灵枢经·寿夭刚柔 Longevity and Premature Death, Firmness and Softness

Huangdi asked Shaoshi, saying: 'I have heard that in the generation of human beings, some are firm and some are soft, some are weak and some are strong, some are short and some are long, some are yin and some are yang. I wish to hear the proper method concerning this.'

Shaoshi replied: 'Within yin there is yin, and within yang there is yang. Only by carefully discerning yin and yang can one needle according to the proper method. By grasping the point at which the illness originated, one's needling will have its proper rationale. One must carefully gauge the origin of the disease and respond to it in accordance with the season. Within, the body corresponds to the five viscera and six bowels; without, it corresponds to the sinews, bones, and skin. Hence, just as there is yin and yang within the body, so too is there yin and yang without. Of what lies within, the five viscera are yin and the six bowels are yang; of what lies without, the sinews and bones are yin and the skin is yang. Hence it is said: when disease lies in the yin aspect of yin, one should needle the brook and stream points (ying and shu) of the yin channels; when disease lies in the yang aspect of yang, one should needle the sea points (he) of the yang channels; when disease lies in the yin aspect of yang, one should needle the river points (jing) of the yin channels; when disease lies in the yang aspect of yin, one should needle the network vessels. Hence it is said: disease located in the yang is called wind, disease located in the yin is called impediment (bi), and disease afflicting both yin and yang together is called wind impediment. Disease that has visible form yet is not painful belongs to the category of yang; disease that has no visible form yet is painful belongs to the category of yin. When there is no visible form yet there is pain, this means the yang is whole while the yin has been injured — one should urgently treat the yin and not attack the yang. When there is visible form yet no pain, this means the yin is whole while the yang has been injured — one should urgently treat the yang and not attack the yin. When yin and yang are both stirred and disturbed, so that the disease is now with visible form, now without, accompanied further by vexation in the heart, this is called yin overcoming yang. Such a condition is neither in the exterior nor the interior alone, and the patient's bodily form will not long endure.'

Huangdi asked Bogao, saying: 'I have heard that in disease, the body's form and its qi may be affected in a certain order, one before the other — what is the correspondence between exterior and interior in this?' Bogao answered: 'Wind and cold injure the form, while worry, fear, and anger injure the qi. When the qi is injured, the viscera become diseased, and the viscera then respond; when cold injures the form, the form then responds; when wind injures the sinews and vessels, the sinews and vessels then respond. This is the mutual correspondence between exterior and interior, form and qi.'

Huangdi said: 'How, then, should one needle in such cases?' Bogao answered: 'If the disease has lasted nine days, three needlings will resolve it; if the disease has lasted one month, ten needlings will resolve it. The number of treatments, whether many or few, near or far apart, should be graduated according to this proportion. If a lingering impediment has remained in the body for a long time and will not depart, one should examine its blood network vessels and drain out all of the blood.'

Huangdi said: 'Between diseases of the exterior and the interior, how does the difficulty or ease of treatment compare?' Bogao answered: 'If the body's form is diseased first and the illness has not yet entered the viscera, one should needle it for half the number of days corresponding to its duration. If the viscera are diseased first and the form only responds afterward, one should needle it for double the number of days. This is the correspondence of difficulty and ease within a month's treatment.'

Huangdi asked Bogao, saying: 'I have heard that the body's form may be slack or tense, the qi may be flourishing or declining, the bones may be large or small, the flesh may be firm or fragile, and the skin may be thick or thin — how, from these, is longevity or premature death determined?' Bogao answered: 'When the form and the qi are matched to one another in strength, one lives long; when they are not matched, one dies young. When the skin and flesh are bound closely together, one lives long; when they are not bound together, one dies young. When the blood, qi, channels, and network vessels are more than sufficient to sustain the body's form, one lives long; when they are not sufficient to sustain it, one dies young.'

Huangdi said: 'What is meant by the slackness or tension of the form?' Bogao answered: 'If the body's form is full and the skin is relaxed and pliant, one lives long; if the body's form is full and the skin is tense and taut, one dies young. If the body's form is full and the pulse is firm and large, this is a favorable sign; if the body's form is full and the pulse is small and weak, the qi is declining, and when it declines the patient is in danger. If the body's form is full yet the cheekbones do not stand out prominently, this indicates that the bones are small, and small bones mean early death. If the body's form is full and the large flesh is firm, well-defined, and shows clear divisions, this indicates that the flesh is firm, and firm flesh means long life; if the body's form is full but the large flesh lacks clear divisions and is not firm, this indicates that the flesh is fragile, and fragile flesh means early death. This is the life bestowed by Heaven. As for establishing the body's form and fixing its qi in order to foresee longevity or premature death, one must be thoroughly clear about how to establish the form and fix the qi, and only then approach the patient and decide upon life and death.'

Huangdi said: 'I have heard of longevity and premature death, but I have no way to measure them.' Bogao answered: 'If the foundation walls of the face are low, so that their height does not rise above the level of the surrounding terrain, such a person will die before reaching thirty years of age. If, in addition, such a person contracts a serious illness, he will die before reaching twenty.'

Huangdi said: 'How is longevity or premature death established through the mutual dominance of form and qi?' Bogao answered: 'In a healthy person, if the qi dominates over the form, this indicates long life. In a person who is ill, if the flesh has wasted away from the form and the qi dominates over the form, this indicates death; if the form dominates over the qi, this indicates grave danger.'

Huangdi said: 'I have heard that there are three variations in needling — what are these three variations?' Bogao answered: 'There is needling that targets the nutritive qi, needling that targets the defensive qi, and needling that targets cold impediment lingering within the channels.'

Huangdi said: 'How does one carry out these three variations of needling?' Bogao answered: 'When needling the nutritive qi, one lets out blood; when needling the defensive qi, one lets out qi; when needling cold impediment, one introduces heat into the body.'

Huangdi said: 'What are the disease manifestations of the nutritive qi, the defensive qi, and cold impediment?' Bogao answered: 'When disease arises from the nutritive qi, there is cold and heat, shortness of qi, and blood moving erratically upward and downward. When disease arises from the defensive qi, there is qi pain that comes and goes intermittently, along with oppressive fullness and rumbling in the abdomen, as wind and cold lodge within the intestines and stomach. When disease takes the form of cold impediment, the evil lingers and does not depart, causing intermittent pain and numbness of the skin.'

Huangdi said: 'How does one needle to introduce heat in the treatment of cold impediment?' Bogao answered: 'When needling the common people, one sears the needle with fire before insertion; when needling the great and noble, one applies a medicinal compress.'

Huangdi said: 'How is the medicinal compress prepared and applied?' Bogao answered: 'Take twenty catties of pure wine, one catty of Sichuan pepper, one catty of dried ginger, and one catty of cinnamon heartwood — four ingredients in all. Chew or crush each of them and steep them in the wine. Take one catty of silk floss and four zhang of fine white cloth, and place these together into the wine as well. Set the wine within a container of warm, smoldering horse dung, seal it thoroughly with a covering, and do not allow the vapor to escape. After five days and five nights, remove the cloth and floss and dry them in the sun; once dried, steep them again, so as to draw out the liquid fully. Each steeping must last a full day and night before the material is taken out to dry again. Once dry, combine the dregs together with the floss, and wrap them in the cloth to make compress-cloths six or seven chi in length, forming six or seven such cloths. Then heat the cloths over charcoal made from fresh mulberry wood, and use them to apply moist heat to the site where cold impediment has been needled, so as to cause the heat to penetrate to the site of the disease. When a cloth cools, heat another over the charcoal and apply it in turn, continuing for thirty rounds in all. Once sweating occurs, wipe the body with a cloth, likewise thirty times. Then have the patient rise and walk about indoors, taking care not to be exposed to wind. Each time one needles, one must also apply this compress — treated in this way, the disease will be resolved. This is what is meant by introducing heat.'