JOURNAL OF CHINESE MEDICINE NUMBER 77 FEBRUARY 2005

The Application of Acupuncture and Moxibustion in the Jin Gui Yao Lue
(Synopsis of Prescriptions of the Golden Chamber)
by Dr. Qu Fan & Dr. Zhou Jue
Abstract
This article summarises the application of acupuncture and moxibustion in the rst clinical medical classic in China, the Jin Gui Yao Lue (Synopsis of Prescriptions of the Golden Chamber) written in the latter part of the Eastern Han dynasty (25 to 220 CE), which can be subdivided into four aspects: 1. moxibustion can be used to restore yang, 2. Acupuncture and moxibustion or medicinal substances can be used on the base of correct and thorough analysis of syndromes, 3. Acupuncture can be used to clear shi (excess) symptoms caused by exogenous pathogens, 4. Moxibustion should be used with caution for it may exacerbate heat. Keywords: Jin Gui Yao Lue (Synopsis of Prescriptions of the Golden Chamber), acupuncture and moxibustion. slight asthma, in most cases the prognosis is unfavourable because true yang is still decient in the lower body and original-qi is waning in the upper body. If after treatment with moxibustion, the wrist pulse remains hidden but the shaoyin pulse [the artery at the location of Taixi KID-3] is weaker than that of the fuyang [the artery at the location of Chongyang ST-42], it means the function of Spleen (earth) is stronger than that of the Kidney and the yang-qi of the Spleen and Stomach are recovering, indicating a more favourable prognosis.

2. Acupuncture and moxibustion or medicinal substances should be used on the basis of the correct and thorough analysis of syndromes
In the Jin Gui Yao Lue, different states of illness are treated with different methods, including acupuncture, moxibustion and herbal medicines. For example, the chapter On Pulse Syndrome Complex and Treatment of Blood Paralysis and Weakness Fatigue says: The disciple asked: What is the cause of blood arthralgia? The master replied: Persons who live lives of leisure generally have weak bones and rich esh and muscle. After working for a short period of time, they will feel tired and begin to sweat. When they lie in bed, they will toss and turn frequently. If they are exposed to a breeze at this time, they will suffer from arthralgia due to stagnation of blood. The pulse will be feeble (wei) and hesitant (se) and slender-tense (xiao jin) at the cun [distal] and guan [middle] positions. Acupuncture can be applied to stimulate yang. When the tense pulse disappears and the pulse returns to normal, the patient is recovering. Blood arthralgia is caused by deciency of qi and blood, lying or sleeping in the wind or by invasion of wind pathogen after perspiring during labour. It presents with numbness of the extremities, joint pain, a slightly uneven pulse and a slightly tense cubit (proximal) pulse. To take another example, the chapter On Pulse Syndrome Complex and Treatment of the Qi Disease Ben Tun says: If acupuncture with a burning needle is applied following a sweating treatment and a swollen red nucleus develops on the site of needle insertion as a consequence of cold evil invasion at the site [of needling], ben tun [running piglet qi] will denitely ensue, with qi rushing from the lower abdomen towards the Heart. The treatment of this condition

Introduction
Acupuncture therapy is a unique treatment that forms part of traditional Chinese medicine (TCM), and can function in regulating qi and blood. The Jin Gui Yao Lue (Synopsis of Prescriptions of the Golden Chamber), the rst clinical medical classic in China1, attaches great importance to diagnosing diseases due to internal injury.2 In this great work, there are some important passages on treatment by acupuncture and moxibustion.

1. Moxibustion can be used to restore yang

In the chapter On Pulse Syndrome Complex and Treatment of Nausea and Vomiting, Retching and Diarrhoea, it says A patient with diarrhoea, cold arms and legs and a hidden pulse will die if his body does not become warm, his pulse does not revive, and he still has asthma after treatment with moxibustion. If the shaoyin pulse is weaker than the palpable fuyang (tarsal) pulse, it means the patient is recovering. This passage discusses rst aid treatment for, and the prognosis of, syncope caused by diarrhoea. If the true yang is declining, moxibustion should immediately be applied to treat it so that the original-qi can be nourished, Kidney qi consolidated and the exhausted yang-qi stimulated. Moxibustion should be applied at Guanyuan REN-4 and Qihai REN-6. The prognosis can be judged from the pulse and symptoms after moxibustion. If the patients arms and legs are still cold, the pulse does not revive, and they still have

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JOURNAL OF CHINESE MEDICINE NUMBER 77 FEBRUARY 2005

calls for the application of one unit of moxibustion on each site of needle insertion and the administration of Gui Zhi Jia Gui Tang (Cinnamon, Licorice and Ginger Decoction). Ben tun is characterised by a feeling like gas rushing from the lower abdomen to the chest, even as far as the heart and throat, causing agonising sensations. After arising it will gradually subside. It is usually caused by upward rebellion of cold Kidney qi, or qi and re rising up the Liver channel.

3. Acupuncture can be used to clear shi (excess) symptoms caused by exogenous pathogens
The chapter On Pulse Syndrome Complex and Treatment of Miscellaneous Gynaecological Diseases says: Sometimes a woman contracts apoplexy with fever and fear of cold at the onset of menses. If after seven to eight days the fever subsides, the pulse slows, and the body cools to normal, but the chest and ribs feel taut and delirium has set in, a fever has invaded the paogong [uterus]. The excess heat should be purged by acupuncture applied at Qimen LIV-14. This is heat of the excess type which occurs when exogenous pathogenic factors penetrate to the interior of the body and give rise to symptoms such as high fever, excessive thirst, constipation, abdominal tenderness and pain, dark urine, a yellowish dry tongue coating and a rapid pulse. The treatment depends on the degree of excess heat. The paogong belongs to the Liver channel. Puncturing Qimen LIV-14 can clear stagnant heat from the Liver and make the paogong clean, thus eliminating all the symptoms. The chapter On Pulse Syndrome Complex and Treatment of Gynopathy during Pregnancy says: In the seventh month of pregnancy the taiyin [Spleen] channel nourishes the foetus. If excess of heart qi occurs as a consequence of contraction of a shanghan [cold attack] disease, exuberant Heart and intestinal re will injure the taiyin channel, which in turn causes injury to the foetus. The symptoms of abdominal distention, oliguria and heaviness with an oedematous appearance below the waist should be purged by puncturing the two points of Laogong P-8 and Guanyuan REN-4 in order to slightly increase urination and bring about recovery. If threat to the foetus (a gynaecology term shang tai which refers to the syndrome endangering the foetus during pregnancy) occurs during pregnancy, a woman is bound to suffer from abdominal fullness, dysuria and uncomfortable feelings of heaviness and stagnation below the waist. These symptoms are caused by excess of Heart qi which disrupts the harmony of the Heart and Kidneys and should be treated by reducing Laogong P-8 and Guanyuan REN-4 so that urination can return to normal and the disease resolve.

moxibustion or the disease may worsen. For example, the chapter On Pulse Syndrome Complex and Treatment of Convulsion, Moisture Disease (Rheumatism), and Heatstroke says: A patient with moisture disease manifesting generalised vexation and aching may be suitably treated by inducing sweating with Ma Huang Jia Zhu Tang (Ephedra Decoction Plus Atractylodes). The doctor should be cautioned against using the re-attacking method. And A person with sunstroke of taiyang type may have a fever, fear of cold, generalised heaviness and pain, a wiry (xian), thin (xi), hollow (kou) and slow pulse, a shivering sensation after urination, cold limbs, fever upon slight physical exertion, gasping, dry front teeth, violent fear of cold when perspiring, severe fever upon treatment with warm needles and serious urinary dripping upon frequent purgation.

Conclusion
The Jin Gui Yao Lue, written by Zhang Zhongjing, the eminent medical scientist of last years of the Easter Han dynasty, is a section of the Treatise on Febrile and Miscellaneous Disease devoted to discussing the diagnosis of miscellaneous diseases due to internal injury. As the rst clinical medical classic in China, the Treatise on Febrile and Miscellaneous Disease describes treatmzents applied according to the diagnosis and differentiation of both exogenous disease and miscellaneous diseases due to internal injury. It establishes a series of principles for applying treatment and lays the foundation for the development of clinical medicine by identifying symptoms with the names of the six channels, the zangfu, and their interrelation. The Treatise on Febrile and Miscellaneous Diseases was later re-edited by Wang Shuhe in the Jin Dynasty into the Treatise on Febrile Disease and the Jin Gui Yao Lue. Although the portions of the text which discuss acupuncture and moxibustion are not great, they can nevertheless offer some useful references to the clinical practitioner of traditional Chinese medicine who may thus benet from this great, ancient classical work.

Notes
1. Although the Neijing is earlier than the Jin Gui Yao Lue, it is viewed as more of a theoretical classic than a clinical work. 2. The Shang Han Za Bing Lun (Treatise on Febrile and Miscellaneous Diseases) was later edited by Wang Shuhe into two books, the Shang Han Lun (Treatise on Febrile Diseases) and the Jin Gui Yao Lue (Synopsis of Prescriptions of the Golden Chamber) which is almost entirely devoted to diseases due to internal injury.
Qu Fan holds a Ph.D. in the eld of Gynaecology in TCM. He now conducts research into treating CPID (chronic pelvic inammatory disease) with TCM in Heilongjiang University of Traditional Chinese Medicine, China. Zhou Jue holds a Ph.D. in the eld of Pharmacognosy. She currently conducts research into the application of serum pharmaco-chemistry in the eld of TCM at Heilongjiang University of Traditional Chinese Medicine, China.

4. Moxibustion should be used with caution for it may exacerbate heat

The Jin Gui Yao Lue pays much attention to the contraindications for the application of re moxibustion (including moxa-stick moxibustion, warm needling, burning needle technique and so on). As it may increase the heat, symptoms of the heat type should not be treated with re

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