《黃帝素問靈樞集註》Vol. 4

The Yellow Emperor inquired of Qibo about the fundamental principles of acupuncture therapy. Qibo explained that the foundation of human life activity lies in five essential elements: Shen (spirit-consciousness), blood, meridians, nutritive and defensive Qi, and Jing (essence). These are all stored within the five viscera. When these elements are excessively depleted or depart from the organs, it leads to the dissipation of essence, scattering of hun and po (ethereal and corporeal souls), mental confusion, and loss of wisdom.

Heaven and Earth bestow life upon humans in different ways: Heaven confers De (innate life force), while Earth provides Qi (acquired material energy). The fusion of these two energies gives rise to life. The primordial state of life is called Jing; the union of yin and yang essences produces Shen. What accompanies Shen's activity is hun (ethereal soul), while what follows Jing's movement is po (corporeal soul). The heart is responsible for cognition; thoughts arising in the heart are yi (intention); fixed intentions become zhi (will); adjusting according to will is si (contemplation); deep thinking and planning constitute lü (deliberation); and applying deliberation to handle affairs constitutes zhi (wisdom).

Those who understand life cultivation adapt to seasonal changes by regulating temperature, maintaining emotional equilibrium, following regular living patterns, and harmonizing yin-yang and hardness-softness. This prevents pathogenic factors from invading and leads to longevity. Conversely, excessive contemplation damages Shen, leading to uncontrolled fear; extreme grief exhausts vitality; excessive joy scatters spirit-energy; worry obstructs Qi movement; rage causes mental confusion; and prolonged fear disturbs the heart-mind.

Specifically: Excessive contemplation injures heart-Shen, manifesting as vulnerability in winter; chronic sorrow damages spleen-yi, showing susceptibility in spring; extreme grief harms liver-hun, appearing as weakness in autumn; excessive joy injures lung-po, demonstrating fragility in summer; and persistent rage damages kidney-zhi, resulting in memory decline. All emotional excesses damage corresponding viscera, ultimately leading to seasonal vulnerabilities.

This scripture primarily discusses the relationship between the five internal organs and mental activities, as well as the principles of acupuncture treatment.

First, it explains that individuals with stiff lower backs and spines who cannot bend are prone to death by late summer. Prolonged fear damages Jing (essence), and when Jing is impaired, it leads to bone pain, weakness in the limbs, and even nocturnal emissions. The five organs are crucial for storing Jing-Qi (essence-energy). Once damaged, they cause Yin deficiency (insufficient Yin fluids), leading to the loss of primordial Qi and endangering life. Therefore, acupuncturists must observe the patient's mental state to determine whether their "Shen, Hun, Po" (spirit, ethereal soul, corporeal soul) remain intact. If these five spiritual components are already impaired, acupuncture will be ineffective.

The text then details the functions of the five organs:

• The liver stores blood and governs the "Hun" (one aspect of mental activity). Weak liver Qi causes fear, while excessive liver Qi leads to anger.
• The spleen stores Ying Qi (nutritive energy) and governs "Yi" (intention). Weak spleen Qi results in limb weakness and disharmony among the five organs, while excess causes abdominal distension and difficulties with urination and defecation.
• The heart governs blood vessels and houses "Shen" (spirit). Weak heart Qi brings sorrow, while excess leads to incessant laughter.
• The lungs govern Qi and store "Po" (corporeal soul). Weak lung Qi causes nasal congestion and shortness of breath, while excess results in wheezing and chest tightness.
• The kidneys store Jing (essence) and govern "Zhi" (willpower). Weak kidney Qi leads to cold limbs, while excess causes abdominal distension and disharmony among the five organs.

When treating, one must first determine whether the organ condition is deficient (insufficient) or excessive before carefully regulating it.

The second part discusses the fundamental principles of acupuncture:

The key to acupuncture lies in understanding the "beginning and end" (the cyclical patterns of the meridians). The five organs belong to Yin, while the six bowels belong to Yang. Yang Qi enters from the extremities, while Yin Qi emerges from the five organs. Draining techniques should go against the flow of meridian Qi, while tonifying techniques should follow it. Only by mastering these patterns can one harmonize Qi and blood, requiring a thorough understanding of Yin-Yang theory and the relationship between the five organs and six bowels.

This theory must be passed down solemnly—those who value it will prosper, while those who neglect it will decline. Acting against the laws of nature invites disaster. When diagnosing the pulse, one must examine both the "Mai Kou" (wrist pulse) and "Ren Ying" (carotid pulse) to assess Yin-Yang balance. In healthy individuals, the pulse adjusts with the changing seasons, the six meridians flow smoothly, body temperatures remain balanced, and physical form and Qi-blood are in harmony.

This passage explains disease diagnosis through pulse examination and corresponding acupuncture treatments. In a healthy individual, the pulse should be balanced. If both the Cunkou pulse (wrist pulse) and Renying pulse (carotid artery pulse) appear weak and deviate from normal measurements, it indicates deficiency in both Yin and Yang Qi.

In such cases, tonifying Yang Qi would deplete Yin, while draining Yin Qi would cause Yang to collapse outward. The appropriate treatment involves gentle regulation with sweet-flavored herbs, avoiding harsh medications. Forcibly applying draining techniques at this stage would damage the Qi of the five zang organs.

The text then details specific pulse patterns and their corresponding disorders:

When the Renying pulse is twice as strong as normal, the disease resides in the Foot Shaoyang Channel. If accompanied by a restless pulse quality, it affects the Hand Shaoyang Channel. A Renying pulse three times stronger indicates Foot Taiyang Channel involvement; threefold strength with restlessness points to Hand Taiyang. Fourfold excess with both largeness and rapidity is called "overflowing Yang," manifesting as external Yang expulsion—a condition termed "external block."

Similarly, a Cunkou pulse twice normal strength indicates Foot Jueyin Channel disorder, with restlessness signaling Hand Jueyin (Pericardium Channel). Threefold strength corresponds to Foot Shaoyin, with restlessness affecting Hand Shaoyin. Fourfold excess with largeness and rapidity is termed "overflowing Yin," constituting an "internal barrier" condition representing severe internal Qi-blood stagnation with poor prognosis.

When both Renying and Cunkou pulses simultaneously exceed fourfold normal strength, this "block-barrier" pattern signifies critical illness with unfavorable outcomes.

Subsequent sections outline acupuncture treatment principles for various pulse abnormalities, primarily employing "two-draining one-tonifying" or "two-tonifying one-draining" techniques. For instance, with Renying pulse twice normal strength: drain Foot Shaoyang while tonifying Foot Jueyin using the two-drain one-tonify method. Treatments should be administered daily with meticulous observation, ceasing when pulse Qi stabilizes. Detailed channel-specific protocols are provided for other pulse deviations.

These diagnostic and therapeutic methods embody Chinese medicine's principle of "pattern differentiation and treatment determination"—assessing pulse qualities to locate affected channels, then applying tonifying/draining techniques to rebalance Yin-Yang.

This passage primarily discusses the principles and methods of acupuncture treatment. It first mentions the close relationship between the Taiyang Channel (Foot Taiyang Bladder Channel) and the Stomach Channel. The stomach is the organ that stores food essence (Jingqi), therefore it can be needled twice daily. When the pulse at the Renying point (neck artery) and Maikou (wrist pulse) both show abnormal vigor, it indicates excessive Yin-Yang Qi and blood. If not promptly regulated, this can lead to blocked blood vessels, obstructed Qi movement, and ultimately internal damage to the five zang organs.

The fundamental principle of acupuncture is to stop treatment once Qi balance is restored. Reinforcing Yin and reducing Yang (supplementing Yin Qi while draining Yang Qi) can improve vocal strength, hearing and vision, while the opposite approach disrupts proper Qi-blood circulation. The saying "effective when Qi arrives" means that reducing techniques should make the pulse weaker, while reinforcing techniques should make it stronger. If the pulse shows no change after treatment, it indicates the old ailment remains.

The specific needling method operates at three levels: the first insertion expels Yang pathogens, the second expels Yin pathogens, and the third allows Guqi (the Qi of food essence) to arrive. The arrival of Guqi is marked by: a stronger pulse after reinforcing or a weaker pulse after reducing. Even if symptoms don't immediately disappear, the condition will certainly improve.

When treating Yin-Yang imbalance, sequence matters: for Yin excess with Yang deficiency, first reinforce Yang then reduce Yin; for Yang excess with Yin deficiency, first reinforce Yin then reduce Yang. Special emphasis is placed on diagnosis of the three foot channels (likely referring to the three Yin channels of the foot), where deficiency and excess must be carefully distinguished. For rapid, strong pulses use reducing techniques; for slow, weak pulses use reinforcing techniques - reversing these will worsen the condition. The Qi of Yangming Channel (Foot Yangming Stomach Channel) primarily circulates in the upper body.

(Note: The "three insertions" refer to ancient acupuncture depth levels corresponding to different therapeutic purposes; "Guqi" denotes the essential Qi transformed from food and drink, which constitutes the fundamental substance sustaining life activities.)

This passage discusses the fundamental principles and techniques of ancient acupuncture therapy, focusing on how to select needling locations and methods according to disease characteristics.

Regarding point selection: The acupoints of the Jueyin channel are located in the middle body region, while those of the Shaoyin channel are in the lower region. Points on the chest and abdomen correspond to the front, and back points correspond to the posterior. For weak shoulders, upper body points are selected; for tongue swelling, the Pi needle is used at the sublingual tongue pillar point.

On disease diagnosis: Inability to straighten bent fingers indicates tendon disorders, while inability to bend straightened fingers suggests bone problems. Bone diseases require bone treatment, tendon disorders need tendon therapy. Excess conditions call for deep insertion with strong pressure to expel pathogens, while deficiency conditions require shallow needling with gentle pressure to nourish the channels.

Concerning needling techniques: Full pulse conditions demand deep insertion to drain Qi, while weak pulses require shallow insertion to cultivate Qi. Painful conditions all employ draining methods. Upper body ailments use points from the Hand Taiyin and Yangming channels; lower body conditions utilize Foot Taiyin and Yangming points.

Therapeutic principles include: Treat upper disorders by needling below, and lower disorders by needling above. Headaches are treated via foot points, back pain via popliteal fossa points. Always address the originating site first. The Qi of spring, summer, autumn and winter respectively resides in skin/hair, skin surface, muscles, and tendons/bones—needling must adapt to seasonal characteristics.

Regarding constitutional differences: Obese patients receive deep insertion like autumn/winter treatment; lean patients get shallow insertion like spring/summer. Pain belongs to Yin conditions—if unrelieved by pressure, insert deeper. Upper body diseases are Yang conditions, lower body diseases are Yin, while itching (Yang) requires shallow needling.

For cold/heat syndromes: Retaining needles transforms heat reversal into cold, and cold reversal into heat. Treat heat reversal by needling Yin channels twice and Yang once; reverse this for cold reversal. Chronic conditions with deep pathogen penetration require deep insertion with prolonged retention, alternate-day treatment, and prior regulation of left/right channels to remove stagnant blood.

These constitute the essential rules of acupuncture therapy, emphasizing flexible application of different needling methods according to disease characteristics, affected areas, seasonal changes, and patient constitution.

When examining a patient's physical condition, if one observes emaciation with muscles not yet completely atrophied, weak breath yet rapid and chaotic pulse, this condition requires treatment with the "contralateral needling method" (a cross-point acupuncture technique). During treatment, the patient should remain in a quiet environment with doors and windows closed, maintaining mental tranquility to preserve internal Jing (essence) and Qi (vital energy).

The physician must concentrate fully, eliminating external distractions. Through shallow needle insertion with gentle lifting and thrusting techniques, they regulate the patient's Shen (spirit) and Qi until "Qi arrival" (the sensation of Deqi) is achieved. Male patients should focus on stabilizing internal Qi, while female patients should regulate external Qi—both must guard against the dissipation of Jing and Qi to truly attain the desired Qi response.

There are twelve contraindications for acupuncture treatment:

1. No immediate needling after sexual intercourse, and no intercourse immediately after needling.

2. No needling while intoxicated, and no alcohol consumption after needling.

3. No needling during anger, and no agitation after needling.

4. No needling when excessively fatigued, and no overexertion after needling.

5. No needling after heavy meals, and no overeating after needling.

6. No needling while hungry, and no fasting after needling.

7. No needling while thirsty, and no dehydration after needling.

For patients experiencing shock or fear, emotional calming must precede treatment. Those arriving by carriage should rest in bed for about the duration of a meal, while those arriving on foot should sit quietly for the time it takes to walk ten li (approximately 5 km), allowing Qi and blood to stabilize before treatment. Violating these prohibitions disrupts the meridians and imbalances the Ying (nutritive) and Wei (defensive) systems, potentially aggravating mild conditions or depleting Yuan Qi (primordial energy) in severe cases, damaging brain marrow and bodily fluids while impairing the absorption of essential nutrients from grains.

Finally, the critical signs of Qi exhaustion in the Six Meridians (Taiyang, Shaoyang, Yangming, Shaoyin, Jueyin, Taiyin) are described:

• Taiyang Meridian Qi exhaustion: upward-turning eyeballs, opisthotonos (arched back spasms), convulsions, pallid complexion, withered skin, and fatal profuse sweating.
• Shaoyang Meridian Qi exhaustion: deafness, lax joints, fixed eyeballs—death within a day and a half, with bluish-white facial hue.
• Yangming Meridian Qi exhaustion: facial and ocular twitching, susceptibility to fright and delirium, yellowed complexion—death from meridian blockage.
• Shaoyin Meridian Qi exhaustion: darkened face, elongated teeth, abdominal distension, and obstruction of urination/defecation.
• Jueyin Meridian Qi exhaustion: dry throat, feverish restlessness, frequent urination—severe cases involve curled tongue and retracted genitals before death.
• Taiyin Meridian Qi exhaustion: abdominal distension with rebellious Qi, vomiting and flushed face—if vomiting doesn't occur, death follows with blackened face and parched skin.

This passage comes from Volume 4 of the Lingshu Jizhu commentary on the Yellow Emperor's Inner Canon, primarily discussing special needling techniques in ancient acupuncture therapy.

"Contralateral needling" (Miuci) refers to a method where points on the opposite side of the body are needled when treating illness on one side (the notation "上眉/救切" represents ancient phonetic transcription). Regarding the principle of "men treated internally, women treated externally" in point selection, the medical classic Classic of Difficult Issues records a different version, stating "men treated externally, women treated internally," indicating divergent views among ancient physicians on needling depth for men and women.

"Excessive diffusion" (Yinluo, pronounced "下述/各切") describes a pathological state where pathogenic factors spread excessively within the body, like water overflowing in all directions. "Elongated teeth" (read with a level tone) may refer to abnormal tooth growth or gum recession causing teeth to appear longer.

These are all important concepts in ancient Chinese acupuncture therapy, reflecting distinctive understandings of Qi-blood circulation and disease treatment at the time.