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Chapter 26 of 78
黄帝内经·素问
The Yellow Emperor asked: In treating illness with acupuncture, there must always be principles to follow. What are the "principles" and "rules" spoken of now?
Qi Bo replied: Take heaven as the principle, earth as the rule, and align with the changes of sunlight and starlight—the sun, moon, and celestial bodies.
The Yellow Emperor said: I wish to hear the details.
Qi Bo said: In all acupuncture regulations, one must first observe the changes of the sun, moon, stars, the four seasons, and the eight cardinal qi. Only when the qi mechanism is settled can acupuncture be performed. Therefore, when the weather is warm and the sunlight is bright, a person's blood flows smoothly and freely, and the defensive qi (qi that circulates on the body surface and provides protection) floats to the exterior, so blood is easily let out and qi moves easily. When the weather is cold and sunlight is dim, a person's blood congeals and becomes sluggish, and defensive qi sinks inward. When the moon is new, blood and qi begin to fill, and defensive qi begins to move freely. When the moon is full, blood and qi are replete and muscles are firm. When the moon wanes, muscles weaken, channels and collaterals become empty, defensive qi disperses, and the physical form stands alone. Therefore, one must regulate blood and qi according to the celestial seasons. Thus, when the weather is cold, do not needle; when the weather is warm, do not hesitate. When the moon is new, do not use draining methods; when the moon is full, do not use tonifying methods; when the moon wanes, do not treat. This is called following the celestial seasons in regulation and treatment. Following the order of the seasons and the changes of deficiency and excess, observing the movement of sunlight to determine the position of qi, stand upright and await the right moment. Therefore, if draining is used when the moon is new, it will cause vacuity of the visceral qi. If tonifying is used when the moon is full, it will cause blood and qi to flood and overflow, with blood stasis retained in the collaterals—this is called "double repletion." Treating when the moon wanes will disturb the channels and collaterals, causing yin and yang to become chaotic, true qi and pathogenic qi to become indistinguishable, pathogenic qi to sink and remain, the body surface to become vacuous while the interior becomes chaotic, and淫邪 (excessive pathogenic factors) to arise.
The Yellow Emperor asked: What do the stars and the eight cardinal regulations observe?
Qi Bo said: The stars are used to calculate the patterns of the sun and moon's movements. The eight cardinal regulations (upright qi of eight seasonal nodes or eight directions) are used to observe when the vacuous pathogenic qi from the eight directions arrives. The four seasons are used to distinguish where the qi of spring, summer, autumn, and winter resides, to regulate the body according to the season, and to avoid the vacuous pathogenic qi of the eight cardinal regulations without being invaded by it. If the body is already vacuous and encounters vacuity from the celestial season, the two vacuous factors interact, and pathogenic qi may penetrate deep into the bones; once it invades, it can damage the five viscera. If a physician can examine and treat in time, injury will not occur. Therefore, it is said that the "celestial prohibitions" must not be unknown.
The Yellow Emperor said: Well spoken. Regarding the principle of emulating the stars, I have heard it. I wish to hear further about how to emulate antiquity and verify with the present.
Qi Bo said: To emulate antiquity, one must first understand the Needle Classic. To verify with the present, one must first understand the cold and warmth of the day and the vacuity and fullness of the moon, to examine the floating and sinking of qi, and then regulate the body, observing that it responds immediately. What is called "observing the obscure" means that the physical form, qi, and nutritive and defensive aspects are not manifest externally, yet the physician alone is able to know them. Based on the cold and warmth of the day, the vacuity and fullness of the moon, and the floating and sinking of the qi of the four seasons, one comprehensively cross-references and regulates. The physician can often foresee these things in advance, but they are not manifest externally—therefore it is called "observing the obscure."
One who can understand infinite transformations can transmit the medical way to later generations. This is what distinguishes the superior physician from ordinary people. However, because these principles are not manifest externally, ordinary people cannot see them. Looking at them, there is no trace; tasting them, there is no flavor—so it is called "obscure," as if divine. Vacuous pathogenic qi refers to the vacuous pathogenic qi produced by the eight cardinal regulations. Upright pathogenic qi refers to encountering vacuous wind when the body has been working with force, sweating, and the interstitial spaces are open. This kind of pathogenic qi injures people lightly, so no one knows its actual condition, and no one sees its traces. The superior physician treats when the disease is still sprouting, always first examining the qi of the three regions and nine indicators, and regulates before it declines—so he is called "superior worker." The inferior physician waits until the disease has already formed and even become corrupted before treating. What is called "treating what has already formed" refers to not understanding the disharmony of the qi of the three regions and nine indicators, allowing the disease to corrupt. Knowing where the disease is, one examines where the diseased pulse of the three regions and nine indicators lies and treats accordingly—therefore it is said to "guard the gate." Even without knowing the actual condition of the pathogenic qi, one can see its traces.
The Yellow Emperor said: I have heard of tonifying and draining methods, but I have not yet understood their meaning.
Qi Bo said: Draining must use "square." What is called "square" means when the qi is at its peak, the moon is just full, the sunlight is just warm, and the body is just settled. Insert the needle on inhalation, then turn the needle on the next inhalation, and slowly withdraw the needle on exhalation. Therefore it is said that draining must use square, allowing pathogenic qi to exit with the needle. Tonifying must use "round." What is called "round" means movement and shifting. Needling must hit the site of disease, and then withdraw the needle on inhalation. Therefore "round" and "square" do not refer to the shape of the needle, but to the timing and technique of tonifying and draining. Therefore, one who is good at nourishing spirit must understand the fatness and thinness of the physical form and the excess and decline of nutritive and defensive qi and blood. Blood and qi are the foundation of a person's spirit—one must not fail to carefully nourish them.
The Yellow Emperor said: How exquisite! Uniting the human physical form with yin and yang and the four seasons, responding to vacuity and repletion, the subtle transformations—who but you, sir, could understand these? However, you have repeatedly mentioned form and spirit. What is called form, and what is called spirit? I wish to hear the details.
Qi Bo said: First, let me speak of form. Form means the external appearance. The eyes cannot see clearly; one asks about the illness and seeks it through the channels and vessels. Although the mind understands, pressing does not reveal it, and one does not know its full details—therefore it is called "form."
The Yellow Emperor asked: What is called spirit?
Qi Bo said: Spirit—how mysterious! The ears cannot hear it, but the eyes perceive it clearly. The heart aperture opens and the intention arrives first, suddenly and uniquely understood. It is difficult to express in words. Among the crowd, all look but only one can see it. It is as if obscured, yet clearly luminous, like wind dispersing clouds—therefore it is called "spirit." The pulse method of the three regions and nine indicators is the foundation for examining spirit qi; one need not be bound by the specific discussions of the nine needles.
The core of this chapter is the concept of "acupuncture timing under the correspondence between heaven and humanity." Ancient scholars believed that human blood and qi undergo cyclical changes in accordance with celestial conditions—especially the movements of the sun and moon and the cold and warmth of the four seasons. Therefore, acupuncture cannot be performed at any time; one must "await the qi and then settle": when the weather is warm and the moon is full, blood and qi float and flourish, suitable for draining repletion; when the weather is cold and the moon wanes, blood and qi sink and become vacuous, and one should not needle recklessly. This is a medical philosophy that incorporates therapeutic action into natural rhythms.
Another core concept is "the superior worker treats disease before it arises" and "observing the obscure." A superior physician can intervene early through subtle observation—such as pulse diagnosis of the three regions and nine indicators—before pathogenic qi has taken form and before blood and qi have declined. An inferior physician can only remedy the situation after the disease has already become apparent. This emphasis on early intervention and recognizing formless precursors shares common ground with modern preventive medicine.
The "square" and "round" of tonifying and draining do not refer to the shape of the needle, but to the timing of operation and the mode of qi movement: draining borrows the moment when qi is flourishing to release pathogenic qi along with the momentum; tonifying borrows the movement of qi to guide and support upright qi. The chapter ultimately rests on "blood and qi are the spirit of a person—one must not fail to carefully nourish them," indicating that although this chapter discusses acupuncture, its ultimate concern is the nourishment of blood and qi as the root of life.
From a modern scientific standpoint, the moon phase, circadian rhythm, and seasons do exert certain influences on human physiology, such as sleep, hormone secretion, and immunity, which follow rhythmic patterns. However, assertions like "when the moon is full, blood and qi are replete; when the moon is empty, channels and collaterals are vacuous" currently lack direct, reproducible physiological evidence and belong more to ancient natural-philosophical reasoning.
The concept of "the superior worker rescues the sprouting" is highly consistent with modern preventive medicine and early screening concepts. Paying attention to subtle signals from the body and regulating in time also has practical significance. However, it must be honestly stated that descriptions such as "observing the obscure" and "spirit" carry an intuitive, experiential, and even mystical coloring. They should not be mystified, nor should they replace modern diagnostic methods.
Regarding the specific operations of tonifying and draining acupuncture, this chapter belongs to academic theoretical exploration, not modern operational standards, and does not serve as any guide for needling or medication.
Related Concepts:
Further Reading:
Bu Gua's note: This content is based on classic ancient Chinese medical texts and is provided solely for traditional cultural study and research. It does not constitute any medical diagnosis, medication, or treatment advice. If you feel unwell, please seek medical attention promptly.
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