Loading...
Chapter 48 of 81
黄帝内经·灵枢
Holistic Paraphrase
Lei Gong asked the Yellow Emperor: I, your disciple, have had the privilege of studying under you, reading through all sixty documents concerning the Nine Needles (the nine ancient types of needles and their needling techniques). I have studied diligently from morning to night, so much so that the binding cords of the recent bamboo slips have broken from repeated handling, and the older slips have been worn smooth by constant touching. Yet I continue to recite and study without daring to set them aside. Despite this, my heart still does not fully grasp the profound meaning within. Externally, I must tie together (synthesize and distill) the scattered knowledge and unite it into a single whole — I do not yet know how to accomplish this. As the saying goes, "The great has no outside; the small has no inside" — the large has no boundary, the small has no core; size has no limit, height has no measure. How then does one constrain and synthesize? People's intellect varies in thickness and thinness; their thinking varies in depth and shallowness. One cannot achieve broad and profound understanding in a single step. For someone like me who struggles to learn through self-study, I fear these teachings will be scattered in later generations and severed from future descendants. May I ask: how does one distill (refine and synthesize) the vast medical wisdom into its essential core?
The Yellow Emperor said: An excellent question! These are teachings that my predecessors sternly forbade from being casually disseminated to the public. They must be passed down through the covenant of cutting the arm and swearing by blood (cutting the arm and dripping blood into a vow). If you truly wish to receive them, why not first undergo ritual purification (bathing, fasting, and quieting the mind)?
Lei Gong bowed twice and rose, saying: Please let me follow your instruction. Thereupon Lei Gong fasted and slept alone for three days, then said: May I ask that today at high noon, when yang energy is at its peak (the time of greatest yang), your disciple be willing to receive the covenant? The Yellow Emperor then entered the purification chamber with him, cut his arm, and dripped blood. The Yellow Emperor personally proclaimed: Today at the height of yang, we seal this bond with blood. Whoever dares to violate this oath shall reap misfortune in return. Lei Gong bowed twice and said: Your disciple accepts.
The Yellow Emperor then held Lei Gong's left hand with his left hand, and with his right hand gave him the text, saying: Be careful! Be careful! I will explain it to you. The principle of needling begins with the channels — the fundamental principle of acupuncture begins with the meridians (the main pathways through which qi and blood circulate in the body). One must understand their pathways and routes of circulation; know their length measurements; internally one can needle the five viscera (the five major organs: heart, liver, spleen, lungs, and kidneys), and externally the six bowels (the six hollow organs: gallbladder, stomach, large intestine, small intestine, bladder, and triple burner); one must examine the defensive qi (qi that circulates on the body surface and provides protection), for disharmony of the defensive qi is the mother of all diseases; one must regulate deficiency and excess, so that deviations in deficiency and excess may be corrected; one must drain the blood collaterals (the small visible blood vessels on the body surface), and when stagnant blood is eliminated, the disease will not reach a critical state.
Lei Gong said: These principles I have already comprehended before, but I still do not know how to distill (refine into essentials). The Yellow Emperor said: The so-called "distilling formulas" is like tying a sack shut. If the sack is full but not tied, what is inside will leak out; when strategies are complete but not refined and distilled, then spirit (the physician's mental clarity and mastery) cannot dwell within them. Lei Gong said: I wish to be of inferior ability (a person of lesser talent) — could I distill before the sack is completely full? The Yellow Emperor said: Those who rush to distill before it is full can only become an average practitioner (an ordinary physician), not a teacher of the realm (a first-class master of medicine). Lei Gong said: Please explain how to become a good physician.
The Yellow Emperor said: The inch-opening pulse governs the interior; the man's greeting pulse governs the exterior — the Cunkou pulse (the radial artery at the wrist, belonging to the Lung channel of Hand-Taiyin) primarily reflects the qi of the internal viscera; the Renying pulse (the carotid artery beside the laryngeal prominence of the neck, belonging to the Stomach channel of Foot-Yangming) primarily reflects the qi of the exterior channels. The two respond to each other, coming and going together, like pulling on a single rope — their sizes should be equal. In spring and summer, the Renying pulse is slightly larger; in autumn and winter, the Cunkou pulse is slightly larger. Such pulse conditions are called a balanced person (a healthy, normal individual).
When the Renying pulse is twice as large as the Cunkou pulse, the disease lies in the Foot-Shaoyang channel (Gallbladder channel); if it is twice as large with a stirring, restless quality, the disease lies in the Hand-Shaoyang channel (Triple Burner channel). When the Renying pulse is three times as large, the disease lies in the Foot-Taiyang channel (Bladder channel); if three times as large and stirring, the disease lies in the Hand-Taiyang channel (Small Intestine channel). When the Renying pulse is four times as large, the disease lies in the Foot-Yangming channel (Stomach channel); if four times as large and stirring, the disease lies in the Hand-Yangming channel (Large Intestine channel).
When the Renying pulse is exuberant (strong and forceful), it indicates heat syndromes; when deficient (weak and feeble), it indicates cold syndromes; when tight (tense as a taut string), it indicates painful bi-syndrome; when intermittent (skipping beats, alternating fast and slow), it indicates the disease alternates between severe and mild. The treatment principle is: exuberant pulse — use the draining method (needling technique that eliminates pathogenic factors); deficient pulse — use the tonifying method (needling technique that supports the righteous qi); tight pulse with pain — needle the intermuscular spaces (the gaps between muscles); intermittent pulse — needle the blood collaterals to let blood and concurrently administer herbal medicine; sunken pulse (sinking and hidden) — use moxibustion. If neither exuberant nor deficient, needle according to the affected channel, which is called channel needling.
When the Renying pulse is four times larger and large and rapid, this is called overflowing yang, and overflowing yang means external repulsion (yang qi overflowing outward and being repelled externally). This is a fatal, untreatable condition. One must carefully examine the root and branch (the fundamental and the peripheral aspects) of the disease, observe the changes of cold and heat, to verify the pathological changes in the viscera.
When the Cunkou pulse is twice as large as the Renying pulse, the disease lies in the Foot-Jueyin channel (Liver channel); if twice as large and stirring, the disease lies in the Heart Protector (the Pericardium channel of Hand-Jueyin). When the Cunkou pulse is three times as large, the disease lies in the Foot-Shaoyin channel (Kidney channel); if three times as large and stirring, the disease lies in the Hand-Shaoyin channel (Heart channel). When the Cunkou pulse is four times as large, the disease lies in the Foot-Taiyin channel (Spleen channel); if four times as large and stirring, the disease lies in the Hand-Taiyin channel (Lung channel).
When the Cunkou pulse is exuberant, it indicates abdominal distension, cold within (cold excess in the spleen and stomach), and undigested food; when deficient, it indicates heat within (internal heat), mushy stools (turbid urinary discharge), shortage of qi, and abnormal urine color; when tight, it indicates painful bi-syndrome; when intermittent, the pain comes and goes. The treatment principle: exuberant — drain; deficient — tonify; tight — needle first, then moxibustion; intermittent — first needle the blood collaterals to let blood, then regulate; sunken — moxibustion only — the so-called sunken means blood clots within the vessels, containing stagnant blood (accumulated static blood). The blood being cold has not dispersed, hence moxibustion is appropriate to warm and unblock. If neither exuberant nor deficient, needle according to the affected channel.
When the Cunkou pulse is four times larger, large and rapid, this is called internal blockage, which is a fatal, untreatable condition. One must examine the cold and heat changes of root and branch to verify the diseases of the viscera, understand the nutritive transport (the points where nutritive qi is infused, namely the acupoints of the channels), and only then can the great principles (the great treatment rules) be transmitted.
The Great Principles state: When the pulse is exuberant, use draining alone; when deficient, use tonifying alone; when tight, use moxibustion and needling together along with herbal medication; when sunken, use moxibustion alone; when neither exuberant nor deficient, treat according to the affected channel. The so-called channel treatment includes both herbal medication and moxibustion-needling therapy. When the pulse is rapid, use guide and traction (therapeutic exercises to relax and regulate); when the pulse is large but weak, one should rest quietly and avoid excessive exertion.
The core of this chapter lies in the character "distill" (约) — how to condense voluminous medical knowledge into an actionable framework. The Yellow Emperor's answer is: Use the channels as the guiding framework, pulse diagnosis as the standard, and deficiency-excess as the basis of treatment.
Among the most important technical content is the Renying-Cunkou comparative pulse method. This chapter of the Spiritual Pivot established a system using Renying (which reflects yang channels and the exterior) and Cunkou (which reflects yin channels and the interior) as two major pulse diagnosis coordinates. The ancients believed:
This is a pattern identification model that determines therapy based on pulse and channel correspondence. The degree of deviation of the pulse from its normal baseline directly points to the corresponding channel level. Combined with exuberance or deficiency (forceful or feeble), tightness or intermittency (pulse shape changes), one further differentiates cold, heat, deficiency, and excess, ultimately establishing the therapeutic strategy of "drain when exuberant, tonify when deficient, needle-moxa when tight, let blood when intermittent, moxa when sunken."
This way of "distilling formulas" essentially compresses complex life phenomena into a repeatable, teachable diagnostic decision tree.
The Renying-Cunkou comparative pulse method was a sophisticated diagnostic system in the era of the Spiritual Pivot, demonstrating the ancients' efforts to establish quantifiable diagnostic standards. The gradient classification of "onefold, twofold, threefold" is essentially a form of rudimentary ordinal scale thinking — quite advanced for over two thousand years ago.
From a modern perspective:
What deserves recognition is this: the core treatment logic throughout the entire chapter — selecting tonification or drainage strategies based on deficiency-excess, and selecting needling or moxibustion methods based on disease depth — resonates philosophically with contemporary approaches to personalized, individualized treatment.
Associated Concepts:
Further Reading:
This content is based on classical Chinese medicine texts and is provided for traditional cultural study and research only. It does not constitute medical diagnosis, prescription, or treatment recommendations. Please consult a healthcare professional if you feel unwell.