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Chapter 23 of 81
黄帝内经·灵枢
Editorial Note: The original text of this section contains several character errors and omissions from repeated copying (e.g., "分睡" should be "分腠", "痒" should be "痱", "波血" should be "溲血", etc.). The following vernacular interpretation follows the commonly circulated version of Ling Shu · Heat Disorders.
Hemiplegia (Pianku) and Fei (Flaccidity): Pianku (hemiplegia) manifests as one side of the body being crippled, unable to move voluntarily with pain, but speech remains normal and consciousness is clear. The disease is located between the fencou (intermuscular spaces). The ancients believed it could be treated with the large needle, supplementing what is deficient and draining what is excessive, with some possibility of recovery. Fei (a disorder with flaccidity of the four limbs, or in severe cases, inability to speak) presents without body pain, with flaccid and contracted limbs. If mental confusion is mild and speech remains distinguishable, it can still be treated; in severe cases with inability to speak, the prognosis is poor. If the disease starts in the yang aspect and later penetrates the yin aspect, the yang aspect should be treated first, then the yin, using shallow needling technique.
General Principles and Prognosis of Heat Disorders: In heat disorders of three days' duration, if the Qikou (cunkou pulse) is calm while the Renyin (carotid pulsation) is agitated, one may needle the various yang channels, using the "fifty-nine punctures" method, draining the heat, promoting sweating, while simultaneously supplementing deficiencies of the yin aspect. If the body heat is severe but both yin and yang pulses are calm, needling should not be performed; if needling is still permissible, treatment should be applied promptly to induce sweating or discharge the heat. The so-called "should not be needled" cases are mostly those where signs of death have already appeared. In heat disorders of seven to eight days, if the pulse at the Qikou is moving, rapid, and short (some versions say wiry), urgent needling is indicated, and sweating will occur spontaneously; shallow needling between the thumb can be applied. In heat disorders of seven to eight days with a minute pulse, accompanied by hematuria and dry mouth, the prognosis is very poor; pulse with intermittent (dai) quality is even more critical. In heat disorders where sweating has already occurred but the pulse remains agitated, with panting and recurrence of fever, shallow needling of the skin surface is not appropriate; severe panting carries a risk of death. In heat disorders of seven to eight days where the pulse is not agitated, or is agitated but not scattered and rapid, sweating may occur in three days; if no sweating in three days, death occurs on the fourth day. When there is no sweating, one must not indiscriminately needle the interstices.
Differentiated Needling Methods: When heat disorder presents initially with skin pain, nasal congestion, and facial swelling, needle the skin layer using the first needle (chanshen/chany needle), coordinating with the fifty-nine punctures; if there are dry papules in the nose, the skin should be treated through the lung, and one should not mistakenly treat from the perspective of heart fire. When heat disorder presents initially with body sluggishness, leaning for support with fever, vexation, and dry lips, mouth, and throat, also take the skin layer with the first needle, fifty-nine punctures; with skin distension, dry mouth, and cold sweating, the vessels should be treated through the heart, and one should not mistakenly treat from the perspective of kidney water. When heat disorder presents with dry throat, excessive drinking, easy fright, and inability to rise from bed, take the muscle layer using the sixth needle (yuanli needle), fifty-nine punctures; if the canthi appear blue, the flesh should be treated through the spleen, and one should not mistakenly treat from the perspective of liver wood. When heat disorder presents with blue complexion, headache, and agitated movement of hands and feet, needle among the sinews using the fourth needle (feng needle); with cold extremities, sinew contracture, and tearing eyes, the sinews should be treated through the liver, and one should not mistakenly treat from the perspective of lung metal. When heat disorder presents with repeated fright, convulsions, and manic agitation, needle the vessels using the fourth needle, urgently draining the excessive pathogen; with baldness from epilepsy, the blood should be treated through the heart, and one should not mistakenly treat from the perspective of kidney water. When heat disorder presents with heavy body, bone pain, deafness, and somnolence, needle the bone layer using the fourth needle, fifty-nine punctures; with bone disease including anorexia, bruxism, and blue ears, the bones should be treated through the kidney, and one should not mistakenly treat from the perspective of spleen earth.
Critical Conditions and Jue-heat (Syncope with Heat): When heat disorder presents with inability to locate pain, deafness, limbs that cannot move spontaneously, and dry mouth—when yang heat is intense yet the yin aspect shows cold signs—this indicates heat deeply entering the marrow and is difficult to treat. When heat disorder presents with headache at the temples, twitching pain of the eyes, and frequent epistaxis, this is jue-heat disorder (heat syncope); use the third needle (di needle), differentiating excess and deficiency; the final phrase "寒热痔" (chills, fever, hemorrhoids) is suspected to contain omissions or textual errors.
Other Heat Disorder Needling Methods: When heat disorder presents with a heavy body and heat in the intestines, take the fourth needle at the lower leg and various points between the toes, seeking the qi at the stomach collaterals. When heat disorder presents with spasmodic pain beside the umbilicus and fullness in the chest and hypochondrium, needle Yongquan (KI1) and Yinlingquan (SP9) with the fourth needle, and also needle near the throat. When heat disorder is about to produce sweat and the pulse is favorable for diaphoresis, take Yuji (LU10), Taiyuan (LU9), Dadu (SP2), and Taibai (SP3); reducing method can reduce fever, supplementing method can promote sweating; if sweating is excessive, take the transverse vessel above the inner ankle to stop it. In heat disorders where sweat has already been produced but the pulse remains agitated and excessive, this is exhaustion of the yin pulse, with poor prognosis; when the pulse becomes calm after sweating, the prognosis is better. In heat disorders with a copious and agitated pulse without sweating, this is exhaustion of the yang pulse, with poor prognosis; when a copious agitated pulse becomes calm after sweating, the prognosis is better.
Nine Kinds of Forbidden Needling: For heat disorders, there are nine circumstances in which needling is forbidden: 1) no sweat with red zygomatic regions and hiccups; 2) diarrhea with severe abdominal distension; 3) blurred vision with unresolved fever; 4) fever in the elderly or infants with abdominal distension; 5) no sweat with vomiting of blood or passage of blood; 6) ulceration at the root of the tongue with unresolved fever; 7) cough and epistaxis, with no sweat or sweat that does not reach the feet; 8) heat in the marrow; 9) heat disorder developing opisthotonos, with arching of the back, convulsions, trismus, and teeth clenching. When any of these nine are seen, needling must not be performed.
The Fifty-nine Punctures: Three places on the lateral and medial aspects of each hand respectively, totaling twelve points; one place between each pair of fingers, totaling eight points, and the same on the feet; on the head, at one cun from the hairline, lateral passes of three fen each in three places, totaling six points; further at three cun within the hairline, lateral five places, totaling ten points; before and behind the ears, one place below the mouth, one place in the middle of the neck, totaling six points; one at the vertex (Baihui), one at Xinhui, one at the anterior hairline, one at Lianquan (CV23), two at Fengchi (GB20), two at Tianzhu (BL10).
Supplementary Needling for Miscellaneous Disorders: For chest fullness and wheezing, take the tip of the big toe on the Taiyin channel, at a distance of one leek-leaf from the nail; for cold conditions, retain the needle; for heat conditions, needle rapidly, withdrawing once qi subsides. For cardiac herniation with sudden pain, take the Foot-Taiyin and Foot-Jueyin channels, and puncture to drain blood from the collaterals. For throat obstruction with curled tongue, dry mouth, vexation, heart pain, and pain along the medial arm extending to the head, take the point below the nail of the second toe at about one leek-leaf distance. For red, painful eyes starting from the inner canthus, take the Yin Qiao vessel. For wind tetany with opisthotonos, first take the Foot-Taiyang channel, popliteal fossa, and let blood from the blood collaterals; if chills accompany, take Zusanli (ST36). For urinary retention, take the Yin Qiao vessel, at three hairs above the big toe, and let blood from the blood collaterals. For men afflicted like withering (gu) and women afflicted with dou (bounding fright), with the body and lower back feeling as if dissolving, and unwillingness to eat or drink, first let blood at Yongquan (KI1), then examine the dorsum of the foot for distended collateral vessels and drain them completely.
The above content concerning needle point selection and supplementation/reduction methods presents the academic theory of the Ling Shu era for study purposes only—do not perform on yourself.
"Pulse—Sweat—Spirit" as the Core of Heat Disorder Prognosis
Ling Shu · Heat Disorders repeatedly employs "sweating" and "pulse stillness/agitation" to judge the advance and retreat of pathogen and vital qi: post-sweating pulse stillness indicates favorable progression, meaning pathogen retreat and healthy qi restoration; persistent agitation of the pulse after sweating, or a full agitated pulse without sweating, indicates heat pathogen unresolved with exhaustion of yin fluid or yang qi, carrying a poor prognosis. This reflects the ancient emphasis on changes in body fluids, yin and yang, and spirit qi in the course of heat disorders.
Heat Disorders Classified by Five Constituents, Correlated with Five Viscera and Five Phases
This chapter categorizes heat disorders across five tissue levels—"skin—vessels—flesh—sinews—bones"—correlating them respectively with lung, heart, spleen, liver, and kidney, using different instruments and methods. The phrase "不得索之X" indicates what should not be treated: it follows the five-phase counter-restriction cycle. For example, skin disease belongs to lung metal shape, and one should not mistakenly treat it via fire (heart), lest fire restrict metal. This demonstrates the integrated system of visceral manifestation—five constituents—five phases in Neijing diagnosis and treatment.
The "Nine Forbidden Kinds" Are Ancient Contraindications for Critical Heat Disorders
The nine circumstances prohibiting needling include high fever with convulsions, opisthotonos, hematuria, hematemesis, tongue ulceration, abdominal distension, etc.—mostly severe conditions characterized by deep heat, exhaustion of yin fluids, or heat entering the blood aspect, pericardium, or marrow. The ancients recognized that reckless needling in these cases could exacerbate the condition or delay treatment.
Pianku and Fei Differ in Disease Depth
Pianku has the disease located in the fencou, with clear consciousness and higher chance of recovery; Fei manifests as flaccid, non-contracting four extremities with mental changes, and in severe cases, inability to speak, carrying a poorer prognosis. This reflects the Neijing approach of prognostication based on disease depth and mental status.
A Basic Correspondence Between Ancient Heat Disorders and Infectious Diseases
The manifestations discussed in this chapter—high fever, sweating, clouded spirit, convulsions, epistaxis, hematuria, abdominal distension—bear similarity to modern infectious diseases, severe infections, febrile seizures, shock, and sepsis. The ancients' observations about "signs of death" constitute empirical clinical experience with some sensitivity, but cannot be equated with modern prognostic criteria.
"Sweating with Pulse Stillness" Has Significance of Circulatory Stability
From a modern perspective, when a febrile patient sweats, body temperature drops and the pulse tend stabilizes, which often indicates improvement; persistent high fever without sweating and a rapid, agitated pulse may suggest dehydration, circulatory instability, or uncontrolled infection. The ancients' judgment of "favorable/unfavorable" can be understood through modern pathophysiology.
Acupuncture and Bloodletting Are Ancient Therapies, Which Must Be Viewed Rationally
This chapter extensively involves needle treatment for fever and collateral bloodletting, representing therapeutic thinking of the Ling Shu period. Modern research has partially explored acupuncture and bloodletting for fever reduction, but they cannot substitute normative diagnosis and treatment. Any acupuncture should be performed only by professionals at irregular healthcare institutions, with self-attempts strictly prohibited.
"Days Until Death" Reflect the Limitations of the Era
Phrases such as "death within one and a half days" or "death on the fourth day" in the original text represent ancient clinical experience under the medical conditions of that time, and cannot serve as the basis for modern prognostication. For high fever, altered mentation, convulsions, or hemorrhage, seek medical care promptly.
Rest Primarily During Heat Disorders
The ancients emphasized protecting body fluids and maintaining spirit vitality during heat disorders. In modern life, during fever one should rest, avoid overexertion, hydrate appropriately, and monitor mental state and sweating—however, the patient should always follow physician instructions.
Regular Daily Rhythm Safeguards Righteous Qi
This chapter repeatedly emphasizes the importance of yin-yang, body fluids, and spirit qi. It suggests that through everyday life, one should follow the four seasons, eat moderately, cultivate mental calm, and avoid excessive depletion of vital qi.
Greater Caution for Fever in the Elderly and Children
The original text lists fever with abdominal distension in elderly persons and infants among forbidden needling cases, highlighting the qi-bearing tissues of these special populations have weaker tolerance. In modern family settings, fever in elderly persons or children demands promptly arising medical care, not unverified remedies or self-administered bloodletting.
The above wellness content provides general health principles, and it is not intended for any specific disease.
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