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Capítulo 19 de 81
黄帝内经·灵枢
The Yellow Emperor asked Qi Bo: The Qi of the four seasons each manifests differently, and the occurrence of various diseases all have their roots. What exactly should be the standard for moxibustion and acupuncture? Qi Bo replied: The qi of the four seasons each has its own location. The fundamental principle of moxibustion and needling lies in accurately locating the corresponding Qi points (acupoints where channel qi enters and exits).
Warm malaria with fever but no sweating: needle fifty-nine acupoints for heat diseases. Wind-edema with skin swelling: needle fifty-seven acupoints for water diseases, and prick the superficial blood collaterals of the skin to drain stagnant blood as much as possible. Sunsie (diarrhea with undigested food): supplement the upper acupoints of the three yin channels and Yinlingquan, retaining needles for a long time until warmth arrives at the affected area. Zhuangjin (muscle cramps): treat the yang aspect if it occurs on the yang side, treat the yin aspect if it occurs on the yin side, using rapid needling.
Tu-shui (simple water disease with edema as the main symptom): first, at "three cuns below Huanghuan," insert with a Pi needle (an ancient needle instrument), then insert a cylindrical needle to repeatedly draw out water until fully drained; if drainage is slow, the patient may feel agitated, while smooth drainage brings calmness. Then bind the area tightly, needle every other day until the water is completely eliminated. Simultaneously administer medications that unblock and drain water; during needling, only medication may be taken, and medication should not be taken with food, nor food with medication, and avoid inappropriate foods for one hundred and thirty-five days.
Zhu-bi (bi syndrome with predominant dampness and heavy numbness) that persists without healing, or prolonged unrelenting cold: urgently needle Zusanli. Intestinal dysfunction also points to Zusanli, with reduction for excess and supplementation for deficiency. Li-feng (leprosy-type conditions): needle the swollen area, then press with a sharp needle to expel the noxious qi, stopping when the swelling subsides; eat only suitable foods and avoid mixed foods.
Large intestine disease: frequent rumbling in the abdomen, qi rushing upward to the chest, panting, inability to stand for long—pathogenic qi in the large intestine—needle the Origin of Huang (approximately Qihai area), Shangjuxu, and Zusanli.
Small intestine disease: lower abdomen pulling the testicles, involving the lower back and spine, rushing upward to the heart—pathogenic qi in the small intestine—because the small intestine connects with the testicles, links to the spine, penetrates the liver and lungs, and networks with the heart system; when qi is excessive, it counterflows upward to the stomach and intestines, fumigating the liver, dispersing into the huang membranes, and accumulating around the navel. Therefore, select the Origin of Huang to disperse pathogenic qi, needle the Taiyin channel for assistance, select the Jueyin channel to descend counterflow, and select Xiajuxu to eliminate small intestine pathogenic qi; then harmonize according to the channels traversed.
Gallbladder disease: frequent vomiting of bitter water, sighing often, fearful unease as if someone is about to arrest the patient—pathogenic qi in the gallbladder, with stomach qi counterflowing upward. Gallbladder fluid leaking outward causes bitter taste in the mouth; stomach qi counterflowing upward causes bitter vomiting; hence called "vomiting of bile." Select Zusanli to descend stomach qi, needle the shaoyang channel blood collaterals to stop gallbladder counterflow, then regulate deficiency and excess to expel pathogenic factors.
Stomach duct disease: inability to swallow food, blockage in the chest and diaphragm—pathogenic qi in the stomach duct. Needle above the upper duct to suppress counterflow qi and below the lower duct to disperse pathogenic factors.
Sanjiao disease: lower abdominal distension, pain, and swelling with difficult urination—pathogenic qi causing Sanjiao constraint and dysfunction. Select the great collateral of the Foot Taiyang channel, observe the shaoyin small collateral stasis and prick to bleed; if swelling extends to the stomach duct, add Zusanli.
Diagnosis and prognosis: Observing the complexion and demeanor of the eyes reveals the dissipation or recovery of righteous qi; examining eye color determines the presence or subsidence of disease. Observe the patient's movement and stillness, and palpate the Qikou and Renyang pulses. If the pulse is firm, large, and slippery, the disease is worsening; if the pulse is soft, the disease is retreating; patterns with excess fullness in the channels are likely to resolve in about three days. Qikou assesses yin; Renyang assesses yang.
"Locating the Qi points accurately is the foundation" is key for four-season needling.
This chapter links the qi of the four seasons with the distribution of channel qi and blood in the body: spring selects channels/flesh, summer selects collaterals, autumn selects Jing and Shu points, winter selects Jing and Ying points. This indicates that the ancients did not subscribe to a fixed point for each disease; rather, they emphasized that treatment must align with the depth of seasonal qi and the state of the inner organs.
"He points manage the Fu organs"—the point selection methodology.
For many six-fu diseases (large intestine, small intestine, stomach, gallbladder, and sanjiao), the He points or lower He points like Zusanli, Shangjuxu, and Xiajuxu are selected. This embodies the consistent principle of "He manages the Fu organs" in the Ling Shu—Fu disorders are often treated via the stomach channel and corresponding lower He points.
Supplementing deficiency and reducing excess run throughout.
As stated, "for intestinal discomfort, select Zusanli—reduce for excess, supplement for deficiency"—explicitly showing that the same point can be treated with either technique depending on deficiency or excess. This is the core philosophy of "seeking balance" in acupuncture.
Integrating channel syndrome differentiation with organ localization.
Small intestine disease involves the testicles, lumbar spine, and heart sensations; gallbladder disease manifests as bitter taste and efflux of bile; sanjiao disease presents with lower abdominal swelling and urinary difficulty. The ancients classified symptoms to channels and organs, then selected points along those pathways.
Integrated diagnosis of complexion, eyes, and pulses predicts outcome.
The end of this chapter integrates changes in facial color, eye color, and Qikou-Renyang pulse status as the basis for assessing pathological progression or retreat, embodying the holistic diagnostic view that "internal conditions manifest externally."
This content is grounded in classical Chinese medicine texts and is offered purely for cultural and educational research, not as any format for health, medicine-practice, treatment instruction; actual demands on feeling infirm demand supplementary investigation on venue. — 卜瓜