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Capítulo 3 de 81
黄帝内经·灵枢
Overall Paraphrase
Note: The original text contains a few corrupt/variant characters, such as "作在数迟" commonly read as "微在数迟" and "退而济之" commonly read as "追而济之." The following is translated according to the common version of the Ling Shu.
What is called "easy to state" means only that the principles of acupuncture are easy to express; "difficult to enter" means that truly applying them to a person and mastering them deeply is difficult. A coarse physician merely fixes on the external forms of needling; an excellent physician holds to the blood and qi of a person — its excess and insufficiency — and applies supplementation and draining based on this. What is called "spirit and guest" means that upright qi and pathogenic qi converge in the same place; spirit is upright qi, and guest is pathogenic qi. "At the gate" means that pathogenic qi invades through the gate through which upright qi enters and exits.
Before a clear manifestation of illness is seen, one must first know in which channel the pathogenic and upright contention lies; to know the root of the disease, one must first know in which channel the disease lies and which area should be selected. The subtlety of needling lies in "slowness and rapidity," that is, the slowness or quickness of inserting and withdrawing the needle. A coarse physician only guards the four limbs and joints, but does not know the movement of blood-qi and the contention of pathogenic and upright; an excellent physician guards the "mechanism," meaning guarding the changes of the qi mechanism. The activity of the qi mechanism does not depart from the acupoint openings; one must know the vacuity and repletion of qi, and apply rapid or slow techniques accordingly. The qi mechanism within the acupoints is pure and subtle; after obtaining arrival of qi, one must focus solely on guarding the qi and not let it disperse. "What is coming cannot be met" means that when qi is at its peak, one must not use supplementation; "what is departing cannot be pursued" means that when qi has become vacuous, one must not use draining. "Cannot be hung by a hair" means that after obtaining qi, the opportunity is extremely easy to miss; "holding the trigger without releasing" means not understanding the meaning of supplementation and draining, and by the time the blood and qi have already declined, the qi beneath the needle still does not arrive.
Knowing the movement of qi coming and going is knowing the counterflow and compliance, excess and vacuity of qi; to grasp the opportunity means knowing the appropriate moment when qi can be taken. Coarse physicians are obscure and unclear, not knowing the subtlety of the qi mechanism; excellent physicians can fully comprehend the meaning of needling. Qi departing is counterflow because qi is vacuous and faint; qi arriving is compliance because the physical form and qi are balanced. Clearly understanding counterflow and compliance enables normal needling without doubt, because one already knows where to select. Moving against arriving qi to reduce its fullness is the draining method; following departing qi to support its vacuity is the supplementation method.
"When vacuous, repletion it" means that when the qi opening pulse is vacuous, one should supplement; "when full, drain it" means that when the qi opening pulse is abundant, one should drain. "When stagnant and old, remove it" means removing the stasis that has accumulated in the blood vessels; "when pathogenic qi prevails, vacuity it" means that when pathogenic qi is abundant in the channels, the draining method should be used. Slowly inserting the needle and rapidly withdrawing it can make qi replete; rapidly inserting the needle and slowly withdrawing it can make pathogenic qi vacuous. What is called "repletion and vacuity as if present, as if absent" means that repletion has qi, vacuity has no qi. Observing what comes first and what comes after, as if vanishing, as if remaining, is judging the vacuity and repletion of qi and the order of supplementation and draining, seeing whether the qi beneath the needle has already calmed or still remains. During supplementation and draining, as if obtaining, as if losing: supplementation is like gaining something, draining is like losing something.
Qi in the vessels can be divided into upper and lower: pathogenic qi above means that external pathogenic influences injuring a person often first invade the upper part of the body; therefore it is said pathogenic qi is above. Turbid qi in the middle means that water and grains enter the stomach; their essential qi rises upward to the lungs, while turbid qi remains in the stomach and intestines; if cold and warmth are unsuitable and food and drink are immoderate, the stomach and intestines become diseased; therefore it is said turbid qi is in the middle. Clear qi below means that the qi of clear, cold, and damp earth injuring people often begins at the feet, therefore it is said clear qi is below. Needling the superficial collateral vessels so that pathogenic qi exits externally should take the upper areas; needling the middle vessels so that turbid qi exits externally may select the He-sea point of the Yangming channel; if the disease sits shallowly and one needles deeply, pathogenic qi will sink inward following the needle, hence it is called "counterflow sinking." Skin, flesh, sinews, and vessels each have their place; the channels and collaterals each have what they govern.
If the disease is internal while qi is already insufficient, yet one uses the needle to greatly drain the yin channels, the ancients warned that it may lead to death; if one excessively drains the qi of the three yang channels, the patient will be vacuous and difficult to recover. The ancients considered that repeatedly needling forbidden areas such as the Foot-Li region of the cubit could seize yin qi and bring danger; seizing yang qi may cause mania. An excellent physician must observe the countenance and examine the sparkle of the eyes, to understand whether qi has dispersed or recovered; combined with examining the cubit-inch pulse — its slowness, urgency, slipperiness, and choppiness — one can determine the disease. Knowing pathogenic and upright allows discerning vacuous pathogens and the winds of upright pathogenic qi. The right hand pushes the needle, the left hand supports it, to control insertion and withdrawal; when qi arrives and is harmonized, the needle may be withdrawn. Regulating qi requires maintaining a focused mind from beginning to end.
The 365 meeting points between the joints are moistened and nourished by the collateral vessels permeating them. If the five viscera' qi has already expired internally, and the pulse opening internally does not arrive comprehensively, but instead one needles the body surface affected areas and the He-sea points of the yang channels, retaining the needle to stir yang qi, the recovery of yang qi will make the interior even more depleted; this double depletion leads to death, and at death, because there is no qi to drive movement, the patient is quiet. If the five viscera' qi has already expired externally, and the pulse opening externally does not arrive comprehensively, but instead one needles the Shu-stream points of the extremities, retaining the needle to stir yin qi, once yin qi arrives, yang qi instead sinks inward, and internal sinking leads to counterflow, counterflow leads to death — death occurs with excess yin qi and agitation. Therefore one must examine the eyes, because the essential qi of the five viscera ascends to pour into the eyes; if the five colors appear clear and moist, the voice manifests clearly, and the voice will differ from its usual state.
From "guarding the form" to "guarding the spirit" and "guarding the mechanism": This chapter repeatedly contrasts the "coarse worker" with the "superior worker." The coarse worker only fixes on points, limbs, and needling movements; the superior worker focuses on qi-blood vacuity and repletion, the contention between pathogenic and upright, and the changes of the qi mechanism. The true object of acupuncture is not some fixed "location" but the dynamic state of a person's qi and blood.
Supplementation and draining based on qi-blood vacuity and repletion: The ancients emphasized "when vacuous, supplement it," "when full, drain it," "when stagnant and old, remove it," and "when pathogenic qi prevails, vacuity it." Supplementation and draining are not arbitrary operations but must be determined by the qi-opening pulse, the sensation beneath the needle, and the movements of qi. The draining method is like "meeting and seizing it," while supplementation is like "following and aiding it," and the slowness or rapidity of the technique also manifests the method of supplementation or draining.
The three-burner disease location and depth of needling: Pathogenic qi, turbid qi, and clear qi correspond respectively to upper, middle, and lower pathways and disease locations. When the disease site is shallow, one should not needle deeply, otherwise one may draw the pathogenic qi deeper. This reflects the layered view of "needling has degrees of depth, each with what it governs."
Warnings against erroneous treatment: Statements such as "taking the five viscera' vessels causes death," "seizing yin causes death," and "seizing yang causes mania" are severe warnings from ancient practitioners against excessive needling and mistakenly needling forbidden areas. These belong to ancient clinical observations and theoretical deductions and cannot be directly equated to modern medical conclusions, but the core idea remains: when qi and blood are vacuous and declined, one must not greatly drain; treatment must not excessively harm upright qi.
This chapter is a sentence-by-sentence explanation of Ling Shu · Jiu Zhen Shi Er Yuan (The Nine Needles and Twelve Source Points), belonging to the format of "canonical text—annotation." It is significant clues for later generations to understand the earlier outline of acupuncture. It elevates needling from "form" to "spirit" and "mechanism," emphasizing individualized, dynamic judgment — a line of thinking that bears commonality with modern medicine's emphasis on individualized evaluation and dynamic observation.
"Obtaining qi" holds a central position in classical literature. In modern acupuncture research, "needle sensation"—soreness, numbness, distension, heaviness, etc.—is often seen as part of the manifestation of obtaining qi; its mechanisms may relate to local and central nervous system, muscular, fascial, and other regulation, but the classical concept of "qi" cannot be entirely equated with modern physiological indicators.
Judgments like "taking the five viscera' vessels causes death," "seizing yin causes death," and "seizing yang causes mania" should be understood against the backdrop of ancient threaded needles, limited disinfection and emergency care, and practitioners' empirical knowledge of forbidden points. Modern acupuncture already operates with stricter safety standards, and one must not operate on oneself based on classical texts alone.
"Pathogenic qi above, turbid qi in the middle, clear qi below" is an ancient classification of disease causes and locations. It reflects the ancients' induction of the distinct pathways of different pathogenic factors, but specific judgments of disease should incorporate modern medicine, not mechanically apply classical categories.
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This content is based on classical Chinese medicine texts and is provided solely for the study and reading of traditional culture. It does not constitute any medical diagnosis, medication, or treatment recommendation; if unwell, please consult a medical professional promptly.