《黃帝素問靈樞集註》Vol. 17

The Yellow Emperor consulted Bogao regarding disorders in the circulation of defensive Qi (Weiqi). When this protective energy stagnates in the abdomen, accumulating without proper flow, causing distension in both flanks, gastric discomfort, and labored breathing with rebellious Qi—how should this be treated? Bogao replied: When Qi accumulates in the chest, treat through upper acupoints; abdominal accumulations require lower points; for simultaneous distension above and below, regulate both regions concurrently. The specific method is: for upper stagnation, needle Renying (ST-9 at the neck), Tiantu (CV-22 in the suprasternal fossa) and throat regions; lower stagnation requires needling Zusanli (ST-36) and Qijie (ST-30 at the groin). Severe cases additionally need needling one cun below the hypochondrium (alternate sources specify deep insertion to one cun), employing the "chicken claw" technique (three needles arranged triangularly). Caution: when pulses appear flooding, wiry-rapid, intermittently absent, or when abdominal skin becomes drum-tight, needling is contraindicated.

The Emperor then inquired how to diagnose disease locations through external signs. Bogao explained: Floating discoloration between eyebrows indicates skin pathology; abnormal lip colors (blue-yellow-red-white-black) reveal muscle disorders; nutrient Qi (Yingqi) dampness signals blood-Qi imbalance; abnormal iris coloration shows tendon-channel disease; dry ears with crusting suggests bone pathology. Pressed for treatment specifics, Bogao clarified: Though pathologies vary infinitely, skin diseases are treated at limb extremities, muscle disorders require yang surface points between flesh divisions of arms/legs intersecting with Foot-Shaoyin channels, blood-Qi imbalances demand regulation of collateral channels, tendon-channel diseases need localized treatment regardless of yin-yang or laterality, while bone pathologies require regulating bone cavities (marrow spaces) to nourish brain marrow. The therapeutic principle remains: mild cases—shallow needling; severe cases—deep insertion; mild illness—few points; grave conditions—multiple points, adjusting Qi-regulation techniques according to pathological changes. This embodies superior medical practice.

Finally, the Emperor sought correlations between constitutional types and health. Bogao classified physiques into three types: adipose (plump-soft), greasy (obese-loose), and muscular (sturdy-balanced), noting greasy types exhibit abundant yang Qi but lax skin making them heat-sensitive, while adipose types with firm muscles have replete Qi-blood but cold-sensitivity. These constitutional characteristics profoundly influence health conditions.

In the discourse between the Yellow Emperor (Huangdi) and Bogao on human constitutional classification, it was noted that those above fifty years are considered elderly, above twenty are in their prime, above eighteen are youth, and above six are children. The Yellow Emperor inquired about distinguishing between body types, to which Bogao replied that people can be categorized into three types: fatty (fei), greasy (gao), and fleshy (rou).

Bogao elaborated: Those with firm muscles and tight skin belong to the fatty type; those with soft muscles and loose skin are the greasy type; while those with tightly integrated skin and flesh are the fleshy type. When asked how to differentiate between cold and heat constitutions, Bogao explained: Greasy-type individuals, with their soft muscles, are cold-sensitive if their skin texture is coarse but heat-sensitive if it is fine. Fatty-type individuals, with their firm muscles, are heat-sensitive if their texture is fine but cold-sensitive if coarse.

Regarding body size, greasy-type individuals have abundant Qi (vital energy) and loose skin, making their bellies prone to sagging. Fleshy-type individuals have broad, large bodies, while fatty-type individuals are compact in build. In terms of Qi and blood, greasy-types have abundant Qi and endure cold well; fleshy-types have ample blood, giving them a full-bodied appearance; and fatty-types have clear blood but scant Qi, resulting in a smaller stature. Ordinary people maintain balanced proportions of skin, flesh, and fat, with harmonious Qi and blood, leading to a moderate physique.

When administering treatment, one must first assess the Qi and blood conditions of these three body types before applying appropriate remedies. Greasy-types exhibit sagging abdomens, fleshy-types are broad both above and below, and fatty-types, despite having substantial fat, do not appear large.

Later, the Yellow Emperor discussed the importance of acupuncture with Qibo. Initially, the Yellow Emperor regarded needles as insignificant tools, but Qibo countered that needle techniques align with celestial principles above, correspond to earthly patterns below, and harmonize with human affairs in between. Qibo stated that nothing surpasses the heavens in greatness, and among man-made objects, only the five weapons (sword, spear, bow, halberd, and shield) exceed needles in size—yet weapons are instruments of killing, while needles are tools of healing. Since humanity holds the highest value between heaven and earth, acupuncture remains the most essential method for treating the ailments of the people.

The Yellow Emperor asked Qibo: When people fall ill, it often stems from uncontrolled emotions of joy and anger, and lack of dietary moderation. When yin qi becomes insufficient while yang qi grows excessive, and the nutritive and defensive qi fail to circulate properly, abscesses (suppurative sores) develop. When yin and yang energies cannot flow freely, the two heat forces clash and transform into pus. Can such conditions be treated with fine needles?

Qibo replied: Even sages cannot reverse fully manifested pathogenic factors. Consider two armies facing each other with banners visible across the battlefield, weapons arrayed in formation - such confrontations aren't planned in a single day. To make common people obey commands and prevent soldiers from suffering blade wounds cannot be achieved through brief instruction. Those afflicted with abscesses and accumulated pus-blood - have they not strayed far from the Dao of nurturing life? The formation of abscesses and pus doesn't descend suddenly from heaven, but accumulates gradually from minor causes. Therefore sages regulate themselves before illness takes form, while fools wait until symptoms fully manifest.

The Yellow Emperor inquired further: When symptoms have appeared and pus has formed, what should be done? Qibo answered: When pus reaches full maturation, only one in ten patients survives. Thus sages don't await complete symptom formation, but record effective prescriptions on bamboo and silk early, transmitting them through generations of capable practitioners, precisely to spare descendants from such afflictions.

The Emperor pressed: When pus-blood has emerged, can't fine needles be used for drainage? Qibo explained: Small methods prove inadequate for major illnesses, while aggressive treatments risk harm. For formed pus-blood, only stone lancets (ancient lithic medical tools) and sharp metal blades can drain the suppuration.

The Emperor questioned: Won't such drastic measures cause irreversible damage? Qibo responded: The crux lies in discerning the "adverse and favorable" (prognostic indicators) of the condition. He then detailed five ominous "adverse syndromes": whites of eyes turning blue-black with shrunken pupils; vomiting after taking medicine; severe abdominal pain with thirst; restricted neck movement; hoarse voice with pallid complexion. All other presentations beyond these five constitute "favorable syndromes."

The Emperor continued seeking criteria for judging other conditions' prognosis. Qibo enumerated additional signs: abdominal distension with fever and surging pulse; abdominal gurgling with fullness, cold limbs and diarrhea yet large pulse; persistent nosebleeds with bounding pulse; cough accompanied by bloody urine. These all indicate critical disease progression.

This passage discusses five critical symptoms indicating imminent death (known as the "Five Rebellions"), along with the severe consequences of improper acupuncture treatment.

The five fatal symptoms are: First, abnormal abdominal distension with cold extremities, emaciation, and severe diarrhea. Second, abdominal swelling accompanied by bloody stools and intermittent pulse. Third, coughing blood with extreme wasting and irregular pulse. Fourth, vomiting blood with chest tightness radiating to the back, coupled with faint and rapid pulse. Fifth, cough-induced vomiting with abdominal distension and diarrhea, showing complete absence of pulse. Patients exhibiting these symptoms typically survive no longer than fifteen days, often dying within a short timeframe.

The Yellow Emperor discusses acupuncture prohibitions with Qibo, who compares medical techniques to swords that can kill or wine that can intoxicate—improper use proves fatal. The stomach serves as the source of Qi and blood in the body, while meridians function as their circulation pathways. Incorrect needling at critical acupoints (such as Wuli point) disrupts Qi-blood flow, an action as perilous as violating natural laws.

A grave warning emphasizes that erroneous needling at specific acupoints (Kuimen and Rumen) causes immediate death at the treatment site. Consequently, the Yellow Emperor decrees these prohibitions be engraved on jade tablets as enduring medical commandments, cautioning practitioners to exercise utmost precision in acupuncture.

The core message stresses practitioners must accurately diagnose conditions, as certain critical symptoms contraindicate acupuncture—forced treatment may accelerate death. It simultaneously documents ancient Chinese medicine's understanding of dangers associated with specific acupoints.

Huangdi inquired of Qibo: "I've heard there are five prohibitions in acupuncture therapy—what exactly are they?" Qibo replied: "The so-called five prohibitions refer to specific body areas that should not be needled during particular times." Huangdi then pressed for details about the five "depletions" (cases of severely damaged primordial qi), five "excesses" (overapplication of tonifying or reducing techniques), five "contradictions" (conditions where symptoms contradict pulse manifestations), and nine suitable needling methods.

Regarding the five prohibitions: On Jia-Yi days (according to the ancient Heavenly Stem calendar), one must not needle the head or inner ear; on Bing-Ding days, the shoulders, throat, and Lianquan point (a neck acupoint) are contraindicated; Wu-Ji days correspond to seasonal transitions when abdominal needling and paracentesis are forbidden; on Geng-Xin days, joints and thigh/knee areas should not be needled; and on Ren-Gui days, needling the lower legs is prohibited. These are the temporal contraindications for acupuncture.

The five "depletions" include: extreme emaciation, post-hemorrhagic conditions, after profuse sweating, following severe diarrhea, and immediately after childbirth or major blood loss. These states of severely depleted primordial qi are unsuitable for reducing needle techniques.

Five "contradictions" manifest as: febrile diseases with calm pulse; post-sweating with hyperactive pulse; diarrhea presenting with surging pulse; stubborn bi-syndrome causing muscular necrosis with fever yet local pulse disappearance; excessive indulgence leading to emaciation, pallor with severe hematochezia; and alternating chills-fever causing wasting with forceful, pounding pulse. These all represent dangerous conditions where symptoms contradict pulse signs.

In Chapter 62 "The Dynamic Conduits," Huangdi asked: "Among the twelve meridians, why do only the Hand-Taiyin Lung, Foot-Shaoyin Kidney, and Foot-Yangming Stomach meridians exhibit continuous pulsation?" Qibo explained: "This stems from the Stomach meridian's vital importance. The stomach serves as the nutritional source for all zang-fu organs—its clear qi ascends to nourish the lungs, and lung qi circulates through the Taiyin meridian. The pulse synchronizes with respiration, beating twice per breath cycle, thus continuing endlessly with breathing." Huangdi further inquired: "When qi passes through the cunkou (wrist pulse diagnosis point), its upward movement registers ten parts prominently while downward movement shows eight parts concealed—through what pathway is this achieved?"

Huangdi (Yellow Emperor) asked Qibo: "When the Qi (vital energy) leaves the internal organs to circulate, why does it sometimes undergo sudden changes?" Qibo replied: "This is like a drawn bow suddenly releasing its arrow, or a river breaching its banks. When Qi and blood ascend to the head, their force gradually diminishes. The remaining Qi and blood then disperse and flow countercurrent, causing the circulating force to weaken."

Huangdi further inquired: "Why does the Foot Yangming Stomach Channel (one of the twelve primary meridians) exhibit pulsations?" Qibo explained: "The Qi from the stomach rises to infuse the lungs, with its vigorous portion surging upward to the head. This current follows the throat upward, passes through the eye's meridian network into the brain, emerges below the cheekbone, traverses the 'Kezhuren' point (Shangguan, ST-3), follows the jawbone to converge with the Yangming channel, and finally descends to the Renying point (ST-9, carotid pulse area). This is the pathway through which stomach Qi branches into the Yangming meridian. Thus, when Yin and Yang channel Qi-blood circulate upward and downward, their pulsations remain harmoniously synchronized. If Yang channels are diseased yet Yang pulses appear weak, or Yin channels are afflicted yet Yin pulses appear excessive—these are pathological reversals. Normally, the movement of Yin-Yang meridians should maintain balanced coordination like a taut measuring cord."

Huangdi continued: "Why does the Foot Shaoyin Kidney Channel pulsate?" Qibo answered: "The Chongmai (Thoroughfare Vessel, one of the Eight Extraordinary Meridians) serves as the sea where the twelve primary meridians converge. Together with the major collateral of the Foot Shaoyin Kidney Channel, it originates below the kidneys, emerges at the Qijie point (ST-30, inguinal region), runs obliquely along the inner thigh to enter the popliteal fossa, then parallels the Foot Shaoyin channel down the inner calf, passing behind the medial malleolus to reach the sole. Its branching vessels slant into the ankle, cross the instep to enter between the big toes, infusing all collaterals to warm the calves and feet. This explains the constant pulsation of the Shaoyin meridian."

Huangdi asked further: "The circulation of Ying-Qi (nutritive energy) and Wei-Qi (defensive energy) connects upper and lower body seamlessly like an endless ring. Yet when suddenly encountering pathogenic factors or severe cold, limbs become weak and Yin-Yang meridian transmission becomes disordered. How does Qi-blood restore its circulation?" Qibo elucidated: "The extremities serve as convergence points for Yin-Yang channel Qi—the main thoroughfares of energetic movement. The 'Four Streets' (head, chest, abdomen, and shin energy pathways) provide Qi's shortcut routes. When certain collaterals become obstructed, Qi diverts to alternate pathways; when limbs relax, energetic movement reunites. Thus Qi-blood circulation reforms its cyclical flow."

Huangdi praised: "Excellent! This is indeed what we call the 'endless ring' state of operation—cyclically recurring without terminus."