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Chapter 75 of 81
黄帝内经·灵枢
The following content involves ancient acupoints, needling instruments, and techniques. It is purely a description of classical academic principles and methods from ancient texts, provided for study purposes only and not as operational guidance.
Huangdi asked Qibo: I have heard that needling methods have "five categories." What do they refer to? Qibo replied: Indeed, there are five categories: Zhen'ai (ancient needling term, describing efficacy as swift as shaking off dust), Fameng (describing restoring hearing and sight as enlightening the benighted), Quzhua (describing removing edema as removing excess nails), Cheyi (describing heat subsiding as quickly as removing clothes), and Jiehuo (describing restoration of consciousness as resolving confusion). Zhen'ai involves needling the external channels (the superficial, yang-aspect portions of the channels on the body surface) to dispel pathogenic factors from the yang aspect. Fameng involves needling the Fu-organ Shu points (acupoints where the qi of the six fu organs is infused) to treat fu-organ disorders. Quzhua involves needling joints and collateral vessels of the limbs. Cheyi involves needling the extraordinary Shu points of all yang channels. Jiehuo involves supplementing deficiencies and draining excesses on the basis of comprehensively understanding the rise and decline of yin and yang, thereby correcting their imbalance.
Huangdi pressed further on the specific meaning of Zhen'ai. Qibo said: When yang qi is severely counterflowing and congested in the chest, there will be fullness and oppression in the chest, mouth open and shoulders raised with labored breathing, qi counterflowing upward, wheezing with audible sound, inability to sit or lie still, aversion to smoke and dust, and difficulty breathing upon exposure to them. It is called "Zhen'ai" because the effect of needling is faster than shaking off dust. The treatment selects Tianrong (SI 17). If there is coughing with qi upflaring, shortness of breath with inability to extend, and chest pain, select Lianquan (CV 23). For needling Tianrong, retention time does not exceed the time it takes to walk one li. For needling Lianquan, the criterion is a change in blood circulation and skin color.
Huangdi then asked about Fameng. Qibo said: Fameng addresses conditions of the ears not hearing sounds and the eyes not seeing objects. This is the subtlety of needling, approaching the category of "spirit illumination." It is difficult to fully convey through verbal instruction or written records. It must be performed at noon, needling Tinggong (SI 19), so that the needling sensation reaches the pupil and the ear can hear sounds — this indicates the acupoint has been located. As for "sound heard in the ear," this refers to the practitioner pressing the patient's both nostrils tightly with the hands during needling while rapidly having the patient lower the head or hold the breath; the sound produced by the patient will correspond to the needling sensation. This is a needling method accomplished through the mutual resonance of spirit and qi, not dependent solely on visual observation.
Regarding Quzhua, Qibo said: The lower back and spine are the great joints of the body. The limbs and lower legs are the supports for human walking and activity. The penis and scrotum are crucial sites of the body, being the external manifestation of essence and the passageway for fluids. If diet is immoderate and emotions fluctuate without restraint, fluids accumulate internally, settling below in the testicular region. Blood passages become obstructed, there is progressive swelling, difficulty bending and straightening, difficulty walking, localized dampness accumulation, and blockage between upper and lower. The ancient method used instruments such as the pi needle (lance needle) and stone needles as external therapeutic tools to remove the water pathogen. Because the pathological form cannot be concealed, like removing excess nail, it is called "Quzhua."
Regarding Cheyi, Qibo said: This refers to yang qi being in excess and yin qi being insufficient. Insufficient yin qi causes internal heat; excessive yang qi causes external heat. Internal and external heat combine, and the body is as hot as if holding charcoal, averse to clothing and bedding touching the body, unable to approach a mat. The couli (interstices between skin and muscle) are blocked, no sweating occurs, the tongue is parched and lips withered, the throat is dry, and food and drink have no flavor. The treatment selects Tianfu (LU 3) and Dazhu (BL 11), each needled three times. Additionally, needle Zhonglü (BL 29) to remove heat, and supplement the Foot and Hand Taiyang channels to promote sweating. When heat subsides and sweating diminishes, it is faster than removing clothes.
Regarding Jiehuo, Qibo said: When severe wind injures the body, the blood and vessels become deficient on one side — the deficient side is insufficient, the excess side is redundant. The limbs become uneven in weight and balance, the body leans and bends, one cannot distinguish east from west, north from south, and symptoms alternate and invert unpredictably between upper and lower — more severe than ordinary confusion. The treatment principle is to drain excess and supplement deficiency, restoring balance between yin and yang. When needling is appropriate, resolution is faster than untying a knot.
Huangdi asked about the five pathogens. Qibo replied: Diseases include persistent abscess, excess enlargement, narrowing deficiency, heat, and cold — these are the five pathogens. The methods for needling the five pathogens number no more than five: heat pathogens are dissipated, swellings and accumulations are dispersed, cold-bi syndrome is warmed, minor pathogens are supplemented with yang, and major pathogens must be eliminated.
Needle selection: For abscess, use the pi needle (lance needle); for major pathogens, use the feng needle (sharp-edge needle); for minor pathogens, use the yuanli needle (round-sharp needle); for heat pathogens, use the chan needle (arrowhead needle); for cold pathogens, use the hao needle (filiform needle).
The theory of resolving knots corresponds to heaven and earth and accords with the four seasons. In low-lying damp ground, reeds and cattails grow above; from this, the ancients inferred the abundance or scarcity of water and earth qi. Humans likewise correspond to heaven and earth and may have their physical form and qi inferred from external signs. Yin and yang may manifest as cold and heat: When the weather is hot, dampness and steam rise upward, and plant roots and stems have less sap. Correspondingly in the human body, qi moves externally — the skin relaxes, the interstices open and drain, qi and blood relatively decrease, sweat flows profusely, and the skin becomes moist. When the weather is cold, the ground freezes and water turns to ice, and human qi moves internally — the skin becomes dense, the interstices close, no sweat is produced, qi and blood are relatively abundant, and the flesh is firm and rough. At such times, one skilled in water navigation cannot travel on ice, one skilled in digging cannot penetrate frozen ground, and one skilled in needling cannot immediately treat cold extremities in the limbs. When blood is congealed, firm, rough, and not flowing freely, it cannot be softened immediately.
Therefore, navigating water requires waiting for the weather to warm and the ice to melt; the human channels and vessels are similar. For treating cold extremities, one must first use warm fomentation to harmonize the relevant channels — such as the palms and armpits, elbows and feet, nape and spine areas. Only after the warmth has permeated and blood flow has resumed can one observe the disease site. If the pulse is slippery, needle to calm it; if firm and tight, break and disperse it; treatment stops when qi descends smoothly. This is called "resolving knots."
The key to using needles lies in regulating qi. Qi accumulates in the stomach, generating nutritive qi and defensive qi (ying qi nourishes; wei qi warms and defends), each traveling its own path. Zong qi (the great qi of the chest that drives respiration and blood circulation) remains in the sea of qi in the chest, descends to infuse the qijie (the street of qi in the lower abdomen), and rises along the respiratory tract. Coldness in the feet arises when zong qi cannot descend — blood in the vessels becomes congealed and stagnant. Without warming and fomentation, needling cannot be applied. Those who use needles must first examine the excess or deficiency of the channels and vessels, press and palpate along their courses, press and pluck to observe where the channel responds by movement under the hand, and only then select points and insert the needle. When the six channels are harmonized, there is no disease — even if disease is present, it will resolve on its own. If one channel is excessive above and deficient below and fails to communicate, there must be a transverse collateral constricting the great channel, rendering it impassable. Identify it and drain it — this is resolving knots.
For cold above with heat below, first needle the Yangtai (Bladder) channel points at the nape with prolonged retention. After needling, warm the nape and scapulae with fomentation so that the warmth descends and joins the heat below. This is called "pushing upward." For heat above with cold below, observe the vacuous sunken vessels in the channels and select points accordingly; treatment stops when qi descends. This is called "drawing downward." For intense heat over the entire body with mania, visual hallucinations, auditory hallucinations, and incoherent speech, inspect the Foot Yangming channel and its great collateral to select points — supplement where vacuous, drain where blood is excessive. Have the patient lie supine with the practitioner standing at the head, using both hands with four fingers each to press alongside the carotid arteries. After prolonged pressure, roll and push toward the supraclavicular fossa. Repeat the procedure as before; stop when the heat subsides. This is called "pushing and dispersing." This is a description of ancient external treatment methods and must not be self-administered in modern times.
Huangdi asked: One channel can produce dozens of diseases — pain, abscess, heat, cold, itching, bi syndrome, numbness with loss of sensation — with endless variations. What is the cause? Qibo replied: All are caused by pathogenic qi.
Qi includes true qi (the fundamental qi received from heaven that combines with grain qi to nourish the entire body), proper qi (the wind from normal seasonal climates), and pathogenic qi (the disease-causing deficient wind and thief wind). True qi is received from heaven and merges with water and grain qi to nourish the whole body. Proper qi is the wind of normal seasonal climate, coming from one direction — neither substantial wind nor deficient wind. Pathogenic qi is the deficient wind and thief wind that injures deeply and cannot dissipate on its own. Proper wind injures superficially, joins with true qi, and disperses of itself — its qi arrives softly and cannot overcome true qi, so it departs on its own.
When deficient pathogens injure a person, there is first a shivering sensation with cold, the body hair stands on end, and the interstices open. When pathogens penetrate deeper: contending with the bones, it becomes bone bi; contending with the sinews, it becomes sinew spasm; contending within the vessels causing blood blockage and non-passage, it becomes abscess; contending with the flesh and battling defensive qi, yang predominance produces heat, yin predominance produces cold; with cold, true qi departs and vacuity develops; contending between skin and flesh, the pathogen issues externally — the interstices open, the body hair stirs, and qi moving back and forth causes itching; remaining without resolution, it becomes bi syndrome; when defensive qi fails to move, it becomes numbness with loss of sensation.
When deficient pathogens adhere to one side of the body and penetrate deeply into the nutritive and defensive qi, the nutritive and defensive qi gradually decline, true qi departs, and the pathogen alone remains — this produces hemiplegia (unilateral paralysis with loss of limb function). When the pathogen is more superficial, there is pain on one side of the channels. When deficient pathogens remain for prolonged periods and settle deeply, cold and heat contend: if cold predominates, bone pain and flesh emaciation develop; if heat predominates, flesh and muscle decay forming pus, with internal injury to bone producing bone erosion. When pathogens bind in the sinews, the sinews contract and cannot extend; if the pathogen remains and does not disperse, this produces sinew tumors. When pathogens bind in the intestines, fluids remain for prolonged periods and over years form intestinal tumors that are soft on palpation. When pathogens aggregate and congeal, chronic tumors (xi tumors) form that are hard on palpation. When pathogens penetrate deeply into the bones, bone and qi combine, increasingly enlarging daily — this becomes bone gangrene (bone abscess). When pathogens bind in the muscles and pectoral qi returns to that site, if the pathogen remains without dispersing, with heat it will transform into pus, and without heat it will become fleshy abscess. These pathogens arise without fixed location, but each has a fixed name.
— Bugua: This content is based on classical Chinese medicine texts and is provided solely for traditional cultural study and research. It does not constitute any form of medical diagnosis, medication guidance, or treatment recommendation. If you feel unwell, please seek medical attention promptly.