The System of the Fifty Nine Heat Piercings of the Huangdi Neijing Suwen 五十九刺

The purpose of this post is not to give spoon fed clinical prescriptions, but to open the readers mind to how and why classical acupuncture methods, point regions, and so forth may be chosen.

Within the style of Neijing medicine, and as we dig our way through the text, we often come across rather straight forward groupings of regions that can be needled, bled, or manipulated in a certain way. The fifty seven water piercings and fifty nine heat piercings are great examples of these groupings and this post will focus on the latter. If we are working our way through the modern layout of the Neijing then the fifty nine heat piercings are first mentioned in NJSW 32, a chapter simply titled 刺熱 "Piercing Heat", a discourse on the correct ways and days to needle various heat based pathology. It is only within the later part of this chapter and only in relation to severe heat disease that the fifty nine heat points are said to be needled - the points themselves are not given. Further on in the Suwen, chapter 36 刺虐 “Piercing Malaria", we get more instruction on the use of these points: 溫瘧汗不出, 為五十九刺 "warm malaria with no sweat leaving, use the fifty nine piercings" and still no exact points are given.

It is not until NJSW 61 水热穴論 "Discourse on points for Water and Heat" that we get the full list according to the Suwen. It should be noted here that the list of points in the Suwen differ to that of the Lingshu Jing. Here we will only discuss the Suwen fifty nine piercings as those listed in the Lingshu Jing seem to be a later edition and not of the original text (although still worth studying). NJSW 61 states 帝曰: 夫子言治熱病五十九俞, 余論其意, 未能領別其處, 願聞其處, 因聞其意. 歧伯曰: 頭上五行行五者, 以越諸陽之熱逆也. 大杼膺俞缺盆背俞此八者, 以寫胸中之熱也. 氣街三里巨虛上下廉此八者, 以寫胃中之熱也. 雲門髃骨委中髓空此八者, 以寫四支之熱也. 五藏俞傍五此十者, 以寫五藏之熱也. 凡此五十九穴者, 皆熱之左右也. "(Huang) Di said: "You sir have discussed the fifty nine points to treat heat disease, I have discussed their importance, I have not been able to discern their locations from your instructions, I would like to hear about their locations and about their importance." Qi Bo said: "On top of the head there are five lines with five (points) on each line, they disperse heat reversal (re ni 熱逆) in the Yang. Dazhu 大杼, Yingshu 膺俞, Quepen 缺盆, and Beishu 背俞, these eight drain heat from the Xiong Zhong (胸中chest centre). QiJie 氣街, Sanli 三里, Juxu Shang Xia 巨虛上下, these eight drain heat from the Wei Zhong (胃中 Stomach centre). Yunmen 雲門, Yugu 髃骨, Weizhong 委中, Suikong 髓空, these eight drain heat from four limbs. Five Zang Shu each side, these ten drain heat from the five Zang. All these fifty nine points on the left and right treat heat."

So let's break these points down and look at the geographical ability to drain heat. First we have the five x five on the head: The five lines, as stated, address the Yang, and are the Du Mai in the centre and the Zu Taiyang - Bladder and Zu Shaoyang - Gall Bladder bilaterally. What five points are to be chosen in this region is not clearly discussed, however, by looking at a general map of the of distribution of scalp points we can see that we have a distinct 5 points that extend from the hairline:

• Dumai: Shenting 神庭, Shangxing 上星, Xinhui 囟會, Qianding 前頂, and Baihui 百會.
• ZuTaiyang - Bladder: Quchai 曲差, Wuchu 五處, Chengguang 承光, Tongtian 通天, and Luoque 洛却
• Zu Shaoyang - Gall Bladder: Toulingqi 頭臨泣, Muchuang 目窗, Zhengying 正營, Chengling 承靈, and Naokong 腦空. 

To be fair there are various takes on these points, this is what i was originally taught, however, i have seen others start the count of five further upon the scalp and include points and regions that run towards the nape of the neck. As we see, these 25 points treat 熱逆 (heat reversal) and this happens to be the only mention in the entire text about this condition. If we take the earlier Suwen chapters note on the fifty nine piercings being used for severe conditions then a sudden heat based reversal would see severe, aggressive fire based patterns attacking the head - pain, swelling, ulcerations, bleeding, redness, and so forth. 

Next we have four points bilaterally that address heat based diseases in the Xiong Zhong or chest centre. It should be noted that the Xiong Zhong must be differentiated to that of the Dan Zhong (centre of the chest) and is diagnosed via the right Cunkou position as opposed to the left. If the Lungs, Heart, Xin Bao Luo, and the exact Centre of the Chest (Dan Zhong) make up the structure of the chest, our remaining section is the chest centre, inclusive of the oesophagus and trachea collectively referred to as the "Qi pipe". Within this Qi pipe heat can become very easily trapped, leading to either the aforementioned reversal or simply a premature cooking of the food we eat and the air we breathe, resulting in stasis within the chest, heat based pathology within the chest, Lungs, possibly Heart and more likely Xin Bao Luo. These four points Dazhu 大杼 and Beishu 背俞 (often discussed as "Feishu 肺俞" or "Fengmen 風門") on the back and Quepen 缺盆 and Yingshu 膺俞 (often discussed as "Zhongfu 中府") on the front, are pathways to allow this constrained Qi within the Xiong Zhong an exit out of the body.

This concept of creating or opening a passage way for this heat to be expelled applies to all of the fifty nine heat piercings as described in the Neijing Suwen. Following the chest we are given a further four points bilaterally to address heat trapped within the Stomach centre or heat inside the Stomach. Qijie 氣街 as a pathway that has a direct link to the Stomach Fu and a strong downward function, Sanli 三里 as the Lower He, and the Upper (Shang) and Lower (Xia) Juxu 巨虛上下 He pairings of the Large Intestine and Small Intestine - all designed to purge heat directly from the organ, not from the channel. 

Following this the text discusses four points bilaterally for draining heat trapped in the four limbs. It should be of note that heat trapped in this manner is discussed at length throughout the Neijing and there are a number of methods that one can employ to address it. Yunmen 雲門 and Yugu 髃骨 (often referred to as "Jianyu 肩髃") address heat within the upper limbs and allow passageway out before entering the centre, while Weizhong 委中 and Suikong 髓空 (often referred to as Henggu 橫骨) address that of the lower. Finally we have the most controversial section of this passage: the Five Shu for the Five Zang. A number of translators discuss this as the five back-shu points on the Zu Taiyang - Bladder, and clinically and theoretically that makes sense as a direct link to the Zang organs themselves. However, many also address these as the five shu of each of the Yin Jingmai (ten in total as no Shu exist on the Shou Shaoyin - Heart) that also directly address the Zang organs. It is the opinion of this author that in order to appropriately respect the cryptic nature of the Neijing that each should be clinically tested. It is also worthwhile to point out, however, that within NJLS 51 背輸 "Back Shu" that six Shu points associated with the Zang and Diaphragm are discussed and that this chapter explicitly states 灸之則可刺之則不可 "One may cauterise it. One may not needle it". Again we have discrepancy between the Suwen and Lingshu in regards to such things, I leave it to the reader to explore this in their own manner, with their own teacher. 

Within the INR Pathology System, heat based diseases compromise a major portion of our studies, understanding how it may display and transform, where, and most importantly how can we as physicians appropriately and dynamically treat the various manifestations. The fifty nine heat piercings are but one concept of dealing with severe, geographically confined heat based pathology. 

|| David White - INR ||

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