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Chapter 13 of 14
针灸甲乙经
This chapter discusses the patterns and point selection for "intermittent pulse" (mài dài) caused by cold pathogen in the chest. If the pulse fails to reach the wrist (Cunkou), the limbs are reversed cold, and the pulse is sluggish, the ancients selected Yunmen (LU 2) to regulate; if there is cold in the chest, intermittent pulse coming and going, heavy upper body, light lower body, feet unable to stand firmly, lower abdominal distension, qi rushing upward to the heart, chest fullness, cough with blood in sputum, the ancients selected Rangu (KI 2).
The Yellow Emperor asked: When a person suffers from epilepsy (diān jí) from birth, how does this come about? Qibo replied: This occurs while in the mother's womb, when the mother suffered repeated severe fright, causing qi to rebel upward without descending. Essence and rebellious qi accumulate together, thus causing the child to develop epilepsy.
When the disease is in the yang channels, with alternating cold and heat, and the flesh between the muscles also alternates between cold and heat, it is called mania (kuáng). When needling, use the draining method and observe the heat signs subsiding between the muscles—then the disease is cured. At onset, if it occurs once a year, without treatment; once a month, without treatment; four to five times a month, it is termed epilepsy (diān jí). Needle between the muscles; where the pulse is especially cold, use the supplementation method.
Someone asks: For those suffering from mania with easy anger, how does this disease arise? Answer: It arises from yang. Question: Why does yang make a person manic? Answer: Yang qi, due to sudden frustration, finds it difficult to recover—this is its manifestation. Question: How is it treated? Answer: Reduce food intake. Food enters the yin aspect and transforms into yang qi, so reducing food suffices. Let the patient drink water from ground iron filings (shēng tiě luò), which has the property of descending qi.
For epilepsy with a pulse that is large and slippery, it may resolve on its own over time; if the pulse is small, firm, and rapid, the prognosis is poor. Epilepsy with a deficient pulse is treatable; with an excess pulse, death results. Reversal (jué nì) can develop into epilepsy. Jaundice, sudden-onset reversal, epilepsy, and mania mostly arise from prolonged qi rebellion. The five viscera disharmony arises from obstruction of the six bowels. At the onset of epilepsy, the patient first experiences unhappiness, heavy head with pain, staring eyes, and pronounced redness of the eyes. After the attack, there is vexation in the heart. Observe the facial complexion and select the Hand Taiyang and Hand Taiyin channels, needling until the blood changes color, then stop. During an epileptic seizure with mouth deviation, crying out, panting, and palpitations, select the Hand Yangming and Taiyang channels—if the left side is strong, needle the right; if the right side is strong, needle the left—until the blood changes color, then stop.
In treating epilepsy, physicians traditionally lodged with the patient to observe the appropriate sites, using draining methods at the time of attack. Place the patient's blood in a gourd vessel; at the time of the attack, the blood will move on its own. If it does not move, moxa the coccyx (Chángqiáng) for thirty zhuàng. Bone epilepsy, vessel epilepsy, and sinew epilepsy have different manifestations and point selections respectively. If there is copious vomiting of frothy saliva and qi draining downward, the ancients deemed the prognosis poor.
At the onset of mania, the patient first experiences sadness, forgetfulness, easy anger, and easy fear, mostly from worry, hunger, and thirst. First select Hand Taiyin and Yangming until the blood changes, then select Foot Taiyin and Yangming. During manic episodes with little sleep and no hunger, considering oneself noble, intelligent, and honorable, cursing day and night without rest, select Hand Yangming, Taiyin, and Taiyang. For mania with visual and auditory hallucinations and a tendency to shout, this arises from qi deficiency—select the corresponding channels: if the pulse is full, take it; if not full, do not take it. For mania with easy fright, easy laughter, fondness for singing, and aimless wandering without stopping, this mostly arises from great anger and great fear. For mania with excessive eating, as if seeing ghosts and spirits, laughing without sound, this mostly arises from great joy—select the corresponding channels in sequence.
For newly onset mania, first select Qiquan (LR 8) on the left and right, and the full vessels—seeing blood brings quick relief. If not cured, treat according to the method and moxa the coccyx twenty zhuàng.
Thereafter, a large number of point indications are listed: Shenting (GV 24), Duiduan (GV 27), Chengjiang (CV 24) primarily treat epilepsy with vomiting of froth; Shangxing (GV 23), Tianyou (TE 16), Fengchi (GB 20), Binhui (GV 22), Qiangjian (GV 18), Houding (GV 19), Naohu (GV 17), Fengfu (GV 16), Luoque (BL 8), Naokong (GB 19), Wangu (GB 12), Tianzhu (BL 10), Shenzhu (GV 12), Jinshu (BL 54), Feishu (BL 13), Geshu (BL 17), Ganshu (BL 18), Shuigou (GV 26), Yinjiao (GV 28), etc., respectively govern different types of epilepsy and mania; Taiyi (ST 23), Huaroumen (ST 24), Riyue (GB 24), Yuji (LU 10), Hegu (LI 4), Wangu (SI 4), Zhizheng (SI 7), Shaohai (HT 3), Kunlun (BL 60), Taiyuan (LU 9), Wenliu (LI 7), Quchi (LI 11), Yemen (TE 2), Xiaxi (GB 43), Qiuxu (GB 40), Guangming (GB 37), Zhongzhu (TE 3), Zhigou (TE 6), Tianjing (TE 10), Qiangu (SI 2), Houxi (SI 3), Yanggu (SI 5), Zhubin (KI 9), Xingjian (LR 2), Rangu (KI 2), Yingu (KI 10), Jiexi (ST 41), Juxu Shanglian (ST 37), Yangjiao (GB 35), Jinggu (BL 64), Shugu (BL 65), Pucan (BL 61), Kunlun (BL 60), Feiyang (BL 58), Weizhong (BL 40), Gongsun (SP 4), etc., respectively correspond to mania, epilepsy, fright, convulsions, reversal, diarrhoea with undigested food, chest and back pain, sinew spasms, falling stiff, epistaxis, and cholera-like disorders. The ancients believed these points predominantly govern conditions related to the spirit and rebellious qi movement.
Corpse reversal (shī jué) manifests as sudden loss of consciousness, appearing like death, yet the pulse still beats normally. Select Yinbai (SP 1) and Dadun (LR 1). For mental confusion like corpse reversal with headache, select Zhongji (CV 3) and Pucan (BL 61). For corpse reversal with sudden death, select Jinmen (BL 63).
Cholera-like disorders can be needled at three sites: beside the Back-Shu points, along the Foot Yangming channel, and beside Shangwan (CV 13).
For vomiting and full vexation, select Pohu (BL 42). For yang reversal with cholera-like symptoms, needle Renying (ST 9) to a depth of four fen. The ancients specifically warned "unfortunately kills people," indicating the danger of needling this site. For cholera with diarrhea and incontinence, first select Taixi (KI 3), then Taicang zhi yuan. For cholera, one may also select Juque (CV 14), Guanchong (TE 1), Zhigou (TE 6), Gongsun (SP 4), Jiexi (ST 41), Qimen (LR 14), Fushe (SP 13), Yuji (LU 10), Taibai (SP 3), Sanli (ST 36), Pucan (BL 61), Jinmen (BL 63), Chengshan (BL 57), Chengjin (BL 56), etc. For sinew spasms, if in the yang aspect, treat the yang; if in the yin aspect, treat the yin—both use rapid needling technique.
If one is injured by wind in spring, summer may bring sūn xiè (diarrhea with undigested food) and blood in the stool. Prolonged wind can cause sūn xiè. For sūn xiè with a small pulse and cold hands and feet, recovery is difficult; with a large pulse and warm hands and feet, recovery is easy.
The Yellow Emperor asked about the prognosis of blood in the stool, passing white froth, and passing pus and blood. Qibo replied: If the body is hot, death; if the body is cold, survival. For passing white froth, a sinking pulse indicates survival; a floating pulse indicates death. For passing pus and blood, an absent and hesitant pulse indicates death; a slippery and large pulse indicates survival. If the body is not hot, the pulse is not absent and hesitant, and is slippery and large, survival; if hesitant and rough, death. For sūn xiè, one may supplement Sanyinjiao (SP 6) and Yinlingquan (SP 9), retaining the needle for a long time, stopping when heat moves through.
Subsequently listed are patterns of blood in the stool, intestinal ringing with diarrhea, pus and blood in the stool, pain around the navel, loose stools, and diarrhea with undigested food, respectively selecting Ququan (LR 8), Wuli (LR 10), Huiyang (BL 35), Xialiao (BL 34), Siman (KI 14), Fu'ai (SP 16), Diji (SP 8), Taichong (LR 3), Yinlingquan (SP 9), Zhongliao (BL 33), Juxu Shanglian (ST 37), etc.
The Yellow Emperor asked: How is it known that people are prone to consumptive thirst (xiāo dān)? Qibo replied: Those with all five viscera weak are prone to xiāo dān. Such weak people tend to be strong-willed and easily angered, with thin skin, deep-set firm eyes, and a violent temperament. Anger causes qi to rebel upward, blood and qi accumulate, transforming into heat. Heat then causes consumption and thirst, thus resulting in xiāo dān. A slightly yellow complexion, yellow tooth coating, and yellow nails indicate jaundice (huáng dǎn).
The Yellow Emperor asked about the name and cause of sweet taste in the mouth. Qibo replied: This is the overflow of the five qi, termed spleen heat (pí dān). The five flavors enter the mouth and are stored in the stomach; the spleen transports fluids for the stomach. When fluids stagnate in the spleen, the mouth becomes sweet—this results from overeating rich and fatty foods. Fatness causes internal heat, sweetness causes mid-section fullness, and qi overflowing upward transforms into consumptive thirst. The ancients proposed using orchid (lán cǎo) and similar substances to eliminate stagnant qi. It is also pointed out that xiāo dān, hemiplegia, and rebellious qi with fullness are mostly diseases of rich fatty foods in obese and wealthy people. Blockage and obstruction with failure of communication between upper and lower mostly arise from sudden grief. For xiāo dān with a pulse that is excess and large, the disease may be treated even if prolonged; if the pulse is absent, small, and firm, the prolonged disease is untreatable.
For heat in the middle with consumption (rè zhōng xiāo zhōng), one must not take rich fatty foods, aromatic herbs, or mineral medicines. The qi of aromatic herbs is fragrant, and the qi of mineral medicines is fierce; both are rapid, urgent, firm, and strong—only those with gentle dispositions can take them. When heat qi encounters medicinal qi, there is fear of internally injuring the spleen. Dān can develop into xiāo zhōng.
Hereafter are listed points related to jaundice and consumptive thirst: Jizhong (GV 6), Pishu (BL 20), Yishe (BL 49), Chengjiang (CV 24), Wangu (SI 4), Taichong (LR 3), Zhongfeng (LR 4), Taixi (KI 3), Rangu (KI 2), Sanli (ST 36), etc.
The Yellow Emperor asked: Why does a person's activity decline at age fifty—does one lose something? Qibo replied: People of our time take wine as their beverage, reckless behavior as normal, enter the bedchamber drunk, exhausting their essence and qi. They do not know how to maintain fullness or regularly nurture their spirit, seeking only momentary pleasure, with irregular rest and activity—thus they decline at half a hundred. The sages, however, labor their bodies without exhaustion, their spirit follows in harmony, are not confused by lust and depravity, and accord with the Dao—thus at a hundred years their activity does not decline.
The five labors causing injury: prolonged looking injures the blood, prolonged lying injures the qi, prolonged sitting injures the flesh, prolonged standing injures the bones, prolonged walking injures the sinews.
For someone with chest and rib fullness obstructing food intake, first smelling fishy and rancid odors, discharging clear nasal mucus, first spitting blood, cold extremities, dizziness, and frequent blood in the stool or urine: the disease name is blood exhaustion (xuè kū). It arises from great blood loss in youth, or from entering the bedchamber drunk, causing exhaustion of middle qi and liver injury, hence the menses become scanty and cease. The ancient formula uses cuttlefish bone and madder root, combined into pills with sparrow eggs, sized like small beans, taken with abalone juice, to benefit the intestines and injured liver. This is an ancient methodology; it is for scholarly study only and not as medication guidance.
Labor wind (láo fēng) has its disease below the lungs, causing stiff neck, blurred vision, spitting like nasal mucus, aversion to wind, and shivering with cold. Treatment aims to relieve the patient's inability to bend forward or backward. The Taiyang channel guides the essence: coughing up green-yellow phlegm resembling pus occurs at three, five, or seven days. If it does not emerge, the lungs are injured; lung injury leads to death. For scanty qi, moist body, shortness of breath with speech, sore bones, heavy body, and indolence with inability to move: supplement Foot Shaoyin. For shortness of breath with breath unable to continue and qi exhaustion upon movement: supplement Foot Shaoyin and drain the blood collaterals.
Hereafter are listed patterns such as cold external genitalia in men, stiff spine with red eyes, nightmares, seminal emission, spermatorrhea, uterine bleeding, chest blood stasis, hematemesis, blood spitting, and coughing blood, respectively selecting Huiyin (CV 1), Zhigou (TE 6), Yingu (KI 10), Shangqiu (SP 5), Zhongji (CV 3), Dahe (KI 12), Taichong (LR 3), Zhongliao (BL 33), Sanli (ST 36), Shangwan (CV 13), Burong (ST 19), Taiyuan (LU 9), Daling (PC 7), Ximen (PC 4), Shenmen (HT 7), Sanyangluo (TE 8), Diwuhui (GB 42), etc. For all blood spitting, the ancients drained Yuji (LU 10) and supplemented Chize (LU 5).
The Yellow Emperor asked about upper and lower diaphragm obstruction. Qibo explained: When joy and anger are inappropriate, diet is irregular, and cold and warmth are untimely, then cold fluid stagnates in the intestines. Worms, affected by cold, accumulate below the lower abdomen (Xiàwǎn, CV 10). The intestines and stomach become distended and full, stomach qi cannot nourish, and pathogenic qi resides there. When a person eats, the worms ascend seeking food, the lower abdomen becomes vacuous, pathogenic qi prevails, accumulation remains, and abscess forms. If the abscess is within the gastric cavity, there is deep pain; if outside it, floating pain with superficial heat. Treatment method: press the abscess, shallowly needle its periphery, gradually going deeper—no more than three times. Assess the floating or sinking to determine shallow or deep. After needling, always apply hot compresses, allowing warmth to enter the interior, causing pathogenic qi to weaken, and the great abscess to rupture. Then, with proper nurturing, tranquility and non-action, qi can circulate. Thereafter take sour and bitter flavors, transforming grains, and the lower diaphragm obstruction resolves.
When diagnosing gastric abscess (wèi wǎn yōng), one should examine the stomach pulse. A deep and rough pulse indicates qi rebellion; qi rebellion means the Renying pulse is extremely full; extreme fullness means heat accumulates at the stomach opening and does not move, thus the stomach becomes an abscess. Fullness of the liver, fullness of the kidney, and fullness of the lung, all in excess, respectively cause corresponding abscesses and swellings. Lung abscess presents with panting and fullness of both shanks. Liver abscess presents with fullness below both ribs, fright upon lying, and inability to pass urine. Kidney abscess extends down to lower abdominal fullness, with one shank larger than the other, causing a limp in walking and proneness to hemiplegia.
The Yellow Emperor asked about the causes of abscesses and deep ulcers (yōng jū). Qibo replied: The channels and vessels flow ceaselessly, corresponding to heaven and earth. When cold pathogen lodges in the channels and vessels, the blood becomes rough and does not flow, defensive qi gathers there and cannot return, thus forming abscesses and swellings. Cold qi transforms into heat; when heat prevails, flesh putrefies; putrefied flesh becomes pus; if pus is not drained, sinews rot; rotting sinews injure bones; bone injury leads to marrow depletion, bones and sinews become empty and withered, channels and vessels fester and leak, fumigating the five viscera; visceral injury leads to death.
The Yellow Emperor asked: When an abscess has already formed pus, can small needles treat it? Qibo replied: Once pus has formed, there are ten deaths to one survival. For pus and blood already formed, only stone needles (biān shí) and sharp lance needles (pī zhēn) are appropriate. There are five signs to judge adversity: whitish-blue whites of the eyes with small eyes is the first adversity; vomiting upon administering medicine is the second; abdominal pain with intense thirst is the third; stiffness and immobility of shoulders and neck is the fourth; hoarse voice with withered complexion is the fifth. Other than these five, it is favorable.
Cold and heat contend; pathogenic qi long lingers internally. Cold prevailing causes bone pain and flesh withering; heat prevailing causes putrefaction of flesh and muscle into pus, and internal injury to bones as bone erosion. Sinews flexing without extending, with qi dwelling between them, causes sinew tumors. Qi stagnation with prolonged retention of fluids combines to form intestinal abscess. Pathogenic qi congeals, worsening daily, accumulating to form longstanding tumors. Qi deep at the bone level causes bone abscess. Qi striking the flesh: with heat it transforms into pus; without heat it becomes flesh abscess.
Disease with abscess-swellings, neck pain, chest fullness, and abdominal distension is called reversal (jué nì). Moxibustion upon it causes muteness; stone needling upon it causes mania—one must wait until the qi combines before treating. Neck abscesses with the same name but different clinical severity: abscesses of qi stagnation are suitable for needle-opening and removal; those with exuberant qi and blood gathering are suitable for stone needle drainage. This is treating the same disease differently.
All abscess-swellings, sinew spasms, and bone pain are due to cold qi, swelling, and the eight wind variations. Treat according to the prevailing qi of the four seasons at the corresponding Shu points. For axillary abscess with high fever: needle Foot Shaoyang with five punctures, Pericardium channel with three, and the Hand Taiyin collateral. For treating abscess-swellings, needle the abscess itself, observing its size and depth for needling.
Hereafter are listed numerous abscess-swellings, leprosy (lì fēng), and spreading sores with their point selections, such as Wangu (GB 12), Tianzhu (BL 10), Quanliao (SI 18), Tianchuang (SI 16), Tianrong (SI 17), Guanmen (ST 22), Rugen (ST 18), Yuanye (GB 22), Zhangmen (LR 13), Zhigou (TE 6), Xiangu (ST 43), Dubi (ST 35), Qiaoyin (GB 44), Jianshi (PC 5), etc. For leprosy, use the method of needling the swelling and sucking out putrid blood, and emphasize dietary prohibitions.
The Yellow Emperor asked about the appearances of abscesses and deep ulcers and their contraindicated days. Qibo enumerated various abscesses: those arising in the throat are called fierce abscess (měng jū)—if not urgently treated, death within half a day; those arising at the neck are called heavenly abscess (yāo jū)—if not urgently treated, death in over ten days; those arising at the shoulder and upper arm are called mole abscess (cí jū); those arising below the armpit are called rice abscess (mǐ jū); those arising at the chest are called well abscess (jǐng jū); those arising at the breast are called sweet abscess (gān jū); those arising at the ribs are called defeated mole (bài cí); those arising at the thigh and shank are called thigh-shank abscess (gǔ jìng jū); those arising at the coccyx are called sharp abscess (ruì jū); those arising on the yin aspect of the thigh are called red relaxation (chì chí); those arising at the knee are called mole abscess (cí jū); those arising at the shin are called rabbit bite (tù niè); those arising at the medial malleolus are called walking slowdown (zǒu huǎn); those arising at the toes are called sloughing abscess (tuō jū), etc. Each has different disease courses, treatment methods, and prognostic judgments.
The Yellow Emperor asked about the difference between yōng (superficial abscess) and jū (deep ulcer). Qibo replied: Yōng is stagnation of nutritive qi, blood becoming rough and stagnant, defensive qi unable to pass, heat prevailing with flesh putrefaction into pus—but it does not deeply sink into bone marrow, and the five viscera are not injured. Jū involves purely exuberant heat penetrating deeply into muscle, sinews, marrow, bones, and flesh, internally connecting with the five viscera, blood and qi completely exhausted, and all good flesh simultaneously lost. Wounds arising at the five regions (throat, calf, back, the Shu points of the five viscera, nape of the neck) have poor prognoses. Finally, it discusses the correspondence of the body to the nine fields and the taboo days of heaven, as well as prognoses based on different times of day at disease onset.
The core principle of this volume systematically incorporates many psychiatric conditions, acute disorders, metabolic diseases, and abscesses into the overall pathogenetic framework of "qi movement rebellion—blood vessel obstruction—pathogenic qi accumulation."
The content of this volume can be regarded as early empirical records of psychiatric illnesses, epilepsy, shock, acute gastroenteritis, diabetes, jaundice, gynecological hemorrhage, and skin and soft tissue infections. Its value lies in:
The limitations are equally evident: several determinations—like "fright in the mother's womb causes epilepsy," "placing blood in a gourd and moxa at the coccyx if it does not move," and "disease arising at different times all prove fatal"—lack modern scientific support. Certain point indications and needling depths, such as "needling Renying to four fen—unfortunately killing people," show that ancients both recognized dangers, and yet such depths are not transferable today. Prescriptions like cuttlefish bone, madder, iron pellets, and lingqiao herb root should be regarded as historical research references only, not modern medicinal directives.
The main non-medical lifestyle insights this volume offers to general readers include:
This content is based on classical Chinese medicine texts and is provided solely for the study and appreciation of traditional culture. It does not constitute any medical diagnosis, medication, or treatment advice. Please consult a physician promptly if you experience any discomfort.