“Setting Fire on the Mountain”

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

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


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.

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.


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.


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.


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.

Documents

“Setting Fire on the Mountain”