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Capítulo 26 de 81
黄帝内经·灵枢
Commentary by Bǔ Guā (卜瓜): In its transmission, this chapter's original text contains several textual errors, e.g., "足少朋" (zú shǎo péng) and "足少阻" (zú shǎo zǔ) should be "足少阴" (zú shào yīn, Foot Shaoyin), "颇痛" (pō tòng) should be "颊痛" (jiá tòng, cheek pain), "吵" (chǎo) should be "哕" (yuě, hiccup), and "疲厥为四米束挽" (pí jué wèi sì mǐ shù wǎn) should be "痿厥为四末束悗" (wěi jué wèi sì mò shù mán, wilting reversal with bound-up discomfort in the four extremities). The following is a free translation based on the current standard edition. The content involves classical acupuncture, bloodletting, etc.; it is provided solely for textual research and theoretical explanation, and does not constitute modern therapeutic advice.
Jué disorders (a category of diseases involving reversed or chaotic qì flow): Pain running along both sides of the spine, rising up to the crown of the head. The head feels heavy and clouded, vision is blurred, and the lower back and spine are stiff. The ancients held that one should select the Foot Tàiyáng Bladder Channel (the channel running along the back, head and neck, and posterior aspect of the lower limbs), specifically the blood collaterals (superficially visible small vessels) in the National Center* (also translated as "popliteal fossa", the hollow behind the knee) for bloodletting. [Note: Since "腘中" refers to "the middle of the popliteal fossa" and "National Center" is likely an erroneous interpretation, we will use "popliteal fossa" or "behind the knee".]
Jué disorders manifesting with a feeling of fullness and oppression in the chest, facial edema, swelling of the lips, sudden difficulty in speaking, or even loss of speech: select the Foot Yángmíng Stomach Channel (the channel running along the face, chest and abdomen, and anterior aspect of the lower limbs).
Reversed qì rushing upward to the throat, causing inability to speak, cold hands and feet, and difficult bowel movements: select the Foot Shàoyīn Kidney Channel (the channel running along the posterior border of the medial aspect of the lower limb, connecting upward to the throat).
Jué disorder with a gurgling sound in the abdomen, a subjective feeling of significant cold, audible fluid sounds in the abdomen, and difficulty with urination and defecation: select the Foot Tàiyīn Spleen Channel (the channel running along the abdomen and the anterior border of the medial aspect of the lower limbs).
Dry throat, a hot sensation in the mouth with sticky saliva like glue: select the Foot Shàoyīn Kidney Channel.
Knee pain: select the Dúbí point (ST-35, the "Nose of the Calf," lateral knee eye, in the depression lateral to the patellar ligament). Use the Yuánlì zhēn (round-sharp needle, one of the Nine Needles, with a round and sharp body). After needling, wait for a certain interval and needle again. The needle is thin like a long hair and can be inserted into the knee area.
Hóu bì (throat obstruction, a condition with swelling and pain of the throat causing occlusion): If the patient cannot speak, select the Foot Yángmíng Stomach Channel. If the patient can speak, select the Hand Yángmíng Large Intestine Channel (the channel running along the anterior border of the lateral aspect of the upper limb, ascending to the face and mouth).
In malaria, if there is no thirst and it occurs every other day, select the Foot Yángmíng Stomach Channel. If there is thirst and it occurs daily, select the Hand Yángmíng Large Intestine Channel.
Toothache: If the patient is not averse to cold drinks, select the Foot Yángmíng Stomach Channel. If the patient is averse to cold drinks, select the Hand Yángmíng Large Intestine Channel.
Deafness without pain: select the Foot Shàoyáng Gallbladder Channel (the channel running along the side of the head, the hypochondriac region, and the lateral aspect of the lower limbs). Deafness with pain: select the Hand Yángmíng Large Intestine Channel.
Persistent nosebleed (epistaxis) with discharge of stale blood: select the Foot Tàiyáng Bladder Channel. If it is from stale blood, select the Hand Tàiyáng Small Intestine Channel (the channel running along the posterior border of the lateral aspect of the upper limb and the scapular region). If bleeding persists, needle below the wrist bone (near the Wǎngǔ point). If it still does not stop, needle the popliteal fossa to let blood.
Low back pain: If the painful area is cold, select the Foot Tàiyáng Bladder Channel and the Foot Yángmíng Stomach Channel. If the painful area is hot, select the Foot Juéyīn Liver Channel (the channel running along the medial aspect of the lower limb and the lower abdomen). If the patient cannot bend or extend (forward or backward), select the Foot Shàoyáng Gallbladder Channel. If there is internal heat with wheezing, select the Foot Shàoyīn Kidney Channel and the blood collaterals in the popliteal fossa.
If a person is prone to anger, has no desire to eat, and their speech becomes faint and weak with a low voice: needle the Foot Tàiyīn Spleen Channel. If a person is prone to anger and talks excessively: needle the Foot Shàoyáng Gallbladder Channel.
Cheek pain (jiá tòng): needle the Hand Yángmíng Large Intestine Channel and let blood from the engorged blood vessels on the cheek.
Neck pain with inability to bend forward or extend backward: needle the Foot Tàiyáng Bladder Channel. If the patient cannot turn the head to look behind: needle the Hand Tàiyáng Small Intestine Channel.
Lower abdominal distension and fullness, with qì rushing upward to the stomach and to the heart, the body occasionally having mild chills and fever, and difficult urination: select the Foot Juéyīn Liver Channel.
Abdominal distension, difficult bowel movements, abdominal enlargement, with qì also rushing upward to the chest and throat, causing wheezing and audible sounds: select the Foot Shàoyīn Kidney Channel.
Abdominal distension, indigestion of food, gurgling sounds in the abdomen, and inability to defecate: select the Foot Tàiyīn Spleen Channel.
Heart pain (cardiac region pain) involving the lower back and spine, with a desire to vomit: select the Foot Shàoyīn Kidney Channel. Heart pain, abdominal distension, aversion to cold with shivering and contraction, and difficult bowels: select the Foot Tàiyīn Spleen Channel. Heart pain involving the back, with difficulty breathing: needle the Foot Shàoyīn Kidney Channel. If ineffective, select the Hand Shàoyáng Sanjiao (Triple Burner) Channel (the channel running along the midline of the lateral aspect of the upper limb).
Heart pain involving lower abdominal distension and fullness, with the pain moving and shifting its location up and down, and difficulty with urination and defecation: needle the Foot Juéyīn Liver Channel. Heart pain characterized only by shortness of breath, as if breathing is insufficient: needle the Hand Tàiyīn Lung Channel (the channel running along the chest and the anterior border of the medial aspect of the upper limb). For heart pain, one may needle at the ninth vertebra (segment). After needling, press and hold; this can bring immediate relief. If not effective, search for a reactive point above and below, needling it, and upon finding it, relief is obtained.
Cheek pain: needle the artery in the flexure of the cheek on the Foot Yángmíng Stomach Channel, let blood, and this gives immediate relief. If not effective, press on the qì at the Rényíng point (ST-9, in the vicinity of the carotid pulse), which can give immediate relief.
Reversed qì rushing upward: needle the depression of the chest (sternal region) and the artery below the chest.
Abdominal pain: needle the arteries on either side of the navel. After needling, press and hold; this brings immediate relief. If not effective, needle the Qìjiē point (ST-30, in the inguinal region, also known as Qìchōng). Press and hold after needling; this gives immediate relief.
Patients with wěi jué (wilting/reversal; fatigue and weakness of the limbs with cold extremities): If the limbs are bound and this causes tingling, numbness, and a sense of stuffy discomfort**, promptly untie the binding**/constraint. Do this twice daily. If the limbs are numb and lack sensation, about ten days are needed for sensation to return. Do not discontinue the treatment/intervention; stop only when the condition is cured.
For yuě (hiccups, hiccough), use a grass stalk to stimulate the nostrils. After inducing a sneeze, the hiccup can stop. Quickly guiding the qì while holding the breath (i.e., breath-holding with focused intention) can also stop it immediately. A sudden startle or fright can also bring about cessation.
This chapter of the Líng Shū is a centralized record of the methods of differentiating channels for selecting treatment strategies in "mixed diseases" (zá bìng). The core point is not a formula per se, but rather the principle of "the same disease treated via different channels based on syndrome differentiation."
Same symptom, carefully discern the difference, then choose the channel. For example, toothache is distinguished by "whether cold drinks are aversive" to determine whether to select the Foot Yángmíng or Hand Yángmíng. Hóu bì is differentiated by "ability or inability to speak". Deafness is differentiated by "presence or absence of pain" to select Foot Shàoyáng or Hand Yángmíng. This reveals that the ancients recognized that behind the same superficial symptom, the disease location or nature can differ significantly, requiring the appropriate channel for regulation.
Equal emphasis on following the channel pathways and selecting local reactive points. Many entries follow the pattern "the disease is in a certain area, select the corresponding channel," e.g., head, neck, lower back, and back conditions often involve Foot Tàiyáng; chest, abdomen, face, and mouth conditions often involve Yángmíng; throat and lower abdomen conditions often involve Shàoyīn and Juéyīn. Simultaneously, there are also "blood collaterals," "arteries," "around the navel," and other local reactive signals where bloodletting or needling is applied. This shows acupuncture did not rely solely on fixed acupoints but also prioritized superficial reactive vessels (like varicosities) and pulsatile sites.
Thought behind "wǎn chén zé chú zhī” (Removing stasis is a therapeutic principle for stagnation): the thought of bloodletting. Several entries, including jué disorders, low back pain, cheek pain, and abdominal pain, repeatedly mention letting blood from "blood collaterals" or "arteries." This represents creating an outlet for locally congested qì and blood by giving it [relief]. The ancients posited that many pain disorders and jué syndromes originate from reversed qi disorders [meaning literally chaotic movement of qì], which can result from stasis/blockage. Bloodletting can dredge the stagnation.
Simple external treatments and emotional appreciation for qi flow normalization. The last (adjacent entry closes with …) speaks to conducting breath-holding treatment. Here, certain extremely old, essential, extraordinary — arguably simpler [interventions: grass-stalk nasal stimulation to induce a sneeze, holding breath/ventral breathing, and employing surprise) reflect at once primitiveness and simple resonance with basic neurophysiological observations that humans feel the reflex and an emotional “movement” — all have acted on correcting certain output disturbances.
Note: Some principles represent parallel forms include when suspicion of herpetic-related, cardiogenic involves potential management.
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