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Capítulo 20 de 81
黄帝内经·灵枢
Overall Paraphrase
This chapter of Lingshu·Five Evils mainly discusses the symptoms that appear after evil qi侵入 the five viscera, as well as the corresponding acupuncture treatment approaches of the ancients.
🌬️ Evil in the Lungs: Causes skin pain, aversion to cold with fever, reversed qi with wheezing, sweating, and coughing that pulls on the shoulders and back. The ancients' point-selection approach was: around the Shu points on the lateral chest and the corresponding Shu points beside the third thoracic vertebra, press quickly with the hand, and when finding the place where the patient feels soreness anddistension with comfort, needle there; then select Quepen point (supraclavicular fossa) to disperse the evil qi in the lungs.
🌿 Evil in the Liver: Causes pain in both flanks, cold in the middle burner, stagnant blood remaining in the body, easy cramping of the joints when walking, and occasional foot swelling. The ancients' treatment approach was: select Xingjian point (between the first and second toes on the dorsum of the foot) to soothe the qi mechanism beneath the flanks; needle Zusanli (anterolateral lower leg) with supplementation to warm and nourish the stomach; prick the superficial collateral vessels to disperse stagnant blood; and take the greenish collateral vessels around the ear to relieve cramping.
🍚 Evil in the Spleen and Stomach: Causes muscle pain. If yang qi (warming and promoting function) is excessive and yin qi (moistening and stabilizing material foundation) is deficient, then there is heat in the stomach with easy hunger; if yang qi is insufficient and yin qi is excessive, then there is cold in the middle burner with intestinal rumbling and abdominal pain; if both yin and yang are in excess or both are insufficient, then mixed cold and heat patterns appear. In all these cases, the ancients regulated through Zusanli.
🌊 Evil in the Kidneys: Causes bone pain and yin bi (yin-type impediment). In so-called yin bi, pressing does not reveal a clear pain location, and it manifests as abdominal distension, low back pain, difficult defecation, pain in the shoulders, back, neck and nape, and frequent dizziness. The ancients selected Yongquan point (sole of the foot) and Kunlun point (posterior to the lateral malleolus); if congested collateral vessels were seen, they bled them.
🔥 Evil in the Heart: Causes pain in the chest and heart, easy sadness, and occasional dizziness with falling. The ancients regulated the corresponding Shu point of the heart meridian according to the deficient or excess state.
Note: The character "偷" in the phrase "膺中外偷" in the original text was likely "俞/腧" (Shu point) as a result of scribal transmission; individual textual emendations belong to textual history and do not affect the understanding of the overall medical principles.
This chapter centrally embodies the viscera-as-outline approach to classifying disease patterns. Traditional Chinese medicine holds that the five viscera correspond to the physical body, sense organs, and emotions: the lungs govern the skin and qi, so when the lungs are attacked by evil, skin pain, cough, and wheezing appear; the liver governs the sinews and stores blood, so when the liver is attacked, flank pain and limb cramping appear; the spleen governs the muscles and transportation and transformation, so when the spleen and stomach are attacked, muscle pain and cold-heat imbalance appear; the kidneys govern the bones and the two excretions, so when the kidneys are attacked, bone pain and difficult defecation appear; the heart governs the blood vessels and the spirit, so when the heart is attacked, heart pain, sadness, and dizziness appear.
Another core principle is "press quickly with the hand; when there is comfort, then needle". This reflects that early acupuncture was not solely dependent on fixed points, but rather involved pressing over relevant regions to find "sensitive points" where the patient felt comfort, soreness, or distension, and then needling. This approach later developed into the ashi point and the method of "palpating points".
Additionally, this chapter emphasizes regulating the Shu points and observing excess and insufficiency, indicating that differentiation of deficiency and excess must precede needling, embodying the basic therapeutic principle of "supplement for deficiency, drain for excess".
From a modern medical perspective, the symptom observations in this chapter have a certain degree of reasonableness. For example, pulmonary diseases can indeed cause cough, wheezing, and referred shoulder-back discomfort; liver diseases or emotional disturbances can manifest as flank discomfort; visceral diseases sometimes produce referred pain or tenderness in specific body surface regions. This indicates that the ancients early on noticed the viscera-body surface association phenomenon.
However, this must be viewed objectively: the "five viscera" here do not completely correspond to the anatomical organs of modern medicine, but rather represent functional systems. Although modern research on acupuncture and bloodletting suggests possible mechanisms through neural, endocrine, and local blood flow pathways, the quality and reproducibility of the evidence remain limited. Especially symptoms like "heart pain" or "difficult defecation with severe abdominal pain", in a modern context, may represent acute and critical conditions that require immediate medical diagnosis, and ancient acupuncture methods cannot replace modern care.
This chapter offers general lifestyle insights rather than treatment protocols:
These all fall under general principles of daily living and emotional regulation, and do not target any specific disease.
Bugu Note: This content is based on classical Chinese medicine texts and is provided solely for the study and research of traditional culture. It does not constitute any medical diagnosis, medication advice, or treatment recommendation. If you feel unwell, please seek medical attention promptly.