weak with turbulent pulse, use缪刺法 (miǔ cì fǎ, crossover needling) to consolidate true qi and disperse邪气.

Needling Posture and Environment: The acupuncturist must remain serene, focused, and undisturbed, akin to a secluded retreat, ensuring精神内守 (jīngshén nèishǒu, inner tranquility). Use浅刺 (qiǎn cì, shallow needling) to divert attention until qi arrives. Retain阳气 (yáng qì) inside and expel阴气 (yīn qì) outside.

Acupuncture Taboos: No needling right after sexual activity, intoxication, anger, exhaustion, a big meal, or starvation. Avoid needling thirsty individuals or those with recent fright. Let travelers rest before needling to ensure accurate diagnosis and treatment. Ignoring these guidelines can misalign qi flow and exacerbate illnesses.

Symptoms of Meridian Qi Exhaustion:

• 手足太阳 (shǒu zú tàiyáng): Upward gaze, rigid neck, spasms, pale face, excessive sweating leading to death.
• 手足少阳 (shǒu zú shǎoyáng): Deafness, joint weakness, immobile eyes, leading to death within a day and a half.
• 手足阳明 (shǒu zú yángmíng): Facial twitching, fear, delirium, yellow face, and imminent death.
• 手足少阴 (shǒu zú shǎoyīn): Black face, long dirty teeth, abdominal fullness, and blocked qi leading to death.
• 手足厥阴 (shǒu zú juéyīn): Chest heat, dry throat, frequent urination, irritability, curled tongue, and contracted scrotum, resulting in quick death.
• 手足太阴 (shǒu zú tàiyīn): Abdominal discomfort, difficult breathing, belching, vomiting, and blackened face, leading to death.

So, acupuncture’s guiding principles revolve around precise diagnosis, targeted needling, and keen observance of the patient’s condition for effective treatment.