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Capítulo 53 de 81
黄帝内经·灵枢
Overall Paraphrase
The Yellow Emperor asked Shao Yu: People differ in the strength of their sinews and bones, the firmness or looseness of their muscles, the thickness or thinness of their skin, and the density or sparseness of their cou li (the textural interstices of skin and muscles). How do these differences affect their tolerance of pain from acupuncture, stone needling, and fire cautery (heat therapies such as fire needles and moxibustion)? The thickness or thinness, firmness or fragility of the stomach and intestines also vary among people—how do these affect tolerance of medicinals? I wish to understand this in detail.
Shao Yu replied: Those with strong bones, supple sinews, relaxed muscles, and thick skin are relatively able to tolerate pain, and they can equally tolerate the pain of acupuncture and stone needling as well as the scorching heat of fire cautery.
The Yellow Emperor asked: How does one determine who can tolerate fire cautery? Shao Yu replied: If, in addition, the person has dark skin and well-proportioned beautiful bones, such a person can tolerate fire cautery. The Yellow Emperor asked: How does one determine who cannot tolerate the pain of needling and stone therapy? Shao Yu replied: Those with firm muscles but thin skin cannot tolerate the pain of needling and stone therapy, and they are equally intolerant of fire cautery.
The Yellow Emperor asked further: When people fall ill, some are harmed by pathogenic influences at the same time, yet some recover easily while others recover with difficulty. What is the reason for this? Shao Yu replied: When struck by the same pathogenic influence, those whose bodies tend toward heat recover easily, while those whose bodies tend toward cold recover with more difficulty.
The Yellow Emperor asked again: How does one determine a person's tolerance for medicinals (which in ancient times were referred to as "poison medicinals" when their potency was strong)? Shao Yu replied: Those with a thick stomach wall, dark skin, large bone structure, and a corpulent build are generally able to tolerate medicinals; whereas those who are thin and emaciated, with a thin stomach wall, are mostly unable to tolerate medicinals.
Note: In the original text, "股理" ("thigh texture") should be "腠理" ("interstices"), and "火炮/火焰" ("fire cannon/flame") appears to be a variant of "火焫" ("fire cautery"). The translation follows standard medical principles accordingly.
This chapter establishes the correspondence between constitution and tolerance of pain, heat, and medicinals, with the core idea that "physical form determines tolerance." Traditional Chinese medicine holds that the skin, flesh, sinews, bones, and the thickness or thinness of the viscera are determined by the nourishment of qi and blood: those who are thick, relaxed, and moist have abundant qi and blood and strong tolerance; those who are thin and tense have somewhat obstructed qi and blood and are more sensitive to pain. 🔥
Regarding disease prognosis, the text states that "those whose bodies tend toward heat recover easily, while those who tend toward cold recover with difficulty," reflecting the relationship between the prosperity or decline of yang qi and the ability to recover—when yang qi is abundant, qi and blood move forcefully, and pathogenic influences disperse easily; when yang qi is insufficient, cold congeals and qi stagnates, and illness tends to linger. 💨
Regarding tolerance of medicinals, the emphasis on whether the stomach qi is substantial reflects the principle that "where there is stomach qi, there is life." Those with a thick stomach can receive and transform the partiality of medicinals, while those with a thin stomach cannot tolerate their force. 🌿
Modern medicine also acknowledges that pain thresholds vary among individuals, related to multiple factors including genetics, sex, age, psychology, neural sensitivity, skin structure, and subcutaneous tissue. However, the original text's use of external features such as "strong bones, supple sinews, relaxed muscles, thick skin" and "dark skin with beautiful bones" to determine tolerance of pain and heat is empirical generalization, lacking rigorous evidence-based basis, and should not be used as a modern clinical standard.
"Those whose bodies tend toward heat recover easily, while those who tend toward cold recover with difficulty" may partially correspond to the body's metabolic and immune status: appropriate fever is often a sign of active immune response, but not all fever is beneficial. The "cold and heat" mentioned by the ancients are concepts of yin-yang excess and deficiency and should not be simply equated with modern body temperature.
Regarding tolerance of medicinals, body weight, body fat, and gastrointestinal function do indeed affect drug distribution and metabolism in the body, but judgments based on "thick stomach," "dark skin," or "large bones" are too crude. Modern medication requires individualized assessment and cannot be determined solely by body type or skin color. 🩺
This content is based on classical Chinese medicine texts and is provided for traditional cultural study and research only. It does not constitute any medical diagnosis, medication, or treatment advice; please consult a physician promptly if you feel unwell.