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Chapter 24 of 81
黄帝内经·灵枢
Overall Paraphrase
This chapter primarily discusses Jue diseases (Reversed diseases) — headaches and heart pain caused by rebellion and counterflow of channel qi surging upward, disturbing the orifices, as well as related conditions of the ears and lower limbs. The following is translated after collating a few evident textual errors in the current standard edition of Ling Shu · Jue Bing.
Jue headache (headache caused by rebellious channel qi surging upward): If it manifests with facial edema and restlessness with anxiety, the ancients selected points of the Foot Yangming Stomach Channel and the Foot Taiyin Spleen Channel. For Jue headache accompanied by throbbing pain of the head vessels, sorrowful emotions, and easy weeping, where the cephalic arteries are visibly distended, first perform collateral pricking to draw blood, then regulate the Foot Jueyin Liver Channel. For Jue headache appearing as heavy and severe pain in the head, use reducing needling on the five pathways of the vertex, taking five points from each pathway. First select Hand Shaoyin Heart Channel points, then Foot Shaoyin Kidney Channel points. For Jue headache with forgetfulness where palpation reveals no distinct tender point, select the left and right arteries on the head and face, then the Foot Taiyin Spleen Channel. For Jue headache that begins with neck pain, followed by corresponding pain along the lower back and spine, first select Tianzhu (BL10), then the Foot Taiyang Bladder Channel. For severe Jue headache, with throbbing and heat sensation in the vessels anterior and posterior to the ears, collateral pricking to draw blood may be performed, then select the Foot Shaoyang Gallbladder Channel.
True headache: The headache is severe, the entire brain is painful, and the hands and feet are cold up to the elbows and knees. The ancients considered this an incurable condition. Some headaches cannot be treated by routine distal point selection: those caused by traumatic impact, with static blood retained internally, or with muscle injury where pain has not yet ceased, may be treated by local needling, but distal points should not be selected. Some headaches are not amenable to needling: when severe Bi disorder afflicts the patient with daily attacks, the condition may be slightly alleviated, but one should not perform distal point selection on Bi pattern. However it is difficult to achieve a radical cure. For cold pain on one side of the head, first select the Hand Shaoyang Sanjiao Channel and the Hand Yangming Large Intestine Channel, then the Foot Shaoyang Gallbladder Channel and the Foot Yangming Stomach Channel.
Jue heart pain (heart pain caused by rebellious channel qi surging upward toward the chest and heart): Pain affecting the heart and back in mutual involvement, with a tendency toward spasm and pulling, as if the heart is being jolted from behind, causing the body to curl and the back to hunch, is Kidney Heart Pain. First select Jinggu (BL64) and Kunlun (BL60); if pain does not stop after needling, then select Rangu (KI2). Jue heart pain manifesting as abdominal distension and chest fullness, with aggravated pain at the epigastric region, is Stomach Heart Pain. Select Dadu (SP2) and Taibai (SP3). Jue heart pain resembling a dagger piercing the heart, with intense pain, is Spleen Heart Pain. Select Rangu (KI2) and Taixi (KI3). Jue heart pain with a grayish-blue complexion like dead ashes, unable to take a deep breath throughout the day, is Liver Heart Pain. Select Xingjian (LR2) and Taichong (LR3). Jue heart pain that is alleviated when lying down or resting, aggravated by movement, without changes in complexion, is Lung Heart Pain. Select Yuji (LU10) and Taiyuan (LU9).
True heart pain: The hands and feet become cyanotic and cold reaching the elbows and knees; the heart pain is intense. When it occurs in the morning, death comes by evening; when it occurs in the evening, death comes the next morning. Heart pain situations in which needling is contraindicated: when there are hard accumulations in the body, point needling should not be applied. If there are intestinal worm accumulations or roundworms, treatment with small needles is not appropriate in any of these cases. For heart and abdominal pain with mental agitation and pain attacks, with masses that gather and move up and down, pain that is intermittent, abdominal heat, thirst with drooling — these are caused by roundworms. The ancients described pressing with the hand and holding firmly so that the mass does not move, then using a large needle to pierce deeply with prolonged retention until the worms no longer move, only then withdrawing the needle. There is another fragment — "意腹铁痛，形中上者" — which, due to textual corruption and obscurity, will not be force-translated here.
Ear disorders: For deafness with no ability to hear, select points within the ear; for tinnitus, select the artery anterior to the ear. Situations where ear pain cannot be treated with needling: when there is pus in the ear, or dried cerumen (ear wax) blocking the ear, causing deafness. For deafness, select the Jing-well points at the junction of nail and flesh on the small toes/small fingers of both the hands and feet. First select the hand, then the foot. For tinnitus, select the points on the fingernails/toenails of the middle fingers/toes. For disease on the left, take the right, for disease on the right, take the left. First select the hand, then the foot. When the thigh cannot be lifted, position the patient on the side, at the joint-space articulation of the hip joint, and use a Yuanli needle; one should not use a large needle. For passage of blood with stool, select Ququan (LR8).
Wind Bi with dampness infiltration, in conditions difficult to cure: the feet feel as if stepping on ice, and at other times as if entering hot water; the thighs and calves feel weak and soft as if soaked in water; there is vexation in the heart, headache, occasional vomiting, or occasional oppression; dizziness followed by sweating; as time passes, blurred vision, sadness and much fear; shortness of breath with displeasure. The ancients held that such patients would not survive three years.
Distinguishing patterns along channels; selecting points along affected channels
The discussion of Jue headache and Jue heart pain in this chapter centers on determining, based on the location of pain, accompanying symptoms, and superficial bodily responses, which channel and organ the pathology belongs to, and then selecting corresponding points on those channels. For example, Jue headache with facial edema and restlessness implicates the Foot Yangming and Foot Taiyin; heart pain drawing to the back with body hunched implicates the Kidney channel. This embodies the Ling Shu's channel-based approach to pattern differentiation.
Discerning "Jue" versus "True"; emphasizing superficial versus deep disease location
"Jue headache" and "Jue heart pain" belong to channel qi rebellion — although painful, they can still be treated through channel regulation; whereas "True headache" and "True heart pain" are critical conditions in which pathogenic factors directly attack the brain marrow and heart — the ancients explicitly stated these are "incurable and result in death." This demonstrates that those ancients already recognized: even in conditions presenting as headache or heart pain, when the site is channels versus organs, and whether the problem is functional or organic, the prognosis is entirely different.
The "fullness dictates draining" approach of collateral pricking for bloodletting
With manifestations such as distended cephalic arteries or gushing pulsation with heat anterior and posterior to the ears, the ancients employed collateral pricking for bloodletting to drain excess heat and static blood. This represents a draining approach targeting states of "qi-blood engorgement and stagnation," reflecting the principles of "excess is drained" and "what is accumulated and stagnant is removed."
Emphasizing contraindications and local management
In conditions such as static blood accumulation, internal masses, parasite accumulation, ear suppuration, and cerumen obstruction, blind distal point selection or using small needles is not appropriate. Particularly with intestinal parasite accumulation or ear pus/cerumen obstruction, the ancients recognized these as substantial pathogens requiring local identification and cautious handling. This reflects the ancients' awareness of distinguishing between "substantial pathogens" and "formless qi counterflow."
Contralateral needling and sequence of upper-limb-then-lower-limb
For tinnitus, the principle of "left-side conditions take the right, right-side take the left" applies — this is the contralateral (Miao-ci) method. For both deafness and tinnitus, the operational sequence "first hand, then foot" is also emphasized, reflecting the ancients' systematic understanding of cross-lateral and distal correspondence.
The classification of headaches and heart pains in this chapter reflects the accumulated empirical observations of ancient clinical practice. The channel attributions based on differing attendant symptoms have points of discourse with modern distinctions among migraines, tension-type headaches, vascular headaches, cervicogenic headaches, as well as angina pectoris, and gastroesophageal reflux-related chest pain. However, it must be noted: the ancient "Jue heart pain" and "True heart pain" cannot be simply equated with modern medical disease names, and especially cannot substitute for modern diagnoses with categories like "Kidney heart pain" or "Stomach heart pain."
The descriptions of "True headache" and "True heart pain" — intense headache, generalized pain, cold extremities reaching elbows and knees, or severe chest pain with cold extremities and death within a short time — show similarity to acute intracranial pathologies, myocardial infarction, and other critical presentations. When ancient practitioners pronounced "incurable death," it was based on the limited resuscitation capacities of their era. Today, this should not be interpreted as abandoning treatment, but rather as early warning signals indicating criticality.
The techniques of collateral pricking for bloodletting and contralateral needling, among other acupuncture methods, are suggested by modern research to be possibly associated with local microcirculation, neural reflexes, and pain regulatory mechanisms, but their specific mechanisms and efficacy still require further evidence. Especially the ancient operation described in the original text — "use a large needle, retain it long, and withdraw only when the worms are no longer moving" — is a primitive ancient approach to abdominal pain from worm accumulation that cannot be replicated in modern practice.
Regarding deafness and tinnitus due to ear suppuration and cerumen impaction, the ancients already recognized that reckless needling should be avoided — an accurate yet simple observation. Modern medicine can definitively address such issues through otologic examination, cleaning, and anti-infective measures.
Linked Concepts:
Further Reading:
(该选段未见已出版通行拼音正序汉英关联翻译工具需合并处理对象；为保险起见用户可能需要普通在线条顺而注-出尾注映射，所以在书简与题列不互乱的条件下方宜加文末铭标、以防浏览粘板跨装误配。此处理独立避免潜在配对舛讹风险。)
To maintain professional integrity, issue note existing formatted text, final en-brief mapping adds baseline appended in translation segment: See „Ling Shu – Nine Needles & Twelve Sources (chapter 1“. end.