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Capítulo 22 de 81
黄帝内经·灵枢
This chapter primarily discusses the manifestations of dianji (epilepsy), kuangbing (mania), as well as fengni (wind reversal), jueni (reversal counterflow), and shaoqi (qi deficiency) / duanqi (shortness of breath), along with the ancient acupuncture treatment approaches. The original text contains some omissions, misplaced bamboo slips, and textual errors; the following is a paraphrase based on common understanding.
The opening passage discusses the names of the eye canthi: the outer corner of the eye extending outward, near the lateral side of the face, is called ruizi (sharp canthus); the corner near the nose is called neizi (inner canthus). This passage is considered by earlier scholars to be misplaced bamboo slips, with little relevance to the theme of "mania/epilepsy."
Early onset of epilepsy: The patient first feels depressed and unhappy, heaviness in the head with pain, eyes gazing upward, and red sclera; after the condition visibly manifests, there is restlessness and anxiety. Ancient physicians observed the complexion of the face and needled the Hand Taiyang, Yangming, and Taiyin channels, stopping only when the color of the bleeding blood changed.
Epileptic seizure — if there is tugging at the corner of the mouth, crying, coughing, wheezing, and palpitations, examine the Hand Yangming and Taiyang channels. If symptoms are severe on the left, needle the right; if severe on the right, needle the left, until the blood changes color. This reflects the ancient Miaoci (opposite-side needling) approach of "treating the right for left-side disorders and the left for right-side disorders."
If during a seizure there is first opisthotonos (arching of the back), body stiffness, followed by back pain, examine the Foot Taiyang, Yangming, Taiyin, and Hand Taiyang channels, and bleed until the blood changes color.
When treating epilepsy, the ancients advised keeping constant watch at the patient's side to observe which areas should be treated. When a seizure occurs, if abnormally engorged blood vessels are seen, use the bloodletting method, and place the blood in a gourd vessel; it was believed that by the next seizure, the blood in the gourd would "throb on its own." If the blood does not move, moxa the qiong bone (sacrum) with twenty moxa cones.
Bone epilepsy (gu dian): The cheeks, teeth, various shu points, and intermuscular spaces are all distended and full, the bones are rigid, there is sweating, and vexation. If there is vomiting of copious frothy saliva and qi leaking downward, the ancients considered the prognosis poor.
Tendon epilepsy (jin dian): The body curls up, the sinews are contracted and tense, the pulse is large — needle the Dazhu point on the major channel of the neck. If there is vomiting of copious frothy saliva and qi leaking downward, the prognosis is poor.
Vessel epilepsy (mai dian): Sudden collapse, the four limb blood vessels are distended and relaxed. If the vessels are full, bleed them all; if the vessels are not full, moxa the Taiyang channels on both sides of the neck, and moxa a point three cun lateral to the Dai channel at the waist, as well as the ben shu points among the intermuscular spaces. If there is vomiting of copious frothy saliva and qi leaking downward, the prognosis is poor.
If dianji (epilepsy) manifests like mania, the ancients considered the condition critical and the prognosis poor.
Early onset of mania: Initially there is sorrow, forgetfulness, irritability, and easy startling, often due to worry and hunger. The ancients needled the Hand Taiyin and Yangming channels until the blood color changed; then took the Foot Taiyin and Yangming channels.
Manic episode: Little sleep, no hunger, self-perceived as noble and worthy, clever and eloquent, high in status, fond of cursing others, day and night without stop. Needle the Hand Yangming, Taiyang, and Taiyin channels, and the sublingual Shaoyin channel. Bleed those vessels that are engorged; do not bleed those that are not.
Mania due to great fright (da kong): Manifested as incoherent speech, easy startling, fondness for laughing, liking to sing, walking around aimlessly without stopping. Needle the Hand Yangming, Taiyang, and Taiyin channels.
Mania due to qi deficiency (shao qi): Manifested as visual hallucinations, auditory hallucinations, and a tendency to shout loudly. Needle the Hand Taiyang, Taiyin, Yangming, Foot Taiyin channels, as well as the head and both cheek areas.
Mania due to great joy (da xi): Manifested as excessive eating, often saying one sees ghosts and spirits, wanting to laugh but not showing it outwardly. First take the Foot Taiyin, Taiyang, and Yangming channels, then the Hand Taiyin, Taiyang, and Yangming channels.
For newly developed mania, where the above typical symptoms have not yet appeared: first take the Ququan point at the bilateral moving vessels; if the vessels are engorged, bleed them. If relief occurs shortly after, stop; if not relieved, then treat with the standard methods, and also moxa the sacrum with twenty moxa cones.
Wind reversal (feng ni): Sudden swelling of the four limbs, the body feeling cold as if drenched by water, frequent chills and shivering, vexation when hungry, and symptoms changing after eating. The ancients took the Hand Taiyin and Hand Yangming (interior-exterior paired channels), as well as the Foot Shaoyin and Yangming channels. If the muscles are cold, needle the ying-spring points; if the bones are cold, needle the jing-well points and jing-river points.
Reversal counterflow (jue ni): The feet suddenly become ice-cold, the chest feels as if it will split open, the intestines feel as if being cut with a knife, vexation with inability to eat, the pulse being rough regardless of size. If the body is warm, take the Foot Shaoyin channel; if the body is cool, take the Foot Yangming channel. For cold patterns use supplementation; for warm patterns use drainage.
Reversal counterflow with abdominal distension and fullness, borborygmus, chest fullness with labored breathing: take the areas below the chest on both sides of the ribs that move upon coughing, as well as the back shu points where pressing brings immediate relief.
Internal blockage (nei bi), urinary retention: Use a long needle on the Foot Shaoyin and Taiyang channels and the area above the sacrum. For qi counterflow, take the Taiyin, Yangming, and Jueyin channels; for severe cases, take the vessels with abnormal throbbing along the Shaoyin and Yangming channels.
Qi deficiency (shao qi): Cold body, shortness of breath with interrupted speech, heavy and aching bones, heavy body, lethargy with no desire to move: supplement the Foot Shaoyin channel.
Shortness of breath (duan qi): Short, disconnected breathing, with qi even more insufficient after activity: supplement the Foot Shaoyin channel, and remove blocked blood collaterals.
The most central academic idea of this chapter is the recognition of dian (epilepsy/depressive-type) and kuang (mania/excited-type) as two categories of emotional-mental disorders.
From the therapeutic perspective, this chapter makes extensive use of bloodletting and moxibustion, with the emphasized principle of "stop when the blood changes color." This reflects the ancients' understanding that "rebellion and chaos of blood and qi" is the core pathogenesis of dian and kuang — by draining the congested blood, the qi and blood are restored to harmony. At the same time, the repeated observation that "vomiting copious frothy saliva and qi leaking downward indicates poor prognosis" shows that the ancients had already noted that mental disorders accompanied by qi collapse and fluid leakage suggest a severe condition.
The "dianji" and "kuangbing" described in this chapter share certain similarities with manifestations in modern psychiatry, such as depression, mania, and schizophrenia-like presentations, but they cannot be simply equated. The ancients' explanation of mental abnormalities from the perspectives of channels, qi-blood, and emotions holds historical value; the bloodletting, moxibustion, and other techniques belong to ancient medical practices whose efficacy and mechanisms require further validation through modern research, and they cannot replace the standardized diagnosis and treatment of modern psychiatry.
Judgments such as "not treatable" or "death" reflect the level of clinical observation and care at the time, and should not be applied literally today. Modern medicine has far more systematic assessment methods and comprehensive intervention approaches for mental disorders.
Some general life lessons may be drawn from this chapter:
Related Concepts
Further Reading
Bu Gua Note: This content is based on classic texts of traditional Chinese medicine and is provided solely for the study and reading of traditional culture. It does not constitute any medical diagnosis, medication, or treatment advice. If you feel unwell, please seek medical attention promptly.