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Chapter 55 of 78
黄帝内经·素问
Overall Interpretive Translation
The needling sites, depths, and treatment courses described below are all recorded in ancient literature and are provided solely for the study of principles and theory. They must not be used as a basis for modern clinical practice.
A skilled acupuncturist sometimes does not take the pulse first as a routine measure, but rather begins by listening to the patient's description. If the disease is in the head with severe headache, deep needling with needle retention may be applied, reaching down to the bone; when the condition subsides, stop. Do not damage the bone, flesh, or skin—the skin is merely the pathway through which the needle enters. 🩺
The Yin Needling Method involves inserting a needle at one site, then needling four sites beside it, in order to regulate cold and heat. If the pathogenic factor is deeply concealed and specifically attacks the five viscera, one may needle the Back-Shu points (acupoints on the back where the qi of the viscera is infused) of the five viscera; the needling approaches the diseased viscus, causing the visceral qi to converge. Withdraw the needle when the cold and heat in the abdomen have subsided. The key point of this method: on withdrawal, needle shallowly and cause slight bleeding.
To treat putrid abscesses and swellings, needle directly on the abscess itself. Observe the size and depth of the abscess to determine the needling method; for large abscesses, promote more bleeding; for small ones, needle deeply; the needle must be held straight and inserted perpendicularly, continuing until the disease is cured. 🌿
When the disease lies in the lower abdomen with accumulations, needle between the skin and flesh of the lower abdomen, descending to the site of the disease; then needle beside the vertebrae near the fourth vertebra, as well as between the iliac bones on both sides, the floating ribs, and the intercostal regions, guiding the warmth of the abdominal qi downward to bring about recovery.
When the disease lies in the lower abdomen with abdominal pain and obstruction of urination and defecation, the disease is called hernia (shan), which the ancients believed was caused by cold pathogen. One may needle between the lower abdomen and the two thighs, and between the waist and the sacral bones, applying multiple needling until local heat is produced, at which point the disease subsides. 🌊
When the disease lies in the sinews, with muscular cramping, joint pain, and inability to walk, it is called sinew bi (sinew impediment). Needle on the sinews themselves, inserting between the muscular interstices (the spaces between muscle groups); do not strike the bone; when heat develops in the sinew region, the disease is cured and may be stopped.
When the disease lies in the skin and flesh, with pain in both skin and muscles, it is called muscular bi (muscle impediment), which the ancients attributed to cold-dampness. One may needle the large and small muscular interstices (large divisions and small divisions), using many needles and deep needling, until a heat sensation is produced; do not damage the sinews or bones—damage to either may lead to abscesses or other pathological changes; when heat pervades all the muscular interstices, the disease is cured and needling stops. 🔥
When the disease lies in the bones, with heavy bone joints, difficulty in lifting and moving, deep ache in the bone marrow, and a subjective feeling of cold attacking the body, it is called bone bi (bone impediment). Needle deeply, with the principle of not harming the blood vessels or muscles; the needle path follows between the large and small muscular interstices; when heat develops in the bone region, the disease is cured and needling stops.
When the disease lies in the yang channels (channels of yang nature), with alternating chills and fever, and the various muscular interstices also manifest alternating chills and fever, it is called mania (kuang). When needling, use the draining method to make the channel qi vacuous; observe when heat pervades all the muscular interstices, and the disease is cured, then stop.
When the disease initially occurs once a year; if not treated in time, it occurs once a month; if again not treated early, it occurs four or five times a month—this is called epilepsy (dian). Needle the various muscular interstices and the channels; if there are no cold signs, regulate with needling, and stop when the disease is cured.
When the disease is due to wind pathogen, with alternating chills and fever, fever with sweating, occurring several times a day, first needle the various skin striations and collateral vessels; if chills and fever still alternate after sweating, needle once every three days, and it will be cured in one hundred days. 💨
A disease called great wind (dafeng) with heavy bone joints and loss of beard and eyebrows is called great wind. First needle the flesh to induce sweating, persisting for one hundred days; then needle the bone marrow to induce sweating for another hundred days; the full course totals two hundred days, not stopping until the beard and eyebrows regrow.
The core of this chapter lies in "needling has shallow and deep levels, each reaching its appropriate layer." Skin, flesh, sinews, bones, vessels, and viscera each correspond to specific strata; when the disease site differs, the depth and pathway of needling also differ. For example, when the disease is in the sinews, do not needle the bone; when the disease is in the bones, needle deeply without harming the vessels or flesh; the skin is merely the entry pathway. This reflects the consistent "treatment by strata" philosophy of the Inner Canon.
Secondly, this chapter repeatedly emphasizes "heat as the guide" and "stop when the disease is cured." The ancients regarded local heat as a marker of qi arrival or therapeutic effect, and the disappearance of symptoms as the endpoint for stopping treatment—rather than mechanically fixing a set number of sessions. This reflects a dynamic, individualized treatment approach: observe continuously during treatment and stop upon achieving effect.
Furthermore, the opening statement "the needling practitioner does not always take the pulse but listens to the patient's words" shows that ancient needling practice placed great importance on inquiry and symptomatic localization. This does not negate diagnostic methods but rather emphasizes that certain acute pains and localized conditions may be rapidly assessed based on chief complaints.
From a modern medical standpoint, needling at different layers—skin, muscle, fascia, periosteum—may indeed activate different receptors and produce different local or systemic regulatory responses. This provides a certain physiological explanatory space for "treat the sinews when the disease is in the sinews, treat the bone when the disease is in the bone." However, ancient sensory indicators such as "bone heat" or "interstice heat" lack modern quantitative definitions and remain at the level of empirical description.
The "great wind" described in the text—with heavy bone joints and loss of beard and eyebrows—shares similarities with modern leprosy (Hansen's disease). Modern medicine has clearly identified Mycobacterium leprae as the causative agent and has standardized anti-infective treatment protocols; the ancient practice of "two hundred days of needling to regrow the beard and eyebrows" is a historical experience and cannot replace modern diagnosis and treatment. Similarly, the ancient classifications of "epilepsy" and "mania" do not correspond exactly to modern neuropsychiatric disorders and cannot be applied literally.
Special attention is needed: in moderne healthcare environments, ancient operations such as directly needling abscessed swellings or deep needling to the bone carry risks of infection, bleeding, and tissue damage. These must only be considered by qualified physicians under strict sterile conditions and with clear diagnosis. This chapter's content is suitable only for studying the theoretical origins of acupuncture and moxibustion, not as an operational manual.
From a non-therapeutic perspective, this chapter offers some lifestyle insights: the repeated appearance of cold-dampness and wind pathogen suggests daily attention to avoiding cold and keeping warm, not dwelling in damp environments, and engaging in moderate physical activity of sinews and bones, which all help reduce muscle and joint discomfort. 🌿
The expression "once a year if untreated, then once a month, then four or five times a month" also indicates that physical abnormalities may worsen if delayed, reminding us to seek medical attention promptly when unwell—do not wait until symptoms become frequent before taking them seriously. Emotional and psychological factors occupy a place in the descriptions of "mania and epilepsy," and maintaining emotional stability and regular routines is beneficial to overall health.
The above are merely extensions of traditional health-cultivation thinking and are not recommendations for the prevention or treatment of any disease.
This content is based on ancient Chinese medical classics and is provided solely for the study of traditional culture and scholarly reading. It does not constitute any medical diagnosis, medication advice, or treatment recommendation. If you experience discomfort, please seek timely medical attention.