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Chapter 1 of 81
黄帝内经·灵枢
Holistic Interpretation
The Yellow Emperor asked Qibo for guidance: I govern the myriad people, nurture the common folk, and also collect taxes; I pity the people's insufficient livelihood, and their frequent affliction by illness. I wish that they need not all take toxic medicines, nor rely solely on stone needles, but instead use fine needles to unblock the meridians (the primary channels through which qi and blood travel in the body), harmonize qi and blood, and regulate the crossing points where qi and blood flow in reverse or smooth order. I also want these methods to be transmitted to later generations—clear rules must be established so they will not disappear or be severed, easy to grasp and difficult to forget, forming a guiding framework; organized by categories, distinguishing interior from exterior, defining beginning and end, so that the nine needles each have their fixed forms. First, establish the "Needle Classic," and I wish to hear its principles.
Qibo replied: Allow me to lay out the sequence, giving it organization and guiding principles, beginning with "one" and ending with "nine." First, I will address the overall principles of needling. The essential points of the fine needle are easy to speak of, yet truly entering into their subtlety is difficult. A coarse physician focuses only on the physical form, while a superior physician focuses on spirit-qi; spirit-qi is extremely subtle, and evil qi is like a guest staying at the gate. Without yet clearly seeing the manifestation of disease, how can one know the root cause? The subtlety of acupuncture lies in the mastery of speed and slowness. A coarse physician clings to fixed sites like joints, while a superior physician attends to the transformations of qi movement. The movement of qi does not depart from the acupoint spaces; the qi within the points is clear, still, and subtle. When qi arrives, do not meet it head-on to block it; when qi departs, do not forcibly chase it. Those who understand the way of qi cannot err by even a hair's breadth; those who do not understand the way of qi are like a crossbow bolt resting on the string yet unable to be released. Knowing the coming and going of qi is how one grasps the timing. Coarse physicians are benighted regarding this; superior physicians alone possess its mystery.
Qi departing is contraflow; qi arriving is with-flow. Understanding contraflow and with-flow allows correct needling without hesitation. Meeting qi as it arrives to drain it—how could this not weaken evil qi? Following qi as it departs to support it—how could this not strengthen upright qi? Meeting to drain and following to tonify, harmonizing through intention, the way of needling is then complete.
In all needling, deficiency is treated with supplementation to make upright qi full, excess with drainage to let evil qi out, stagnation that has long accumulated should be eliminated, and hyperactive evil qi should be weakened. The Great Essentials says: Slow insertion with rapid withdrawal gives fullness to upright qi; rapid insertion with slow withdrawal weakens evil qi. What is called deficiency and excess is felt as if present yet absent; one must discern what comes first and what comes after, as if existing and as if vanishing. When supplementing or draining, the patient feels as if gaining something or as if losing something. The crux of deficiency and excess lies in the marvelous use of the nine needles; the timing of supplementation and drainage is accomplished through the act of needling.
🌿 Draining technique: After inserting the needle, rock it to enlarge the needle hole, letting out yang qi and allowing evil qi to drain away. If, upon withdrawing, one presses the hole closed, this is called "inner warming," causing blood not to disperse and qi not to exit. 🌿 Supplementing technique: Follow the qi with guidance; in intention it is like a subtle movement, or pressing, or rotating. After insertion, rest as gently as a mosquito or gadfly on the skin, lingering and returning; the withdrawal should be as swift as a severed zither string, while the left hand presses the hole closed, causing upright qi to remain, the outer gate to close, and the inner qi to become replete. But do not allow stagnant blood to remain; if there is stagnant blood, it should be removed quickly.
The way of holding the needle holds firmness as paramount; align the fingers for direct insertion, not veering left or right; concentrate the spirit upon the subtleties, attend to the patient, examine the state of the blood vessels, and then needling will not bring danger. When about to insert, observe the transformations of yang qi and defensive qi; if the spirit remains gathered and undistracted, one can know whether illness may persist or resolve. When blood vessels lie horizontally in the acupoint regions, they are clear to the sight and firm to the touch.
The nine needles have names and shapes that each differ: The first is called the chan needle (arrowhead needle), measuring one cun and six fen. The second is called the yuan needle (round needle), measuring one cun and six fen. The third is called the di needle (spoon needle), measuring three cun and a half. The fourth is called the feng needle (lance needle), measuring one cun and six fen. The fifth is called the pi needle (sword needle), measuring four cun, two and a half fen wide. The sixth is called the yuanli needle (round-sharp needle), measuring one cun and six fen. The seventh is called the hao needle (filiform needle), measuring three cun and six fen. The eighth is called the chang needle (long needle), measuring seven cun. The ninth is called the da needle (large needle), measuring four cun.
🔪 The chan needle has a large head with a sharp tip, used for shallow insertion to drain yang qi. 🥚 The yuan needle has a body shaped like an egg, used for rubbing between the muscle layers without injuring the flesh, to drain the qi of the interstices. 🌾 The di needle has a tip slightly sharp like millet or panicum seed, chiefly used to press the vessels without deep penetration, to guide the qi. 🔺 The feng needle has three cutting edges, used to treat stubborn illnesses. 🗡 The pi needle has a tip like a sword's edge, used for incising to drain pus. 📏 The yuanli needle resembles long hair, both round and sharp, with the middle of the body slightly larger, used to treat explosive qi attacks. 🦟 The hao needle has a tip like a mosquito or gadfly's mouth, gently inserted and retained briefly to nourish qi, used to treat painful bi-impediment. 📐 The chang needle has a sharp tip and thin body, capable of treating bi-impediment in distant locations. 💧 The da needle has a tip like a staff, the edge slightly round, used to drain water-dampness from the joints. The complete contents of the nine needles are thus established.
Qi resides in the vessels; evil qi often lies in the upper region, turbid qi in the middle region, and clear qi in the lower region. Therefore, needling sunken vessels lets evil qi out; needling the middle vessels lets turbid qi out. If insertion is too deep, evil qi instead sinks deeper and the condition worsens. Thus it is said: the skin, flesh, sinews, and vessels each have their proper locations; illness each has its suitable treatment; the shapes differ, so one should follow what is appropriate. One must not make the replete more replete or the deficient more deficient; damaging what is insufficient and supplementing what is excessive is called aggravating illness; the illness will become more severe. The ancients held that mistakenly needling the vessels of the five organs can cause death; mistakenly needling the three yang vessels can cause debility; draining yin can cause death; draining yang can cause mania. These are the harms of acupuncture.
If after needling, qi has not yet arrived, one may needle again without limiting the number of attempts; when qi arrives, one should withdraw, not repeat the needling. Each needle has what it suits; each differs in form; each is used for what it is suited. The essential point of needling is that qi arrival brings effectiveness—the effect is manifest, like wind scattering clouds, clearly seeing the azure sky; then the way of needling is complete.
The Yellow Emperor asked: I wish to hear where the qi of the five organs and six bowels issues forth. Qibo said: Each of the five organs has five transporting points (shu), giving five times five, twenty-five points. Each of the six bowels has six transporting points, giving six times six, thirty-six points. There are twelve primary meridians, and fifteen collateral vessels, making a total of twenty-seven qi that circulate above and below. Where qi issues forth is the well (jing), where it glides is the spring (ying), where it pours is the stream (shu), where it moves is the river (jing), and where it enters is the sea (he). The movement of the twenty-seven qi all takes place within the five transporting points.
There are 365 meeting points at the crossings of the body's joints. One who knows the essential principle can explain it in a single sentence; one who does not grows more dispersed with each added word. What is called "juncture" (jie) is the place where spirit-qi travels in and out; it is not merely skin, flesh, sinew, or bone. Observing the facial complexion and the eyes reveals the gathering and dispersing of qi and blood; observing the physical form and the movements reveals the relation of evil and upright. The right hand advances the needle, the left hand aids and controls it; when qi arrives, withdraw. Whenever about to needle, one must first examine the pulse, observe the lightness or heaviness of qi, and only then proceed to treat.
When the qi of the five organs is already exhausted within yet one instead fills the exterior, this is called repeated exhaustion (chongjie); repeated exhaustion inevitably leads to death, and the death is quiet. Those who mistreat often reverse the qi's course by taking points at the axilla and chest. When the qi of the five organs is already exhausted externally yet one instead fills the interior, this is called counterflow reversal (nijue); counterflow reversal inevitably leads to death, and the death is restless. Those who mistreat instead take points at the extremities. The harms of needling: striking the location of disease but lingering too long leaks essence-qi; not striking the location of disease yet withdrawing allows evil qi to accumulate. When essence is leaked, illness worsens and the body is weakened; when evil qi accumulates, abscesses and ulcers may arise.
The five organs correspond to the six bowels; the six bowels have twelve source-points (yuan). The twelve source-points issue from the four passes (near the elbows and knees), and the four passes govern the five organs. When the five organs are diseased, one should take the twelve source-points. The twelve source-points are where the five organs receive the qi and flavors of the 365 junctures. When the five organs are diseased, they respond in the twelve source-points—knowing where the source-points are located and observing their responses enables one to understand the pathological changes of the five organs.
Within yang, the Lesser Yin belongs to the Lungs; its source issues from Taiyuan, which has two points, left and right. Within yang, the Greater Yang belongs to the Heart; its source issues from Daling, which has two points, left and right. Within yin, the Lesser Yang belongs to the Liver; its source issues from Taichong, which has two points, left and right. Within yin, the Extreme Yin belongs to the Spleen; its source issues from Taibai, which has two points, left and right. Within yin, the Greater Yin belongs to the Kidneys; its source issues from Taixi, which has two points, left and right. The source of the Gao (vitals) issues from Jiuwei (Turtle Tail), one point. The source of the Huang (membranes) issues from Boyang (Lower Abdomen), one point. These twelve source-points, according to the ancients, govern diseases of the five organs and six bowels. Distention is treated via the three yang meridians; undigested diarrhea (sunshe) is treated via the three yin meridians.
When the five organs are diseased, it is like having a thorn embedded, being stained with dirt, a knot tied, or a blockage stopped up. Though the thorn has been there long, it can still be pulled out; though the stain is old, it can still be washed clean; though the knot has been long, it can still be untied; though the blockage is old, it can still be opened. Some say that prolonged illness cannot be treated—this is wrong. Those who are skilled with the needle treat chronic illness like pulling out a thorn, washing away a stain, untying a knot, or opening a blockage. Though the illness has lasted long, it can still be treated; to say it is untreatable is to say one has not grasped the method.
When needling heat patterns, be quick and shallow, like a hand withdrawing from hot soup. When needling cold patterns, retain the needle as if one has no wish to move. When there is yang-heat disease within the yin aspects, take Xia Ling Sanli (Zusanli, ST-36); with correct needling, stop once the qi descends; if it does not descend, do it again. For disease located in the upper region but biased to the interior, take Yinlingquan (SP-9); for disease located higher yet biased to the exterior, take Yanglingquan (GB-34).
This chapter's core is the establishment of a system of needling theory and method—the "Needle Classic." It progresses in layers from general principles, the forms of the nine needles, principles of supplementation and drainage, the criteria for qi arrival, the acupoint system, and taboos for mistreatment. Three most important scholarly ideas stand out:
"Guarding the spirit" ranks above "guarding the form"; "guarding the qi-movement" ranks above "guarding the joints."
Acupuncture is not merely the puncturing of a fixed point, but the grasp of the dynamic transformations of spirit-qi and qi movement. A superior physician looks not only at local structures but attends to the coming and going of qi, the contraflow and with-flow, the opening and closing of the process. This embodies traditional Chinese medicine's mode of thought—"treating within movement."
Supplement deficiency, drain excess, with "qi arrival" as the measure of effect
The overarching principle of acupuncture is to supplement deficiency, drain repletion, eliminate stagnation, and weaken hyperactive evil. Supplementation and drainage are not mechanical actions but must be coordinated through contraflow/with-flow, slowness/rapidity, and opening/closing to bring about qi arrival. When qi arrives, symptoms diminish like wind scattering clouds, indicating that the needling objective has been fulfilled. This is an important origin of the later "deqi" (needling sensation/qi arrival) theory.
The nine needles each have their appropriate uses; importance is placed on division of labor
The nine needles are not merely different sizes of the same instrument but are tools designed for different pathogenic factors and tissue levels. For example, the chan needle is for shallow needling to drain yang qi, the pi needle for incising to drain pus, the hao needle for prolonged retention to treat painful bi-impediment, and the chang needle for distant bi-impediment. This shows that early acupuncture already possessed the approach of "selecting needles according to pattern differentiation."
From a contemporary viewpoint, several aspects of this chapter merit objective analysis:
Bu Gua Note: This content is based on classical Chinese medical texts and is provided solely for traditional cultural study and reading. It does not constitute any medical diagnosis, medication, or treatment advice. In case of discomfort, please seek medical attention promptly.