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บทที่ 24 จาก 81
黄帝内经·灵枢
Holistic Paraphrase
This chapter mainly discusses Jue disorders——headaches and heart pain caused by reversed ascent of channel qi disturbing the orifices, as well as related conditions of the ear and lower limbs. The following translation is based on the standard edition of Ling Shu · Jue Bing with emendation of a few obvious textual errors in the original text.
Jue headache (headache caused by reversed ascent of channel qi attacking the head): If it manifests as facial swelling and restlessness, the ancients selected points on the Stomach Channel of Foot-Yangming and the Spleen Channel of Foot-Taiyin. For Jue headache with throbbing pain in the head vessels, emotional sadness, and easy weeping, where the visible temporal arteries are unusually distended, first perform bloodletting on the collaterals, then regulate the Liver Channel of Foot-Jueyin. For Jue headache presenting with heavy sensation and severe pain in the head, use reducing method on the five rows of the scalp vertex, taking five points from each row; first select the Heart Channel of Hand-Shaoyin, then the Kidney Channel of Foot-Shaoyin. For Jue headache accompanied by forgetfulness where palpation finds no distinct tender point, take the arteries on the left and right of the face and head, then the Spleen Channel of Foot-Taiyin. For Jue headache that begins with neck pain and then involves corresponding pain in the lumbar spine, first select Tianzhu point, then the Bladder Channel of Foot-Taiyang. For severe Jue headache where the vessels before and behind the ear throb with a heat sensation, bloodletting on the collaterals may be performed, followed by selecting the Gallbladder Channel of Foot-Shaoyang.
True headache: The headache is severe, the entire brain hurts, and the hands and feet are cold all the way up to the elbows and knees; the ancients considered this an incurable condition. Some headaches cannot be treated by routine distal point selection: those caused by falls and impacts, with stagnant blood retained in the body, or muscle injury where 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 impediment conditions with daily episodes may be somewhat alleviated, but are difficult to cure completely. For cold pain on one side of the head, first select the Sanjiao Channel of Hand-Shaoyang and the Large Intestine Channel of Hand-Yangming, then the Gallbladder Channel of Foot-Shaoyang and the Stomach Channel of Foot-Yangming.
Jue heart pain (heart pain caused by reversed ascent of channel qi attacking the chest and heart): When heart pain and the back pull on each other, with easy twitching, as if something is touching the heart from behind the back, and the body curls up with a hunched posture, this is Kidney heart pain——first select Jinggu and Kunlun points; if the pain does not stop after needling, then select Rangu point. For Jue heart pain manifesting as abdominal distension and chest fullness, with heart pain that is even more severe, this is Stomach heart pain——select Dadou and Taibai points. For Jue heart pain where the pain feels like an awl piercing the heart, extremely severe, this is Spleen heart pain——select Rangu and Taixi points. For Jue heart pain with a dull grey complexion like dead ashes, unable throughout the day to take a deep breath, this is Liver heart pain——select Xingjian and Taichong points. For Jue heart pain that subsides when lying down or sitting quietly but worsens with activity, without change in facial color, this is Lung heart pain——select Yuji and Taiyuan points.
True heart pain: The hands and feet become cold and blue up to the elbows and knees, with severe heart pain; if it occurs in the morning, death may come by evening; if it occurs in the evening, death may come the next morning. Heart pain that cannot be needled: when there are firm accumulations within the body, points should not be selected. When there are worm masses and roundworms in the intestines, treatment with fine needles is inappropriate. For heart and abdominal pain with mental turmoil and episodes of pain, where masses aggregate and move up and down, pain that comes and goes, abdominal heat, thirst with drooling—this is caused by roundworms. The ancients described pressing firmly with the hand to immobilize the mass, inserting a large needle, retaining it for a long time, and only withdrawing the needle once the worms no longer move. There is another fragment, "意腹铁痛，形中上者," which is difficult to interpret due to textual corruption and is not force-translated here.
Ear disorders: For deafness with inability to hear sound, take points within the ear; for tinnitus, take the artery anterior to the ear. Ear pain that cannot be needled: when there is pus in the ear, or dry cerumen (earwax) blocking the canal, causing deafness. For deafness, take the well points at the junction of nail and flesh on the small finger and ring finger of both hands and feet; first the hand, then the foot. For tinnitus, take points on the nails of the middle fingers, for left-side disorders select the right, for right-side select the left; first the hand, then the foot. For inability to lift the thigh, have the patient lie on the side and needle at the hip joint fulcrum where the bones meet, using the Yuanli needle, not a large needle. For blood in the stool, select Ququan point.
Wind impediment with dampness macerating the body and being difficult to cure: the feet feel as if treading on ice, yet at times as if stepping into hot water; the thighs and calves feel limp as if soaked in water; vexation in the heart with headache; bouts of vomiting and fidgeting; dizziness followed by sweating; over time blurring of vision; sadness and proneness to fear; shortness of breath and lack of joy; the ancients believed death within three years.
Pattern differentiation by channel, point selection along the channel
The chapter's discussion of Jue headache and Jue heart pain centres on determining, based on pain location, accompanying signs, and body-surface reactions, which channel or organ the disease belongs to, and then selecting points on the corresponding meridians. For example, Jue headache with facial swelling and vexation is attributed to Foot-Yangming and Foot-Taiyin; heart pain referring to the back with a hunched posture is attributed to the Kidney channel. This reflects the channel-oriented diagnostic approach of the Ling Shu.
Distinguishing "Jue" from "True," with emphasis on depth of disease location
"Jue headache" and "Jue heart pain" belong to reversed ascent of channel qi; painful though they are, they can still be treated through regulating the channels. "True headache" and "true heart pain," however, are critical conditions in which pathogenic factors directly invade the brain or heart, and the ancients explicitly stated "death without cure." This demonstrates awareness that for the same pain, whether the location lies in the channels or the organs, is functional or organic, the prognosis is entirely different.
"Reducing when replete”—the method of collateral bloodletting
When seeing distended arteries of the head, or surging warmth in the vessels before and behind the ear, the ancients resorted to collateral bloodletting to drain stagnant heat and blood stasis. This represents a reducing strategy aimed at the state of "qi and blood stagnation," embodying the principles of "reduce when replete" and "remove the chronic and stagnant."
Emphasis on contraindications and local management
In conditions involving retained blood stasis, internal accumulations, worm accumulation, ear pus, or cerumen obstruction, blind distal point selection or the use of fine needles is inappropriate. In particular, for intestinal worm masses and for the ear with pus or impacted earwax causing deafness, the ancients recognized these as tangible, formed pathogens requiring local identification and cautious handling. This reflects an awareness of the distinction between "formed, tangible pathogens" and "intangible reversed qi."
Contralateral needling and sequence of upper-lower points
For tinnitus, the points used were "left for right, right for left"—a form of contralateral needling (Miu needling). For both deafness and tinnitus, the order "first the hand, then the foot" is emphasized, illustrating systematic understanding of crossed laterality and matching of distal sites.
The classification of headaches and heart pain in this chapter testifies to the accumulated empirical observation of ancient clinical practice. The channel attributions based on different accompanying signs show, to a certain extent, parallels with modern distinctions among migraine, tension-type headache, vascular headache, cervicogenic headache, and the chest pains of angina pectoris or gastroesophageal reflux disease. It must be clearly stated, however, that ancient "Jue heart pain" and "True heart pain" cannot be simplistically equated with modern disease names, and one should particularly not substitute "Kidney heart pain" or "Stomach heart pain" for modern diagnoses.
The descriptions of "true headache" and "true heart pain"—severe headache with pain throughout the body, cold hands and feet reaching to the elbows and knees, or violent chest pain with cold extremities and death within a short time—bear similarity to critical presentations of acute intracranial disorders or myocardial infarction. The ancients' statement of "incurable death" reflects the limitations of therapeutic capability in their time; today this should not be read as abandoning treatment, but as an early warning of signals of critical danger.
Bloodletting, contralateral needling, and other acupuncture methods have been suggested by modern research to relate to local microcirculation, neural reflex mechanisms, and pain modulation, yet their exact mechanisms and achievements still require further evidential support. In particular, the operation described in the original, ["Inserting a large needle, retaining it for a prolonged hold, and only removing it once the worms stop moving,"] belongs to the ancient primitive approach to abdominal pain from worm accumulation and cannot be applied in modern practice.
For deafness and tinnitus caused by purulent ear discharge or impacted cerumen, the ancients had already recognized that blind needling was inadvisable—a plain but correct observation. In modern medicine, such cases can be clearly managed through otologic examination, cleaning, and anti-infection measures.
Associated concepts:
Further reading:
This content is grounded in classical Chinese medicine texts and is provided solely for the study of traditional culture. It does not constitute any medical diagnosis, medication prescription, or therapeutic recommendation；consult a qualified physician when in discomfort.