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Capítulo 24 de 81
黄帝内经·灵枢
Overall Paraphrase
This chapter primarily discusses Jue diseases — headaches, heart pain, and related conditions of the ears and lower limbs caused by reversed and chaotic qi flow rushing upward to disturb the orifices. The following is a translation based on the standard edition of Lingshu · Jue Disease, with minor corrections of a few obvious textual errors.
Jue headache (headache caused by reversed qi flow rushing upward to the head): If it manifests with facial swelling and restlessness, the ancients would select points on the Foot-Yangming Stomach Meridian and the Foot-Taiyin Spleen Meridian. When Jue headache is accompanied by throbbing pain in the head vessels, a sad emotional state with a tendency to weep easily, and visibly engorged and protruding temporal arteries, one should first perform bloodletting at the collaterals, then regulate the Foot-Jueyin Liver Meridian. When Jue headache manifests as a heavy head with severe pain, use the draining method on the five pathways of the scalp vertex, taking five points from each pathway. First select the Hand-Shaoyin Heart Meridian, then the Foot-Shaoyin Kidney Meridian. When Jue headache is accompanied by forgetfulness and palpation reveals no obvious tender point, take the arteries on the left and right sides of the face and head, then select the Foot-Taiyin Spleen Meridian. When Jue headache begins with neck pain that subsequently extends to lower back and spine pain, first select the Tianzhu point (BL10), then the Foot-Taiyang Bladder Meridian. When Jue headache is severe, with the vessels in front of and behind the ears throbbing and feeling hot, bloodletting at the collaterals can be performed, followed by selecting the Foot-Shaoyang Gallbladder Meridian.
True headache: The headache is extreme, with the entire brain in pain, and the hands and feet are cold all the way to the elbows and knees. The ancients considered this an incurable condition. Some headaches should not be treated by conventional distal point selection: those caused by falls and impacts, where static blood has accumulated in the body, or where muscle tissue has been injured and the pain has not yet ceased — these may be treated with local needling, but distal points should not be selected. Some headaches cannot be needled: severe bi-impediment conditions that manifest daily may be slightly alleviated but are difficult to cure completely. For cold pain on one side of the head, first select the Hand-Shaoyang Sanjiao Meridian and the Hand-Yangming Large Intestine Meridian, then the Foot-Shaoyang Gallbladder Meridian and the Foot-Yangming Stomach Meridian.
Jue heart pain (heart pain caused by reversed qi flow rushing upward to the chest): When heart pain is mutually pulling with the back, with easy twitching, as if something is touching the heart from behind the back, and the body curls up and hunches over, this is Kidney heart pain. First select Jinggu (BL64) and Kunlun (BL60); if the pain does not stop after needling, then select Rangu (KI2). When Jue heart pain manifests as abdominal distension and chest fullness, with even greater pain at the heart region, this is Stomach heart pain. Select Dadu (SP2) and Taibai (SP3). When Jue heart pain feels like being stabbed by an awl through the heart, with extremely intense heart pain, this is Spleen heart pain. Select Rangu (KI2) and Taixi (KI3). When Jue heart pain presents with a grayish-blue complexion like dead ashes, and the person cannot take a deep breath all day long, this is Liver heart pain. Select Xingjian (LR2) and Taichong (LR3). When Jue heart pain is relieved when lying down or resting, aggravated by activity, with no change in complexion, this is Lung heart pain. Select Yuji (LU10) and Taiyuan (LU9).
True heart pain: The hands and feet turn cold and cyanotic reaching the elbows and knees, with severe heart pain. If it occurs in the morning, death may follow by evening; if it occurs in the evening, death may follow the next morning. Heart pain that cannot be needled: when there are firm accumulations inside the body, acupuncture points should not be selected. When there are worm masses and roundworms in the intestines, treatment with fine needles is not appropriate. When there is heart and abdominal pain with mental disturbance and episodic attacks, with lumps that gather and rise, moving up and down, pain that comes and goes, abdominal heat, thirst, and drooling — this is caused by roundworms. The ancients described pressing with the hand and securing firmly, not allowing movement, then inserting a large needle, retaining it for a long time, and only withdrawing the needle once the worms no longer move. There is another fragmentary sentence "意腹铁痛，形中上者" which, due to textual corruption and difficulties in interpretation, is not force-translated here.
Ear disorders: For deafness with inability to hear sounds, take points inside the ear; for tinnitus, take points at the artery in front of the ear. Ear pain that should not be needled: when there is pus in the ear, or dry cerumen (earwax) blocking the ear canal, causing deafness. For deafness, take the well points at the junction of the nail corners and flesh of the small fingers of both hands and feet; first take the hand points, then the foot points. For tinnitus, take the points on the nail corners of the middle fingers of both hands and feet; for left-side disorders, take the right side, and for right-side disorders, take the left side; first take the hand points, then the foot points. When the thigh cannot be lifted, position the patient in a side-lying posture and needle at the pivotal joint space of the hip using the Yuanli needle — a large needle is not appropriate. For passage of blood in the stool, take the Ququan point (LR8).
Wind-bi with dampness infiltration that is difficult to cure presents with feet feeling as if treading on ice, and at times as if stepping into hot water; the thighs and calves feel sore and weak as if soaked in water; with heart vexation and headache, occasional vomiting, occasional restlessness, dizziness followed by sweating; over time, the eyes become dim and blurred; with sadness and frequent fear, shortness of breath and lack of joy — the ancients believed death would occur within three years.
Meridian-based differentiation and point selection along the affected channel
The chapter's discussion of Jue headache and Jue heart pain centers on determining, based on pain location, accompanying manifestations, and superficial body reactions, which meridian and organ the condition belongs to, and then selecting points along the corresponding meridian. For example, Jue headache with facial swelling and restlessness points to the Foot-Yangming and Foot-Taiyin; heart pain pulling to the back with a hunched posture points to the Kidney meridian. This reflects Lingshu's meridian-centered approach to pattern differentiation.
Differentiating "Jue" from "True" conditions, emphasizing depth of disease location
"Jue headache" and "Jue heart pain" belong to reversed qi flow — though painful, they can still be treated by regulating the meridians. "True headache" and "True heart pain," by contrast, are critical conditions where pathogenic factors directly invade the brain marrow or the heart itself; the ancients explicitly said these are "incurable." This demonstrates that the ancients already recognized a crucial distinction: whether the disease is located in the meridians or in the organs — functional or organic — dramatically affects the prognosis.
Bloodletting for excess conditions — "drain what is in excess"
When observing engorged temporal arteries or throbbing hot vessels in front of and behind the ears, the ancients employed bloodletting at the collaterals to drain excess heat and static blood. This represents a draining approach targeting the state of "qi and blood stagnation" and embodies the treatment principles of "excess is drained" and "stagnant accumulations are removed."
Emphasis on contraindications and local treatment
In conditions such as static blood accumulation, internal masses, worm accumulations, ear pus, or impacted cerumen, blind distal point selection or fine needle use is contraindicated. Especially for worm accumulations in the intestines and ear conditions with pus or impacted earwax, the ancients recognized these as tangible pathogenic factors requiring local identification and careful management. This reflects the ancients' discerning distinction between "tangible pathogens" and "intangible reversed qi."
Contralateral needling and the order of upper-lower, hand-foot sequencing
For tinnitus, "for left-side disorders take the right side, and for right-side disorders take the left side" — this belongs to the contralateral needling (Miu Ci) method. For deafness and tinnitus, the emphasis on "first take the hand, then take the foot" reveals a systematic understanding of left-right crossing and distal correspondence in operation sequence.
The classification of headaches and heart pain in this chapter reflects the accumulated empirical observations of classical clinical practice. The meridian attributions tied to different accompanying symptoms are, to some extent, compatible with modern distinctions among migraine, tension-type headache, vascular headache, cervicogenic headache, as well as angina pectoris and gastroesophageal reflux-related chest pain. However, it must be noted that the ancient "Jue heart pain" and "True heart pain" cannot be simply equated with modern medical disease names — particularly, "Kidney heart pain" and "Stomach heart pain" should not be used as substitutes for modern diagnoses.
The descriptions of "True headache" of "True heart pain" — severe headache, pain throughout the entire body, hands and feet cold to the elbows and knees, or severe chest pain with cold extremities and death within a short time — bear resemblance to critical presentations such as acute intracranial conditions and myocardial infarction. The ancients' statement of "incurable death" was based on the limited treatment capacity of their era; today, this should not be interpreted as abandoning treatment but rather as an early warning for critical signals.
Bloodletting at collaterals, contralateral needling, and other acupuncture methods are suggested by modern research to possibly relate to local microcirculation, neural reflexes, and pain modulation, but their precise mechanisms and efficacy still require more evidentiary support. In particular, procedures described in the original text such as "insert a large needle, hold it for a long time, and withdraw the needle only when the worms no longer move" represent the ancients' rudimentary approach to treating abdominal pain from worm accumulation — modern practice must not adopt this literally.
For deafness and tinnitus due to ear pus or impacted cerumen, the ancients had already recognized that careless needling was inappropriate — a simple yet correct observation. Modern medicine can address these issues definitively through otological examination, cleaning, and antimicrobial treatment.
Related Concepts:
Further Reading:
This content is based on classical Chinese medicine texts and is provided solely for traditional cultural study and research. It does not constitute any medical diagnosis, medication, or treatment advice; if unwell, please seek medical attention promptly.