Nine Needles, Nine Methods

The Yellow Emperor’s Classic of Internal Medicine, or Nei Jing,is one of the fundamental acupuncture texts of Chinese Medicine. The text provides not only the rationale but also many methods for the treatment of disease using acupuncture. An analysis of some of the ideas and techniques of acupuncture found in the Nei Jing, focusing on the Nine Ancient Insertion Methods will form the main body of this post.

Introduction

To explore these methods in any depth, however, will require some preliminary comments on the history of acupuncture and the historical development of the acupuncture needle. In keeping with the Yellow Emperor’s own admonition that all successful therapy derives from accurate diagnosis, we will also explore some of the concepts which guide the physician in identifying the salient aspects of a disorder. A discussion of the Nine Needles is particularly suited to this discussion, as the nine needles were initially developed to treat according to the location and level of penetration of the pathogenic factor. Finally, the historical progression which led from the use of the nine needles to their extrapolation into nine methods of needle insertion will be discussed in terms of its implications for the significance of Nei Jing theory and its application in the modern clinical setting.

Underscoring this discussion is the concept of the “roundness” of Chinese Medicine, as outlined in Chapter 26 of the Su Wen: “Roundess refers to flow, the flow of Qi…A cultivated physician with mastery of techniques must understand the meaning of the patient’s physical appearance and shape, size, and relative state of ying and wei, or nutritive and defensive, Qi and Blood in order to accomplish the intended purpose. The human body is so precious that one must pay the utmost attention with great care” (Ni, 105). This is, perhaps, the ultimate message we can derive from our study of the Nei Jing.

Archeological evidence suggests the existence of acupuncture as early as Neolithic times. At that time, needles were made of stone, with later developments employing other natural materials like fish and animal bones. By the time of the publication of the Nei Jing, metal needles of the type described as the Nine Needles, were already in existence. Prior to the development of the modern filiform needle in the Second Century AD, acupuncture treatment relied on the use of the nine different needles, wherein the type of needle used governed the technique being used (Johns, 117).

The Nine Needles

The nine types of needles each differ in name and form.

• The Chan needle is arrow-shaped and 1.6 cun long. Used at the level of skin, the Chan is used for external pathogenic influences which have penetrated into the body.
  
• The Yuan needle (1.6 cun), with its rounded tip, is used for shallow massage.
• The Di needle has a blunt tip which is used only on the surface. It is 3.5 cun long.
  
• The Feng needle is 1.6 cun long and is used for bleeding; it is very sharp.
  
• The name of the Pi needle refers to its sword-like tip. It is 4 cun long .25 cun wide and is utilized to pierce the skin and discharge pus.
  
• The Yuan-Li needle is 1.6 cun long. Its sharp, thick and rounded tip is useful in the treatment of acute disease.
  
• The modern filiform needle is based on the Hao needle, the most fine of the nine types. It is used for obstruction, joint pain and paralysis, and its use was distinguished by the retention of the needle in the body.
  
• At 7 cun, the Long, or Chang needle is used for paralysis and obstruction.
  
• The Da needle is used for the treatment of articular swelling and to drain fluid from swollen joints. It is 4 cun long.

Thus the nine needles were historically used for treating specific conditions, and each was adapted to a unique purpose. Chapter 6 of the Ling Shu describes this:

“the therapeutic effects of needling depend on the length and size of the needle being employed. Cure is impossible without the application of a right needle. When a deep insertion is applied to treat a superficial disease, it will only cause harm to the healthy muscles below the skin and give rise to carbuncles” (Lu, 716).

With the development of the filiform needle, acupuncture theory and technique changed so that it could be used to deliver the same type of effects.

But how is the physician to recognize the location of the pathogen, and discern the proper treatment to adopt? The Nei Jing provides ample clues to aid the acupuncturist in choosing the appropriate method to utilize. Obviously there are too many guidelines in the text to discuss each one here, but some examples will suffice.

Returning to Chapter 26 of the Su Wen, we read that

“Mastery of acupuncture is like using a bow and arrow: you must know the precise moment to unleash the arrow. Mediocre acupuncturists are like those who hammer a wooden nail, dull and imprecise. You must find the right moment and without hesitation, but with clarity, then you insert the needle. This is how you hit the target and dispel the pathogen” (Ni, 108).

Later, in Chapter 50, titled “Rudiments of Acupuncture,” Huang Di asks Qi Bo to explain the important principles of acupuncture. Qi Bo replies that it is imperative to recognize the effects of pathogens on different areas and depths of the body, and that the first of these considerations is to determine whether the disease is superficial or deep. These distinctions form one of the guiding principles for acupuncture treatment.

“Qi Bo answered, ‘In disease one must differentiate between the external and internal location of the pathogen. In acupuncture there are differentiations of deep or shallow insertions. If the illness is on the biao, or external level, one should insert superficially; if on the internal level, one should insert more deeply.” He goes on to conclude that “acupuncture performed without a guiding principle can be dangerous or damaging” (Ni, 184).

As confined as this discussion is, it demonstrates the necessity of applying great attention and discernment to even the most basic distinctions. Qi Bo explains at some length the differentiation and effects of pathogens invading the level of hair, skin, muscle, channels, tendons, bones, and marrow. But the seemingly simple division into the two categories of superficial and deep is fundamental to these further divisions.

How can one determine the exact location of a disease if he cannot distinguish internal from external? Nevertheless, we find Qi Bo voicing this one caveat in conversation with the Yellow Emperor:

“It appears fairly easy to talk about the essentials of applying minute needles, but it is so only on a superficial level. Just as soon as we enter into a discussion of this nature in depth, we discover many difficult points. In my opinion, only an unskilled physician will confine himself to the physical appearance of his patient. A skilled physician will carry a step further and examine the spirit of his patient as well” (Lu, 652).

Almost as if a play on words, Qi Bo describes not only the body but the discussion itself as having its superficial and deep levels; imagine to what depths we must delve to fathom the spirit of the patient! Chapter 8 of the Ling Shu touches on this concept when it suggests that “For every needling, the method is above all/ Not to miss the rooting in the Spirits” (Larre & Rochat, 4).


Nine Ancient Methods

The Nei Jing, with its sophisticated understanding of the human body in all its profound depths, can still guide us in the conditions we face in the modern clinic. Developments in the technical quality of needles have changed the face of acupuncture, such that techniques for acupuncture have been developed which are designed to mimic the effects of the Nine Needles described in the Nei Jing. This demonstrates the extent to which the modern clinician can continue to be open to the influences of ancient understanding while adapting to changed circumstances. Thus, we now employ the filiform needle according to the methods previously so intimately associated with the use of nine different types of needles. What follows is a brief introduction to the Nine Ancient Insertion Methods Based on the Uses of the Nine Needles, with examples of their application.

• Mao Ci refers to puncturing very superficially. Today the cutaneous needle is used for this purpose. In ancient times the Chan needle served this function. It is useful in the treatment of numbness of the skin.
• Fen Ci refers to needling at the borders of muscles or between muscle layers. This suggests that the needle used in the past was the Hao needle. An example is the use of LI 14 through and through to LI 15 to treat pain in the shoulder and arm.
• Luo Ci refers to superficial puncturing with a three-edged needle. It is for the removal of pathogenic Heat and excess conditions. This method is based on the Yuan Li needle.
• The Pi needle was used to open the skin and discharge pus. The method derived from its use is known as Da Xie Ci. It is used in the treatment of large abscesses, boils, and carbuncles.
• Jing Ci is translated as Channel puncturing and refers to the treatment of channel obstruction or in the area traversed by the channel. It is a method chosen according to symptoms presenting in the meridians or related to individual organs. An example is the use of LI 4 combined with LI 20 to treat nasal congestion (Johns, 138).
• Shu Ci is a method of choosing points which exert a direct influence on their associated organs. Points selected for this method of puncturing are the distal Shu points as well as Back-Shu points.
• Yuan Dao Ci refers to remote puncturing. This technique is related to other theories expounded in the Nei jing, such as utilizing points in the lower part of the body to treat conditions in the upper aspect of the body, or treating points on the left in a condition manifesting on the left.
• Another similar style of treatment is that of Ju Ci. Ju Ci utilizes points according to the manifestation of abnormality on the pulse. It is indicated in conditions where a problem occurs on one side of the body but is reflected in the pulse on the opposite side. An example of this might occur in the treatment of stroke (Johns, 141).
• The final method derived from the ancient use of the Nine Needles is Cui Ci. Cui Ci utilizes a special needle to this day, due to the unusual demands which the method places on the needle. Translated as Flame Needle Puncturing, it is seldom used in the United States. A needle is heated until very hot, then inserted as quickly as possible into the body. The Shanghai text, Acupuncture: a comprehensive text describes its use for “rheumatic type conditions caused by cold (painful, swollen joints feeling of heaviness, sometimes accompanied by soreness in the muscles).”

Some of the methods derived from the Ancient Nine Needles are less clearly founded on the principles related to the form of the needles than others. In determining a diagnosis, whether it be merely discerning whether the pathogenic influence is superficial or deep, or piercing to the depths of the Spirits, what is absolutely necessary is distinguishing that which is essential from that which is not. The methods described, in their application according to specific needs, recalls Qi Bo’s statement that,

“The proper application of needles makes up the total secrets of needling” (Lu, 716).

Bibliography
Auteroche, B, et al. Acupuncture and Moxibustion. Churchill Livingstone, 1989.

Johns, Robert. The Art of Acupuncture Techniques. North Atlantic Books, 1996.

Larre, Claude. Rooted in Spirit. Station Hill Press, 1995.

Lu, Henry. Yellow Emperor’s Classic. Academy of Oriental Heritage, 1978.

Ni, Maoshing. Yellow Emperor’s Classic of Medicine. Shambhala, 1995.