Loading...
Chapter 9 of 81
黄帝内经·灵枢
Overall Paraphrase
I. General Principles of Acupuncture: Understanding Beginning and End, Regulating Yin and Yang
All principles of acupuncture ultimately converge on beginning and end (终始) — that is, the origin and termination of qi and blood in the meridians, along with the waxing and waning of yin and yang. Once the beginning and end are understood, with the five viscera as the guiding framework, yin and yang can be determined. Yin governs the five viscera; yang governs the six bowels. The qi of yang meridians is received from the extremities of the four limbs, while the qi of yin meridians is distributed from the five viscera. Therefore, the reduction method (泻法) should meet the oncoming force of qi, while the supplementation method (补法) should follow the direction of qi's departure. One who understands "meeting and following" (迎随) can harmonize the qi mechanism. The method of harmonizing qi requires understanding yin and yang: the five viscera pertain to yin, and the six bowels pertain to yang. The ancients solemnly transmitted this to later generations, sealing it with blood oath; those who reverently uphold this way prosper, while those who treat it lightly perish; those who act selfishly without following the correct path will surely encounter disaster.
Respectfully following the Way of Heaven to discuss beginning and end: beginning and end take the meridians as their framework. Press the cunkou (寸口, the radial artery pulse at the wrist, governing the qi of yin meridians) and renying (人迎, the carotid artery pulse at the side of the neck, governing the qi of yang meridians) to understand the excess and deficiency, balance and imbalance of yin and yang. In this way, the essential meaning of the Way of Heaven is complete.
The so-called balanced person (平人) refers to a healthy person free from disease. For such a person, the cunkou and renying pulses correspond to the four seasons, the upper and lower pulse qi respond to each other in concert, the six meridians show no stagnation or agitation, the body maintains coordination between root and branches in cold and warmth, and the physical form, flesh, blood, and qi are proportionate — this is the balanced person. One with qi deficiency has both cunkou and renying pulses weak, not matching the normal proportions. Such individuals have insufficiency of both yin and yang. If yang is supplemented, yin fluids become exhausted; if yin is reduced, yang qi escapes externally. The ancients believed such cases should be treated with sweet, gentle medicinals to nourish, not with harsh or drastic agents; moxibustion should not be applied; if the condition does not improve and reducing methods are used instead, the true qi of the five viscera will decline.
II. Comparative Diagnosis of Renying and Cunkou Pulses
When the renying pulse is twice the size of the cunkou, the disease is in the Foot-Shaoyang meridian; twice with restlessness indicates disease in the Hand-Shaoyang meridian. When three times the size, the disease is in the Foot-Taiyang meridian; three times with restlessness indicates disease in the Hand-Taiyang meridian. When three times the size entirely, the disease is in the Foot-Yangming meridian; three times with restlessness indicates disease in the Hand-Yangming meridian. When four times with a large and rapid pulse, this is called overflowing yang (溢阳), representing yang qi being repelled externally — the external obstruction (外格).
When the cunkou pulse is twice the size of the renying, the disease is in the Foot-Jueyin meridian; twice with restlessness indicates disease in the Hand-Jueyin Pericardium meridian. When twice the size fully, the disease is in the Foot-Shaoyin meridian; three times with restlessness indicates disease in the Hand-Shaoyin meridian. When three times the size, the disease is in the Foot-Taiyin meridian; three times with restlessness indicates disease in the Hand-Taiyin meridian. When four times with a large and rapid pulse, this is called overflowing yin (溢阴), representing yin qi being closed within — the internal obstruction (内关). Internal obstruction with no passage indicates critical illness. When both renying and cunkou are four times greater than normal with a large and rapid pulse, this is called obstruction-separation (关格) and carries a very poor prognosis.
When renying is one time greater, the ancients' corresponding needling method was to reduce the Foot-Shaoyang meridian and supplement the Foot-Jueyin meridian — two reductions and one supplementation, once daily, always verifying by pulse examination, stopping once qi is harmonized. When renying is two times greater, reduce the Foot-Taiyang meridian and supplement the Foot-Shaoyin meridian — two reductions and one supplementation, once every two days. When renying is three times greater, reduce the Foot-Yangming meridian and supplement the Foot-Taiyin meridian — two reductions and one supplementation, twice daily, stopping once qi is harmonized. When cunkou is one time greater, reduce the Foot-Jueyin meridian and supplement the Foot-Shaoyang meridian — two supplementations and one reduction, once daily. When cunkou is two times greater, reduce the Foot-Shaoyin meridian and supplement the Foot-Taiyang meridian — two supplementations and one reduction, once every two days. When cunkou is three times greater, reduce the Foot-Taiyin meridian and supplement the Foot-Yangming meridian — two supplementations and one reduction, twice daily; the reason twice daily is permissible is that the Foot-Taiyin Spleen meridian is associated with the Stomach and has relatively abundant grain qi.
III. Principles of Supplementation/Reduction and "Arrival of Grain Qi"
When both renying and cunkou are more than five times greater, this is called overflow of both yin and yang (阴阳俱溢). At this point, if the passage cannot be opened, the blood vessels become obstructed, qi has no path to travel, and it overflows internally, injuring the five viscera. If moxibustion is mistakenly applied at this time, other diseases will arise. The principle of needling takes harmonization of qi as its standard; supplementing yin and reducing yang can strengthen the voice and qi, sharpening hearing and brightening vision. Violating this principle results in blood and qi failing to circulate.
What is meant by qi arriving and achieving effect: After reduction, the proper qi becomes relatively deficient, and the pulse, though larger than before, is not firm; if it remains firm as before, even if temporarily comfortable, the disease has not left. After supplementation, the proper qi becomes relatively replete, and the pulse is larger and firmer than before; if it is反而 not firm, even if there is momentary relief, the disease has not left either. Therefore, supplementation achieves repletion and reduction achieves deficiency. Although pain may not necessarily cease instantly with needle insertion, the pathological trend will surely diminish. One must first understand the diseases of all twelve meridians before transmitting the Way of "beginning and end." When yin and yang do not deviate from their positions, and deficiency and excess do not become mutually confused, one may select the appropriate meridians for treatment.
In all types of needling, three insertions are performed to achieve arrival of grain qi (谷气至, the return of essential qi transformed from water and grain, with gentle and harmonious pulse). Evil qi binding improperly, yin and yang exchanging positions, perversion of normal and abnormal directions, loss of proper in ascending and descending movements, loss of seasonal rhythms, and lingering of evil qi — all these must be eliminated with needles. The first insertion drives out yang evil, the second insertion drives out yin evil, and the third insertion brings grain qi to arrive; when grain qi arrives, stop. What is meant by grain qi arriving: if supplementation was used, the pulse becomes replete; if reduction was used, the pulse becomes deficient — from this, one may know that grain qi has arrived. When evil qi alone has retreated, even if yin and yang are not yet fully harmonized, the disease has already tended toward recovery.
When yin is exuberant and yang deficient, first supplement yang then reduce yin to harmonize; when yin is deficient and yang exuberant, first supplement yin then reduce yang to harmonize. The pulsation of the three meridians between the great toe must be examined carefully for deficiency and excess. If a deficient condition is mistakenly treated with reduction, this is called "doubled deficiency" (重虚), and doubled deficiency will worsen the disease. When needling this area, press the pulse with fingertips; if the pulse is strong and rapid with excess, reduce immediately; if deficient and slow, supplement. Doing the opposite will aggravate the disease. The positions of pulsation: Yangming above, Jueyin in the middle, Shaoyin below. The back and chest shu points correspond to chest and back disease locations; for deficiency of the shoulder and upper arm, select upper points; for heavy tongue, needle the sublingual frenulum (舌柱) with a lancet needle (铍针). If the hand flexes but cannot extend, the disease is in the sinews; if it extends but cannot flex, the disease is in the bones. For disease in the bones, treat the bones; for disease in the sinews, treat the sinews.
In supplementation and reduction, for replete pulses needle deeply and, upon withdrawal, press the needle hole minimally to allow evil qi to escape as much as possible. For deficient pulses needle shallowly and, upon withdrawal, press the needle hole quickly to prevent evil qi from entering and to nourish the meridians. When evil qi arrives, the pulse becomes tight and rapid; when grain qi arrives, the pulse becomes slow and gentle. For replete pulses, needle deeply to drain evil qi; for deficient pulses, needle shallowly, ensuring essential qi does not leak out, nurturing the meridians and only draining evil qi. For various pains, the pulses are often replete. Hence the ancients observed: for diseases above the waist, govern with the Hand-Taiyin and Hand-Yangming meridians; for diseases below the waist, govern with the Foot-Taiyin and Foot-Yangming meridians. For disease above, select points below; for disease below, select points above; for disease in the head, select points on the feet; for disease in the feet, select points in the popliteal fossa. When disease originates in the head, the head becomes heavy; when originating in the hand, the arm becomes heavy; when originating in the foot, the foot becomes heavy — in treatment, first needle the area where the disease originates.
IV. Point Selection Guidelines and Seasonal Needling Methods
Seasonal needling methods: in spring, qi resides in the body hair; in summer, qi resides in the skin; in autumn, qi resides in the intermuscular spaces (分肉); in winter, qi resides in the sinews and bones. When needling for disease, determine depth according to the season. For needling obese persons, follow the measure of autumn and winter — that is, needle deeply. For needling thin persons, follow the measure of spring and summer — that is, needle shallowly. Pain pertains to yin; where pressure at the painful site elicits no relief also pertains to yin and should be needled deeply. Disease in the upper body pertains to yang; in the lower body pertains to yin. Itching pertains to yang and should be needled shallowly. When disease first arises from yin, first treat yin then yang; when disease first arises from yang, first treat yang then yin. For heat reversal (热厥), retaining the needle can transform heat into cold; for cold reversal (寒厥), retaining the needle can transform cold into heat. For heat reversal, use the method of two yin and one yang (二阴一阳); for cold reversal, use the method of two yang and one yin (二阳一阴). What is meant by two yin is needling the yin twice; one yang is needling the yang once. For chronic disease with deeply rooted evil qi, needle deeply with prolonged retention and treat on alternate days; always first regulate left and right, eliminate blood stasis from the vessels — then the needling method is complete.
V. Guarding the Spirit and Obtaining Qi
In all needle use, one must carefully examine the physical form and qi. When the physical form and flesh have not withered, yet qi is deficient and the pulse is restless, with restlessness and reversal, use opposite needling (缪刺, crossing left-right with shallow needling). Thus scattered qi can be gathered and accumulated qi can be dispersed. The practitioner should dwell in deep seclusion, concentrate the spirit with full attention, as if the ethereal and corporeal souls remain undispersed; heed not human voices, gather the essential qi, focus single-mindedly; fix the intention upon the needle. Needle shallowly with retention, lightly floating the needle, to shift the patient's spirit; stop when qi arrives. The man guards within, the woman guards without — firmly resist and do not permit escape; cautiously maintain and forbid entry. In this way, qi is obtained.
VI. The Twelve Prohibitions in Acupuncture
Prohibitions in needling: do not needle shortly after sexual intercourse, and do not engage in intercourse shortly after being needled. Do not needle someone who is intoxicated; one who has been needled should not become intoxicated. Do not needle someone recently angered; one who has been needled should not become angry. Do not needle someone recently fatigued; one who has been needled should not exert themselves. Do not needle someone who has just eaten; one who has been needled should not eat a full meal. Do not needle someone who is hungry; one who has been needled should not remain hungry. Do not needle someone who is thirsty; one who has been needled should not remain thirsty. After great fright or great anger, one must first settle their qi, and only then may needling be performed. For those who have arrived by carriage, have them lie down and rest for approximately the duration of one meal before needling. For those who have traveled a long distance on foot, have them sit and rest for approximately the time needed to walk ten li before needling. These twelve prohibitions exist because at such times the pulse is disordered and qi is scattered; nutritive and defensive qi (营卫, the two operational layers of qi and blood in the body) are disturbed in their respective levels; and meridian qi (经气) is thrown out of sequence. If needling is forced at such times, then yang disease may enter yin, yin disease may emerge into yang, and evil qi will regenerate. The coarse practitioner who knows not these things commits "injury to the body" (伐身). When the physical form suffers destruction and damage, the brain and marrow are consumed, fluids and humor fail to transform properly, and the essence of the five flavors is lost — this is called "loss of qi" (失气).
VII. Manifestations of Qi Exhaustion in the Six Meridians
When the qi of the Taiyang meridian is exhausted: the eyes look upward, the body arches backward like a bow with convulsions, the complexion becomes white, and when terminal sweat emerges, life comes to an end. When the qi of the Shaoyang meridian is exhausted: deafness occurs, the joints throughout the body become lax, the ocular connection is severed; one and a half days after the ocular connection is severed, death ensues, with a complexion turning greenish-white. When the qi of the Yangming meridian is exhausted: the mouth and eyes twitch, the person easily startles and speaks deliriously, the complexion becomes yellow, and when the qi of the upper and lower meridians is congested and cannot flow, life comes to an end. When the qi of the Shaoyin meridian is exhausted: the face becomes black, the teeth appear elongated with coating, abdominal distention with obstruction develops, and when upper and lower passages are impassable, life comes to an end. When the qi of the Jueyin meridian is exhausted: heat in the chest, dryness of the throat, frequent urination with restlessness; in severe cases, the tongue curls and the testicles retract upward, and life comes to an end. When the qi of the Taiyin meridian is exhausted: abdominal distention with obstruction and difficulty breathing, belching, and a tendency to vomit; when vomiting occurs, qi reverses upward and the face becomes red; if there is no reversal, upper and lower passages fail to communicate, the face becomes black, and the skin and hair become withered and dry — then life comes to an end.
The above descriptions of needle supplementation and reduction, point selection, prohibitions, and "qi exhaustion" all pertain to ancient theoretical understanding and are provided for scholarly study only. They must not be performed or applied on one's own.
This content is based on classical texts of traditional Chinese medicine and is provided solely for study and appreciation of traditional culture. It does not constitute any form of medical diagnosis, medication prescription, or treatment recommendation. If you are experiencing health-related issues, please seek timely medical attention.