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Chapter 26 of 81
黄帝内经·灵枢
Bu Gua's Note: The original text of this chapter contains several textual errors that have been passed down through history, such as "足少朋" (zú shào péng) and "足少阻" (zú shào zǔ) which should be "足少阴" (zú shào yīn, Kidney Meridian of Foot-Shaoyin), "颇痛" (pō tòng) which should be "颊痛" (jiá tòng, cheek pain), "吵" (chǎo) which should be "哕" (yuě, hiccup), and "疲厥为四米束挽" (pí jué wèi sì mǐ shù wǎn) which should be "痿厥为四末束悗" (wěi jué wèi sì mò shù mán). The following is a paraphrased translation based on the standard edition. The content involves ancient acupuncture methods and bloodletting, which is provided only for literary study and discussion of principles, and does not constitute modern medical treatment advice.
Jue disease (a category of disorders involving counterflow of qi): Pain along both sides of the spine, extending upward to the top of the head; the head feels heavy and clouded; vision is blurred; the lower back and spine feel stiff. The ancients held that one should take the Bladder Meridian of Foot-Taiyang (which traverses the back, head and neck, and posterior aspect of the lower limbs) and perform bloodletting on the blood collaterals (small superficial visible vessels) in the popliteal fossa (the depression behind the knee).
Jue disease with fullness in the chest, facial edema, swollen lips, sudden difficulty speaking, or even inability to speak: take the Stomach Meridian of Foot-Yangming (which traverses the face, chest and abdomen, and anterior aspect of the lower limbs).
Counterflow qi rushing upward to the throat, causing inability to speak, cold hands and feet, and difficult bowel movements: take the Kidney Meridian of Foot-Shaoyin (which traverses the posterior border of the medial aspect of the lower limbs and connects upward to the throat).
Jue disease with audible gurgling sounds in the abdomen, a subjective sensation of severe cold, water sounds in the abdomen, and difficulty with urination and defecation: take the Spleen Meridian of Foot-Taiyin (which traverses the abdomen and the anterior border of the medial aspect of the lower limbs).
Dry throat, with a hot, sticky sensation in the mouth as if coated with glue: take the Kidney Meridian of Foot-Shaoyin.
Pain in the knee: take Dubi point (ST 35, lateral knee eye, in the depression lateral to the patellar ligament), using the yuan-li needle (one of the nine classical needles, with a rounded yet sharp body). Needle insertion should be repeated at intervals; the needle is as fine as a long hair and may be inserted into the knee region.
Hou-bi (throat impediment — swelling and blockage of the throat) with inability to speak: take the Stomach Meridian of Foot-Yangming; if the patient can still speak, take the Large Intestine Meridian of Hand-Yangming (which traverses the lateral anterior aspect of the upper limb and ascends to the face and mouth).
With malaria, if the patient is not thirsty and the attack occurs every other day: take the Stomach Meridian of Foot-Yangming. If the patient is thirsty and the attack occurs daily: take the Large Intestine Meridian of Hand-Yangming.
Toothache without aversion to cold drinks: take the Stomach Meridian of Foot-Yangming. With aversion to cold drinks: take the Large Intestine Meridian of Hand-Yangming.
Deafness without pain: take the Gallbladder Meridian of Foot-Shaoyang (which traverses the lateral side of the head, the flanks and ribs, and the lateral aspect of the lower limbs). Deafness with pain: take the Large Intestine Meridian of Hand-Yangming.
Unrelenting nosebleed with the blood being dark and stale: take the Bladder Meridian of Foot-Taiyang. If it is deemed stale blood, take the Small Intestine Meridian of Hand-Taiyang (which traverses the posterior border of the lateral aspect of the upper limb and the scapular region). If bleeding persists, needling below the wrist bone (near Wangu point) may be performed; if it still does not stop, perform bloodletting in the popliteal fossa.
Low back pain where the painful area feels cold: take the Bladder Meridian of Foot-Taiyang and Stomach Meridian of Foot-Yangming. Where the painful area feels hot: take the Liver Meridian of Foot-Jueyin (which traverses the medial aspect of the lower limbs and the lower abdomen). If the patient cannot bend forward or arch backward: take the Gallbladder Meridian of Foot-Shaoyang. If there is internal heat with wheezing: take the Kidney Meridian of Foot-Shaoyin and the blood collaterals in the popliteal fossa.
When the patient is prone to anger, has no desire to eat, and the voice becomes progressively weaker: needle the Spleen Meridian of Foot-Taiyin. When the patient is angry and talkative: needle the Gallbladder Meridian of Foot-Shaoyang.
Check pain (pain in the cheek): needle the Large Intestine Meridian of Hand-Yangming and perform bloodletting on the engorged blood vessels in the cheek.
Neck pain such that the patient cannot bend the head forward or arch it backward: needle the Bladder Meridian of Foot-Taiyang. If the patient cannot turn the head to look behind: needle the Small Intestine Meridian of Hand-Taiyang.
Lower abdominal distension and fullness, with qi rushing upward to the stomach and to the heart, occasional mild chills and fever, and difficult urination: take the Liver Meridian of Foot-Jueyin.
Abdominal distension with difficult bowel movements, enlarged abdomen, qi rushing upward to the chest and throat, and wheezing with audible sounds: take the Kidney Meridian of Foot-Shaoyin.
Abdominal distension with undigested food, gurgling sounds in the abdomen, and inability to defecate: take the Spleen Meridian of Foot-Taiyin.
Heart pain involving the lower back and spine, with a desire to vomit: take the Kidney Meridian of Foot-Shaoyin. Heart pain with abdominal distension, fear of cold with shivering, and difficult bowel movements: take the Spleen Meridian of Foot-Taiyin. Heart pain involving the back, with labored breathing: needle the Kidney Meridian of Foot-Shaoyin; if ineffective, take the Sanjiao Meridian of Hand-Shaoyang (which traverses the midline of the lateral aspect of the upper limb).
Heart pain involving lower abdominal distension, with pain that shifts position upward and downward, and difficulty with urination and defecation: needle the Liver Meridian of Foot-Jueyin. Heart pain with shortness of breath and insufficient breathing: needle the Lung Meridian of Hand-Taiyin (which traverses the chest and the anterior border of the medial aspect of the upper limb). Heart pain may also be addressed by needling at the ninth vertebra; after needling, press the area and the pain may be immediately relieved. If not effective, search above and below for a reaction point, needle it, and relief will follow.
Cheek pain: needle the artery in the flexed curve of the cheek along the Stomach Meridian of Foot-Yangming and let blood — relief is immediate. If not effective, press the qi at Rendying point (ST 9, at the carotid pulse) and relief will follow immediately.
Counterflow qi rushing upward: needle the depressions in the chest and the area of the lower thoracic artery.
Abdominal pain: needle the arteries to the left and right of the navel; press after needling, and relief is immediate. If not effective, needle Qijie point (ST 30, in the inguinal region); press after needling, and relief is immediate.
For patients with wei-jue (atrophy and flaccidity of the limbs with reversal cold of the extremities): due to the limbs being bound and feeling distended and uncomfortable, the bindings should be quickly removed, and this should be done twice daily. If the limbs are numb and insensitive, consciousness may return in about ten days. Do not discontinue the treatment, and stop once the condition is resolved.
For yue (hiccups): stimulate the nostrils with a grass stem; after sneezing, the hiccups may stop. Holding the breath and swiftly guiding the qi may stop it immediately. Being suddenly startled may also stop it.
This chapter is a focused record in the Ling Shu of the approach to differentiating channels and selecting points for "miscellaneous diseases." The core is not any single prescription, but rather the principle of "same disease, different channels; differentiate syndrome patterns, then select channels."
For the same symptom, carefully discern differences before selecting the channel
For example, for toothache, whether the patient has an aversion to cold drinks determines whether the Stomach Meridian of Foot-Yangming or the Large Intestine Meridian of Hand-Yangming is selected. For throat impediment, whether the patient can speak determines which of these same two channels is chosen. For deafness, whether there is pain distinguishes between the Gallbladder Meridian of Foot-Shaoyang and the Large Intestine Meridian of Hand-Yangming. This shows that the ancients had already noticed that beneath the same surface symptom, the location and nature of the disease may differ, and so different channels were selected for regulation.
Equal emphasis on tracing the channel and on local reaction points
Most entries follow the pattern of "the disease is in a certain area, select the corresponding channel" — for example, head, neck, lower back, and back conditions often call for Foot-Taiyang; chest, abdomen, face, and mouth conditions often call for Yangming; throat and lower abdomen conditions often call for Shaoyin or Jueyin. At the same time, there are also "blood collaterals," "arteries," "left and right of the navel," and other local reaction point methods, reflecting that needling did not rely entirely on fixed points but also valued superficial reaction points and pulsating sites.
The bloodletting concept of "remove what has accumulated and stagnant"
In the entries on jue disease, low back pain, cheek pain, and abdominal pain, "needling the blood collaterals" and "drawing blood from the arteries" appear repeatedly. The essence is to give locally congested qi and blood an outlet. The ancients believed that many painful and jue conditions were caused by counterflow, stagnation, and obstruction of qi and blood, and that bloodletting could dispel that accumulation.
Simple physical and emotional therapies
The final entry—using a grass stem to tickle the nose to induce sneezing, holding the breath to guide qi, and sudden startling to stop hiccups—belongs to ancient, primitive, and simple methods of physical stimulation and emotional redirection. This shows that the ancients recognized early the influence of neural reflexes and emotions on certain symptoms.
The way of thinking reflected in this chapter—"selecting different channels based on symptom differences"—has formal similarity to what modern medicine calls differential diagnosis. The same toothache could be odontogenic in origin, or could be trigeminal neuralgia, or referred cardiac pain, and must be distinguished and managed differently.
Modern acupuncture research has provided some evidence supporting the analgesic, antiemetic, and gastrointestinal regulatory effects of certain points such as Zusanli (ST 36), Hegu (LI 4), and Neiguan (PC 6), but most conclusions still require support from high-quality evidence-based medicine. The ancient experiential dictum "taking one channel cures a certain disease" cannot be simplistically equated with modern verified therapeutic effect.
The entry "for malaria, taking a certain channel" is now clearly understood in the context of Plasmodium infection requiring standardized antimalarial treatment. Ancient acupuncture cannot replace modern therapy. This reminds us that classical text experience cannot be directly transplanted into modern disease treatment.
Procedures such as bloodletting and needling arteries carry risks of infection, bleeding, and neurovascular injury, and must never be self-imitated. Physical methods for hiccups, such as breath-holding or being startled, are accessible in daily life, but if hiccups are persistent or caused by organic disease, medical evaluation is needed.
Related Concepts
Channel-pattern differentiation, channel-based point selection, the three yin and three yang channels of the hands and feet, jue syndrome, bi syndrome, wei syndrome, throat impediment, hiccup, nine classical needles, bloodletting method
Further Reading
Ling Shu, Chapter 10: The Channels — the pathways and pathologies of the twelve channels
Su Wen, Treatise on Jue Disorders (Chapter 45) — the causes, classifications, and manifestations of jue disorders
Ling Shu, Chapter 1: The Nine Needles and Twelve Origin Points — the forms and basic uses of the nine needles
The A-B Canon of Acupuncture and Moxibustion (Jia Yi Jing) — organized compilation of acupuncture points and indications
Ling Shu, Chapter 26: Miscellaneous Diseases (full text) — additional entries on miscellaneous disease differentiation and treatment precede and follow this chapter
Bu Gua reminds you: This content is based on classical Chinese medicine texts and is offered solely for the study of traditional culture and research purposes. It does not constitute any form of medical diagnosis, medication, or treatment advice. If you are unwell, please seek medical attention in a timely manner.