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Chapter 67 of 81
黄帝内经·灵枢
Comprehensive Paraphrase
The Yellow Emperor asked Qi Bo: I have heard your teachings on the Nine Needles (the nine ancient types of needling instruments), and have applied them to the people, finding that each person's blood and qi constitution differs. After needling, six different manifestations appear: some people have their spirit qi stirred first, with qi moving ahead of the needle; some respond with qi simultaneously as the needle enters; some have qi moving on its own only after the needle is withdrawn; some require multiple needling before any sensation occurs; some experience qi rebellion immediately upon needle insertion; and some have their condition worsen after repeated needling. These six situations manifest differently, and I wish to hear the reasoning behind them.
Qi Bo replied: For those of the chong-yang constitution (persons with particularly predominant yang qi), the spirit qi is easily stirred, and qi is also easily aroused to move ahead.
The Yellow Emperor asked: What is meant by a person of the chong-yang constitution? Qi Bo said: Such persons have blazing, exuberant yang qi that flares outward 🔥 — they speak rapidly, lift their feet high when walking, and have surplus zang qi (the functional qi stored within the organs) of the heart and lungs. Their yang qi is slick, vigorous, and expansive, and therefore, once the spirit qi is stirred, qi moves forth first.
The Yellow Emperor asked: Among those of the chong-yang constitution, why do some not have their spirit qi move ahead? Qi Bo said: Such persons also possess a considerable measure of yin qi (the class of functions characterized by inhibition and stillness).
The Yellow Emperor asked: How does one know they also possess yin qi? Qi Bo said: Those with abundant yang qi tend toward joy and delight; those with abundant yin qi tend toward anger. If a person is frequently angered but the anger dissipates easily, this indicates yang carrying yin within it. Such a person's yin-yang intermingling is not pure, and therefore the spirit qi cannot move ahead.
The Yellow Emperor asked: What is the reason for qi meeting the needle simultaneously? Qi Bo said: When yin and yang are harmoniously balanced, blood and qi are moist and slick 💨, so the moment the needle enters, qi responds and meets it promptly.
The Yellow Emperor asked: When the needle has already been withdrawn and qi then moves independently, what kind of qi produces this? Qi Bo said: Such persons have more yin qi and less yang qi. Their yin qi tends to sink while their yang qi tends to float yet remains concealed within. Therefore, only after the needle is withdrawn does qi follow along and move — appearing as independent movement.
The Yellow Emperor asked: When multiple needling is required before any response occurs, what kind of qi produces this? Qi Bo said: Such persons have more yin and less yang, with qi mechanism deep and subdued, making qi movement difficult. Hence, multiple needling is required before sensation is perceived.
The Yellow Emperor asked: When qi rebellion occurs immediately upon needle insertion, and when repeated needling actually aggravates the condition, what kind of qi produces this? Qi Bo said: Qi rebellion after needling and aggravation of disease after repeated needling do not stem from the natural tendency of yin-yang qi to float or sink. Rather, they result from technical errors by careless practitioners — faults of the physician. The patient's own constitution and qi are not at fault.
Note: Certain characters in the original text are suspected of textual corruption from transcription. For example, "搞墙高高" is later commonly rendered as "熇熇高高," "多朋" is suspected to read "多阴," and "数利" is suspected to read "数刺." These have been interpreted according to standard medical reasoning.
The central theme of this discourse is: Individual differences in yin-yang, blood, and qi determine different needling responses. Qi Bo employs the quantities of yin and yang, along with the floating and sinking of qi mechanism, to explain the six phenomena:
This embodies the Neijing philosophy of "treating according to individual differences" and "discerning qi to guide the spirit" in acupuncture: needling is not merely about point selection but involves observing the patient's spirit-qi state and the arrival of qi. It particularly emphasizes that if treatment is ineffective or adverse reactions occur, one should first examine the practitioner's technique rather than merely attributing the problem to the patient's constitution.
The sensations of soreness, numbness, distension, heaviness, or a traveling sensation after acupuncture are termed de-qi (acquisition of qi) in Chinese medicine. Modern research and clinical observation likewise confirm that significant individual differences exist in the speed, intensity, and quality of needling sensation, related to factors such as neural sensitivity, local connective tissue responses, and psychological state.
"Chong-yang" and "abundant yin" are ancient constitutional classification models that cannot be rigidly mapped onto modern medicine nor used as self-diagnostic labels. Nevertheless, the underlying principles — that individual differences affect responses and that practitioner safety comes first — resonate with modern acupuncture's emphasis on individualized assessment, standardized technique, and prevention of injury.
It should be noted that the ancients' understanding of the mechanisms behind adverse reactions such as "qi rebellion" was relatively general. If significant discomfort occurs after needling, the procedure should be immediately discontinued and evaluated by a professional — the matter should not be dismissed with a single phrase about "careless practitioners." 🩺
This content is based on classical Chinese medicine texts and is provided solely for the study of traditional culture. It does not constitute any medical diagnosis, medication prescription, or treatment advice. Please seek professional medical care if you experience any health issues.