Foreword by Heiko Lade: This article originally appeared in the Newsletter of the Australian Chinese Medicine Education and Research Council. Ltd Vol.2:1, July 1996 and has been reprinted here with the permission of Steve Clavey, the former editor. Steve Clavey is the author of Fluid Physiology and Pathology in Traditional Chinese Medicine and also currently is the editor of The Lantern, one of the most renowned TCM journals in the English language.
Acupuncture History: Wang Ji and the Zhen jiu Wen Dui
(Queries and Responses on Acupuncture and Moxibustion)
The zhen jiu wen dui (针灸问对) has three long chapters, and was completed in 1530. It uses a “question and answer” approach to discuss acupuncture theory and difficult questions, Wang Ji providing explanations from his own experience. He covers 80 separate questions, backed up with classical references from the Nei Jing and the Nan Jing.
Wang wrote the book, he tells us, because he was appalled at the low level of understanding amongst the acupuncturists of his day. So he combined all of his notes from the Su Wen, Ling Shu, Nan Jing and other treatises on acupuncture, plus the clinical experience he had gained over many years, and put together the Zhen Jiu Wen Dui. He says self-deprecatingly in his introduction: “I had a small chest filled with notes that I had copied from the Nei Jing and Nan Jing, but I couldn’t bear to throw them away. So I made this book, and called it the Queries and Responses on Acupuncture and Moxibustion.” His primary objective was to emphasise that acupuncture did not differ from any of the other specialisations within medicine, in that all diagnostic techniques were required; set point formulas for specific diseases were simply not enough.
Wang Ji (汪机) lived in the Ming Dynasty, from 1463 – 1539 AD, in Anhui Province south of Nanjing. His zi-name was Sheng Zhi (省之), and his self-selected hao-name was Shi Shan Ju Shi (石山居士 “The Lay Buddhist of Stone Mountain”). His father was a well-known doctor, and Wang Ji combined stringent study of the medical classics with studies in the Yi Jing and the Confucian classics.
He wrote ten other books including Original Principles of Medicine (Yi Xue Yuan Li), Shang Han Xuan Lu (Selected Records from the Shang Han Lun) and Du Su Wen Chao (Copied Readings from the Su Wen), the remaining works spanning external medicine, pulse diagnosis, meteorologic qi permutations, the Yi Jing’s medical applications, and a pharmacopoeia. Of several compiled by his disciples, the book Stone Mountain Case Histories (Shi Shan Yi An) has been the most influential.
Wang Ji is very straightforward with his opinions, some of which might raise hackles even today. Overall however the impression given by the Zhen Jiu Wen Dui is that of a no-nonsense practitioner who knows his material inside out and is not afraid to express the viewpoints which he has gained from this study coupled with his clinical experience – even if these go against current “wisdom”.
Excerpts and discussion from the Zhen Jiu Wen Dui
I. Acupuncture treats shi/excess condition, moxa treats xu/deficiency conditions
Wang Ji felt that acupuncture was best used for treating shi/excess cases where the pathogen was relatively recent and had not invaded the depths of the body, and the yuan qi remained undamaged.
But he felt it was not good for deficiency cases. He says, in an annotation following a section explaining the use of the Nine Needles:
Today’s acupuncture practitioner might use the feng or the pi needle for dealing with boils, but for all other illness – no matter whether the problem is at the skin level, the muscle level, the blood level or the tendon or bone – they only use the filiform needle. The rest are placed aside and not used. This is really turning ones back on the guidance of the Classics. From the foregoing discussion we know that the nine needles mainly deal with impinging external pathogens, for which needles are used to drain. This deeply suits the nature of the disease. If someone of today has that type of illness, then needles are still necessary.
Those cases where the pathogen has gone too deep and the yuan qi is injured – these are definitely not the cases where acupuncture is going to be of benefit. For example, in exhaustion cases where yin is weak and xu-fire is active, the proper method is nourishing yin to bring down fire – but can needles add to the yin fluids? In wei/atrophy cases where the Lungs are heated and the lobes parched, the proper method is clear Metal and tonify Water – but can needles tonify water? The Classics say: When yin and yang, form and qi, all are weak, do not choose the needle but rather regulate with sweet herbs. This is just to the point.
Those who know this will be able to determine which illnesses can be needled and which can not. But what is to be down with hose, nowadays, who specialise in acupuncture but do not recognise the pulse and do not examine the body type, but only ask “What’s the problem?” then needle certain set points. There have been some cases where incorrect needling like this has led to the disease turning chronic. Of course occasionally there are also lucky hits amongst the damage – when this happens, the practitioner crows about his marvellous needling. But which of us, knowing him, can refrain from laughing?
II. Acupuncture drains but cannot tonify
This viewpoint priginated with Zhu Dan-Xi, whith whom Wang Ji agrees and takes the argument futher. Wang’s reasoning is based on two facets:
A. The needle itself
The Classics state: If yang is insufficient, warm through the qi; if yin is insufficient, tonify through the wei (favour). Now needles are made of stone, and have neither qi nor flavour. They break the skin and injure the flesh, making holes in the body through which qi can escape. From where would tonification derive?
Later he builds upon this saying
If the body’s qi is weak, and the illness qi also weak, this is weakness of both yin and yang and cannot be needled. Needling will heavily drain and exhaust the qi – the old will die, (even) the strong will never recover.
Thus he advocates following the Classic’s statement that insufficiency of yin and yang must be “tonified with sweet herbs”.
B. The effect of needling
Wang felt that there is no way for needles to supplement the qi of the body directly by adding anything to it. Acupuncture is only able, he says, to regulate the functioning of the body and promote the free movement of qi: when pathological qi is dominant, by draining; when normal qi is retarded, by encouraging its flow; when normal qi is stopped, by getting it to move. All of these effect changes within the body which can be classified as xie/draining.
Those passages in the Classics which discuss “tonification”, he says, are in the nature of “removing the pathogen in order to enhance the zhen/normal qi” (qu xie fu zheng 祛邪扶正).
Wang refers to Zhang Zi-He’s noted School of Purging views when he explains: “The tonification methods mentioned in the Classics are actually what Zhang Zi-He called eliminating the pathogenic excess in order to rectify the zheng qi, removing old evil to allow a new rebirth!”
Thus when Wang Ji discusses tonification methods with needles, it is in this sense.
III. Emphasising differentiation of pattern to determine treatment: no “Set Points” in the treatment of disease.
Wang Ji opposes the idea that pre-determined point formula can be used in the treatment of disease, saying that such a mechanical approach is too rigid to deal with the exigencies of everyday clinic.
For any disease one should differentiate the variable strength of the pathogen and that of the zheng qi, the location of the disease internally or externally, the relative weakness and fullness around the body. Only then can reduction or tonification be used…There are no set points in treatment; when a pathogen invades the body, it travels around with the circulation, up and down, perhaps in the qi level, perhaps in the blood level – there is no settled spot. Thus it is said that using needles is like directing an army; if the energy moves, we respond, now attacking with special forces, now defending with the standard troops. There is no pre-determined way to control the situation.
He also feels that the practice of setting standard depths for needling and even specifying a set number of moxa cones is too mechanical for the same reasons.
The acupuncture books of several experts recommend specified depths for each point, now many breaths the needles should be left, how many cones of moxa should be used; does this accord with the Classics?
This is not recorded in the Classics, and exceeds the tradition of the Classics, which say: An illness can be floating or sunken, the needling can be shallow or deep. If the depth is not achieved, this conversely causes major problems. Overly deep injures the interior, not deep enough leaves obstruction in the exterior. The treatment methods of the ancients involved observing the depth of the disease and then needling either shallow or deep to match; how could there is a set depth as a restriction?
There authors you mention also say that at certain points needles must be left for a certain number of breaths – this perversion of sense if extreme! The Classics say: needling shi/excess requires making it (ie the pathogen) xu, leave the needle until the yin qi arrives in full and there is a cold sensation under the needle, only then remove it. When the channel qi arrives, carefully guard it without loss. The Classics also state: When needling and the qi does not arrive, do not worry about how long it takes; when needling and the qi does arrive, then the needles can be removed;- but do not needle again.
Acupuncture in each situation is different; the important thing is that the qi arrives, only then will there be effect. And this effect can be seen as clearly as wind blowing away clouds, as clear as the blue sky above. The Classics also state: When qi and blood have not yet responded to the needle, it is like the stillness of a cocked crossbow; but when they do respond, the rapidity is that of a sped bolt! When this is the case, how can the circulation of qi and blood be accurately pinpointed by leaving the needle for a certain number of breaths?
… Illnesses change without end, likewise our needles and moxibustion methods must be limitless … determine channel or collateral, differentiate blood or qi. The disease follows the existing pathway of a channel, you must choose points according to this channel, only in this way can you keep up with the changes. How can you hold to the idea that ‘this point treats this disease’?
IV. Opposing using moxa without illness; the use of the middle finger joint to determine a variable body “cun”; and the idea that men and women, day and night all have differing needle manipulation requirements
People say the moxa even without illness can prevent an illness occurring. What about this?
When a patient is ill, it is like a country afflicted with bandits; the army must be used to punish them. One cannot help but bring out the troops. Acupuncture and moxibustion is like this, one cannot help but use them for treating illness.
People say that moxibustion without illness is like repairing an old boat by adding nails; they also say “if you want peace, do not let Gao Huang (UB – 43) or San Li (St 36) dry up” (ie from supportive moxibustion). All these are common places nowadays – only I alone disagree, when a point is moxa’d (supportively), the flesh in that area hardens, in fact it is like nails in a boat! When the qi and blood reach this area they stop and cannot move through. There once was a patient who was lame, in whom the pathogen was located in the Foot Shao Yang channel; moxibustion was applied to several points along the channel above the outer ankle. When I needled Zu Lin Qi (GB 43) and wanted the qi to move past the affected area, the qi only reached the moxibustion scars, then stopped and would go no further. That is when I first leaned the damage that moxibustion fire can do to the body’s channels and collaterals.
There may be an emergency when we need to free the flow of qi, but it will no longer be effective. When an illness invades the channels and collaterals, then it causes suffering and we have no alternative but to moxibustion. Moxibustion without illness, though, how could it benefit?
Wang Ji’s views on variable body cun are a bit shocking, but have certain logic. He says: “Using the middle finger joint to determine a single cun… have they never thought about those people who are tall with short arms or short with long arms … definitely a mistake.”
As to differing needle manipulations according to male or female, night or day, Wang says:
The circulation of wei/protective qi is only differentiated by day or night, I have never heard of a difference of above and below! There is no difference, either, in the zang-fu, channels or collaterals of men and women. The acupuncture odes presently speak as if there were such a difference, but it seems like baseless rumours to me, not a method to be used on people.
He also says:
After reviewing ths Su Wen and the Nan Jing, there is no male-female difference in the day or night circulation amongst zang-fu, channels, collaterals, points, qi or blood, but these odes talking about “before noon” and “after noon” turn men and women’s tonification and reduction on its head and create confusion in a manner that is really a deep perversion of the intent of the Classics.
Wang Ji’s vigorous prose, unfailing common sense and excellent grounding in the Classics makes the Zhen Jiu Wen Dui both fascinating and enlightening reading, with ample material for the acupuncture iconoclast to whet her teeth.
The Zhen Jiu Wen Dui contains a tremendous amount of material on the accurate use of acupuncture, including specific information on special function points, needling manipulation, times according to the meteorologic circulation of qi and pulse diagnosis.
Furthermore the whole of the long final chapter is concerned with the proper application of moxibustion.