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Chapter 22 of 81
黄帝内经·灵枢
This chapter primarily discusses the manifestations of withdrawal disorders (dianji) , manic disorders (kuangbing) , as well as wind reversal (fengni) , reversal disorder (jueni) , qi deficiency (shaoqi) , and shortness of breath (duanqi) , along with ancient acupuncture treatment approaches. The original text contains some omissions, misplaced bamboo slips, and textual errors; the following is a paraphrased translation based on common scholarly understanding.
The opening passage describes the nomenclature of the eye canthi: the outer canthus extending outward near the lateral aspect of the face is called the sharp canthus (ruizi) ; the canthus near the nasal side is called the inner canthus (neizi) . Earlier scholars considered this passage to be misplaced bamboo slips, as it bears little relevance to the theme of "mania and withdrawal disorders."
Early stage of withdrawal disorder: The patient first experiences feelings of melancholy, heaviness in the head with headache, upward gazing of the eyes, and redness of the sclera; once the condition becomes fully manifest, the patient develops restlessness and anxiety. The ancients observed facial coloration and needled the Hand Taiyang, Yangming, and Taiyin channels, continuing until the color of the released blood changed before stopping.
Withdrawal disorder episodes accompanied by mouth angle deviation, crying, coughing, wheezing, and palpitations: examine the Hand Yangming and Taiyang channels. If symptoms are more severe on the left side, needle the right side; if more severe on the right side, needle the left side, continuing until the blood color changes. This reflects the ancient opposite-side needling (miaoci) approach of "treating the right for left-side disease and the left for right-side disease."
If the episode begins with opisthotonos—the body arching backward and becoming rigid—followed by back pain, examine the Foot Taiyang, Yangming, Taiyin, and Hand Taiyang channels, and bleed until the blood color changes.
In treating withdrawal disorders, the ancients advocated keeping constant watch beside the patient to observe which areas should be treated. When an episode occurs, any abnormally engorged blood vessels are treated with bloodletting, and the blood is collected in a gourd vessel; it was believed that by the time of the next episode, the blood in the vessel would "pulsate on its own." If the blood did not pulsate, then moxibustion was applied to the exhausted bone (qionggu) with twenty cones. The exhausted bone refers to the sacrum.
Bone-type withdrawal disorder: The cheeks, teeth, various transport points (shu), and intermuscular spaces all appear full and distended; there is rigidity of the bones, sweating, and mental oppression. If there is copious vomiting of frothy saliva and downward discharge of qi, the ancients considered the prognosis poor.
Tendon-type withdrawal disorder: The body curls up, the sinews are cramped and tense, the pulse is large. Needle the Dazhu point on the major channel of the neck. If there is copious vomiting of frothy saliva and downward discharge of qi, the prognosis is poor.
Vessel-type withdrawal disorder: Sudden collapse with fainting, the blood vessels of the four limbs are distended but flaccid. Where the vessels are full, bleed them all; where the vessels are not full, apply moxibustion to the Taiyang channels on both sides of the neck, and also to the points three cun lateral to the belt vessel (dai mai) at the lumbar region, as well as the source transport points among the intermuscular spaces. If there is copious vomiting of frothy saliva and downward discharge of qi, the prognosis is poor.
Withdrawal disorder manifesting with manic-like episodes: the ancients considered this critical and the prognosis poor.
Early stage of manic disorder: The patient first experiences sadness, forgetfulness, irritability, and easily becoming frightened, often due to worry and hunger. The ancients needled the Hand Taiyin and Yangming channels, continuing until the blood color changed; they then also treated the Foot Taiyin and Yangming channels.
Manic disorder episodes: Little sleep, no hunger, self-perception as noble and virtuous, clever and eloquent, of high status; tendency to curse others, day and night without stopping. Needle the Hand Yangming, Taiyang, and Taiyin channels, as well as the Shaoyin channel beneath the tongue; where vessels are engorged, bleed them; where they are not engorged, do not.
Mania due to great fear: Presents with incoherent speech, easy startling, excessive laughter, enjoyment of singing, and wandering about ceaselessly. Needle the Hand Yangming, Taiyang, and Taiyin channels.
Mania due to qi deficiency (shaoqi) : Presents with visual hallucinations, auditory hallucinations, and a tendency to shout loudly. Needle the Hand Taiyang, Taiyin, Yangming, and Foot Taiyin channels, as well as points on the head and both cheek regions.
Mania due to great joy: Presents with excessive eating, repeatedly claiming to see ghosts and spirits, wanting to laugh but not showing it outwardly. First treat the Foot Taiyin, Taiyang, and Yangming channels, then the Hand Taiyin, Taiyang, and Yangming channels.
Newly arisen manic disorder, without the above typical symptoms: first take the Ququan point at the bilateral arteries; if the vessels are engorged, bleed them. If there is relief shortly thereafter, stop; if no relief, treat with the routine methods, and also apply moxibustion to the sacrum with twenty cones.
Wind reversal (fengni) : Sudden swelling of the four limbs, the body feeling as if drenched by cold water, frequent chills and shivering, restlessness when hungry, and pronounced changes in symptoms after eating. The ancients treated the Hand Taiyin and Hand Yangming exterior–interior channels, along with the Foot Shaoyin and Yangming channels; where the flesh is cold, needle the Ying-spring points; where the bones are cold, needle the Jing-well points and Jing-river points.
Reversal disorder (jueni) : Sudden coldness in the feet, a sensation as if the chest is splitting open, intestines being cut by a knife, restlessness with inability to eat, and a rough pulse regardless of whether it is large or small. If the body is warm, treat the Foot Shaoyin channel; if the body is cold, treat the Foot Yangming channel; for cold patterns use supplementation, for warm patterns use drainage.
Reversal disorder accompanied by abdominal distension and fullness, borborygmus, chest fullness, and difficult breathing: treat the areas beneath the chest where both hypochondria are tugging upon coughing, as well as points on the back that become comfortable immediately upon manual pressure.
Internal blockage (neibi) or urinary retention: Use a long needle on the Foot Shaoyin and Taiyang channels and the area above the sacrum. If qi is rebelling upward, treat the Taiyin, Yangming, and Jueyin channels; in severe cases, treat the Shaoyin and Yangming channels where there is abnormal pulsation.
Qi deficiency (shaoqi) : The body is cold, speech is short with intermittent breath, the bones feel heavy and sore, the body is heavy and sluggish, with a disinclination to move. Supplement the Foot Shaoyin channel.
Shortness of breath (duanqi) : Breathing that is short, insufficient, and unconnected; upon activity the qi becomes even more insufficient. Supplement the Foot Shaoyin channel and remove the stagnant blood in the collateral vessels.
The most central academic insight of this chapter is the distinction between withdrawal disorders (dian) and manic disorders (kuang) as two separate categories of emotional–mental disorder.
Regarding treatment methods, this chapter makes extensive use of bloodletting and moxibustion, with repeated emphasis on "stopping when the blood changes color." This reflects the ancients' recognition that "rebellious chaos of blood and qi" is the core pathomechanism of manic–depressive disorders—by draining congested blood, qi and blood are brought back into harmony. Additionally, the recurrent observation of "copious vomiting of frothy saliva with downward discharge of qi is untreatable" indicates that the ancients had already recognized that when mental disorders are accompanied by qi depletion and failure of fluid consolidation, the condition is grave.
The "withdrawal disorders" and "manic disorders" described in this chapter bear some resemblance to certain depressive, manic, and schizophrenia-like presentations in modern psychiatry, but they cannot be simply equated. The ancient interpretation of mental abnormalities in terms of channels, qi and blood, and emotions holds historical value; bloodletting and moxibustion represent ancient medical techniques whose efficacy and mechanisms require further validation through modern research and cannot replace standardized modern psychiatric diagnosis and treatment.
Statements such as "untreatable" or "fatal" reflect the clinical observations and therapeutic capabilities of their time and should not be directly applied today. Modern medicine has developed more systematic assessment tools and comprehensive intervention approaches for psychiatric conditions.
Several general lifestyle insights may be drawn from this chapter:
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Bgua Note: This content is based on classical Chinese medicine texts and is provided solely for traditional cultural study and research purposes. It does not constitute any medical diagnosis, medication, or treatment advice. If you experience any discomfort, please seek medical attention promptly.