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Chapter 20 of 81
黄帝内经·灵枢
Overall Paraphrase
This chapter of Lingshu·Five Pathogens primarily discusses the symptoms that appear when pathogenic qi invades the five viscera, as well as the corresponding acupuncture treatment approaches of the ancients.
🌬️ Pathogen in the Lung: Symptoms include skin pain, aversion to cold with fever, qi counterflow with wheezing, sweating, and coughing that pulls on the shoulders and back. The ancients' point selection approach was: on the Shu points lateral to the chest and near the corresponding Shu points beside the third thoracic vertebra, press quickly with the hand to find the location where the patient feels soreness, distension, and comfort, then needle there; also select Quepen point (supraclavicular fossa) to disperse pathogenic qi from the lung.
🌿 Pathogen in the Liver: Symptoms include pain in both hypochondriac regions, cold in the middle burner, static blood stagnating in the body, joint spasms when walking, and occasional foot swelling. The ancients' treatment approach was: select Xingjian point (between the first and second toes on the dorsum of the foot) to course and guide qi below the flanks; needle Zusanli (anterolateral lower leg) with supplementation to warm and nourish the stomach; puncture superficial collateral vessels to dissipate static blood; select the blue-green collaterals around the ear to relieve spasms.
🍚 Pathogen in the Spleen and Stomach: Symptoms include muscle pain. If yang qi (warming, driving functions) is exuberant and yin qi (moistening, tranquilizing material basis) is deficient, then the stomach is relatively hot and the person easily feels hungry; if yang qi is insufficient and yin qi is exuberant, then the middle burner is relatively cold, manifesting as intestinal rumbling and abdominal pain; if both yin and yang are in excess or both are insufficient, mixed cold and heat patterns appear. In all these cases, the ancients regulated through Zusanli.
🌊 Pathogen in the Kidney: Symptoms include bone pain and yin bi (yin abscess/bi syndrome). With yin bi, pressing does not reveal a clear location of pain; it manifests as abdominal distension, low back pain, difficult defecation, pain in the shoulders, back, and neck, and frequent dizziness. The ancients selected Yongquan point (sole of the foot) and Kunlun point (posterior to the lateral malleolus); if stagnant collateral vessels were visible, they bled them.
🔥 Pathogen in the Heart: Symptoms include pain in the chest and heart region, a tendency toward sadness, and frequent dizziness with sudden collapse. The ancients, according to the deficiency or excess state, regulated the corresponding Shu point of the heart channel.
Note: In the original text, the character "偷" in "膺中外偷" should, through textual transmission, be "俞/腧" (Shu point); individual textual emendations are editorial information from ancient versions and do not affect understanding of the overall medical principles.
This chapter centrally embodies a syndrome classification approach organized around the five viscera. Traditional Chinese medicine holds that the five viscera correspond to the physical body, sensory orifices, and emotions: the lung governs the skin and body hair and governs qi, so when the lung is invaded by pathogens, skin pain, coughing, and wheezing appear; the liver governs the sinews and stores blood, so when the liver is invaded, hypochondriac pain and limb spasms appear; the spleen governs the muscles and governs transportation and transformation, so when the spleen and stomach are invaded, muscle pain and cold-heat disharmony appear; the kidney governs the bones and governs urination and defecation, so when the kidney is invaded, bone pain and difficult defecation appear; the heart governs the blood vessels and governs the spirit, so when the heart is invaded, heart pain, sadness, and dizziness appear.
Another core principle is "press quickly with the hand; when the patient feels comfort, then needle". This reflects that early acupuncture did not rely solely on fixed points. Instead, practitioners pressed relevant areas to locate "sensitive points" where the patient experienced comfort or soreness/distension, and needled there. This approach later developed into Ashi points and the method of "palpating points."
Additionally, this chapter emphasizes regulating the Shu points and observing excess and deficiency, indicating that one must first differentiate deficiency and excess before needling, embodying the basic treatment principle of "supplement for deficiency, drain for excess."
From a modern medical perspective, the observations of symptoms in this chapter have a certain degree of rationality. For example, pulmonary diseases can indeed cause coughing, wheezing, and referred discomfort in the shoulders and back; liver diseases or emotional disharmony can manifest as discomfort in the hypochondriac region; visceral diseases can sometimes produce referred pain or tenderness in specific body surface areas. This shows that the ancients recognized the viscera–body surface association phenomenon very early on.
However, this must be viewed objectively: the "five viscera" here are not entirely equivalent to the anatomical organs of modern medicine; rather, they represent functional systems. Modern research on acupuncture, bloodletting, and other methods suggests that they may act through neural, endocrine, and local blood flow pathways, but the quality of evidence and reproducibility remains limited. In particular, symptoms such as "heart pain" and "difficult defecation with severe abdominal pain" may, in a modern context, represent acute and critical conditions requiring prompt medical diagnosis—ancient acupuncture methods cannot replace professional medical care.
What this chapter offers are general life guidance principles, not treatment protocols:
These are general principles of daily living and emotional regulation and are not directed at any specific disease.
Bu-gua Note: This content is based on classical Chinese medicine texts and is provided solely for traditional cultural study and research. It does not constitute any medical diagnosis, medication, or treatment advice. If you are unwell, please seek medical attention promptly.