灵枢经·根结 Root and Knot
歧伯曰：天地相感，寒暖相移，阴阳之道，孰少孰多，阴道偶，阳道奇。发于春夏，阴气少，阳气多，阴阳不调，何补何写。发于秋冬，阳气少，阴气多；阴气盛而阳气衰，故茎叶枯槁，湿雨下归，阴阳相移，何写何补。奇邪离经，不可胜数，不知根结，五藏六府，折关败枢，开閤而走，阴阳大失，不可复取。九针之玄，要在终始；故能知终始，一言而毕，不知终始，针道咸绝。
太阳根于至阴，结于命门。命门者，目也。阳明根于厉兑，结于颡大。颡大者，钳耳也。少阳根于窍阴，结于窗笼。窗笼者，耳中也。太阳为开，阳明为閤，少阳为枢，故开折，则肉节渎而暴病起矣。故暴病者，取之太阳，视有馀不足。渎者，皮肉宛膲而弱也。閤折，则气无所止息而痿疾起矣。故痿疾者，取之阳明，视有馀不足。无所止息者，真气稽留，邪气居之也。枢折，即骨繇而不安于地。故骨繇者，取之少阳，视有馀不足。骨繇者，节缓而不收也。所谓骨繇者，摇故也。当窃其本也。
太阴根于隐白，结于太仓。少阴根于涌泉，结于廉泉。厥阴根于大敦，结于玉英，络于膻中。太阴为开，厥阴为阖，少阳为枢。故开折，则仓廪无所输，膈洞。膈洞者，取之太阴，视有馀不足，故开折者，气不足而生病也。閤折，即气绝而喜悲。悲者取之厥阴，视有馀不足。枢折，则脉有所结而不通。不通者，取之少阴，视有馀不足，有结者，皆取之不足。
足太阳根于至阴，溜于京骨，注于昆仑，入于天柱、飞扬也。足少阳根于窍阴，溜于丘墟，注于阳辅，入于天容、光明也。足阳明根于厉兑，溜于冲阳，注于下陵，入于人迎，丰隆也。手太阳根于少泽，溜于阳谷，注于小海，入于天窗，支正也。手少阳根于关冲，溜于阳池，注于支沟，入于天牖、外关也。手阳明根于商阳，溜于合谷，注于阳溪，入于扶突、偏历也。此所谓十二经者，盛络皆当取之。
一日一夜五十营，以营五藏之精，不应数者，名曰狂生。所谓五十营者，五藏皆受气，持其脉口，数其至也。五十动而不一代者，五藏皆受气。四十动一代者，一藏无气。三十动一代者，二藏无气。二十动一代者，三藏无气。十动一代者，四藏无气。不满十动一代者，五藏无气。予之短期，要在终始。所谓五十动而不一代者，以为常也。以知五藏之期，予之短期者，乍数乍疏也。
黄帝曰：逆顺五体者，言人骨节之大小，肉之坚脆，皮之厚薄，血之清浊，气之滑涩，脉之长短，血之多少，经络之数，余已知之矣，此皆布衣匹夫之士也。夫王公大人，血食之君，身体柔脆，肌肉软弱，血气慓悍滑利，其刺之徐疾浅深多少，可得同之乎。歧伯答曰：膏梁菽藿之味，何可同也？气滑即出疾，其气涩则出迟，气悍则针小而入浅，气涩则针大而入深，深则欲留，浅则欲疾。以此观之，刺布衣者，深以留之，刺大人者，微以徐之，此皆因气慓悍滑利也。
黄帝曰：形气之逆顺奈何？歧伯曰：形气不足，病气有馀，是邪胜也，急写之；形气有馀，病气不足，急补之；形气不足，病气不足，此阴阳气俱不足也，不可刺之，刺之则重不足。重不足则阴阳俱竭，血气皆尽，五藏空虚，筋骨髓枯，老者绝灭，壮者不复矣。形气有馀，病气有馀，此谓阴阳俱有馀也。急写其邪，调其虚实。故曰：有馀者写之，不足者补之，此之谓也。
故曰：刺不知逆顺，真邪相搏。满而补之，则阴阳四溢，肠胃充郭，肝肺内䐜，阴阳相错。虚而写之，则经脉空虚，血气竭枯，肠胃㒤辟，皮肤薄著，毛腠夭膲，予之死期。
故曰：用针之要，在于知调阴与阳。调阴与阳，精气乃光，合形与气，使神内藏。故曰：上工平气，中工乱脉，下工绝气危生。故曰：下工不可不慎也，必审五藏变化之病，五脉之应，经络之实虚，皮之柔粗，而后取之也。
Qibo said: 'Heaven and Earth mutually affect one another, and cold and warmth shift back and forth in turn. As for the Way of yin and yang, which is the lesser and which the greater? The way of yin is even in number, the way of yang is odd. When illness arises in spring and summer, yin qi is scant and yang qi is abundant; yin and yang are then out of balance — in such a case, what should be supplemented and what should be drained? When illness arises in autumn and winter, yang qi is scant and yin qi is abundant; yin qi is exuberant while yang qi wanes, so that the stalks and leaves wither and dry, the damp rains sink downward and return to the earth, and yin and yang shift places with one another — in such a case, what should be drained and what should be supplemented? Aberrant evils that depart from the channels are too numerous to count. If one does not understand the root and knot of the channels and of the five viscera and six bowels, the pivots and hinges will break and fail, and the opening and closing will run astray; yin and yang will be gravely lost and cannot be restored. The mystery of the nine needles lies essentially in the beginning and end (zhongshi) of the channels — the point at which the channel qi arises and terminates. If one is able to understand this beginning and end, it can be summed up in a single phrase; if one does not understand the beginning and end, the Way of needling is entirely severed.'
The Taiyang channel is rooted at Zhiyin and knotted at Mingmen — Mingmen here refers to the eye. The Yangming channel is rooted at Lidui and knotted at Sangda — Sangda refers to the region that clasps the ear. The Shaoyang channel is rooted at Qiaoyin and knotted at Chuanglong — Chuanglong refers to the interior of the ear. Taiyang serves as the opening, Yangming serves as the closing, and Shaoyang serves as the pivot. Hence, when the opening breaks down, the joints of the flesh become leaky and sudden illness arises; for sudden illness, one should select points along the Taiyang channel, examining whether it is in excess or deficient. 'Leaky' here means that the skin and flesh become wasted, shrunken, and feeble. When the closing breaks down, the qi has nowhere to rest and comes to a halt, and wilting disease (wei) arises; for wilting disease, one should select points along the Yangming channel, examining whether it is in excess or deficient. By 'having nowhere to rest' is meant that the true qi becomes detained and stagnant, and evil qi comes to dwell there. When the pivot breaks down, the bones sway loosely and cannot settle firmly upon the ground; for such swaying of the bones, one should select points along the Shaoyang channel, examining whether it is in excess or deficient. By 'swaying of the bones' is meant that the joints become slack and cannot draw themselves in. This so-called swaying of the bones comes from unsteadiness, and one must seek out its root.
The Taiyin channel is rooted at Yinbai and knotted at Taicang. The Shaoyin channel is rooted at Yongquan and knotted at Lianquan. The Jueyin channel is rooted at Dadun and knotted at Yuying, with a network vessel connecting to Danzhong. Taiyin serves as the opening, Jueyin serves as the closing, and Shaoyang serves as the pivot. Hence, when the opening breaks down, the granary has nowhere to transport its contents, and diaphragmatic flux (getong) arises; for diaphragmatic flux, one should select points along the Taiyin channel, examining whether it is in excess or deficient — for when the opening breaks down, it is because the qi is insufficient that illness is generated. When the closing breaks down, the qi becomes cut off and one is prone to sorrow; for sorrow, one should select points along the Jueyin channel, examining whether it is in excess or deficient. When the pivot breaks down, the vessel becomes knotted at some point and fails to flow through; for such non-flow, one should select points along the Shaoyin channel, examining whether it is in excess or deficient — wherever there is a knot, in every case one should treat it as a deficiency and select points accordingly.
The Foot Taiyang channel is rooted at Zhiyin, flows at Jinggu, pours into Kunlun, and enters at Tianzhu and Feiyang. The Foot Shaoyang channel is rooted at Qiaoyin, flows at Qiuxu, pours into Yangfu, and enters at Tianrong and Guangming. The Foot Yangming channel is rooted at Lidui, flows at Chongyang, pours into Xialing, and enters at Renying and Fenglong. The Hand Taiyang channel is rooted at Shaoze, flows at Yanggu, pours into Xiaohai, and enters at Tianchuang and Zhizheng. The Hand Shaoyang channel is rooted at Guanchong, flows at Yangchi, pours into Zhigou, and enters at Tianyou and Waiguan. The Hand Yangming channel is rooted at Shangyang, flows at Hegu, pours into Yangxi, and enters at Futu and Pianli. These are what are called the twelve channels; wherever their network vessels are exuberant and full, one should in every case select points there for treatment.
In the course of a single day and night, the qi makes fifty circuits (ying), so as to nourish the essence of the five viscera. When the pulse fails to correspond to this number, this is called a reckless survival — life sustained against the proper norm. What is meant by the fifty circuits is this: the five viscera all receive qi in turn, and one holds the pulse at the wrist opening and counts its arrivals. If in fifty beats there is not a single intermittent, skipped beat (dai), the five viscera are all receiving qi properly. If in forty beats there is one skipped beat, one viscus is without qi. If in thirty beats there is one skipped beat, two viscera are without qi. If in twenty beats there is one skipped beat, three viscera are without qi. If in ten beats there is one skipped beat, four viscera are without qi. If there is a skipped beat before ten beats have passed, all five viscera are without qi. In assigning the patient's remaining span of life, the essential point lies in the beginning and end of the pulse. What is meant by 'fifty beats without a single skipped beat' is taken as the normal, healthy pattern. It is by this that one comes to know the appointed time of the five viscera; in assigning a short remaining span of life, one observes whether the pulse is now rapid, now sparse and irregular.
Huangdi said: 'As for the compliance and resistance of the five bodily constitutions — that is, the largeness or smallness of a person's bones and joints, the firmness or fragility of the flesh, the thickness or thinness of the skin, the clarity or turbidity of the blood, the smoothness or roughness of the qi, the length or shortness of the vessels, the abundance or scantiness of the blood, and the number of the channels and network vessels — I already understand these matters, but they concern only the common people, the men in plain cloth. Now, kings, dukes, and great men, rulers who feast on meat and blood, have bodies that are soft and delicate, flesh that is tender and weak, and blood and qi that are brisk, keen, and smoothly flowing. Can the slowness or quickness, shallowness or depth, and the extent of needling be made the same for them as for the common people?' Qibo answered: 'How could the flavor of rich meats and fine grains be compared to that of beans and coarse greens? When the qi is smooth, it emerges quickly upon needling; when the qi is rough, it emerges slowly. When the qi is brisk and keen, the needle should be small and inserted shallowly; when the qi is rough, the needle should be large and inserted deeply — when inserted deeply, one should retain the needle; when inserted shallowly, one should withdraw it quickly. From this it can be seen that in needling the common people, one should insert deeply and retain the needle, while in needling the great and noble, one should needle lightly and withdraw quickly — all this follows from the briskness, keenness, and smooth flow of their qi.'
Huangdi said: 'What of the compliance and resistance between the body's constitution and its qi?' Qibo said: 'When the body's constitution is deficient while the disease qi is in excess, this means the evil qi is prevailing, and one should urgently drain it. When the body's constitution is in excess while the disease qi is deficient, one should urgently supplement it. When both the body's constitution and the disease qi are deficient, this means that both yin and yang qi are deficient, and one must not needle — for needling would only compound the deficiency. When the deficiency is compounded, yin and yang are both exhausted, the blood and qi are both spent, the five viscera become empty and hollow, the sinews, bones, and marrow wither, the old will perish entirely, and the young and vigorous will never recover. When both the body's constitution and the disease qi are in excess, this is called both yin and yang being in excess; one should urgently drain the evil and regulate its deficiency and excess. Hence it is said: what is in excess should be drained, and what is deficient should be supplemented — this is precisely what is meant.'
Hence it is said: if in needling one does not understand compliance and resistance, the true qi and the evil qi will clash with one another. If one is already full and yet is further supplemented, then yin and yang will overflow in all four directions, the intestines and stomach will become swollen and distended, the liver and lung will become congested within, and yin and yang will fall into disorder and cross one another. If one is already deficient and yet is further drained, then the channel vessels become empty and hollow, the blood and qi become utterly exhausted, the intestines and stomach shrivel and fold in upon themselves, the skin becomes thin and clings to the flesh beneath, the body hair and interstices wither and shrink — and this fixes the patient's date of death.
Hence it is said: the essential point in the practice of needling lies in knowing how to regulate yin and yang. When yin and yang are regulated, the essence qi shines forth in brilliance; when the body's form and its qi are united in harmony, the spirit is caused to be stored within. Hence it is said: the superior physician levels the qi; the mediocre physician throws the pulse into disorder; the inferior physician cuts off the qi and endangers life. Hence it is said: the inferior physician must be especially cautious — he must carefully examine the transformations and diseases of the five viscera, the responses of the five pulses, the excess or deficiency of the channels and network vessels, and the softness or coarseness of the skin, and only afterward select the proper points for treatment.