《黃帝素問靈樞集註》Vol. 21

The Yellow Emperor inquired of Qibo, saying: "From you, Master, I have heard extensive teachings on the nine needles, so profound they defy enumeration. I have organized this knowledge into a systematic framework, and now wish to have you verify whether my understanding is correct. Should there be any errors, please correct them, that this medical art may be transmitted accurately to future generations without deviation. These techniques should only be imparted to suitable recipients and never to the unworthy."

Qibo bowed respectfully and replied: "May I humbly listen to the sage king's instruction." The Yellow Emperor continued: "The principles of needling require clear understanding of the relationship between physical form and qi mechanisms—their left-right, upper-lower orientations, their yin-yang and exterior-interior aspects, and the conditions of blood and qi abundance or depletion. One must grasp the normal and reverse pathways of qi-blood circulation, the principles of their entry, exit, and convergence, know how to regulate imbalances, understand methods to resolve stagnation, and comprehend techniques for supplementing deficiency and draining excess.

One must be thoroughly familiar with all qi points of the body, comprehend the distribution of the Four Seas (major convergence points of vital points), and discern the varying manifestations of cold and heat disorders in different locations. Mastery of qi regulation methods is essential, with clear knowledge of channel pathways and understanding of collateral intersections in left and right limbs. For disorders where cold and heat contend, one must be able to harmonize them; when facing mixed deficiency-excess conditions, one must know how to unblock and resolve them. Should left-right coordination be impaired, appropriate intervention is required.

Understanding the progression or regression of disease enables judgment of treatability; mastering yin-yang balance allows proper timing of treatment. Examine the root and manifestation of disorders, observe transformations of cold and heat, and accurately locate pathogenic factors—only then can needling be applied without error. Complete familiarity with the nine needles' distinct applications makes the way of needling truly comprehensive.

Understand the characteristics of the Five Transporting points (Well, Spring, Stream, River, and Sea points), control the rhythm of needle insertion speed, and comprehend how limb flexion-extension affects qi-blood movement—all these follow discernible patterns. Yin-yang transformations must be integrated with Five Phase theory, as each of the five zang and six fu organs has its correspondences. The four seasons and eight winds (winds from eight directions) all differentiate yin-yang, each manifesting corresponding qi colors in the facial mingtang region (nose and surrounding area).

During diagnosis, observe pathological changes in the five zang and six fu organs, determine cold-heat attributes through left-right and upper-lower symptoms, and identify affected channels. Palpate the skin to perceive temperature, moisture, and texture, thereby understanding the patient's discomfort. Comprehend qi movement above and below the diaphragm—master these principles before needling. Superficial conditions require shallow insertion, while deep-seated disorders demand prolonged needle retention. For intense heat in the upper body, guide it downward with needles; for pathogens ascending from below, guide them outward. Address areas of obvious pain first.

For severe external cold, retain needles to supplement yang; for internal pathogens, drain through He-sea points. Where needles are unsuitable, employ moxibustion. For upper qi deficiency, lift and promote; for lower qi deficiency, gather and consolidate. Dual yin-yang deficiency requires warm supplementation. When encountering reversal cold patterns—even to the point of sunken joints and coldness below the knees—select the Zusanli point (three inches below the knee) for treatment."

This scripture elucidates the essential principles of acupuncture therapy and the qualities required of practitioners.

It first explains the fundamental tenets of meridian treatment: When cold pathogens invade the meridians causing stagnation of Qi and blood circulation, fire needling (a specialized acupuncture technique) should be employed. For cases involving sunken meridians or hardened meridian nodules, fire needling is also appropriate. Special attention must be paid to the locations of the two Qiao vessels (Yinqiao and Yangqiao among the Eight Extraordinary Meridians) - treating the yin vessel for males and the yang vessel for females, a crucial prohibition all skilled physicians must observe.

Acupuncture practice must align with cosmic principles: observing celestial phenomena and harmonizing with the eight directional energies to avoid pathogenic influences. Practitioners must carefully differentiate deficiency and excess conditions without provoking pathogenic factors. During years of abnormal climatic conditions, improper treatment may invite misfortune. Thus, understanding temporal prohibitions is prerequisite to mastering acupuncture's essence.

Superior physicians (shanggong) perceive subtle Qi transformations and treat diseases at their inception; ordinary practitioners (xiagong) only address manifest symptoms, often after damage has occurred. The crux of acupuncture lies in discerning Qi movement, guarding meridian gateways, and mastering techniques for regulating Qi through supplementation and drainage. Specific techniques include:

• For drainage: Employ circular manipulation - applying pressure with rotating motions to facilitate Qi flow, inserting needles swiftly while withdrawing slowly, enlarging needle holes to rapidly expel pathogens
• For supplementation: Use square-rooted techniques - gently stretching skin to locate precise points, coordinating bilateral movements, inserting needles with slow rotation while maintaining composed mental focus, retaining needles briefly before swift withdrawal, then pressing needle holes to preserve genuine Qi

Leigong inquired of the Yellow Emperor about selecting acupuncture inheritors. The Emperor advised assigning roles according to individual strengths: those with keen vision observe complexion; those with acute hearing discern sounds; eloquent individuals transmit theory; while dexterous, meticulous practitioners perform needling - thus harmonizing Qi-blood and discerning pathological progression.

This passage emphasizes acupuncture's alignment with natural laws, underscores practitioner cultivation, and meticulously records supplementation-drainage techniques, preserving classical medical wisdom.

This scripture primarily discusses two main sections:

The first section outlines selection criteria for individuals suited to practice Daoyin (导引, guiding and pulling) and Xingqi (行气, energy circulation) techniques: Those with calm temperaments and flexible bodies are best suited for learning Daoyin and Qi circulation; eloquent individuals may use incantations for healing; while those with strong hand strength are appropriate for therapeutic massage. It emphasizes the necessity of teaching according to each person's characteristics. If techniques are wrongly transmitted to unsuitable candidates, not only will they prove ineffective, but they may also damage the master's reputation. The text also describes a method for testing hand strength: Pressing one's hand on a turtle shell—those with powerful hand strength can kill the turtle within fifty days, while those with gentle pressure won't harm it.

The second section records the Yellow Emperor (黄帝) consulting Qibo (岐伯) about diagnosing illnesses by observing the "chi skin" (尺肤, the inner forearm skin). Qibo provides detailed diagnostic correlations:

• Slightly swollen eyelids, prominent neck pulses, and persistent indentations when pressing limbs indicate wind-water edema (风水肤胀病)
• Smooth, moist skin suggests wind syndrome (风症)
• Flaccid muscles signify physical weakness
• Rough, scaly skin resembling fish scales points to water swelling
• Hot skin with strong pulses indicates warm disease (温病)
• Cold skin with weak pulses suggests diarrhea and Qi deficiency
• Heat in specific areas of the elbow and palm corresponds to pathological changes in different body regions
• Blue-green blood vessels appearing at the thenar eminence (鱼际) reveal cold in the stomach

These diagnostic methods, which discern internal disorders through external observations, embody the Chinese medical principle of "knowing the interior by examining the exterior."

This passage primarily discusses methods for diagnosing illnesses by observing blood vessels, facial complexion, and pulse conditions, along with the patterns of Yin-Yang and cold-heat transformations.

Regarding vascular diagnosis:

When cold accumulates in the stomach, the chi pulse (wrist pulse) becomes hot like a torch. Violent pulsation of the renying pulse (carotid artery) indicates potential blood loss. A hard chi pulse with weak overall pulse suggests Qi deficiency, and worsening symptoms may lead to death. Eye colors reflect organ disorders: red corresponds to heart, white to lungs, green to liver, yellow to spleen, and black to kidneys. An indescribable yellowish hue indicates chest disorders.

Eye pain diagnosis:

Red veins extending downward suggest Taiyang channel disorder; upward extension indicates Yangming channel disorder; inward spreading points to Shaoyang channel disorder. In febrile diseases, red veins reaching the pupil signify critical condition—one vein predicts death within a year, one and a half veins within eighteen months, and so forth.

Toothache diagnosis:

Palpate the Yang channels (hand/foot Yangming) to locate heat and identify affected side. Observe vessel colors: predominantly red indicates heat syndrome, green suggests pain, black denotes chronic numbness. Mixed red, black, and green signals alternating cold-heat symptoms.

Jaundice diagnosis:

Manifestations include slightly yellow complexion, yellowish teeth and nails, lethargy, dark yellow urine, thin and irregular pulse, and poor appetite.

Pulse diagnosis:

When cunkou pulse (radial artery) and renying pulse show identical size and depth, recovery becomes difficult. Pronounced pulsation of women's hand-shaoyin (heart channel) suggests pregnancy. Infant hair standing on end indicates critical condition; green vessels on ears foretell convulsive pain.

Diarrhea diagnosis:

Bloody stool with weak pulse and cold extremities is hard to treat; warm limbs suggest favorable prognosis.

Yin-Yang transformation principles:

Yin and Yang mutually transform—excess Yin generates cold, excess Yang produces heat; extreme cold generates heat, extreme heat generates cold. Seasonal injuries cause specific disorders: winter cold leads to spring fever; spring wind causes summer diarrhea; summer heatstroke brings autumn malaria; autumn dampness results in winter cough—these are seasonal pathological progressions.

(Note: "Malarial disorder" refers to a type of malaria; "convulsive pain" indicates spasmodic pain; "undigested diarrhea" means dyspeptic diarrhea)

The Yellow Emperor inquired of Qibo, saying: "I have heard there are five essential techniques in acupuncture—what exactly are they?" Qibo replied: "Indeed there are five. The first is called 'Shaking Off Dust' (zhen ai), the second 'Dispelling Obscurity' (fa meng), the third 'Removing Claws' (qu zhao), the fourth 'Stripping Away Clothes' (che yi), and the fifth 'Resolving Confusion' (jie huo)."

When the Emperor expressed confusion about these names, Qibo explained in detail: "What we call 'Shaking Off Dust' involves needling the superficial meridians to treat diseases of excessive yang qi. 'Dispelling Obscurity' means needling the back transport points of the zang-fu organs to treat internal disorders. 'Removing Claws' refers to needling the collateral vessels at joints and limbs. 'Stripping Away Clothes' entails comprehensive needling of special points along the yang meridians. As for 'Resolving Confusion,' it regulates the balance of yin and yang—supplementing deficiency and draining excess—to restore harmony to qi and blood."

Still puzzled about the specific application of "Shaking Off Dust," the Emperor pressed further. Qibo elaborated: "When rebellious yang qi fills the chest cavity, causing oppression, labored breathing, panting difficulties, or even aversion to smoke and dust, then 'Shaking Off Dust' is applied. Its effect is as swift as shaking dust from one's clothes." The needling points selected are Tianrong (at the neck region), supplemented with Lianquan (above the Adam's apple) if accompanied by coughing or chest pain. The depth should not exceed one cun at Tianrong, while at Lianquan the needle is withdrawn upon seeing the blood color change.

Regarding "Dispelling Obscurity," Qibo clarified this technique treats hearing and vision impairment—though named after sensory functions, it actually works through needling the zang-fu transport points. The optimal treatment time is high noon, selecting Tinggong (in front of the ear) for needling. The patient should pinch both nostrils and exhale suddenly; a resonant sound in the ears confirms correct point location. The Emperor marveled at this method of accurate point selection without visual confirmation, demonstrating the profound spiritual connection between physician and patient.

Finally concerning "Removing Claws," Qibo described this as treating limb disorders through needling joints and collateral vessels of the extremities. He emphasized all these techniques require precise understanding of meridian pathways and needling skills to achieve immediate therapeutic effects.

The Yellow Emperor inquired of Qibo about acupuncture methods for treating joint and meridian disorders in the limbs. Qibo replied: The waist and spine constitute the body's most vital articulations, the legs and feet are crucial for walking and running, while the reproductive organs serve as the pivot of physical vitality, governing the circulation of Jing (essence) and bodily fluids. Irregular eating habits and emotional disturbances can cause abnormal fluid accumulation in the testicular region, leading to blocked blood vessels, swelling, and pain that makes bending, turning, and movement difficult. This edema condition obstructs both upper and lower pathways, requiring treatment with sharp bian stones (ancient medical tools) to drain the accumulated fluid, making the swelling impossible to conceal—hence the name "Qu Zhao" (Removing Claws) therapy.

The Yellow Emperor then asked about the "Che Yi" (Removing Clothes) acupuncture method. Qibo explained: This addresses conditions of excessive Yang Qi and deficient Yin Qi. Yin deficiency generates internal heat, while Yang excess produces external heat. When these dual heats intertwine like carrying burning charcoal, patients cannot tolerate even lightweight clothing and find sitting unbearable. Blocked pores prevent sweating, causing dry mouth, bitter taste, and loss of appetite. Treatment involves needling Tianfu and Dazhu points three times, followed by Zhonglü point to dissipate heat, while supplementing the Hand Taiyin meridian to induce sweating. Once fever subsides and perspiration occurs, recovery is swift.

The Emperor further inquired about the "Jie Huo" (Resolving Confusion) acupuncture technique. Qibo clarified: This method regulates Yin-Yang balance. When pathogenic wind invades the body, it disrupts Qi and blood circulation, creating imbalance between deficiency and excess that manifests as dizziness, disorientation, and unsteady movement. The therapeutic principle involves draining excessive pathogenic Qi while replenishing deficient vital Qi to restore Yin-Yang equilibrium. When performed with such precision, the effects are immediate.

Finally, the Emperor asked about the classification of five pathogenic conditions. Qibo categorized them as: abscess-related disorders, large masses, constricted-area pathologies, heat syndromes, and cold syndromes. The Yellow Emperor recorded these precious medical techniques in the Linglan Chamber (ancient repository for important texts), preserving them with reverence and caution against indiscriminate dissemination.

This scripture primarily discusses different acupuncture treatment methods for five pathogenic influences (blockage, heat, dissipation, swelling, aggregation/dispersion, and cold), along with corresponding needle selections.

Principles for treating the five pathogenic influences: For blockage disorders, eliminate heat pathogens; to disperse swellings, completely dissipate the pathogenic qi; for cold blockage, apply warming supplementation; mild conditions require yang qi supplementation, while severe cases demand complete pathogen removal.

Specific treatment methods:

For suppurative inflammation (abscess pathogens), avoid forceful attack during peak pathogen activity—proceed gradually like changing customs. Prematurely draining immature pus will spread the pathogenic influence. Use draining technique at relevant meridian transport points.

For major pathogens (severe pathogenic influences), gradually reduce them daily with fine needles to weaken their force. When using sharp needles between muscles, observe carefully to avoid damaging upright qi, focusing on yang meridian intermuscular spaces.

For minor pathogens (mild pathogenic influences), apply daily supplementation to strengthen upright qi, preventing harm. Select points according to disease location, stopping when pathogens can no longer invade—mainly needle between muscle layers.

For heat pathogens, promote complete dispersion like a wandering traveler not returning home. Open pathways for pathogen expulsion, primarily using chisel needles.

For cold pathogens, apply daily warming supplementation with slow needle manipulation to restore shen (spirit) qi. When pathways close and qi mechanisms harmonize, upright qi is preserved. Use filiform needles primarily.

The Yellow Emperor inquires about needle selection: Use lanceolate needles for abscesses, sharp needles for major pathogens, round-sharp needles for minor pathogens, chisel needles for heat, and filiform needles for cold.

Finally, treatments must accord with heaven-earth and seasonal cycles: As marshes naturally grow reeds, observation reveals form-qi waxing and waning. Yin-yang operates like seasonal changes—in heat, abundant rain makes plants watery (with yang qi floating outward, relaxed skin sweats); in cold, frozen water drives yang qi inward with tense, dry skin. Like experts who can't break ice for waterworks or dig frozen earth, treat cold limbs first by warming channels until qi-blood flows smoothly before needling. Mainly regulate meridians at palms, armpits, elbows, feet, neck, and spine.

This passage explains the methods and principles of acupuncture therapy in ancient Chinese medicine, focusing on regulating Qi (vital energy) and blood to treat diseases.

First, after using acupuncture to promote the smooth flow of Qi and blood circulation, the practitioner must observe the patient's pulse: if the pulse feels slippery and smooth, use needling to calm it; if the pulse feels hard and tense, use needling to disperse it until the Qi mechanism descends—this is called the "untying knots" therapy.

The key to needling lies in regulating Qi. The body's Qi gathers in the stomach area, circulating to connect the Ying (nutritive) and Wei (defensive) energies (the two fundamental life energies), each following its own pathway. The Zong Qi (pectoral Qi) resides in the Sea of Qi (Qihai), descending to the Qijie point and ascending to the respiratory tract. If Qi stagnates in the feet and the Zong Qi cannot descend, blood in the vessels will congeal and stagnate, requiring moxibustion therapy to regulate.

Before acupuncture, the practitioner must first examine the channels' conditions of excess or deficiency by pressing and plucking them manually to observe the response, then proceed with treatment. If the six main channels are harmonious, there is no disease; even if illness exists, it can heal naturally. If a channel shows excess above and deficiency below with obstruction, there must be transverse collaterals blocking the main channel—observe and use draining techniques, which is another form of "untying knots."

For patients with cold above and heat below, first needle the Taiyang channel at the neck, retaining the needles for an extended period. After needling, apply heat to the neck and shoulder blades until warmth circulates evenly—this is called "pushing upward." For those with heat above and cold below, observe the sunken channels and use needling to guide Qi downward—called "drawing downward."

When patients with high fever exhibit manic behavior, hallucinations, or delirium, examine the Foot Yangming channel and its major collaterals—tonify if deficient, drain if blood is excessive. Have the patient lie supine while the practitioner presses the cervical artery with four fingers of both hands, gradually moving downward to the Quepen point, repeating until fever subsides—this is called "pushing to disperse."

The Yellow Emperor asked why a single channel could produce dozens of symptoms—pain, abscesses, heat, cold, itching, numbness—with endless variations. Qibo replied these are all caused by pathogenic Qi. When asked about types of Qi, Qibo explained: Zhen Qi (original Qi) is innate, combining with postnatal Qi from food to nourish the body; Zheng Qi (normal climatic Qi) comes as harmonious winds from fixed directions; while Xie Qi (pathogenic Qi) refers to harmful "thief winds" that damage health.

This passage describes the various manifestations of pathogenic Qi (Xieqi) invading the human body. Pathogenic influences are categorized into two types: "regular wind" (Zhengfeng) and "deficient evil" (Xuxie). Regular wind causes deeper injuries that are difficult to resolve spontaneously, while deficient evil causes shallower injuries that tend to dissipate on their own because its Qi is weaker and cannot overpower the body's genuine Qi (Zhenqi).

When deficient evil first invades the body, it manifests as superficial symptoms like goosebumps and open pores. As it penetrates deeper, different areas develop distinct pathologies: invading bones causes bone impediment (Gubi, marked by pain and numbness), invading sinews leads to sinew cramping (Jinluan, muscle spasms), invading blood vessels results in blood stasis and suppuration. When it enters muscles and contends with defensive Qi (Weiqi), excess Yang Qi causes fever while excess Yin Qi brings chills. Severe cold depletes genuine Qi, leading to weakness and aversion to cold.

When pathogenic Qi wanders between skin layers, it causes itching; prolonged retention leads to numbness. If it disrupts defensive Qi circulation, sensory dullness occurs. When deficient evil penetrates one side of the body and weakens nourishing-defensive Qi (Rong-Wei), retention causes hemiplegia; shallower invasion manifests as unilateral body pain.

Deeper penetration with prolonged cold-heat contention yields different outcomes: cold overpowering heat causes bone pain with muscle atrophy; heat overpowering cold leads to suppuration, putrefaction and bone damage. Accumulation in sinews restricts flexion-extension; intestinal accumulation forms intestinal tumors (developing over years, soft on palpation). Progressive congealing forms hard masses; deep bone penetration merges with bone Qi, gradually enlarging into bone abscesses (Guju). Muscle accumulation with heat causes suppuration; without heat, it forms muscular nodules (Rouju).

The text concludes that while these pathogenic manifestations occur in varying locations, each follows specific patterns with distinct names.