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Meridian Palpation and Meridian Timing
——Clinical Experience of Chen Zifu
Author BiographyChen Zifu, from Tangshan, Hebei, was born in October 1935. He entered Beijing University of Chinese Medicine in 1956. After graduating in 1962, he was assigned to work at the Tonghua Mining Bureau in Gulin Province. In 1979, he transferred to Tangshan Traditional Chinese Medicine Hospital, and in 1982, he returned to Beijing. Over more than twenty years of clinical teaching, he has conducted extensive research on meridians and acupoints, authored “Lectures on Meridian Theory” and “Teaching Reference Materials on Meridian Theory” (unpublished), and published over ten papers. He has served as the head of the Meridian Research Office in the Acupuncture and Tuina Department of Beijing University of Chinese Medicine, an associate professor, and a council member of the Beijing Acupuncture Society.1. Academic Characteristics and Medical Expertise1 Advocating Meridian Palpation Meridian palpation methods have been recorded since the “Neijing” (Inner Canon). These include various techniques such as examination, palpation, following, pressing, tapping, pulling, grasping, and passing, among others. The responses from palpation can also include temperature variations, smoothness, dryness, thickness, fineness, hardness, and softness in the skin areas. The responses of the meridians can be categorized into three types: first, sensations such as soreness, numbness, pain, distension, woodiness, heaviness, hardness, tightness, warmth, coolness, blood stasis, swelling, and sinking; second, sensations resembling tendons, cords, knots, beads, millet, small hammers, and horizontal wood; third, sensations of qi movement resembling a bowstring (electric shock), ant movement, peristalsis, water flow, qi rushing, heat flow, and cool flow. As stated in the “Lingshu: True Evil of Needling”: “Those who use needles must first observe the reality and emptiness of the meridians, palpate and follow them, press and tap them, and observe their responses before selecting points to treat.” Therefore, palpating the meridians is an essential method for acupuncturists to diagnose diseases and select acupoints along the meridians. Chen Zifu excels in this method and has many insights. For example, he treated a 38-year-old male miner who suddenly experienced severe pain in his upper front teeth three months prior, with pain that was unrelenting. He had sought treatment from local doctors, but common analgesics were ineffective, and morphine only provided temporary relief. Any exposure to cold air, hot drinks, cold food, or light touch triggered excruciating pain, especially at night. After three days of sleeplessness and no food intake, he sought treatment from Chen Zifu at night in early February 1966. Upon examination, the color of his teeth had not changed, their shape remained the same, the gums were not swollen, and his tongue was thin, yellow, and greasy. Chen Zifu then selected the acupoints of Xiaguan (下关) and Hegu (合谷) for a draining technique, and the pain ceased almost immediately, allowing him to sleep. However, after half an hour of needle retention, the pain returned intensely, causing agitation. Chen Zifu, at a loss, then palpated the five transport points of the Yangming meridians and the source points, but found no response. After some contemplation, he instructed the patient to lie face down and palpated the back shu points, discovering that both sides of the jueyin (厥阴) shu point were painful like a needle prick; he then needled the Ah Shi point using the sparrow pecking technique, which resulted in a sensation of blood flowing into the tooth, and the pain stopped, allowing the patient to sleep peacefully. After an hour of needle retention, the pain did not return. Chen Zifu pondered this case repeatedly, struggling to understand the mystery of the jueyin shu point pain in the upper teeth. He inquired further and learned that the patient was preparing for the upcoming Spring Festival and had conflicts with family members, which coincided with the onset of the tooth pain. Chen Zifu realized that this was due to the heart governing the spirit and acting on its orders. Another case involved a 30-year-old female patient with a long history of gastric pain. Each episode was alleviated by oral or injected antispasmodics, but the pain recurred. A barium swallow revealed a diagnosis of “gastric spasm.” The patient was robust but had a quick temper, and her gastric pain would flare up with emotional changes. On the night of her visit, she experienced severe gastric pain, moaning continuously, with a pale red tongue and scant coating, and a wiry, slightly rapid pulse, diagnosed as liver qi stagnation with spleen deficiency leading to accumulation of Yangming meridian qi, resulting in pain. Thus, she was treated by palpating the foot jueyin and foot Yangming meridians, adhering to the principle of “combined treatment of the internal organs,” and palpating the corresponding yin and yang acupoints. The Taichong (太冲) point showed a knot-like response, the Zusanli (足三里) point showed a sinking response, and the Yanglingquan (阳陵泉) point also showed a sinking response. Upon further palpation of the back shu points, there was no response in the liver, spleen, or stomach points, but the diaphragm point showed a response resembling a tendon, which was painful upon needling. Chen Zifu speculated that the blood was accumulating at the diaphragm point, possibly due to prolonged pain affecting the stomach’s network, and upon further inquiry, the patient indicated that the most intense pain was below the xiphoid process, clarifying that it was not due to blood stasis but rather because the pain had reached the diaphragm, causing qi counterflow and nausea. Therefore, he aimed to soothe the jueyin and open the Yangming, guiding the yin down to alleviate the qi counterflow, starting with the four gates, and then needling the diaphragm point, which resulted in pain relief. He then selected Yanglingquan and Zusanli to maintain the effect. After one minute of needle retention, the pain disappeared, and she did not experience a recurrence that summer or autumn. 2 Proficient in Needle Penetration and Wind-Damp Dispelling Chen Zifu believes that the principle of “drawing yin from yang and drawing yang from yin” is essential for acupuncturists in point selection based on syndrome differentiation. However, if one needle can access two acupoints, penetrating both meridians, both yin and yang are obtained, and the flow of qi is connected, resulting in rapid efficacy. Here is a brief example: A patient, Xue XX, a 68-year-old retired worker, reported that after drinking alcohol the previous night, he woke up to find his left side paralyzed and was urgently sent to the hospital’s acupuncture department for treatment. The patient was elderly, tall, and healthy-looking, with a rosy complexion, well-developed muscles, clear consciousness, and fluent speech. The left corner of his mouth was slightly drooping to the right, the nasolabial fold was shallow, and he could not close his left eye, with the wrinkles on his left forehead disappearing. His left upper and lower limbs were weak and flaccid. His tongue was pale red with little coating, and his pulse was deep, wiry, and strong. The diagnosis was stroke. Although the patient appeared robust, his kidney qi had declined with age, and his yang qi was deficient, making it difficult to promote blood circulation, leading to blood stasis in the meridians. The treatment should focus on tonifying qi and promoting blood circulation, warming the meridians, and dispelling wind. Acupuncture was applied to Baihui (百会), Qihai (气海), and Guanyuan (关元); needling Xuehai (血海) (bilateral) and Zusanli (足三里) (bilateral); facial points included Yangbai (阳白) penetrating Yuyao (鱼腰), Sibai (四白) penetrating Yingxiang (迎香), and Jiachuan (颊车) penetrating Dica (地仓); upper limb points included Jianyu (肩髃) penetrating Arm (臂臑), Quchi (曲池) penetrating Shaohai (少海), and Waiguan (外关) penetrating Neiguan (内关), Hegu (合谷) penetrating Houxi (后溪); lower limb points included Huantiao (环跳) penetrating Changqiang (长强), Fengshi (风市) penetrating Yinmen (殷门), Yanglingquan (阳陵泉) penetrating Yinlingquan (阴陵泉), Xuanzhong (悬钟) penetrating Sanyinjiao (三阴交), and Kunlun (昆仑) penetrating Taixi (太溪). One acupuncture session per day, and after a month, he was able to walk and manage his daily activities. 3 Advocating Meridian Timing Chen Zifu has grasped the essence of the Dan Yutang flow needle technique and, under its guidance, summarized it into the manuscript “Ziwu Liuzhu Xun Gu.” After more than twenty years of in-depth research on this classical acupuncture technique, regarding the Ziwu Liuzhu needle method, Chen Zifu has summarized the “Three Essential Principles of Dan’s Flowing Needle”:(1) Carefully assess the disease and correspond with the timing: The Ziwu Liuzhu needle method has two types of point selection: one is the routine point selection based on time; the other is the clinical syndrome differentiation point selection. Routine point selection refers to the method described in textbooks, calculating the time and corresponding heavenly stems and earthly branches, and then using the Jia method to open points according to the “Xu’s Ziwu Liuzhu Time Point Selection Method.” The Jia method opens points based on the principle of tonifying the mother and draining the child. However, routine point selection alone cannot treat all diseases. Therefore, it is essential to “carefully assess the disease and correspond with the timing,” meaning that syndrome differentiation must be combined with the timing of point selection. “Carefully assess” has two meanings: one is to be cautious and meticulous, meaning that syndrome differentiation must be accurate and careful; the other is to adhere strictly to the principles of syndrome differentiation to assess the disease situation. The method of “corresponding with the timing” has two aspects: one is to “carefully wait for the right time, when the qi can be expected,” meaning that after syndrome differentiation, one should wait for the appropriate timing to open points that correspond to the disease; the other is to select the appropriate timing points based on the original point selection after syndrome differentiation. Therefore, the Ziwu Liuzhu needle treatment does not contradict the principles of syndrome differentiation but is very flexible in selecting timing points based on syndrome differentiation. The Jia method, also known as the Jia branch method, can be used in clinical syndrome differentiation to select timing points based on the relationship between the yin and yang of the organs. For example, on a yang day, open yang points at yang times; on a yin day, open yin points at yin times; meridians give rise to meridians, and points give rise to points, opening the five transport points of the meridian corresponding to the day in a sequential manner is known as the timing point selection method. Additionally, according to the five movements, the Jia and Ji correspond, Yi and Geng correspond, Bing and Xin correspond, Ding and Ren correspond, and Wu and Gui correspond, selecting points that harmonize yin and yang, combining hard and soft points. For example, on a Jia Xu day, select the Gallbladder Jing point, which belongs to the metal point; if there is a spleen dysfunction, also open the spleen meridian metal point Shangqiu, achieving the effect of harmonizing qi and blood. Furthermore, based on the relationship between the lungs and large intestine, heart and small intestine, spleen and stomach, liver and gallbladder, kidney and bladder, and pericardium and sanjiao, select the corresponding five transport points of the same name. On a Jia Xu day, select the Gallbladder Jing point, and if there is a liver meridian disease, also select the Liver Jing point Dadu, known as the interior-exterior harmonizing point selection method. According to the five movements and the relationship between the yin and yang stems, it is said that Jia and Ji correspond to the day, Yi and Geng correspond to the day, Bing and Xin correspond to the day, Ding and Ren correspond to the day, and Wu and Gui correspond to the day. Based on this, the transport points of the corresponding day can be mutually used, known as the mutual use point selection method. Additionally, points can be selected based on the disease’s needs to match the timing points, known as the timing and disease point selection method. The Jia method, also known as the Zhi method, can be used in clinical syndrome differentiation to select timing points based on the relationship between the yin and yang of the organs, flexibly applying the original network point selection method. For example, when opening the original point of the lung meridian, one can also select the network point of the large intestine meridian, known as the organ communication point selection method. In clinical practice, the Linggui Eight Methods and the Jia method or the Zhi method are often used together. Depending on the patient’s condition, one can first open the timing points of the Eight Methods, then combine them with the routine timing points opened by the Jia method, known as the Eight Methods and Jia method combined point selection method. If using the Zhi method for timing points, it is called the Eight Methods and Zhi method combined point selection method. There are also various combinations such as Eight Methods and Jia original point selection method, Eight Methods and Jia five transport main disease point selection method, Eight Methods and Jia point selection method, Eight Methods and Jia yin-yang intersection point selection method, Eight Methods and Jia mutual use point selection method, and Eight Methods and Jia timing and disease point selection method, making it flexible and variable in clinical practice. (2) Open points during closed times, in accordance with heavenly timing: In the “Ziwu Liuzhu Circular Diagram,” there are twelve time periods in a week where no points can be opened; in another week, there are also twelve time periods where no points can be opened, referred to as closed times. Historically, Ziwu Liuzhu acupuncturists have referred to this as a “natural defect.” Later generations have attempted various methods to open these closed times to seek points, but these methods are often not effective and somewhat forced. Dan’s method follows heavenly timing, creating the “142530” method for opening points during closed times, appropriately supplementing the twenty-four closed time points, marking the continuous flow of qi and blood in the human body without an endpoint, which has been adopted by contemporary practitioners. Chen Zifu follows his teacher’s teachings, based on the “Suwen: Six Stages of the Zang and Xiang Theory,” which states: “Heaven uses six sixes as a cycle, with ten days in heaven, six days complete a cycle, and six cycles complete a year, totaling three hundred sixty days.” Excluding the sixty cycles of heavenly stems and earthly branches, seeking the Jia day, the short and long cycles are the basis of pre-heaven, while the mutual generation is the source of post-heaven. However, upon careful examination of the “Ziwu Liuzhu Circular Diagram,” the sequence of “142530” does not follow heavenly timing but rather goes against it. If following the “first Jia and then determining the movement” theory, in accordance with heavenly timing, it should start from Jiazi, and the sequence of Jia days should be “410352.” However, the timing points opened during closed times are the same as those of “142530.” If one further investigates its roots, the sequence of “142530” should be the sequence of the intersection of yin and yang stems, but this sequence has “Xun Kong” in it, causing the loss of points, which occurs when encountering Gui, as Gui rises at the Hai time. Thus, Dan has completed the opening of points during closed times in the “Ziwu Liuzhu Circular Diagram.” (3) Supplement and drain as needed: The principles of welcoming and following supplementing and draining are the essence of the Ziwu Liuzhu method. This is essentially the transmission of the principles of the “Neijing,” where the technique follows the direction of qi and blood flow in the meridians, welcoming and seizing is called draining, and following and assisting is called supplementing. Specific techniques include twisting, lifting, inserting, breathing, and varying speeds, among others. The ancient methods differentiated between men and women, but this is often not used today. Some determine the direction of welcoming and following based on the needle’s direction, while others determine it based on the direction of the thumb of the hand holding the needle, but it is essential to distinguish between yin and yang meridians. The eight extraordinary vessels have a wide range of clinical applications, as noted in the book “Guidelines for Acupuncture Classics.” Therefore, when encountering a disease, one can first open the timing points of the Eight Methods (referring to Linggui) and then, based on the disease’s needs (syndrome differentiation), open the points used in the Jia method. For example, on a Jia Xu day at Jia Xu time, first open the Eight Methods Houxi and Shenmai points to treat floating pulse, cough, cold and heat, and abdominal movement, which may be painful upon palpation, etc. If there is also fullness under the heart, then combine with the hand Taiyin Jing point Shaoshang and foot Taiyin Jing point Yinbai; if there is also fever, then combine with the hand and foot Taiyin Ying point Yujie and Dadu; if there is also cough with cold and heat symptoms, then combine with the hand and foot Taiyin Jing points Jingqu and Shangqiu; if there is also counterflow qi and diarrhea, then combine with the hand and foot Taiyin He points Chize and Yinlingquan. In addition, if there are original points that correspond to the symptoms, they should be combined; if there are network points that correspond to the symptoms, they should be combined; if there are points that correspond to the mutual use of the day, they should be combined. The methods are flexible, and the key lies in the accurate differentiation of syndromes and meridians.2. Selected Medical CasesCase 1: Facial Muscle Spasm Wang X, male, 54 years old, a miner, first diagnosed in early July 1970. The patient had left-sided facial muscle spasms for over ten years, with facial twitching, the left eye opening and closing intermittently, and the left corner of the mouth moving up and down. The patient was yellow and thin, having sought various treatments without success, and thus turned to acupuncture. The diagnosis was internal wind movement, ascending to the face. Prescription: Right Hegu (合谷), Jiachuan (颊车), Sibai (四白), Yangbai (阳白), Yifeng (翳风). Treatment process: Using the large needle technique, treatment lasted for three months without effect. Chen Zifu palpated the hand and foot Yangming meridians, finding a response of soreness and pain at the left arm’s Sanli (三里) point; he also palpated the hand Shaoyang and Taiyang meridians, finding no response below the elbow. He then palpated the back shu points, also finding no response, but at the Tianzong (天宗) point, there was a response resembling a knot and soreness. He then needled the two points with responses, adding the same side Hegu and Waiguan points. After two months of treatment, the episodes gradually lessened and eventually resolved. Case 2: Migraine Guo XX, female, 43 years old, an office worker, first diagnosed in early October 1965. She reported that two years prior, due to family discord, she developed left-sided migraines the next day, which gradually worsened. After two months of ineffective painkillers, she took a leave of absence. For nearly two years, each episode was so painful that she felt she could not live, often feeling as if she would die. Upon examination, her complexion was slightly brown, with cupping marks on her forehead, a thin yellow tongue coating, a red tip, and a slightly rapid wiry pulse. The diagnosis was long-standing liver qi stagnation transforming into fire, affecting the Shaoyang. Treatment focused on draining the liver, benefiting the gallbladder, regulating qi, and relieving pain. Prescription: Taichong (太冲), Zulinqi (足临泣), Yangbai (阳白), Fengchi (风池), Hegu (合谷). Treatment process: After more than a month of treatment, each needle was light, but the pain returned after needling. Chen Zifu then palpated the head and face, discovering a response at the Touwei (头维) point, which was sunken and sore; he also palpated the back shu points, finding responses at the diaphragm and gallbladder points, which were painful upon needling. He then palpated below the elbow and found no responses, but upon palpating below the knee, he found the Zhaohai (照海) point to be knot-like and very sore. He then selected the points with responses and combined them with syndrome differentiation points, all using draining techniques, needling every other day. After more than three months of treatment, the frequency of headaches decreased, and the condition improved. After treatment, the patient was cured, and follow-up after a year showed no recurrence. Case 3: Urinary Retention Hu XX, male, 82 years old, a retired worker, first diagnosed in mid-September 1972. The patient was hospitalized for two months due to liver cirrhosis and ascites, and due to “urinary retention,” he requested a consultation from the TCM department. The patient appeared with a yellowish complexion, lacking luster, thin cheeks, a thin neck, half-sitting in bed, and a lethargic spirit. Upon lifting the blanket, his abdomen was distended like a drum but still soft. The lower abdomen was significantly distended, and upon palpation, the bladder was full and clearly defined. His tongue was smooth and bare, with a purple-brown texture resembling the liver; his pulse was deep, thin, and slightly choppy. The water retention was due to liver blood stasis, which over time transformed into fire, consuming the essence and fluids, leading to kidney water depletion. The deficiency of the spleen caused water and dampness to be improperly transformed, leading to accumulation in the abdomen; the urinary retention was due to age-related kidney qi deficiency and poor qi transformation. The treatment method was to address the symptoms urgently, thus acupuncture and herbal medicine were used to promote water flow. Prescription: Modified Zhenwu Wuling Decoction, promoting yang and benefiting water; acupuncture at Taixi (太溪), Fuliu (复溜), and Yinlingquan (阴陵泉) (tonifying method); and manual pressure on Guanyuan (关元) and Zhongji (中极). Treatment process: After about five minutes of acupuncture and manual pressure, urine began to flow continuously until it was completely drained. After daily acupuncture, the patient was able to urinate passively. After more than ten days, he could urinate independently. After a combined treatment of acupuncture and herbal medicine for over forty days, the ascites completely resolved, and the condition significantly improved, allowing him to walk slowly. Further treatment continued for three months before he was discharged for recuperation.
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