“setting fire on the mountain”
TRANSCRIPT
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Journal of Chinese Medicine Number 80 February 2006 Setting Fire on the Mountain and Coolness through Penetrating Heaven Revisited 29
Setting Fire on the Mountain and Coolness through Penetrating Heaven Revisited Abstract The needle techniques Setting Fire on the Mountain and Coolness through Penetrating Heaven originated from the
Yellow Emperors Classic of Medicine (Huang Di Nei Jing), were further elaborated in later classical texts and are still
applied clinically today. This article reviews these two needle techniques as documented in several classical texts and
explores their clinical application.
Introduction inhale through the nose and exhale through the mong the many compound techniques of mouth normally.
reinforcing and reducing, Setting Fire on the During the patients exhalation, insert the needle
By: Wen Jiang
and Wei Liu
Keywords:
Setting Fire on
the Mountain,
Coolness
through
Penetrating
Mountain (Shao Shan Huo) as a reinforcing into the shallow portion, or heaven level, and obtain Heaven, needle
technique1 and Coolness through Penetrating
Heaven (Tou Tian Liang) as a reducing technique are
the most widely used in clinical practice.
The reinforcing needling technique of setting fire
on the mountain is used to promote yang qi, remove
yin cold and tonify deficiency. The reducing needle
technique, coolness through penetrating heaven, is
applied to promote yin qi, dissipate pathogenic heat
and reduce excess.
Setting Fire on the Mountain (Shao Shan Huo) Formalisation in classical literature The Yellow Emperors Classic of Medicine (Huang Di
Nei Jing) states, puncturing for deficiency can bring
about excess which produces heat beneath the needle.
Only strong qi can induce heat sensation.
The Guidelines of Acupuncture Classic (Zhen Jing Zhi
Nan) records, reinforcing by inducing heat sensation
and reducing by inducing cool sensation.
The Ode to the Golden Needle (Jin Zhen Fu) reports
that, setting fire on the mountain technique treats
obstinate numbness and cold pain .
The Great Compendium of Acupuncture and
Moxibustion (Zhen Jiu Da Cheng) states, setting fire
on the mountain can dissipate cold.
Operational procedures The point to be needled is divided into three levels,
shallow, middle and deep, also known as heaven,
man and earth levels2. This is reduced to two levels
by some practitioners.
When inserting the needle the practitioner should
press the acupoint heavily with the left hand, known
as the pressing hand. The patient is then asked to
deqi (needling sensation). technique,
After obtaining deqi, thrust the needle quickly and acupuncture,
lift it slowly for a total of nine times, always remaining Huang Di Nei
within the shallow portion. Jing, Zhen
Then insert the needle more deeply to the middle Jing Zhi Nan,
portion, and keeping the needle at this level thrust it Jin Zhen Fu,
quickly and lift it slowly nine times. Zhen Jiu Da
Now penetrate the needle to the deep portion and Cheng, Jin
thrust it quickly and lift it slowly nine times within Zhen Fu, heat,
this deep level. If the patient reports a heat sensation cold, yang, yin,
at the acupoint, retain the needle there for 15-20 deficiency,
minutes, and then on the patients inhalation quickly excess.
withdraw the needle.
If the patient does not experience any feelings of
heat at the acupoint, repeat the whole procedure,
beginning again with the patients exhalation and
manipulating the needle at the shallow portion.
It is recommended not to repeat the procedure for
more than three courses.
When a heat sensation has been achieved, or three
courses have been completed, retain the needle at the
deep level for 15-20 minutes. Make sure the muscle
beneath the needle is relaxed, and swiftly withdraw
the needle on the patients inhalation, quickly pressing
the acupoint.
Clinical applications Setting fire on the mountain as a reinforcing technique
is applied to patterns of Spleen and Kidney yang
deficiency, chronic retention of cold, deficiency
cold patterns, yang qi declining and/or original qi
deficiency. Appropriate indications for its use are
deficiency type windstroke, paralysis, cold and damp
bi-syndrome, cold limbs, abdominal pain, diarrhoea,
impotence, nocturnal emission and prolapse of the
A
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30 Setting Fire on the Mountain and Coolness through Penetrating Heaven Revisited Journal of Chinese Medicine Number 80 February 2006
internal organs. These pathologies would be differentiated
according to traditional Chinese medicine as patterns of
cold or deficiency.
Setting fire on the mountain is a compound needle
technique appropriate for thick muscle areas of the body.
Coolness through Penetrating Heaven (Tou Tian Liang) Formalisation in classical literature The Yellow Emperors Classic of Medicine (Huang Di Nei
Jing) states, when treating excess with acupuncture, one
should apply the reducing method. When a cool sensation is
obtained beneath the needle, it shows that the pathogen has
been removed.
The Guidelines of Acupuncture Classic (Zhen Jing Zhi
Nan) records, reinforcing by inducing heat sensation and
reducing by inducing cool sensation.
The Ode to the Golden Needle (Jin Zhen Fu) reports that,
coolness through Penetrating Heaven treats muscular or
bone-heat syndrome.
The Great Compendium of Acupuncture and Moxibustion
(Zhen Jiu Da Cheng) states, cool-inducing puncture can
remove heat.
Operational procedures The point to be needled is divided into three levels,
shallow, middle and deep, also known as heaven, man
and earth levels.
When inserting the needle the practitioner should press
the acupoint lightly with the left hand (known as the
pressing hand). The patient is then asked to inhale through
the nose and exhale through the mouth normally.
During the patients inhalation, insert the needle into
the deep portion or earth level and obtain deqi.
Thrust the needle slowly and lift it quickly for a total of
six times within the deep portion, then lift the needle to the
middle portion and, keeping the needle at this level, thrust
the needle slowly and lift it quickly six times. Finally lift
the needle to the shallow portion and thrust it slowly and
lift it quickly six times at this shallow level. If the patient
reports a cool sensation at the acupoint, retain the needle
for 20 minutes. The needle is then slowly removed on the
patients exhalation - this is one course.
If the patient does not experience any cool sensation at
the acupoint, then repeat the manipulation, beginning
again with the patients inhalation and inserting the
needle to the deep portion. As soon as the cool sensation is
obtained stop the manipulation.
It is recommended not to repeat the procedure for
more than three courses.
When a cool sensation has been achieved, or three courses
have been completed, retain the needle at the shallow
level for 20 minutes. Slowly withdraw the needle on the
patients exhalation and, either leave the acupoint open, or
press the point slowly.
Clinical applications Coolness through penetrating heaven as a reducing
technique can be applied to patterns of exuberant
pathogenic heat and excessive channel heat or to purge
fire. Some of the appropriate indications for the use of
this needle technique are windstroke due to excess heat,
mania, hot bi-syndrome, carbuncle, erysipelas, tonsillitis,
sore throat, toothache, halitosis, abdominal pain, dysentery
and high fever. These pathologies would be differentiated
according to traditional Chinese medicine as patterns of
heat or excess.
Coolness through penetrating heaven is a compound
needle technique appropriate for thick muscle areas of
the body.
Comparison and review of operational technique Many variations of these two techniques have been
developed since the Ode to the Gold Needle (Jin Zhen
Fu) first defined the procedures. In this section, seven
representative versions of setting fire on the mountain
and coolness through Penetrating Heaven are reviewed
and compared. These seven versions include two from
the Ming Dynasty, one from the Qing Dynasty and four
versions from leading contemporary acupuncturists in
China.
The Ode to the Gold Needle The Ode to the Gold Needle (Jin Zhen Fu) is the first extant
classic to set out the procedure for these two needle
techniques. As described in this text, the method for
setting fire on the mountain requires the practitioner to
puncture shallow and then deep. The needle is pushed
forward quickly three times and pulled backward slowly
three times, this is repeated nine times until a heat
sensation is produced, and then the needle hole is closed. In
performing coolness through penetrating heaven, the
practitioner punctures deep and then shallow. The needle is
lifted quickly three times and thrust slowly three times, this
is repeated six times until a cool sensation is produced, and
then the needle is withdrawn slowly.
Great Compendium of Acupuncture and Moxibustion Yang Jizhou (1522-1620) expounded setting fire on the
mountain and coolness through penetrating heaven in his
Great Compendium of Acupuncture and Moxibustion (Zhen
Jiu Da Cheng). He outlined the technique for setting fire
on the mountain as: insert the needle to a depth of half a
cun then twirl it nine times, thrust the needle to a depth of
one cun, lifting slowly three times and thrusting quickly
three times. If there is a tight and heavy sensation beneath
the needle, heat qi is obtained. If the heat qi sensation is
not obtained, repeat the procedure. In performing coolness
through penetrating heaven, insert the needle to a depth
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Journal of Chinese Medicine Number 80 February 2006 Setting Fire on the Mountain and Coolness through Penetrating Heaven Revisited 31
of one cun and then twirl it six times. If a qi sensation is
obtained, lift the needle a half cun and gently thrust three
times and forcefully lift three times. If there is tight and
heavy sensation beneath the needle, slowly withdraw
the needle and the cool qi can be obtained. If the cool qi
sensation is not obtained, repeat the procedure.
Blossom Poetic Text of Golden Needles Zhou Shudong (1862-1915) developed the most
comprehensive procedures for performing setting fire on
the mountain and coolness through penetrating heaven in
the Qing Dynastys pre-eminent acupuncture text, Blossom
Poetic Text of Golden Needles. Zhou sets out eight steps for
performing setting fire on the mountain; (1) exhalation is
emphasised and the needle is inserted on an exhalation. (2)
needle shallow first, then deeply, twist the needle left as the
patient exhales. (3) pull the needle along with the inhalation
and lift the needle slowly; (4) thrust the needle nine times
and lift the needle once; (5) concentrate the attention and
repeat the procedure; (6) incline the needle with the tip
pointing to the diseased location and induce the qi to move
forward; (7) retain the needle and regulate qi, scrape the
needle handle downward; (8) withdraw the needle as the
patient inhales and press the puncture hole quickly.
The eight steps for performing coolness through
penetrating heaven are; (1) inhalation is emphasised and
the needle is inserted on an inhalation. (2) needle deep
first, then shallow, twist the needle right as the patient
inhales (3) pull the needle along with the exhalation and
thrust the needle slowly; (4) lift the needle six times and
thrust the needle once; (5) concentrate the attention and
repeat the procedure; (6) incline the needle with the tip
pointing to the diseased location and induce the qi to flow
out; (7) retain the needle and regulate qi, scrape the needle
handle upward; (8) withdraw the needle as the patient
exhales and leave the punctured hole open.
Acupuncture Needling Techniques by Jiao Mianzhai Jiao Mianzhai incorporated the practitioners breathing
into setting fire on the mountain and coolness through
penetrating heaven. The operational procedure for
setting fire on the mountain according to Jiao, is for the
practitioner to exhale when the needle is thrust quickly,
(this exhalation should be long and with strength), and as
the needle is lifted slowly the practitioner inhales and this
inhalation should be short and slow. This breath technique
is performed in accordance with the following compound
needling technique.
The needle is inserted to obtain the qi sensation and
then lifted to the shallow level. From the shallow level the
needle is quickly thrust three times and lifted once. This
means that the needle is successively inserted to the three
levels, shallow, middle and deep. From the deep level it is
then lifted directly to the shallow level and this is repeated
for five minutes until a heat sensation is obtained.
In performing coolness through penetrating heaven the
practitioner inhales (this should be long and with strength)
when the needle is lifted and twirled. As the needle is
thrust, the practitioner exhales and this exhalation should
be short and slow. This breath technique is performed
in accordance with the following compound needling
technique.
Insert the needle to obtain the qi sensation and then
move the needle to the deep level. From the deep level
the needle is quickly thrust once and lifted three times.
This means that the needle is inserted directly to the deep
level and then successively lifted through the three levels,
deep, middle and shallow. Perform this procedure for five
minutes until cool qi sensation is obtained.
Yan Hongchen Yan Hongchen, like Zhou, added a needle head scraping
technique into setting fire on the mountain and coolness
through penetrating heaven.
His method for setting fire on the mountain was that
the needle be first inserted to the heaven level, where it is
twirled forward (clockwise) nine times while having the
patient inhale deeply through the nose once, and exhaling
through the mouth in five soft puffs.
This process is repeated again at both the man and earth
levels.
If no heat sensation is reported by the patient, the needle
handle is scraped downwards, and if this still fails to elicit a
sensation of heat, the needling procedure is repeated,
starting again at the heaven level. Once a heat sensation is
obtained, withdraw the needle slowly and close the
punctured hole quickly.
In performing coolness through penetrating heaven,
the needle is inserted to the earth level, where it is twirled
backwards (anti-clockwise) six times while having
the patient inhale deeply through the mouth once and
exhaling slowly through the nose in five soft puffs.
This procedure is repeated again at both the man and
heaven levels.
If the patient reports no cool sensation, the needle
handle is scraped upwards, and if this still fails to elicit a
cool sensation, the needling procedure is repeated starting
from the earth level. Once a cool sensation is obtained,
withdraw the needle quickly and leave the punctured
hole open.
Complete Works of Zheng Familys Acupuncture Zheng Kuishan and his family tradition incorporated the
flying technique into setting fire on the mountain. The
instructions Zheng gave for setting fire on the mountain,
was to have the patient inhale normally through the nose
and exhale normally through the mouth. As the patient
exhales insert the needle to the heaven level, and using
the thumb and index finger, twist the needle to promote
the arrival of qi.
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32 Setting Fire on the Mountain and Coolness through Penetrating Heaven Revisited Journal of Chinese Medicine Number 80 February 2006
When the practitioner feels a sensation of heaviness
and tightness beneath the needle, this sensation is
used to guide the manipulation of the needle as it is
quickly thrust and slowly lifted three or five times
in a clockwise or forward rotation, between 45 to
180 degrees. As the needle manipulation affects the
point, the sensation of heaviness and tightness will
disperse.
Repeat this same procedure at the man and then the
earth levels until a heat sensation is obtained. If there
is no feeling of heat, lift the needle to the heaven level
and repeat the procedure. Once the patient reports a
sensation of heat, withdraw the needle slowly on the
patients inhalation, and close the punctured hole.
In performing coolness through penetrating heaven,
the patient is instructed to exhale normally through
the nose and inhale normally through the mouth.
As the patient inhales insert the needle to the earth
level, and using the thumb and index finger, twist
the needle to promote the arrival of qi. When the
practitioner feels a sensation of heaviness and tightness
beneath the needle, this sensation is used to guide the
manipulation of the needle as it is quickly lifted and
slowly thrust three or five times in an anticlockwise or
backward rotation between 45 to 180 degrees. As the
needle manipulation affects the point, the sensation of
heaviness and tightness will disperse.
Repeat this same procedure at the man level and
the heaven level until a cool sensation is obtained.
If there is no feeling of coolness, begin again from the
earth level and repeat the procedure. Once the patient
reports a cool sensation, withdraw the needle quickly
on the patients exhalation, and leave the puncture
hole open.
Li Shizhen Li Shizhen provides a simplified version of this
compound needle technique.
His instruction for setting fire on the mountain is
for the practitioner to insert the needle to the desired
depth, obtain the qi sensation, twirl the needle in the
direction of reinforcing while keeping a firm grasp on
the needle, (to make the local muscle tight in order
to avoid thrusting the needle deeper) and press the
needle downward. A heat sensation is obtained.
In performing coolness through penetrating heaven,
the practitioner is instructed to insert the needle to
the desired depth, obtain the qi sensation and twirl
the needle in the direction of reducing. The needle
is again held firmly (to make the local muscle tight in
order to avoid pulling out the needle) and the needle
is pulled upward. A cool sensation is obtained.
Case histories Case 1 A 43 year old female patient had been suffering from
abdominal pain for ten years. She had been in the
habit of consuming cold foods and began suffering
from recurrent bouts of stomachache. At a local
western medical hospital the patient was diagnosed
with acute gastritis and discharged after the acute
symptoms had been relieved.
Since then, abdominal pain and diarrhoea frequently
occurred and could be aggravated by improper food
intake or changes in the weather. The diarrhoea was
watery and mixed with undigested food and she had
five to six bowel movements each day. Her face was
pale and she reported aversion to cold, cold limbs and
frequent pain in the abdomen. Her tongue was pale
with a white-moist coating, and her pulse was slow
and wiry. The Western medical diagnosis was chronic
gastroenteritis and intestinal disturbance; the Chinese
medical diagnosis was abdominal pain due to cold
retention. The treatment principle was to strength
the Spleen and Stomach, dispel cold and warm the
interior. Treatment method was to use the compound
needle technique of setting fire on the mountain at
Tianshu ST-25, Zusanli ST-36 and Zhongwan REN-
12. The patient was treated once every other day, ten
sessions of treatment forming one course. After two
courses of treatments, she was clinically cured. At a
six month follow-up no recurrence was reported.
Case 2 A 35 year old male patient complained of high fever.
Five days ago with his temperature at 39.5C he took
some Western medicine, which temporarily reduced
his fever. When the patient presented for treatment his
signs and symptoms were fever, red face, hot limbs,
yellow urine, dry stools and thirst for cold water. His
tongue was red with a dry-yellow coating, and his
pulse was rapid. The Chinese medical diagnosis was
fever due to exterior-heat and the treatment principal
was to dispel the heat and cool the interior.
Treatment method was to use the compound needle
technique of coolness through penetrating heaven for
acupoints Dazhui DU-14, Quchi L.I.-11 and Sifeng
(M-UE-9). The treatment was performed once a day.
After two treatment the patient was completely
recovered.
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Journal of Chinese Medicine Number 80 February 2006 Setting Fire on the Mountain and Coolness through Penetrating Heaven Revisited 33
Wen Jiang graduated from Shandong University of Traditional
Chinese Medicine and researched both classical and contemporary
needling techniques for her PhD at Tianjin College of Traditional
Chinese Medicine. She has practised acupuncture at the Fourth
Hospital affiliated to Shandong University of Traditional Chinese
Medicine, and also at Tianjin Weixie Hospital. She is a professor
at the American Academy of Acupuncture and Oriental Medicine
in Roseville, Minnesota (USA).
Wei Liu graduated from the Shandong University of Traditional
Chinese Medicine and received her Masters of Public Health
(MPH) in nutrition from the University of Minnesota. She is a
licensed acupuncturist, a licensed nutritionist, and a diplomate in
Chinese herbology. Dr. Wei Liu has been teaching and practising
traditional Chinese medicine for more than fifteen years. She
writes on topics covering traditional Chinese medicine and
nutrition, and is the featured presenter on the multi-media
CD-ROM, Complete Acupuncture. She is a professor at the
American Academy of Acupuncture and Oriental Medicine in
Roseville, Minnesota (USA).
Notes 1 Regular reinforcing and reducing techniques include the methods of
lifting, thrusting, twirling, rotating, rapid, slow, insertion, withdrawal,
closing the acupoint after withdrawal, leaving the acupoint open
after withdrawal, inserting the needle along or against the direction
of the channel and coordination with patient respiration.
2 Needling techniques use three depths of insertion. The most shallow
level is known as Heaven, the middle level is known as Man and the
deep level is known as Earth. Anatomically they can be described
as subcutaneous, medial and deep strata. The depths of these levels
are relative to the anatomical structure of each acupuncture point.
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(Chang Yong Shu Xue Lin Chuang Fa Hui), Peoples Hygiene Press,
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