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บทที่ 22 จาก 81
黄帝内经·灵枢
This chapter primarily discusses the manifestations of dianji (epilepsy/seizure disorders), kuangbing (mania/madness), as well as fengni (wind counterflow), jueni (reversal counterflow), shaoqi (qi deficiency), and 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 paraphrased translation based on common understanding.
The opening passage discusses the names of the eye canthi: the outer corner of the eye extending outward toward the lateral face is called ruizi (sharp canthus); the corner near the nose is called neizi (inner canthus). Earlier scholars considered this passage to be misplaced bamboo slips, with little connection to the theme of "madness."
Early stage of dianji (epilepsy): The patient first experiences a dull, unhappy mood, heaviness in the head with headache, eyes gazing upward, and red sclera; after the condition fully manifests, there is restlessness and anxiety. The ancients observed facial complexion and needled the Hand Taiyang, Yangming, and Taiyin channels, stopping only when the color of the blood drawn changed.
Dianji episode with deviation 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 side; if severe on the right, needle the left side, stopping when the blood color changes. This reflects the ancient Miaoci (opposite needling) approach of "treating the left for right-side conditions and the right for left-side conditions."
If the episode begins with opisthotonos (back arching like a bow), body stiffness, followed by spinal pain: examine the Foot Taiyang, Yangming, Taiyin, and Hand Taiyang channels, and bleed until the blood color changes.
When treating dianji, the ancients advised staying close to the patient's side and observing which areas should be treated. When an episode occurs, if abnormally engorged blood vessels are seen, use bloodletting, and place the blood in a gourd vessel; it was believed that by the next episode, the blood in the gourd would "pulse on its own." If the blood does not pulse, then moxa the qionggu (sacral bone) with twenty cones. The qionggu refers to the sacrum.
Bone dianji (Gu Dian Ji): The cheeks, teeth, various Shu points, and intermuscular spaces are all distended and full; bones are stiff and rigid; there is sweating and mental restlessness. If there is vomiting of copious frothy saliva and qi leaking downward, the ancients considered the prognosis poor.
Tendon dianji (Jin Dian Ji): The body curls up, tendons and vessels are cramped and tense, the pulse is large; needle the Dazhu point on the large channel of the neck. If there is vomiting of copious frothy saliva and qi leaking downward, the prognosis is poor.
Vessel dianji (Mai Dian Ji): Sudden collapse with unconsciousness; the vessels of the four limbs are distended and slack. For those with full vessels, bleed them all; for those with insufficient vessels, moxa the Taiyang channels on both sides of the neck, moxa the points three cun beside the Dai channel at the waist, and moxa the Ben Shu points among the intermuscular spaces. If there is vomiting of copious frothy saliva and qi leaking downward, the prognosis is poor.
Dianji that erupts like mania is considered by the ancients to be critical and of poor prognosis.
Early stage of mania: The patient first experiences sadness, 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 needled the Foot Taiyin and Yangming channels.
Mania episode: Little sleep, no hunger, self-perceived as noble, worthy, intelligent, eloquent, and honorable; fond of cursing, day and night without stopping. Needle the Hand Yangming, Taiyang, Taiyin channels and the sublingual Shaoyin channel. Those with engorged vessels should be bled; those without engorgement should not.
Mania due to extreme fear: manifests as incoherent speech, being easily startled, liking to laugh, enjoying singing, and walking around aimlessly without rest. Needle the Hand Yangming, Taiyang, and Taiyin channels.
Mania due to qi deficiency: manifests as visual hallucinations, auditory hallucinations, and a tendency to shout loudly. Needle the Hand Taiyang, Taiyin, Yangming, and Foot Taiyin channels as well as the head and both cheek areas.
Mania due to great joy: manifests as excessive eating, often saying they see ghosts and spirits, wanting to laugh but not showing it outwardly. First take the Foot Taiyin, Taiyang, Yangming channels, then the Hand Taiyin, Taiyang, Yangming channels.
For newly onset mania, without the typical symptoms described above: first take the Ququan point at the moving vessel on both sides; if the vessels are engorged, bleed them; if there is relief after a short while, stop; if there is no relief, treat according to the conventional methods and moxa the sacrum with twenty cones.
Wind counterflow (Feng Ni): Sudden swelling of the four limbs, the body feeling cold as if drenched by water, frequent chills, restlessness when hungry, and symptoms that change after eating. The ancients took the Hand Taiyin and Hand Yangming as the exterior-interior pair, along with the Foot Shaoyin and Yangming channels; for cold in the flesh, needle the Ying-Spring points; for cold in the bones, needle the Jing-Well points and Jing-River points.
Reversal counterflow (Jue Ni): Sudden coldness in the feet, the chest feeling as if it will split open, the intestines feeling as if cut by a knife, distressing fullness preventing eating, and a pulse that is either large or small but always choppy. If the body is warm, take the Foot Shaoyin channel; if the body is cool, take the Foot Yangming channel; use supplementation for cold patterns and drainage for warm patterns.
Reversal counterflow with abdominal distension and fullness, borborygmus, chest fullness and difficulty breathing: take the areas below the chest on both flanks that move when coughing, as well as the Shu points on the back where pressure brings immediate comfort.
Internal blockage and 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 channels with abnormal pulsations among the Shaoyin and Yangming channels.
Qi deficiency: The body feels cold, speech is short and intermittent, bones feel heavy and sore, the body feels heavy, lethargic, and unwilling to move. Supplement the Foot Shaoyin channel.
Shortness of breath: Breathing is short and discontinuous, with qi failing to connect; activity makes the breath even more insufficient. Supplement the Foot Shaoyin channel and remove blood stasis from the collateral vessels.
The most central academic idea of this chapter is the distinction between dian (epilepsy/seizure) and kuang (mania) as two categories of emotional and mental-spiritual abnormalities.
In terms of treatment methods, this chapter heavily employs bloodletting and moxibustion, and emphasizes stopping "when the blood color changes." This reflects the ancients' understanding that "blood and qi reversal and chaos" is the core pathogenesis of diankuang — by draining stagnant blood, qi and blood are restored to harmony. Meanwhile, the chapter repeatedly observes "vomiting copious frothy saliva with qi leaking downward indicates poor prognosis," showing that the ancients already noticed that mental-spiritual disorders accompanied by qi depletion and body fluid instability indicated a grave condition.
The "dianji" and "kuangbing" described in this chapter share some similarities with certain depressive, manic, and schizophrenia-like presentations in modern psychiatry, but they cannot be simply equated. The ancients explained mental abnormalities from the perspectives of channels, qi-blood, and emotions, which holds historical value; the bloodletting and moxibustion techniques belong to ancient medical practices, and their efficacy and mechanisms require further validation by modern research — they cannot replace standard psychiatric diagnosis and treatment.
Statements such as "not treatable" or "death" reflect the clinical observations and treatment capabilities of that era and should not be directly applied today. Modern medicine has more systematic assessment tools and comprehensive intervention approaches for mental illness.
Some general life insights can be drawn from this chapter:
Related Concepts
Further Reading
Bu Gua Note: 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 advice, or treatment recommendations. If you feel unwell, please seek medical attention promptly.