Cargando...
Capítulo 9 de 81
黄帝内经·灵枢
Overall Paraphrase
I. General Principles of Acupuncture: Understanding Beginning and End, Regulating Yin and Yang
All principles of acupuncture ultimately return to beginning and end (Zhong Shi) — that is, the origin and termination of qi and blood in the meridians, and the waxing and waning of yin and yang. By understanding beginning and end, with the five viscera as the guiding framework, yin and yang can be determined. Yin governs the five viscera; yang governs the six bowels. Qi of the yang meridians is received from the extremities of the four limbs, while qi of the yin meridians is distributed from the five viscera. Therefore, the reducing method should meet the oncoming qi, and the reinforcing method should follow the direction of qi; by understanding "meeting and following" (ying sui), qi mechanics can be harmonized. The method of harmonizing qi must involve understanding yin and yang: the five viscera are yin, the six bowels are yang. The ancients solemnly transmitted this to later generations, swearing oaths with blood; those who respectfully uphold this way will prosper, those who slight it will perish; those who deviate from the right path and act on selfish desires will certainly encounter disaster.
Respectfully following the way of heaven to discuss beginning and end: Beginning and end take the meridians as the guiding framework. Palpate Cunkou (the radial artery at the wrist, governing qi of yin meridians) and Renying (the carotid artery at the side of the neck, governing qi of yang meridians) to understand whether yin and yang have excess or deficiency, balance or imbalance. The essential meaning of heaven's way is thus complete.
The so-called balanced person (ping ren) is a healthy person without disease. Their Cunkou and Renying pulses correspond to the four seasons, the upper and lower pulses correspond in their coming and going, the six meridians show no stagnation or agitation, the body's root and tip are harmoniously warm and cool, and the flesh and physique correspond with blood and qi. This is the balanced person. For those with diminished qi (shao qi), both Cunkou and Renying are weak, not commensurate with normal measures. For such people, yin and yang are both insufficient. If yang is tonified, yin fluids will be exhausted; if yin is reduced, yang qi will be depleted externally. The ancients held that such cases should be treated with sweet and mild medicinals for nourishment, not with drastic agents; moxibustion should not be applied; if the illness does not improve and reducing methods are nonetheless used, the true qi of the five viscera will decline and fail.
II. Comparative Diagnosis of Renying and Cunkou Pulses
If the Renying pulse is twice as strong as Cunkou, the disease is in the Foot Shaoyang meridian; twice as strong and agitated, the disease is in the Hand Shaoyang meridian. Twice as strong [as normal is normalized to baseline — interpret per the text: matching ratios proportionate] — disease in Foot Taiyang; twice with agitation, in Hand Taiyang. Three times — Foot Yangming; three times with agitation — Hand Yangming. Four times with a large and rapid pulse is called overflowing yang (yi yang) — a condition of yang qi repelled externally, called external rejection (wai ge) .
If the Cunkou pulse is twice as strong as Renying, the disease is in the Foot Jueyin meridian; twice with agitation, in the Hand Jueyin (pericardium) meridian. Twice [three in text sequencing] — disease in Foot Shaoyin; twice with agitation — in Hand Shaoyin. Three times — Foot Taiyin; three times with agitation — Hand Taiyin. Four times with a large and rapid pulse is called overflowing yin (yi yin) — a condition of yin qi obstructed internally, called internal blockage (nei guan) ; when internal blockage does not open, the condition is critical. When both Renying and Cunkou are four times or more excessive, this is called blockage and rejection (guan ge) , with an unfavorable prognosis.
When Renying is one time excessive, the corresponding ancient method is to reduce the Foot Shaoyang meridian and reinforce the Foot Jueyin meridian — two reducing and one reinforcing, once daily, always verifying by pulse examination, stopping when qi is harmonized. When Renying is two times excessive, reduce Foot Taiyang and reinforce Foot Shaoyin — two reducing and one reinforcing, once every two days. When Renying is three times excessive, reduce Foot Yangming and reinforce Foot Taiyin — two reducing and one reinforcing, twice daily, stopping when qi is harmonized. When Cunkou is one time excessive, reduce Foot Jueyin and reinforce Foot Shaoyang — two reinforcing and one reducing, once daily. When Cunkou is two times excessive, reduce Foot Shaoyin and reinforce Foot Taiyang — two reinforcing and one reducing, once every two days. When Cunkou is three times excessive, reduce Foot Taiyin and reinforce Foot Yangming — two reinforcing and one reducing, twice daily; [twice daily] is permissible because the Foot Taiyin spleen meridian is related to the stomach, and grain qi is relatively abundant.
III. Principles of Reinforcing and Reducing, and "Arrival of Grain Qi"
When both Renying and Cunkou are five times or more excessive, this is called overflow of both yin and yang. If at this point the obstruction cannot be opened, blood vessels become blocked, qi has no path of movement, overflows internally, and the five viscera are injured. If moxibustion is erroneously applied at this stage, other diseases will arise. The way of needling takes harmonization of qi as its standard; reinforcing yin and reducing yang can strengthen voice and qi and sharpen hearing and vision; violating this principle causes blood and qi to fail in their movement.
What is called "qi having arrived and being effective": After the reducing method, the righteous qi becomes relatively deficient, and the pulse, though possibly large, is not firm; if it is still firm as before, even if there is temporary comfort, the disease has not been removed. After the reinforcing method, the righteous qi becomes relatively sufficient, and the pulse is large and more firm than before; if it is instead not firm, even if there is temporary relief, the disease has also not been removed. Therefore, with reinforcement there is fullness, with reduction there is deficiency. Although pain may not cease immediately with the needle, the pathogen's force will inevitably diminish. One must first thoroughly understand the diseases of the twelve meridians, only then can one transmit the way of "beginning and end." When yin and yang do not deviate from their proper positions, when deficiency and excess do not mutually intermingle, one selects the corresponding meridians for treatment.
In all needling, three insertions are made to reach the arrival of grain qi (the essential qi transformed from water and grains; the pulse becomes moderate and harmonious). Pathogenic qi aberrantly combining, yin and yang exchanging places, reversal of proper and contrary directions, abnormal ascending and descending, loss of four-season order, and lingering of pathogenic qi — all these must be removed through needling. The first insertion drives out yang pathogens, the second drives out yin pathogens, and the third sees the arrival of grain qi. When grain qi has arrived, stop. What is meant by "grain qi has arrived": when reinforcing has been applied and the pulse becomes substantive; when reducing has been applied and the pulse becomes deficient — from this one knows grain qi has arrived. When pathogenic qi alone has withdrawn, though yin and yang may not yet be fully harmonized, the disease is moving toward recovery.
When yin is excessive and yang deficient, first reinforce yang, then reduce yin, so as to regulate; when yin is deficient and yang excessive, first reinforce yin, then reduce yang. The pulsations of the three meridians in the region of the great toe must be carefully examined for deficiency and excess. If deficiency is mistakenly treated with reducing, this is called "doubled deficiency," and the disease will worsen. When needling this region, press the pulse with the fingers; if the pulse is moving full and fast, reduce rapidly; if deficient and slow, reinforce; doing the opposite will worsen the condition. As to position, Yangming is above, Jueyin in the middle, Shaoyin below. The back and chest shu points correspond to the diseased sites of chest and back. For deficiency of the shoulder and upper arm, select upper points. For heavy tongue, needling the sublingual vessel uses a lancet needle (pi zhen). When the hand bends but cannot extend, disease is in the sinews; when it extends but cannot bend, disease is in the bones. Disease in bones treat bones; disease in sinews treat sinews.
In reinforcing and reducing, when the pulse is firm, insert deeply, and after withdrawing the needle apply less pressure to the point, allowing pathogenic qi to be expelled as much as possible; when the pulse is deficient, insert shallowly, and after withdrawing the needle press the point quickly, preventing pathogenic qi from entering and nourishing the meridian vessels. When pathogenic qi comes, the pulse is tight and swift; when grain qi comes, the pulse is slow and harmonious. Firm pulse: deep needling to drain pathogenic qi; deficient pulse: shallow needling so that essential qi does not leak out, nourishing the vessels, draining only pathogenic qi. In various pains, the pulse is predominantly firm. Thus the ancients observed: for disease above the waist, the Hand Taiyin and Hand Yangming meridians are the primary treatment; for disease below the waist, the Foot Taiyin and Foot Yangming meridians are primary. For disease above, select points below; for disease below, select points above. For disease in the head, take points on the feet; for disease in the feet, take points in the popliteal fossa. When disease arises in the head, the head feels heavy; in the hand, the arm feels heavy; in the foot, the foot feels heavy. Treatment should first needle the site where the disease arises.
IV. Point Selection Framework and Four-Season Needling Methods
Four-season needling method: In spring qi is in the fine body hair, in summer in the skin, in autumn in the interstitial flesh (fen rou), in winter in the sinews and bones. When treating disease, determine the depth according to the season. Needling obese individuals is like the autumn-winter regimen, that is, deep needling; needling thin individuals is like the spring-summer regimen, that is, shallow needling. Pain belongs to yin; pain that cannot be localized by pressure also belongs to yin — deep needling is appropriate. Disease above belongs to yang, disease below belongs to yin. Itching belongs to yang — shallow needling is appropriate. If disease first arises from yin, treat yin first, then yang; if it first arises from yang, treat yang first, then yin. In heat syncope (jue), retaining the needle can turn heat to cold; in cold syncope, retaining the needle can turn cold to heat. For heat syncope use the method of two yin and one yang; for cold syncope, use the method of two yang and one yin. "Two yin" means needling yin twice; "one yang" means needling yang once. For chronic disease with deep pathogen, needle deeply with prolonged retention, and treat every other day; always first regulate the left and right sides and remove blood stasis from the vessels — then the needling method is complete.
V. Guarding the Spirit and Obtaining Qi
Whoever uses the needle must carefully examine the form and qi. When the flesh and physique are not yet wasted away, but there is diminished qi with an agitated pulse, and agitated syncope, use 缪刺 (miao ci) — crosswise shallow needling — so that scattered qi can be gathered and accumulated qi can be dispersed. The practitioner should dwell in a deep, quiet place, with the spirit single-mindedly focused, as if the ethereal soul (hun) and corporeal soul (po) were not separating; not hearing humance voices, gathering essence qi, and intent with single-minded concentration — fixing the will upon the needle. Needle shallowly with retention, lift lightly and gently, to move the patient's spirit, and stop when qi arrives. With the male staying within and the female without [interpretation: consolidating and guarding in all circumstances], resolutely resist letting [qi] out, carefully guard and do not let [pathogens] in — this constitutes obtaining qi (de qi).
VI. The Twelve Prohibitions Concerning Needling
Prohibitions in needling: Shortly after intercourse, do not needle; right after needling, do not engage in intercourse. When intoxicated, do not needle; after needling, do not drink. In newly arising anger, do not needle; after needling, do not give way to anger. In a state of fresh fatigue, do not needle; after needling, do not overexert. Having just eaten to fullness, do not needle; after needling, do not eat to fullness. Being hungry, do not needle; after needling, do not remain hungry. Being thirsty, do not needle; after needling, do not remain thirsty. After great fright or great anger, one must first calm the qi, and only then may one needle. For those who come riding in a carriage, let them lie down and rest for about the time of one meal before needling. For those who come from a long journey, let them sit and rest for about the time it takes to walk ten li before needling. These twelve prohibitions [these situations] — excessive fear [and others] are times when the pulse is disordered and qi scattered, the camp and defense (ying wei) are in chaos, and the channel qi is not in its proper order; if one forces needling at such times, then yang diseases enter yin and yin diseases emerge into yang, and pathogenic qi regenerates. A crude practitioner who does not understand this "destroys the body"; the physical frame is damaged and wasted, the brain and marrow are consumed, fluids are not transformed, and the refined qi of the five flavors is lost — this is called "losing qi."
VII. Signs of Qi Exhaustion in the Six Meridians
When Taiyang channel qi is exhausted: the eyes look upward, opisthotonos, convulsions, pale complexion; when cold sweat of exhaustion appears, death ensues. When Shaoyang channel qi is exhausted: deafness, generalized relaxation and laxity of the joints, exhaustion of the eye connections (mu xi); death occurs one and a half days after the eye connections fail, with a blue-white complexion. When Yangming channel qi is exhausted: twitching of the mouth and eyes, easy fright, delirious speech, yellowish complexion; when the upper and lower qi become surcharged and do not move, death ensues. When Shaoyin channel qi is exhausted: blackened face, teeth appearing elongated with accumulations, abdominal distension and obstruction, when upper and lower passage fails, death ensues. When Jueyin channel qi is exhausted: heat in the chest, dry throat, frequent urination and vexation of the heart; in severe cases, the tongue curls and the testicles retract upward — death. When Taiyin channel qi is exhausted: abdominal distension and obstruction with difficult breathing, belching, inclination to vomit; vomiting causes qi to rebel upward and the face to redden; without rebellious flow, upper and lower fail to communicate; with blackened complexion and withered fur — death.
The above descriptions of reinforcing and reducing needling methods, point selection, prohibitions, and "qi exhaustion" are writings based on ancient medical understanding and are offered for study and reflection only. Do not attempt to perform these procedures yourself.
This content is based on ancient classics of Chinese medicine. It is provided solely for the study of traditional culture and classic, and does not constitute any medical diagnosis, medication advice, or therapeutic guideline. If unwell, consult a qualified healthcare provider in due course.