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Chapter 25 of 78
黄帝内经·素问
The Yellow Emperor asked: Heaven covers the earth, the earth sustains all things, and among all things that exist, none is more precious than the human being. Humans are born from the transformation of the qi of Heaven and Earth 💨, and grow in accordance with the laws of the four seasons 🌿. Whether sovereign or commoner, all wish to preserve their bodies. Yet when the body falls ill, people often fail to understand the condition of the pathogenic factors—the illness lingers, spreads, and deepens day by day, even penetrating to the bone marrow. I am privately troubled by this and wish to use needling 🩺 to expel disease. What should be done?
Qi Bo replied: Salt has a salty flavor, and its qi can cause containers to seep water; when a string is about to break, the sound becomes hoarse and cracked; when a tree's interior becomes disordered, the leaves may appear abnormally luxuriant on the outside (commentators through the ages have differed in their understanding of this line—the general meaning is that when the interior has already changed, the exterior may show false appearances); when disease has penetrated deeply, the patient will emit hiccup-like sounds. If a person manifests these three categories of signs, it indicates that the internal organs have already decayed, drugs cannot treat them effectively, and even fine needles cannot achieve results. These are critical stages in which the skin and flesh have withered and sustained damage, and blood and qi contend with each other, appearing murky and defeated.
The Yellow Emperor said: I am concerned for the suffering of the sick, and my mind becomes disturbed and confused, which may even worsen the illness; this suffering cannot be borne by another person on their behalf. When the people hear of this, they may consider me cruel and harmful. What should I do?
Qi Bo replied: Humans are born and nourished by the earth, and life is linked to Heaven; the qi of Heaven and Earth 💨 unite to form the human being. If a person can follow the four seasons, Heaven and Earth will nurture them as parents; one who comprehends the patterns of all things may be called a "Son of Heaven." Heaven has yin and yang; humans have twelve joints (which may be understood as the twelve meridians or twelve rhythmic articulations of the human body). Heaven has cold and heat; humans have deficiency and excess. One who can master the changes of yin and yang in Heaven and Earth will not violate the four seasons; one who understands the principles of the twelve joints cannot be deceived even by the supremely clever; one who can perceive the movements of the eight winds and the sequential succession of the five phases—one who penetrates the patterns of deficiency and excess—can move freely amidst the most subtle changes, perceiving the faintest breathing and groans of the patient as clearly as autumn down.
The Yellow Emperor asked: Humans are born with physical form and cannot depart from yin and yang; the qi of Heaven and Earth unite and are divided into the nine fields (the nine provinces) and into four seasons. Months vary in length, and days vary in duration between short and long. All things emerge simultaneously, too numerous to count. The subtle manifestations of deficiency and excess are like faint groans—may I ask about the method here?
Qi Bo replied: Wood meets metal and is cut down; fire meets water and is extinguished; earth meets wood and becomes permeable; metal meets fire and suffers damage; water meets earth and is blocked 🔥🌊🌿. Thus it is with all things, without end. Therefore, needling has five great principles promulgated to the world, yet the common people only concern themselves with daily food and drink, and none truly understands them. The first is called governing the spirit (regulating and settling the mind), the second knowing how to nourish life, the third understanding the true nature of medicinals, the fourth fashioning stone needles of appropriate size, and the fifth understanding diagnosis of the viscera and blood-qi. Though all five methods are established, each has its proper precedence and emphasis. Now, ordinary physicians applying needles use supplementation for deficiency to make it full, and drainage for excess to make it empty—this is what ordinary physicians all know. When it comes to taking the laws of Heaven and Earth as one's standard, responding to changes immediately, like an echo answering a sound or a shadow following a form, the Way of medicine involves no ghosts or spirits—it relies wholly on focused attention and moving alone without distraction.
The Yellow Emperor said: I wish to hear the principles therein.
Qi Bo replied: The true essential of needling lies first in governing the spirit (stabilizing the mind). When the conditions of the five viscera are already clear, and the nine indicators (an ancient pulse diagnostic method—head, hand, and foot regions, each divided into Heaven, Earth, and Human positions, totaling nine) are already assessed, only then should one consider inserting the needle. Even if the various pulse signs are not clearly manifest and no ominous portents have been heard, one must bring the outer manifestations into accord with the inner condition, without being led astray by superficial appearances; one must repeatedly assess the coming and going of qi movement before applying treatment to the patient. The human body has deficiency and excess. When encountering the five deficiencies (five categories of vacuity), do not hastily approach with the needle; when encountering the five excesses (five categories of repletion), do not miss the opportune moment. When the time for needle insertion arrives, one cannot afford even the blink of an eye. The movements of the hands must be focused, the needles clean and well-proportioned; calmly observe the response to needling, watching the changes that occur when qi arrives. This state is profound and subtle, revealing no tangible form. It is as if qi gathers with a dark, converging presence, and swells with abundant fullness—yet one perceives the flying movement of qi without knowing exactly what it is. Before the needle is inserted, one resembles the tension of a drawn crossbow; when the moment arrives, one releases it like the trigger mechanism.
The Yellow Emperor asked: What constitutes deficiency? What constitutes excess?
Qi Bo replied: When needling a deficiency, one must transform it toward fullness; when needling an excess, one must transform it toward emptiness. Once the meridian qi (the needling sensation that courses along the channels) has arrived, one must guard it attentively and not let it be lost. The depth of insertion is governed by mindful intention, and distal or proximal point selection should be as one unified approach. Be as careful as if facing a deep abyss, as focused as if grasping a tiger, and let the spirit not be distracted by external things.
The central theme of this chapter is "protecting life and preserving the body": life is most precious, and humans are born of the qi of Heaven and Earth and formed through the laws of the four seasons. The highest level of treating disease is not mere supplementation or drainage, but governing the spirit and modeling oneself after Heaven and following the patterns of Earth.
Qi Bo presents the five methods of needling: governing the spirit, knowing how to nourish life, understanding the true nature of medicinals, fashioning stone needles of appropriate size, and understanding diagnosis of the viscera and blood-qi—with "governing the spirit" placed first. This suggests that ancient understanding of needling went beyond mere technical manipulation, encompassing the settling of one's mental state, daily self-cultivation, true knowledge of medicinal properties, proper instrument crafting, and diagnosis of the viscera and blood-qi.
The text uses four types of abnormal phenomena—salt, musical strings, trees, and deep illness—to illustrate that when the interior has already been damaged, the exterior may manifest distinctive signs, indicating that disease at the stage of "decayed viscera" is difficult to reverse. This reflects the early emphasis on prognostication of critical illness.
Needling technique emphasizes: making a clear diagnosis first without being misled by superficial pulse signs and symptoms; waiting for the optimal moment, "not allowing even the blink of an eye"; maintaining intense mental focus before and after needle insertion—"as if facing a deep abyss, as if grasping a tiger, the spirit not lingering over mundane affairs." The principle of supplementation and drainage holds that "for vacuity, one must seek fullness; for excess, one must seek emptiness," and once meridian qi arrives, one must "guard it attentively and not lose it."
"The Way has no ghosts or spirits—it moves alone and comes alone" emphasizes that the Way of medicine relies not on supernatural forces but on comprehending natural laws and maintaining dedicated focus. This reflects a rational spirit for its era.
Pugua's tip: This content is based on classical Chinese medical classics and is provided for traditional cultural study and research only; it does not constitute any medical diagnosis, medication, or treatment recommendation. Please consult a physician promptly if you feel unwell.