Combining Difficulties
Innovating the Nánjīng
A few weeks back we looked at the Dōngyuán acupuncture method as presented in Gatherings from Acumoxa Heroes [Zhēnjiǔ Jùyīng針灸聚英, more commonly known as Gatherings from Eminent Acupuncturists] by Gāo Wǔ [高武] from 1529. In going through the Jùyīng I came across another passage that I found interesting: an adaptation of material from the Classic of Difficulties [Nánjīng].
I’ve written on Nánjīng several times before, as it is the text most closely associated with the Japanese meridian therapy [keiraku chiryō] style, which is the foundation of my approach to acupuncture. With its rigorous application of yīn-yáng and five-phase theory, Paul Unschuld called Nánjīng “the mature classic of systematic correspondence [emphasis from original]” (Unschuld, 1985). In terms of diagnostics, Nánjīng is often celebrated for its multiple innovations in pulse diagnosis – which, if you are curious, I highly recommend Z’ev Rosenberg’s excellent commentary Ripples in the Flow (Rosenberg, 2020) – but another chapter has, in my mind, an equally illustrious place in the development of keiraku chiryō.
Difficulties 16 and 68
Nánjīng chapter 16 gives us actual pattern-based diagnostics and therapeutics based on yīn-yáng and five-phase theory. There are external and internal symptoms, along with signs such as pulse and abdominal palpation that can confirm the diagnosis. This is the source of the patterns [shō] used in keiraku chiryō.
Other chapters in the text give us a multidimensional view of not only pulse diagnosis, but also etiology and pathogenesis, and an expanded discussion of extraordinary vessels. Later chapters lay out a system of therapeutics distinct from the Yellow Emperor’s Inner Classic: Spiritual Pivot [Huángdì Nèijīng Língshū], focusing tightly on five-phase dynamics. One such chapter is difficulty 68, which we discussed in a post from a few years back.
This section from Zhēnjiǔ Jùyīng combines difficulties 16 and 68, with some influence from later commentators.
臟腑井滎俞經合主治
假令得弦脈。病人善潔。（膽為清淨之府故耳）面青善怒。此膽病也。若心下滿當刺竅陰。（井）身熱當刺俠谿。（滎）體重節痛刺臨泣。（俞）喘咳寒熱刺陽輔。（經）逆氣而泄刺陽陵泉。（合）又總取丘墟。（原）
Indications for the five transport points of the zàngfǔ
In case of a wiry pulse, where the patient inclines toward fastidiousness (because the gallbladder is the fǔ of purity), the facial complexion is greenish, and there is a tendency to anger. This is gallbladder disease.
If there is fullness below the heart, one should needle Qiàoyīn [GB-44] (jǐng-well);
if there is heat in the body, one should needle Xiáxī [GB-43] (yíng-spring);
if there is heaviness of the body and joint pain, one should needle Línqì [GB-41] (shù-stream);
if there is panting and coughing, cold and heat, one should needle Yángfǔ [GB-38] (jīng-river);
if there is counterflow qì and leakage, one should needle Yánglíngquán [GB-34] (hé-sea).
In every case, select Qiūxū [GB-40] (yuán-source).
假令得弦脈。病人淋溲難。轉筋。四肢滿閉。臍右有動氣。此肝病也。若心下滿當刺大敦。（井）身熱刺行間。（滎）體重節痛刺太衝。（俞）喘嗽寒熱刺中封。（經）逆氣而泄刺曲泉。（合）
In case of a wiry pulse, where the patient has [symptoms such as] difficulty urinating, cramping sinews, fullness and obstruction in the four limbs, and stirring qì to the right of the navel [note: this is a typo, Nánjīng 16 has “left of the navel 齊左” here], this is liver disease.
If there is fullness below the heart, one should needle Dàdūn [LR-1] (jǐng-well);
if there is heat in the body, one should needle Xíngjiān [LR-2] (yíng-spring);
if there is heaviness of the body and joint pain, one should needle Tàichòng [LR-3] (shù-stream);
if there is panting and coughing, cold and heat, one should needle Zhōngfēng [LR-4] (jīng-river);
if there is counterflow qì and leakage, one should needle Qūquán [LR-8] (hé-sea).
Note: in Nánjīng 16, the zàng organs are the only ones mentioned, thus all of the exterior and interior signs are allocated to the zàng. Later commentators, such as Lǚ Guǎng [呂 廣], ascribed the exterior signs – facial appearance, outward behavior, emotional states, and a few more superficial physiological phenomena – to the corresponding fǔ (Unschuld, 1986). Thus greenish complexion, anger and fastidiousness are assigned to the gallbladder, where symptoms involving organ function and abdominal palpation belong to the liver.
Urinary block as a liver symptom is explained by Xú Dàchūn (Xu, 1727) in his Commentary on Classic of Difficulties [Nánjīng jīngshì 難經經釋]:
《靈·經脈篇》云，足厥陰循陰股，結於陰器，故病見於溲便也。）
Líng [shū] Channels and Vessels chapter [10] says: Foot juéyīn circulates to the groin and binds at the yīn organ [genitalia], so its diseases are seen in the urination.
The point selection in this and all following examples is mostly adapted from Nánjīng difficulty 68. The yuán-source point is added to the examples on yáng channels. They are not added to the yīn channels because on those channels the yuán-source and shù-stream points are, of course, identical.
假令得浮洪脈。病人面赤口乾喜笑。此小腸病也。若心下滿刺少澤。（井）身熱刺前谷。（滎）體重節痛刺後谿。（俞）喘嗽寒熱刺陽谷。（經）逆氣而泄刺小海。（合）又總刺腕骨。（原）
In case of a floating and full pulse, where the patient has [symptoms such as] a red face, dry mouth, and a tendency to laugh, this is small intestine disease.
If there is fullness below the heart, one should needle Shàozé [SI-1] (jǐng-well);
if there is heat in the body, one should needle Qiángǔ [SI-2] (yíng-spring);
if there is heaviness of the body and joint pain, one should needle Hòuxī [SI-3] (shù-stream);
if there is panting and coughing, cold and heat, one should needle Yánggǔ [SI-5] (jīng-river);
if there is counterflow qì and leakage, one should needle Xiǎohǎi [SI-8] (hé-sea).
In every case, select Wànggǔ [SI-4] (yuán-source).
假令得浮洪脈。病人煩心。心痛。掌中熱而噦。臍上有動氣。此心病也。若心下滿刺少衝。（井）身熱刺少府。（滎）體重節痛刺神門。（俞）喘嗽寒熱刺靈道。（經）逆氣而泄刺少海。（合）
In case of a floating and full pulse, where the patient has [symptoms such as] vexation, heart pain, heat in the palms, and vomiting, with stirring qì above the navel, this is heart disease.
If there is fullness below the heart, one should needle Shǎochòng [HT-9] (jǐng-well);
if there is heat in the body, one should needle Shǎofǔ [HT-8] (yíng-spring);
if there is heaviness of the body and joint pain, one should needle Shénmén [HT-7] (shù-stream);
if there is panting and coughing, cold and heat, one should needle Língdào [HT-4] (jīng-river);
if there is counterflow qì and leakage, one should needle Shàohǎi [HT-3] (hé-sea).
Note: I do find it interesting that the behavioral and psychoemotional signs, because of their outward nature, are considered to indicate the fǔ organs. The heart stores the shén-spirit, and I think many would regard the shén as being a deeper aspect of the organ. However, these signs (anger, laughter, fussiness) show up as part of our interface with the outside world, and thus are given as external signs. Vexation, as Gāo Wǔ explains in another passage in Jùyīng, is experienced inwardly, where agitation is apparent from the outside:
Also note that there is no mention of the pericardium or triple burner. The pericardium channel is generally substituted for the heart channel in standard consensus Japanese keiraku chiryō. One could make a case that the triple burner, which Nánjīng identifies as the thoroughfare for the source qì, is involved when one needles the yuán point, which we are here advised to do when treating the other fǔ organ patterns.
假令得浮緩脈。病人面黃。善噫善思善沫。此胃病也。若心下滿刺厲兌。（井）身熱刺內庭。（滎）體重節痛刺陷谷。（俞）喘嗽寒熱刺解谿。（經）逆氣而泄刺三里。（合）又總刺衝陽。（原）
In case of a floating and moderate pulse, where the patient has [symptoms such as] a yellowish face; and a tendency to belch, to ponder, and to drool, this is stomach disease.
If there is fullness below the heart, one should needle Lìduì [ST-45] (jǐng-well);
if there is heat in the body, one should needle Nèitíng [ST-44] (yíng-spring);
if there is heaviness of the body and joint pain, one should needle Xiàngǔ [ST-43] (shù-stream);
if there is panting and coughing, cold and heat, one should needle Jièxī [ST-41] (jīng-river);
if there is counterflow qì and leakage, one should needle Sānlǐ [ST-36] (hé-sea).
In every case, select Chòngyáng [ST-42] (yuán-source).
假令得浮緩脈。病人腹脹滿。食不消。體重節痛。怠隋嗜臥。四肢不收。當臍有動氣。按之牢若痛。此脾病也。若心下滿刺隱白。（井）身熱刺大都。（滎）體重節痛刺太白。（俞）喘嗽寒熱刺商丘。（經）逆氣而泄刺陰陵泉。（合）
In case of a floating and moderate pulse, where the patient has [symptoms such as] abdominal distension, lack of appetite, heaviness of the body, joint pain, fatigue [note: Nánjīng has this as 怠惰] and a habit of lying down, inability to retract the four limbs, with stirring qì at the navel, this is spleen disease.
If there is fullness below the heart, one should needle Yǐnbái [SP-1] (jǐng-well);
if there is heat in the body, one should needle Dàdū [SP-2] (yíng-spring);
if there is heaviness of the body and joint pain, one should needle Tàibái [SP-3] (shù-stream);
if there is panting and coughing, cold and heat, one should needle Shāngqiū [SP-5] (jīng-river);
if there is counterflow qì and leakage, one should needle Yīnlíngquán [SP-9] (hé-sea).
Note: Here the symptomology does reflect some of the stomach organ functions, such as belching. In contrast, the small intestine symptoms listed above are extensions of fire phase manifestations, with no mention of urinary difficulty or any connection with the separation of clear and turbid, as is usually ascribed to the small intestine in TCM.
假令得浮脈。病人面白。善嚏。悲愁不樂欲哭。此大腸病也。若心下滿刺商陽。（井）身熱刺二間。（滎）體重節痛刺三間。（俞）喘嗽寒熱刺陽谿。（經）逆氣而泄刺曲池。（合）又總刺合谷。（原）
In case of a floating pulse, where the patient has [symptoms such as] a white face, tendency to sneeze, sorrow and anxiety, unhappiness, and a desire to cry, this is large intestine disease.
If there is fullness below the heart, one should needle Shāngyáng [LI-1] (jǐng-well);
if there is heat in the body, one should needle Èrjiān [LI-2] (yíng-spring);
if there is heaviness of the body and joint pain, one should needle Sānjiān [LI-3] (shù-stream);
if there is panting and coughing, cold and heat, one should needle Yángxī [LI-5] (jīng-river);
if there is counterflow qì and leakage, one should needle Qūchí [LI-11] (hé-sea).
In every case, needle Hégǔ [LI-4] (yuán-source).
假令得浮脈。病人喘嗽。灑淅寒熱。臍右有動氣。按之牢若痛。此肺病也。若心下滿刺少商。（井）身熱刺魚際。（滎）體重節痛刺太淵。（俞）喘嗽寒熱刺經渠。（經）逆氣而泄刺尺澤。（合）
In case of a floating pulse, where the patient has [symptoms such as] panting and coughing, [aversion to] cold and heat [effusion] as after a soaking, stirring qì to the right of the navel, with pain upon firm pressure, this is lung disease.
If there is fullness below the heart, one should needle Shǎoshāng [LU-11] (jǐng-well);
if there is heat in the body, one should needle Yújì [LU-10] (yíng-spring);
if there is heaviness of the body and joint pain, one should needle Tàiyuān [LU-9] (shù-stream);
if there is panting and coughing, cold and heat, one should needle Jīngqú [LU-8] (jīng-river);
if there is counterflow qì and leakage, one should needle Chǐzé [LU-5] (hé-sea).
Note: Large intestine manifestations here are largely emotional, with a very superficial upper-respiratory symptom included: sneezing, well-explained by the course of the hand yángmíng channel. The lung conformation also includes a surface manifestation of chills and fever.
假令得沉遲脈。病人面黑。善恐欠。此膀胱病也。若心下滿刺至陰。（井）身熱刺通谷。（滎）體重節痛刺束骨。（俞）喘嗽寒熱刺崑崙。（經）逆氣而泄刺委中。（合）又通刺京骨。（原）
In case of a sunken and slow pulse, where the patient has [symptoms such as] a blackish face, a tendency to fearfulness and yawning, this is urinary bladder disease.
If there is fullness below the heart, one should needle Zhìyīn [UB-67] (jǐng-well);
if there is heat in the body, one should needle Tōnggǔ [UB-66] (yíng-spring);
if there is heaviness of the body and joint pain, one should needle Shùgǔ [UB-65] (shù-stream);
if there is panting and coughing, cold and heat, one should needle Kūnlún [UB-60] (jīng-river);
if there is counterflow qì and leakage, one should needle Wěizhōng [UB-40] (hé-sea).
In general, needle Jīnggǔ [UB-64] (yuán-source).
假令得沉遲脈。病人逆氣。小腹急痛。泄如下重。足脛寒而逆。此腎病也。若心下滿刺湧泉。（井）身熱刺然谷。（滎）體重節痛刺太谿。（俞）喘嗽寒熱刺復溜。（經）逆氣而泄刺陰谷。（合）。
In case of a sunken and slow pulse, where the patient has [symptoms such as] counterflow qì, urgency and pain in the lower abdomen, heavy diarrhea, and counterflow cold of the feet and lower legs, this is kidney disease.
If there is fullness below the heart, one should needle Yǒngquán [KD-1] (jǐng-well);
if there is heat in the body, one should needle Rángǔ [KD-2] (yíng-spring);
if there is heaviness of the body and joint pain, one should needle Tàixī [KD-3] (shù-stream);
if there is panting and coughing, cold and heat, one should needle Fùliū [KD-7] (jīng-river);
if there is counterflow qì and leakage, one should needle Yīngǔ [KD-10] (hé-sea).
Note: Heavy diarrhea, which one may associate with the large intestine or spleen, and counterflow qì, which one might associate with the liver or lung, here both pertain to the kidney; difficult urination, which one might associate with kidney or lung, is ascribed to the liver.
此五臟六腑井滎俞經合刺法。深得素、難之旨。學者不可不知。
This is the needling method for jǐng-well, yíng-spring, shù-stream, jīng-river, and hé-sea points of the five zàng and six fǔ. To achieve its profundity is an aim both simple and difficult, scholars cannot be ignorant of it.
Summary
The Nánjīng gave us a rigorous and relatively consistent framework with which to approach needle therapy especially from a five-phase perspective. Later commentators and authors from China, Japan, and Korea further developed its innovations. The Zhēnjiǔ Jùyīng passage above presented a combination of diagnostics and therapeutics based on both the original Nánjīng text and its annotated versions that is worthy of consideration and may prove useful when applied clinically.
Okay, that’s all for now. Thanks for reading.
Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.
References
Gao, W. (1529). Zhenjiu juying. Retrieved October 11, 2025, from https://jicheng.tw/tcm/book/%E9%87%9D%E7%81%B8%E8%81%9A%E8%8B%B1/index.html
Rosenberg, Z. (2020). Ripples in the flow: Reflections on vessel dynamics in the Nán Jīng. Singing Dragon.
Unschuld, P.U. (1985). Medicine in China: A history of ideas. University of California Press.
Unschuld, P.U. (1986). Medicine in China: Nan Ching: The classic of difficult issues. University of California Press.
Xu, D.C. (1727). Nanjing jingshi. Retrieved October 29, 2025, from https://jicheng.tw/tcm/book/%E9%9B%A3%E7%B6%93%E7%B6%93%E9%87%8B/index.html
Thanks for the shoutout for my book, Robert! Excellent article!