《黃帝素問靈樞集註》Vol. 15

Lei Gong inquired of the Yellow Emperor, saying: "Though I, your disciple, have studied all sixty chapters of the Nine Needles (ancient acupuncture therapy), diligently reviewing them morning and night—wearing out recent bamboo slips and allowing dust to gather on the older ones—I still recite them tirelessly without negligence. Yet I cannot fully grasp their profound meaning. The chapter 'Outer Measurement' speaks of distilling complex content into unifying principles, but I truly fail to comprehend its subtleties. The vast has no boundaries; the minute has no core. Neither size has limits; neither height nor depth has measure—how can such things be distilled? Moreover, human talents vary in capacity. Someone of my shallow wisdom finds it difficult to grasp such vast and profound knowledge. Fearing these precious teachings may be lost, I venture to ask: How should their essential principles be refined?"

The Yellow Emperor praised him: "An excellent question! These are secret methods our master forbade from open transmission, requiring a blood-oath covenant (an ancient ritual of cutting arms and mingling blood in wine). If you truly wish to learn, why not first observe purification?" Lei Gong bowed respectfully and immediately began three days of purification. At high noon, he requested to take the oath. The Yellow Emperor led him into the fasting chamber for the blood-oath ritual, personally intoning the invocation: "Today at noon we swear by blood to transmit these teachings. Those who break this oath shall face retribution." Lei Gong knelt again to receive it.

Holding Lei Gong’s hand with his left, the Yellow Emperor presented the scriptures with his right, solemnly admonishing: "Be cautious, ever cautious! I shall explain the essentials of needling: To treat illness, one must first understand the pathways of the meridians and master the patterns of Qi and blood circulation. Internally, regulate the five viscera; externally, harmonize the six bowels. Observe the transformations of defensive Qi (the body’s protective energy against external pathogens)—this is the root of all disease. Regulate excess and deficiency, drain stagnant blood, and when pathogenic toxins are fully expelled, no danger remains."

Lei Gong said: "I understand these principles, but how does one refine their essence?" The Yellow Emperor replied: "Refining medical formulas is like tying a sack. If left unbound when full, it will leak. Medical knowledge, if unrefined after mastery, cannot reach its ultimate potential." Lei Gong pressed further: "Should those of mediocre aptitude refine early?" The Emperor answered: "Those who seek shortcuts before mastery will remain ordinary physicians, never becoming great healers."

Finally, the Yellow Emperor imparted diagnostic secrets: "The cunkou pulse (radial artery at the wrist) reveals the internal organs; the renying pulse (carotid artery) reflects the body’s surface. Their coordinated undulations resemble intertwined ropes. In spring and summer, the renying pulse is slightly stronger; in autumn and winter, the cunkou pulse grows more pronounced. This is the fundamental law of pulse diagnosis."

This passage explains how to diagnose diseases by examining the pulsations at the Renying pulse (carotid artery) and Cunkou pulse (radial artery) to determine affected meridians and treatment methods.

When the Renying pulse is twice as strong as the Cunkou pulse, the disease resides in the Foot Shaoyang Gallbladder Meridian; if accompanied by a restless pulse quality, it indicates involvement of the Hand Shaoyang Triple Burner Meridian. A Renying pulse three times stronger suggests disease in the Foot Taiyang Bladder Meridian; with restlessness, it affects the Hand Taiyang Small Intestine Meridian. A Renying pulse four times stronger points to the Foot Yangming Stomach Meridian; with restlessness, the Hand Yangming Large Intestine Meridian is involved. A full, strong pulse indicates heat syndrome, while a weak pulse suggests cold syndrome. A tense pulse signifies painful obstruction, and an irregular (dai) pulse reflects fluctuating severity. Treatment principles: draining for excess patterns, tonifying for deficiency, needling muscle interstices for pain, bloodletting for irregular pulses combined with herbal medicine. Sunken pulses require moxibustion.

A Renying pulse four times stronger with rapid, forceful beats is termed "overflowing yang" or "external blockage" syndrome, indicating poor prognosis. Careful examination of disease causes and cold/heat symptoms is needed to determine visceral pathology.

Conversely, when Cunkou pulse is twice as strong as Renying pulse, disease affects the Foot Jueyin Liver Meridian; with restlessness, the Hand Jueyin Pericardium Meridian. A Cunkou pulse three times stronger indicates Foot Shaoyin Kidney Meridian involvement; with restlessness, Hand Shaoyin Heart Meridian. A Cunkou pulse four times stronger shows Foot Taiyin Spleen Meridian disorder; with restlessness, Hand Taiyin Lung Meridian. Excess manifests as abdominal distension and digestive cold syndromes, while deficiency presents with internal heat, diarrhea, shortness of breath, and discolored urine.

The text concludes with the "Five Colors" diagnostic method, where Minister Lei Gong asks the Yellow Emperor whether facial diagnosis should focus solely on the mingtang (nose) region. The Emperor responds (the full answer isn't quoted here) that he will explain in detail how color changes across different facial areas indicate disease.

This passage records a dialogue between the Yellow Emperor (Huangdi) and the Thunder Duke (Leigong) concerning facial diagnosis, explaining how to assess health conditions by observing facial features and color changes.

The Yellow Emperor explains: The Hall of Light (nose) should be high and straight, the Palace Gate (space between eyebrows) broad, the Court (forehead) full, while the Outer Walls (cheekbones) and Shields (area before the ears) should be symmetrical. When these features are well-proportioned and prominent enough to be clearly visible from ten paces away, such individuals often live to a hundred years.

When the Thunder Duke inquires about correlating facial features with health, the Emperor responds: The nose should be tall and straight. The Qi (vital energy) of the five zang organs manifests along the facial midline, while the six fu organs' Qi appears on the sides. When the zang organs are balanced, the complexion remains normal and healthy; during illness, pathological colors emerge. A healthy complexion should appear luminous, moist, and translucent.

The discourse then examines pathological color patterns: blue/black hues indicate pain conditions, yellow/red denote heat syndromes, while white suggests cold syndromes. When pathological colors spread from localized areas, it signifies worsening conditions; if they dissipate like dispersing clouds, it indicates recovery. Colors progressing inward show external pathogens penetrating deeper, while outward progression suggests pathogens exiting the interior.

Regarding pulse diagnosis: A slippery, thin, tense and deep pulse at the Inch Opening (cunkou pulse) suggests worsening internal conditions, while a large, tense and floating pulse at the Renying (carotid artery) indicates aggravated external conditions. Balanced floating/sunken or large/small pulse qualities make recovery difficult. A deep, large pulse signifies zang organ disease with better prognosis, whereas a thin pulse indicates critical conditions. A floating, large pulse suggests fu organ disorders that are also more treatable.

Finally, it notes: A strong, firm Renying pulse results from cold damage, while a robust, tense Inch Opening pulse indicates food injury. Assessing illness severity through complexion: dark, dull colors denote serious conditions; upward-spreading hues suggest worsening states, while downward-fading colors indicate improvement.

The text explains methods for diagnosing illnesses by observing changes in facial complexion across different zones, along with key principles for treating Yin-Yang imbalances.

The Yellow Emperor (Huangdi) emphasizes that treatment should first address Yin (internal aspects) before Yang (external aspects). Reversing this sequence may worsen the condition. For illnesses originating in the Yang aspect, external treatment should precede internal intervention. A pulse that is slippery, large, and intermittently prolonged indicates pathogenic invasion from the exterior. Visual hallucinations or emotional disturbances signal disordered Yang Qi (vital energy), which can be resolved with timely regulation.

Leigong inquires about distinguishing wind pathogens (the root of all diseases) from cold-damp induced reversal symptoms. Huangdi explains: Observe the glabella (between the eyebrows). A pale, faint hue indicates wind syndrome; turbidity suggests obstruction (Bi syndrome), while a dark tint signifies reversal (Jue syndrome). These can all be discerned through shifts in complexion.

Regarding sudden death, Huangdi notes: If pathogenic Qi directly penetrates the organs, even seemingly healthy individuals may perish abruptly. Thumb-sized red patches on both cheekbones forewarn sudden death despite temporary improvement, while a black patch of the same size on the glabella signals imminent death even without apparent illness.

The text then details facial zones corresponding to internal organs and body parts:

• The glabella reflects the head; above it, the throat.
• The space between the eyebrows corresponds to the lungs; the nasal root to the heart; the nasal bridge to the liver, with its left side linking to the gallbladder.
• The nose tip represents the spleen; the wings, the stomach.
• The cheek centers correlate with the large intestine, their outer regions with the kidneys, and areas below with the navel.
• Above the philtrum (renzhong) reflects the small intestine; below, the bladder and uterus.
• The cheekbones map to shoulders; behind them, the arms; lower still, the hands.
• The inner canthus (eye corner) upper zone connects to the chest and breasts; nasolabial folds extend to the back.
• The jaw angles mirror the thighs; their centers, the knees; lower zones, the calves; and the lowest, the feet.

These divisions align with the five viscera (Zang), six bowels (Fu), and skeletal joints.

The conclusion stresses: Mastery of these zones enables treatment through Yin-Yang harmonization. Precise localization of pathology ensures accurate intervention. Gender differences in zone positioning necessitate attention to Yin-Yang distinctions. Skilled physicians discern conditions by observing complexion—dullness and turbidity indicate internal disease; brightness, external afflictions. Yellow-red hues suggest wind disorders; blue-black, pain; and white, cold syndromes.

This passage primarily discusses methods for diagnosing illnesses by observing changes in facial complexion, as well as how different physical constitutions affect one's resistance to seasonal pathogenic winds.

When examining a patient's facial coloration: Yellowish, greasy, and moist skin indicates suppuration; deep red hues signify severe hemorrhage; intense pain leads to muscle spasms; extreme cold causes skin numbness. By observing the location of the five colors, their depth (superficial or deep), one can determine the severity of illness. Assessing whether the complexion appears lustrous or withered helps predict disease progression; examining whether discolorations are dispersed or concentrated reveals the duration of illness; analyzing the vertical distribution of colors identifies the affected areas. Physicians must concentrate their Shen (spirit) to accurately interpret these color changes and track disease development.

Specifically: A bright but not dull or withered complexion suggests serious illness, while colors that lack brightness and moisture indicate milder conditions. Dispersed discolorations resembling galloping colts signify unconsolidated pathogenic Qi, characteristic of Qi stagnation pain; concentrated discolorations indicate formed pathologies. When kidney disease affects the heart, the heart manifests symptoms first while the kidney displays corresponding pathological hues—this pattern applies to other organ systems as well.

For men, pathological colors appearing on the nasal tip (facial king): Primarily indicate lower abdominal pain extending to testicular pain; circular discolorations suggest penile pain—upper marks point to root pain, lower marks to glans pain, possibly accompanied by conditions like inguinal hernia. For women, nasal tip discolorations: Primarily indicate bladder and uterine disorders—dispersed marks denote pain, concentrated ones suggest masses. The shape of discolorations corresponds to lesion morphology; downward extension toward the coccyx may indicate leukorrhea, while oily skin suggests food poisoning.

Lateral facial color distribution: Left-sided discolorations indicate left-side pathologies, and vice versa. Abnormal clustering or dispersion of pathological colors all point to specific lesion locations. Normal green, black, red, white, and yellow hues should appear upright and full; abnormal discolorations appearing in non-corresponding organ zones (e.g., coin-sized red marks on the nasal tip) often presage impending illness. Observing discoloration tips reveals disease progression: upward-pointing marks develop upward, downward-pointing ones progress downward, with similar left-right orientation.

The five colors correspond to five organs: Green belongs to the liver, red to the heart, white to the lungs, yellow to the spleen, and black to the kidneys. The liver governs tendons, the heart governs blood vessels, the lungs govern skin and hair, the spleen governs muscles, and the kidneys govern bones.

The latter section features a dialogue between the Yellow Emperor and Shao Yu discussing constitutional differences: Among people of same age wearing similar clothing, some fall ill when suddenly exposed to wind and rain while others don't—this stems from physical constitution variations. Shao Yu explains: Seasonal pathogenic winds (spring's green wind, summer's yang wind, autumn's cool wind, winter's cold wind) each have distinct disease characteristics. Those with thin skin, weak muscles, and yellowish complexions are particularly susceptible to spring wind pathogens.

This passage primarily discusses the relationship between human constitution, illness, and personality traits. In a dialogue between the Yellow Emperor (Huangdi) and Shao Yu, several scenarios are examined:

First, they discuss how people with different constitutions are susceptible to seasonal pathogenic influences: Those with thin skin and weak muscles who have pale complexions cannot withstand the summer's weakening winds; those with bluish complexions are vulnerable to autumn's weakening winds; while reddish complexioned individuals cannot endure winter's weakening winds. However, people with dark complexions who have thick skin and solid muscles can resist wind pathogens throughout all four seasons. Those with thin skin, weak muscles, and uneven complexion are prone to illness when encountering weakening winds during the late summer season.

The discussion then turns to pain tolerance and its connection with courageous or timid dispositions. The Yellow Emperor observes that the ability to endure pain isn't solely determined by bravery or cowardice. Truly brave individuals face difficulties head-on and persist through pain, while those who appear brave but aren't truly so will retreat when encountering difficulties and stop at the first sign of pain. Timid people, when confronted with hardship or pain, become speechless with fear, their complexion changes dramatically, and they appear as if about to faint.

Shao Yu explains that pain tolerance depends mainly on skin thickness and muscle firmness rather than being purely a matter of personality. Genuinely courageous individuals typically have deep-set, spirited eyes, broad chests, properly positioned hearts, large and firm livers, and full gallbladders. When such people become angry, their qi surges powerfully, their chests expand, their eyes widen, their hair stands on end, and their complexion turns bluish.

In contrast, timid individuals have large but spiritless eyes, slack chest muscles, loose liver systems, and underdeveloped gallbladders. Even when they become angry, their qi surge doesn't last and quickly dissipates.

Finally, the Yellow Emperor asks why timid people become fearless like brave warriors when intoxicated. Shao Yu explains that alcohol stimulates the liver and gallbladder, temporarily altering their condition.

Shao Yu (an ancient renowned physician) said: Alcohol is a fermented liquid distilled from the essence of grains, possessing an inherently fierce nature. When wine enters the stomach, it causes distension and forces qi upward, resulting in chest congestion. At this stage, the liver qi rises while gallbladder qi becomes unruly, making one appear as fierce as a warrior. However, when the alcoholic qi dissipates, regret follows. This state of reckless bravado without restraint after drinking is called "jiubei" (drunken misconduct).

Regarding back acupoints: The Yellow Emperor inquired with Qi Bo (an ancient physician) about the corresponding acupoints of the five zang organs on the back. Qi Bo replied: The great point of the chest is located at the tip of the scapula; the lung shu (BL13) lies beside the third thoracic vertebra; the heart shu (BL15) beside the fifth; the diaphragm shu (BL17) beside the seventh; the liver shu (BL18) beside the ninth; the spleen shu (BL20) beside the eleventh; and the kidney shu (BL23) beside the fourteenth vertebra. These points are all positioned three cun lateral to the spinal column, and pressing them elicits a sore, distended sensation—the tender spot indicates the correct location. These points are suitable for moxibustion but not for needling. For excess patterns, use the draining method (quickly blowing on the moxa flame), while for deficiency patterns, employ the tonifying method (letting the moxa flame extinguish naturally).

Regarding the movement of defensive qi: The Yellow Emperor stated that the five zang organs store the essence-spirit (jingshen), ethereal soul (hun), and corporeal soul (po), while the six fu organs digest food and transport nutrients. These qi internally nourish the zang organs and externally connect the limbs. The floating qi that does not follow the meridian pathways is called defensive qi (weiqi, the qi that guards against external pathogens), while the refined qi circulating through the meridians is called nutritive qi (yingqi, the qi that nourishes the body). The yin and yang qi mutually depend on each other in an endless cycle. Only by discerning the deficiency and excess patterns of the twelve yin-yang meridians can one identify the root of disease. Understanding the qi pathways (qijie) of the six fu organs enables the regulation of qi stagnation, while comprehending the starting and ending points of meridians ensures accurate treatment. Qi Bo praised the Yellow Emperor's profound insight and expressed willingness to elaborate in detail. The root of the foot taiyang channel lies five cun above the heel, while its branch pulse manifests at the jingming (BL1) acupoint near both eyes.

This passage explains the relationship between the "root" (本) and "branch" (标) in the human meridian system. The root refers to the foundational area of a meridian, while the branch indicates its terminal manifestation points.

For the Foot Lesser Yang (Gallbladder) meridian, the root lies near the Zuqiaoyin point, with its branch at the "Window Basket" point (Tinggong) before the ear. The Foot Lesser Yin (Kidney) meridian's root is located three cun above the medial malleolus, branching to the back's Shenshu point and two sublingual veins. The Foot Reverting Yin (Liver) meridian has its root five cun above the Xingjian point, branching to the back's Ganshu point.

The Foot Yang Brightness (Stomach) meridian roots at the Lidui point, branching to the Renying point and cheek area. The Foot Greater Yin (Spleen) meridian's root is four cun anterior to the Zhongfeng point, branching to the back's Pishu point and tongue root. The Hand Greater Yang (Small Intestine) meridian roots behind the lateral malleolus, branching one cun above the "Life Gate" (here referring to the eye). The Hand Lesser Yang (Triple Burner) meridian roots two cun above the space between the little and ring fingers, branching to the upper corner behind the ear and outer canthus.

The Hand Yang Brightness (Large Intestine) meridian roots at the elbow joint, branching below the cheek. The Hand Greater Yin (Lung) meridian roots at the cunkou pulse position, branching to the inner armpit artery. The Hand Lesser Yin (Heart) meridian roots at the wrist's sharp bone end, branching to the back's Xinshu point. The Hand Heart Governor (Pericardium) meridian roots two cun between two tendons behind the palm, branching three cun below the armpit.

For diagnosis: Deficiency in lower regions manifests as cold reversal, while excess causes heat. Upper deficiency leads to dizziness, and upper excess causes heat pain. Excess patterns require draining needling techniques, while deficiency patterns need reinforcing methods to guide qi and blood.

The body has four major qi thoroughfares (气街) - convergence pathways: The chest thoroughfare connects front chest and back shu points; the abdominal thoroughfare links back shu points with the Chong vessel beside the navel; the head thoroughfare corresponds to the brain; the leg thoroughfare runs between the Qichong and Chengshan points. When needling, first apply finger pressure to the point until qi arrives beneath the hand before inserting the needle. These methods treat headaches, vertigo, abdominal pain/distension, and newly formed masses. Mobile masses are easily treated, while fixed, painless masses prove difficult.