《黃帝素問靈樞集註》Vol. 9

The Lingshu section of the Yellow Emperor's Inner Classic discusses the symptoms and corresponding acupuncture treatments for pathogenic influences invading the five zang organs.

When pathogenic qi invades the lungs, patients experience skin pain, alternating chills and fever, panting, excessive sweating, and coughing. Treatment involves pressing acupoints on the chest and back (Yingzhongwaishu and the fifth paravertebral point beside the third thoracic vertebra) to locate tender spots for needling. The Quepen (ST-12) point may also be selected to drain pathogenic qi.

Liver invasion manifests as hypochondriac pain, cold sensation in the stomach, internal blood stasis, and in severe cases, joint spasms and foot swelling. Treatment requires needling Xingjian (LR-2) to regulate the hypochondrium, warming supplementation at Zusanli (ST-36), bloodletting to remove stasis, and puncturing the blue vessels behind the ears to relieve spasms.

Spleen-stomach pathologies present as muscle pain. Excess yang with deficient yin causes internal heat and hunger; deficient yang with excess yin leads to cold stomach, borborygmi, and abdominal pain; balanced deficiency or excess of both results in mixed cold-heat patterns—all treatable by regulating Zusanli (ST-36).

Kidney pathologies involve bone pain, yin obstruction (numbness insensitive to pressure), abdominal distension, lumbar pain, constipation, neck-shoulder pain, and dizziness. Treatment targets Yongquan (KI-1) and Kunlun (BL-60), with complete bloodletting required for blood stasis.

Heart invasion causes heart pain, susceptibility to grief, and sudden fainting, requiring heart channel point regulation based on deficiency/excess patterns.

The text then details cold-heat disease treatments:

• Skin cold-heat (inability to lie flat, withered body hair, dry nose, anhidrosis) requires needling luo-connecting points of the three yang channels combined with hand taiyin supplementation.
• Muscle cold-heat (muscle pain, dry lips, anhidrosis) involves bloodletting on the three yang channels of the lower limbs with foot taiyin supplementation.
• Bone cold-heat (restlessness, profuse sweating) is treated by needling lower limb luo-points of the shaoyin channel if teeth remain intact—otherwise prognosis is poor.

Bone obstruction presents as stiff painful joints with profuse sweating and irritability, requiring supplementation of the three yin channels (some texts say three yang). Post-traumatic blood loss, wind-cold exposure, or falls causing limb weakness—termed "body lethargy"—is treated at the triple intersection point below the navel (Guanyuan REN-4, three cun below umbilicus where yangming and taiyin channels converge).

This passage explains ancient Chinese medical diagnostic and treatment methods through observing pulse variations at different body locations, primarily involving the application of meridians (pathways for Qi and blood circulation) and acupoints (specific therapeutic points along meridians).

When pathogenic Qi surges upward to the abdomen, one should examine the collateral branches of the yin and yang meridians, treating according to the primary disease location. Excess patterns require draining yang meridians, while deficiency patterns require tonifying yin meridians. The lateral neck pulse location is called Renying (ST-9), belonging to the Foot Yangming Stomach Meridian, situated anterior to the sternocleidomastoid muscle (called "infant sinew" in ancient texts); posterior to this muscle lies Futu (LI-18) of the Hand Yangming Large Intestine Meridian.

Next are Tianyou (TB-16) of the Foot Shaoyang Gallbladder Meridian and Tianzhu (BL-10) of the Foot Taiyang Bladder Meridian. The axillary pulse belongs to Tianfu (LU-3) of the Hand Taiyin Lung Meridian. Different symptoms require different acupoints: headaches with chest oppression and dyspnea call for Renying (ST-9); sudden loss of voice with Qi stagnation requires Futu (LI-18) combined with tongue-root bloodletting; sudden deafness with blurred vision needs Tianyou (TB-16); convulsions with dizziness and weak legs require Tianzhu (BL-10); while nosebleeds caused by internal heat damaging liver and lungs are treated at Tianfu (LU-3). These five acupoints are collectively called the "Five Tianyou Points."

Facial treatments also follow different meridians: the Hand Yangming Meridian has a branch reaching the cheekbone and teeth called Daying (ST-5), treating lower toothache; the Foot Taiyang Meridian has a cheekbone branch called Jiaosun (SJ-20), treating upper toothache. The treatment principle states that excess pulse conditions require draining techniques, while deficient conditions need tonifying methods.

The Foot Yangming Meridian has a branch entering the face beside the nose called Xuanlu (GB-5), opposite the mouth and connecting to the eyes. The Foot Taiyang Meridian passes through the neck's rear into the brain, connecting to the eyes to form the "ocular system" - for headaches and eye pain, treat between the two tendons at the neck's back. This is also where the yin and yang heel vessels (two of the eight extraordinary meridians) converge, influencing eye-opening and closing functions.

Finally, it discusses seasonal acupuncture essentials: spring treatments target superficial diseases by needling collaterals; summer treats muscular disorders by needling between muscle layers; autumn addresses tendon disorders by treating at the qi opening (wrist pulse location); winter treats bone marrow conditions by needling meridian transport points. When internal organs are diseased, treatment methods should also be selected according to seasonal characteristics.

This passage discusses acupuncture treatment methods and precautions for manic-depressive disorders (癫狂病).

Regarding the treatment of abscesses (痈疽, suppurative infections): life-threatening risks arise when abscesses develop in five critical body regions - the thigh muscles (伏兔), calves (腓), back (背), acupoints corresponding to the five zang organs (五脏腧穴), and neck (项部). Treatment must target the corresponding meridians based on location: hand Yangming and Taiyin meridians for arm afflictions; neck Taiyang meridian for head conditions; and foot Yangming meridian for lower leg issues. Acupuncture should be applied moderately, as excessive needling may lead to Jing (essence) leakage, potentially worsening the condition or triggering new abscesses.

Symptoms and treatment of manic-depressive disorders: During episodes, patients exhibit abnormal eye movements (lateral or medial deviation), depression, headaches, red eyes, and restlessness. Physicians should observe facial complexion changes to assess the condition. Treatment involves bloodletting from corresponding meridians (hand Taiyang, Yangming, Taiyin, etc.) until the blood color normalizes.

Three key principles govern manic-depressive disorder treatment: First, cohabitation with patients for continuous observation; second, precise identification of affected meridians and acupoints; third, timely bloodletting during episodes. Diagnostic methods include observing drawn blood in a gourd - spontaneous movement indicates improvement, while stillness necessitates moxibustion with twenty cones at the sacral region (尾骨).

Three manic-depressive subtypes are described: Bone-type (骨癫疾, featuring locked jaw, muscle rigidity, sweating, restlessness, frothy vomiting, and Qi leakage); Tendon-type (筋癫疾, with body convulsions, stiff neck/back, frothy vomiting, and Qi leakage); and Vessel-type (脉癫疾, involving sudden fainting and distended/flaccid limb vessels). Cases presenting both frothy vomiting and Qi leakage in the latter two types indicate poor prognosis.

This passage primarily discusses ancient Chinese medical acupuncture techniques for treating madness (similar to modern mental disorders) and various counterflow syndromes (disorders of reversed Qi and blood flow). For different types of manic symptoms, physicians would select corresponding meridian points for treatment.

When treating madness, the selection of meridians should correspond to the symptoms: for instance, if the patient initially exhibits sorrow, forgetfulness, irritability, or fear, bloodletting should be performed at points along the Hand Taiyin Lung Meridian and Hand Yangming Large Intestine Meridian. If the patient behaves arrogantly and curses people day and night, points on the Hand Yangming and Hand Taiyang Small Intestine Meridians should be selected. If hallucinations (visual or auditory) occur, points on the Hand Taiyang and Foot Taiyin Spleen Meridians should be used.

For newly developed manic episodes, the first step is to needle the artery near the Ququan point (a point on the inner knee). Once bleeding occurs, the condition should improve. If there is no effect, alternative methods should be employed, followed by applying twenty moxibustion cones (a unit of measurement in moxibustion therapy) at the coccyx.

The text also describes methods for treating "wind counterflow" (similar to stroke symptoms): when symptoms such as swollen limbs, body tremors, chills, or hunger-induced agitation appear, points on the Hand Taiyin Lung Meridian and its internally-externally paired meridians should be selected. For symptoms caused by "reversal counterflow" (upward rebellion of Qi and blood), such as sudden coldness in the feet or severe pain in the chest and abdomen, points on the Foot Shaoyin Kidney Meridian or Foot Yangming Stomach Meridian should be chosen based on whether the patient exhibits cold or heat patterns, applying either reinforcing or reducing techniques.

Lastly, for cases of urinary or fecal retention, points on the Foot Shaoyin Kidney Meridian and Foot Taiyang Bladder Meridian should be needled, along with the Changqiang point above the sacrum. In severe cases of Qi counterflow, points on the Taiyin Spleen and Yangming Stomach Meridians should also be selected.

This passage primarily discusses treatment methods for febrile diseases (heat-related illnesses) and hemiplegia (paralysis of one side), along with prognostic assessments for certain critical conditions.

Regarding hemiplegia (pianku), if one side of the body becomes immobile and painful while the patient remains conscious with normal speech, it indicates the illness resides between the muscles and superficial tissues. This can be treated with large needles, supplementing deficiencies and draining excesses to restore function. For "paralysis disorder" (feibing) where the body isn't painful but limbs lack strength, with slightly disturbed consciousness yet retained speech capacity, treatment is possible. Complete loss of speech indicates a difficult-to-treat condition.

Treatment should follow the disease progression sequence: if the illness first manifests in yang channels before transferring to yin channels, treat the yang channels first followed by the yin channels. For febrile diseases on the third day, if the wrist pulse remains calm while the neck pulse becomes agitated, one can apply bloodletting at fifty-nine specific acupuncture points (an ancient set of heat-treatment points) to purge heat, while simultaneously supplementing yin fluids. However, if both yin and yang pulses remain calm during high fever, acupuncture must not be applied—this indicates a fatal condition.

The text details needling methods for various febrile symptoms: for instance, when the illness persists for seven or eight days with rapid pulse and panting, quickly needle points between the thumb joints. Symptoms like bloody urine, dry mouth, and faint pulse indicate extremely poor prognosis with possible death within one or two days. For patients who have already sweated but maintain rapid pulse with recurring fever, skin needling must be avoided—severe panting in such cases leads to death.

Specialized needling approaches are described for particular febrile conditions: if skin pain, nasal congestion and facial swelling appear first, treat through the lung channels; if physical rigidity, feverish restlessness and dry mouth occur initially, address the heart channels; for cases with dry throat, excessive drinking, susceptibility to fright, and inability to rise from bed, treat through the muscular system using specific sixth-needle techniques at the fifty-nine points. Greenish eyes also indicate certain febrile disorders.

These treatment methods embody the TCM principle of "pattern differentiation and treatment determination" (bianzheng shizhi), diagnosing affected channels through symptoms and applying supplementation or drainage techniques. The repeated emphasis on "do not needle" (wu ci) for certain critical symptoms demonstrates ancient physicians' profound understanding of febrile disease crises.

This passage from the Lingshu section of the Yellow Emperor's Inner Canon discusses the diagnosis and acupuncture treatment of febrile diseases. When a patient exhibits symptoms like a bluish complexion, headache, and restless limbs, the practitioner should select acupoints between the sinew channels, using the fourth needle (the sharp needle) from the nine classical needles to treat the extremities—this indicates liver heat.

If the patient experiences frequent convulsions and manic agitation, the practitioner must urgently drain the pulse points with the sharp needle. Hair loss accompanied by manic behavior signifies heart heat. For symptoms like bodily heaviness, bone pain, deafness, and excessive sleepiness, the sharp needle should be applied to the bones with fifty-nine needle insertions. When heat penetrates the bone marrow, manifesting as mental confusion, deafness, limp limbs, and dry mouth, the condition becomes difficult to cure.

The text details acupoint selection for various febrile diseases: for acute periumbilical pain, use Yongquan (the depression on the front sole) and Yinlingquan (the inner side of the lower leg); for sweating with harmonious pulses, select points like Yuji (on the palm) and Taiyuan (on the wrist), applying draining techniques to reduce heat and reinforcing techniques to induce sweating. It specifically lists nine critical febrile conditions—such as absence of sweating with flushed face and hiccups, diarrhea with abdominal distension, persistent high fever, fever with abdominal distension in infants or the elderly, vomiting or passing blood, tongue ulceration with high fever, coughing blood with incomplete sweating, marrow heat, and high fever with convulsions—all contraindicated for acupuncture.

Finally, it emphasizes key prognostic indicators: if the pulse remains agitated after sweating, this signals a fatal depletion of Yin; a calm pulse indicates survival. High fever without sweating signifies fatal Yang depletion, but if sweating occurs with a calm pulse, the patient may recover. These diagnostic methods embody the foundational TCM principle: "Observe the complexion and palpate the pulse to first distinguish Yin and Yang."

This passage primarily discusses the contraindications and specific techniques of ancient acupuncture therapy. It first outlines nine situations where acupuncture should not be applied, then details fifty-nine needling locations and methods.

Regarding acupuncture points:

• There are three points each on the inner and outer sides of both hands, totaling twelve points; one point between each finger joint, making eight points; with a similar distribution on the feet.
• On the head, starting one cun behind the hairline, there are three points on each side (six total); three cun further back, five points per side (ten total).
• One point each in front of and behind the ears, below the mouth, and one at the center of the neck (six total).
• Additional points mentioned include the crown of the head, xinhui (anterior fontanelle), hairline, lianquan (throat), fengchi (posterior neck sides), and tianzhu (neck).

Treatment methods for various conditions:

• For chest oppression and panting: needle the big toe along the Foot Taiyin channel, about a leek-leaf width from the nail. Retain needles for cold syndromes, withdraw quickly for heat syndromes, stopping when Qi descends.
• Sudden heart pain: needle Foot Taiyin and Jueyin channel points, pricking blood vessels to release blood.
• Throat swelling, curled tongue, dry mouth, heart vexation, and inner arm pain: needle points on the little finger side.
• Eye redness and pain starting from inner canthus: needle Yin Heel Vessel points.
• Convulsions with body arching: first needle Foot Taiyang channel and popliteal fossa points, pricking blood vessels. For internal cold, add zusanli point.
• Urinary retention: needle Yin Heel Vessel and big toe points, pricking blood vessels.
• Male abdominal distension (guzhang) or female melancholy with backache and poor appetite: first prick yongquan point, then examine engorged vessels on foot dorsum for bloodletting.

Headache treatments:

• Headache with facial edema and heart vexation: needle Foot Yangming and Taiyin channels.
• Throbbing vascular headache with tendency to weep: first prick engorged head vessels, then regulate Foot Jueyin channel.
• Heavy headache: needle five head points along the Five Phases, first Hand Shaoyin then Foot Shaoyin channels.
• Forgetful headache: first massage temporal arteries, then needle Foot Taiyin channel.
• Neck-originating headache with spinal pain: first needle tianzhu point, then Foot Taiyang channel.
• Severe headache with pulsating periauricular vessels: first bloodletting, then Foot Shaoyang channel.
• True headache (most severe): excruciating whole-head pain with icy extremities to joints—considered incurable.

Pronunciation notes for rare characters are provided: "痉" as "jù jǐng qiè", "噤" as "jù jìn qiè", and "齘" pronounced like "jiè".

This scripture primarily discusses the diagnosis and acupuncture treatment methods for various pain symptoms. For pain caused by falls or trauma resulting in internal blood stasis and unresolved muscle damage, local needling is appropriate, and distant acupoint selection should be avoided.

Regarding headaches that cannot be directly needled: in cases of severe intractable headaches (major bi syndrome) that progressively worsen, temporary relief may be achieved but complete cure is difficult. For cold pain affecting half the head, first needle points along the Hand Shaoyang and Yangming channels, then proceed to the Foot Shaoyang and Yangming channels.

Different types of "jue xin tong" (symptoms resembling angina pectoris) have distinct manifestations and treatments:

• Heart pain radiating to the back with hunched posture indicates kidney-related heart pain—first needle Jinggu and Kunlun points.
• When accompanied by abdominal distension and chest oppression, it's stomach-related heart pain—select Dadu and Taibai points.
• Stabbing pain like an awl suggests spleen-related heart pain—use Rangu and Taixi points.
• A bluish complexion with frequent sighing indicates liver-related heart pain—choose Xingjian and Taichong points.
• Pain worsening when lying down or moving but without facial discoloration signifies lung-related heart pain—select Yuji and Taiyuan points.
• True "heart pain" (possibly referring to myocardial infarction) involves icy limbs extending to joints, violent attacks, and potential fatality within a short time.

Contraindications for needling heart pain include severe internal accumulations or intestinal parasites (jiao wei). For parasite-induced abdominal pain characterized by paroxysmal pain, abdominal heat, thirst, and drooling, firmly press the affected area and insert a large needle until the parasites cease movement before withdrawal.

Ear disorder treatments:

• For deafness, needle points within the ear.
• For tinnitus, use the artery anterior to the ear.
• Avoid needling when pus or earwax blockage is present.
• Deafness may also be treated by needling the point near the nail of the ring finger—treat hand points before foot points.
• For tinnitus, needle the point near the middle fingernail using contralateral needling (left disease treated on right side and vice versa).

For lower limb mobility impairment, position the patient laterally and needle the hip joint area using round-sharp needles. For bloody stool, select Ququan point. Severe wind-bi syndrome (resembling rheumatism) where feet feel as if treading ice yet soaked in hot water, with sore weak legs and irritability, proves difficult to cure.

Note: The mentioned channels (e.g., Shaoyang, Yangming), acupoints (e.g., Taichong, Ququan), and needles (round-sharp needles) are standard Chinese acupuncture terminology, with "jiao wei" referring to intestinal parasitic diseases.

This passage describes severe pathological manifestations and prognostic assessments in traditional Chinese medicine. When a person experiences headaches with intermittent vomiting, episodes of chest oppression and dizziness, prolonged blurred vision after sweating, sudden mood swings alternating between sorrow and joy, accompanied by feelings of fear, shortness of breath, and persistent melancholy—if this condition persists without improvement, the prognosis suggests life-threatening danger within three years.

The subsequent rare characters with phonetic annotations are specialized medical terms used by ancient physicians to describe specific symptoms: "貞貞" (pronounced "dū gēng qiē") depicts the nature of a headache; "憹" (pronounced "nǎi lǎo qiē") refers to a state of discomfort and irritability; "㤣" (pronounced "pēng") indicates a sensation of fullness and distension; "耵聹" (pronounced "shàng dū lǐng qiē / xià nǎi dǐng qiē") denotes earwax or secretions in the ear canal. These terms, found in the Yellow Emperor's Inner Canon (Huangdi Neijing), were used to precisely characterize the nuanced manifestations of illness.

This record originates from the commentary collection of Lingshu (the Spiritual Pivot), a crucial text in ancient Chinese medical diagnosis and prognosis. By observing the duration and combination of symptoms, physicians determined disease progression. The three-year timeframe mentioned reflects a prognostic standard derived from clinical experience in classical medical practice.