Journal of Chinese Medicine Number 80 February 2006

Setting Fire on the Mountain and Coolness through Penetrating Heaven Revisited

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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. By: Wen Jiang and Wei Liu Keywords: Setting Fire on the Mountain, Coolness through Penetrating Heaven, needle technique, acupuncture, Huang Di Nei Jing, Zhen Jing Zhi Nan, Jin Zhen Fu, Zhen Jiu Da Cheng, Jin Zhen Fu, heat, cold, yang, yin, deficiency, excess.

Introduction
mong the many compound techniques of reinforcing and reducing, Setting Fire on the Mountain (Shao Shan Huo) as a reinforcing 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.

inhale through the nose and exhale through the mouth normally. During the patients exhalation, insert the needle into the shallow portion, or heaven level, and obtain deqi (needling sensation). After obtaining deqi, thrust the needle quickly and lift it slowly for a total of nine times, always remaining within the shallow portion. Then insert the needle more deeply to the middle portion, and keeping the needle at this level thrust it quickly and lift it slowly nine times. Now penetrate the needle to the deep portion and thrust it quickly and lift it slowly nine times within this deep level. If the patient reports a heat sensation at the acupoint, retain the needle there for 15-20 minutes, and then on the patients inhalation quickly 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 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 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

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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.

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.

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.

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.

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.

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 Moxibustion

of

Acupuncture

and

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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Setting Fire on the Mountain and Coolness through Penetrating Heaven Revisited

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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.

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.

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.

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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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.

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 REN12. 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.

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.

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Setting Fire on the Mountain and Coolness through Penetrating Heaven Revisited

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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.

References
Dou, Hanqing, Guidelines of Acupuncture Classic (Zhen Jing Zhi Nan), Peoples Hygiene Press, Beijing, 1983. Jiao, Mianzhai, Acupuncture Needling Techniques (Zhen Shu Shou Fa), Peoples Hygiene Press, Beijing, 1960. Li, Shizhen, Clinical Applications of Commonly Used Acupuncture Points (Chang Yong Shu Xue Lin Chuang Fa Hui), Peoples Hygiene Press, Beijing, 1985. Lu, Shoukang, Collections of Needling Techniques from Hundred Acupuncturists (Zhen Ci Shou Fa Bai Jia Ji Cheng), China Chinese Medicine Press, Beijing 1995. Wu, Liangsheng and Wu, Qi, Yellow Emperors Canon Internal Medicine (Huang Di Nei Jing), China Science & Technology Press, Beijing, 1997. Xu, Feng, Ode to the Gold Needle (Jin Zhen Fu), in Chinese Acupuncture and Moxibustion, edited by Qiu Mao-liang, Churchill Livingstone, 1993. Yang, Jizhou, Great Compendium of Acupuncture and Moxibustion (Zhen Jiu Da Cheng), Peoples Hygiene Press, Beijing, 1983. Zheng Kuishan, Complete Works of Zheng Familys Acupuncture (Zheng Shi Zhen Jiu Quan Ji), Peoples Hygiene Press, Beijing, 2000. Zhou, Shudong, Blossom Poetic Text of Golden Needles (Jin Zhen Mei Hua Shi Chao), Anhui Science and Technology Press, Hefei, 1982.