灵枢经·周痹 Encircling Impediment

Huangdi asked Qibo: 'In encircling impediment (zhoubi) as it occurs in the body, it moves up and down, shifting and traveling along the vessels, so that its manifestations above and below, left and right, correspond to one another without the least gap between them. I wish to hear whether this pain lies within the blood vessels, or whether it lies between the interstices of the flesh, and how it comes to be so. When the pain shifts, there is not even time to insert the needle; by the time the aching pain is felt, there is not even time to settle on a treatment before the pain has already ceased. What is the principle that causes this? I wish to hear the reason.' Qibo replied: 'This is manifold impediment (zhongbi), not encircling impediment.'

Huangdi said: 'I wish to hear about manifold impediment.' Qibo replied: 'This condition occurs each time in its own particular location, arising and ceasing in turn, settling and stirring in turn — the right responding to the left, the left responding to the right, but it is not able to encircle the whole body; it merely arises and rests in turn.' Huangdi said: 'Good. How should it be needled?' Qibo replied: 'In needling this condition, even though the pain has already ceased, one must still needle the affected site, so as not to let it arise again.'

Huangdi said: 'Good. I wish to hear what encircling impediment is like.' Qibo replied: 'Encircling impediment lies within the blood vessels, following the vessels upward and following the vessels downward; it cannot move to left or right, but remains confined to its own place along the vessel.' Huangdi said: 'How should it be needled?' Qibo replied: 'When the pain moves from above downward, first needle below to intercept it, then needle above to release it. When the pain moves from below upward, first needle above to intercept it, then needle below to release it.'

Huangdi said: 'Good. Where does this pain arise, and for what reason does it bear this name?' Qibo replied: 'Wind, cold, and damp qi lodge externally between the interstices of the flesh, where they are forced together and form froth. When this froth encounters cold, it congeals, and once congealed it pushes the interstices of the flesh apart and splits them; this splitting causes pain, and pain draws the spirit to that place. Once the spirit arrives there, heat is generated; once heat arises, the pain is dispersed; once the pain is dispersed, reversal occurs; once reversal occurs, another impediment breaks out elsewhere — and it develops in just this way.' Huangdi said: 'Good. I have now grasped its meaning. This condition does not reside within the viscera, nor has it yet broken out upon the skin externally; it dwells alone between the interstices of the flesh, so that the true qi cannot circulate all around — hence it is called encircling impediment. Therefore, in needling impediment disorders, one must first press along and follow the six channels below the affected region, observing whether they are deficient or excess, and whether the great network vessels have blood stagnation that fails to flow freely, or are so deficient that the vessel sinks and becomes hollow — and regulate accordingly, applying heat therapy to open the passage. Where there is convulsive tautness and contraction, guide it along its course.' Huangdi said: 'Good. I have now grasped both its meaning and its practice. This encompasses the principle governing the nine varieties, and the disorders of yin and yang among the twelve channels.'