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Capítulo 67 de 81
黄帝内经·灵枢
Overall Paraphrase
Huangdi asked Qibo: I have heard your teachings on the nine needles (nine kinds of ancient acupuncture needles) and applied them to the people, finding that each person's blood and qi patterns differ. After needling, there are six different kinds of responses: some people's spirit moves first, and qi already travels ahead of the needle; some people's qi responds simultaneously with the needle; some people's qi travels alone only after the needle is withdrawn; some people need multiple needlings before they feel anything; some people experience qi counterflow (adverse qi rising) as soon as the needle is inserted; some people's condition worsens after multiple needlings. These six situations manifest differently—I would like to hear the reasoning behind them.
Qibo replied: For chongyang persons (those with particularly exuberant yang qi), the spirit is easily stirred, and qi is also easily drawn forth to move ahead.
Huangdi asked: What is meant by a chongyang person? Qibo said: A chongyang person has blazing yang qi that spreads outward 🔥. They speak quickly, lift their feet high, and their heart and lung organ qi (the functional qi stored within the viscera) is abundant. Yang qi is smooth, vigorous, and expressive, so as soon as the spirit is stirred, qi moves ahead.
Huangdi asked: Among those who are also chongyang persons, some do not have their spirit move ahead—why is that? Qibo said: Such people also carry a considerable portion of yin qi (the type of function that inhibits and settles).
Huangdi asked: How do we know they also harbor yin qi? Qibo said: Those with more yang qi tend toward joy; those with more yin qi tend toward anger. If a person is often angry but the anger dissolves easily, this shows mereka contain yin within yang. This kind of yin-yang intermingling is not pure, so the spirit cannot move ahead.
Huangdi asked: What causes qi and the needle to meet at the same time? Qibo said: When yin and yang are harmonized, blood and qi are moist and slippery 💨. Therefore, as soon as the needle enters, qi responds to the needle and comes forth, swiftly meeting it.
Huangdi asked: When the needle has already been withdrawn and qi then travels alone, what kind of qi brings this about? Qibo said: Such people have more yin qi and less yang qi. Yin qi tends to sink, and yang qi tends to float but is stored inside. Therefore, only after the needle is withdrawn does qi follow behind and move, appearing to travel alone.
Huangdi asked: When multiple needlings are required before there is a response, what kind of qi brings this about? Qibo said: Such people have more yin and less yang. The qi mechanism is sunken and latent, and qi movement is difficult, so multiple needlings are necessary before sensation arises.
Huangdi asked: When qi counterflow occurs after needling, and when the illness worsens after multiple needlings, what kind of qi brings this about? Qibo said: Qi counterflow after needling and worsening of illness after multiple needlings do not belong to the natural tendency of yin-yang qi to float or sink. Rather, they result from the operational errors of a careless physician—the fault of the practitioner. The patient's own constitution and form are not to blame.
Note: Some individual words in the original text are suspected of transcription errors, such as "gao qiang gao gao" which later versions often render as "he he gao gao," and "duo peng" suspected to be "duo yin," and "shu li" suspected to be "shu ci." The above is interpreted according to conventional medical reasoning.
The central theme of this chapter is: Individual differences in yin-yang, blood, and qi determine different needling responses. Qibo explains the six phenomena using the abundance or deficiency of yin and yang and the floating or sinking of the qi mechanism:
This reflects the "treatment according to individual differences" and "differentiating qi and caring for the spirit" needling philosophy of the Neijing: needling is not just about selecting points—it requires observing the patient's spirit state and the arrival of qi. It especially emphasizes that if treatment results are poor or adverse reactions occur, one should first look for causes in the practitioner's technique, rather than merely attributing them to the patient's constitution.
The sensations of soreness, numbness, distension, heaviness, or a sensation of qi movement after needling are called deqi in Chinese medicine. Modern research and clinical observation also find that the speed, intensity, and quality of needling sensation show obvious individual differences, related to factors such as neural sensitivity, local connective tissue responses, and psychological state.
The terms "chongyang" and "duoyin" are ancient constitution classification models. They cannot be rigidly mapped onto modern medicine, nor should they be used as self-diagnostic labels. However, the underlying ideas—that individual differences affect responses and that practitioner safety in operation comes first—are compatible with modern acupuncture's emphasis on individualized assessment, standardized technique, and prevention of injury.
It should be noted that the ancients' understanding of the mechanisms behind adverse reactions such as "qi counterflow" was somewhat general. If obvious discomfort occurs after needling, needling should be stopped immediately and professional evaluation sought—this cannot be reduced to a single phrase like "the failure of a careless practitioner." 🩺
This content is based on classical Chinese medicine texts and is provided solely for traditional cultural learning and study. It does not constitute any medical diagnosis, medication, or treatment advice. Please seek timely medical attention if unwell.