灵枢经·玉版 The Jade Tablet

Huangdi said: "I had thought the small needle to be a trifling thing, yet you speak of it as being above united with Heaven, below united with Earth, and in the middle united with man — I feel this goes beyond the true meaning of the needle. I wish to hear your reasoning." Qibo said: "What thing is greater than Heaven? Yet greater in significance than the needle are only the five weapons, and the five weapons are instruments prepared for death, not implements for life. Now, man is that which stabilizes Heaven and Earth — must this not be taken into account? In governing the people, one also relies solely on the needle. Between the needle and the five weapons, which, then, is truly the lesser?"

Huangdi said: "When disease arises, there is sometimes unpredictable joy and anger, immoderate eating and drinking; the yin qi becomes insufficient, the yang qi becomes excessive, and the nutritive qi fails to circulate, and thus welling-abscess and flat-abscess erupt. When yin and yang fail to communicate, the two heats contend with one another and transform into pus — can the small needle remove this?" Qibo said: "Even the sage cannot make what has already transformed undo itself; once evil has taken hold, it cannot simply be left to remain. Consider: when two armies stand opposed, their banners facing one another, bare blades arrayed across the open field — this is not the outcome of a single day's planning. To make one's soldiers obey commands, and to keep the rank and file free of the calamity of bared blades, is not the achievement of a single day's instruction, nor something gained in a mere instant. So too, to allow the body to reach the point of suffering welling-abscess and flat-abscess, with pus and blood gathering within — is this not to have strayed far from the Way? The generation of welling-abscess and flat-abscess, the formation of pus and blood, does not descend from Heaven nor rise up from Earth — it is generated from the accumulation of subtle beginnings. Thus the sage treats the condition before it has taken form, while the fool encounters it only after it has already formed."

Huangdi said: "But suppose one does not encounter it before it has taken form, and does not see it before the pus has already formed — what is to be done then?" Qibo said: "Once pus has already formed, of ten cases nine die and only one survives. This is why the sage does not allow it to reach completion, but clearly sets forth excellent prescriptions, inscribes them on bamboo and silk, and has capable persons carry them forward and transmit them to later generations without end — precisely because one may fail to intervene in time."

Huangdi said: "But if one does encounter it only after pus and blood have already formed, can it not be guided out and treated with the small needle?" Qibo said: "To treat a small matter with a small instrument yields only small results; to treat a great matter with a great instrument brings much harm. Thus, once pus and blood have already formed, only the stone lancet and the pointed blade-needle can remove it."

Huangdi said: "Since much harm may result, can such cases never be brought to a full recovery?" Qibo said: "This depends on whether the signs are contrary or favorable." Huangdi said: "I wish to hear of the contrary and favorable signs." Qibo said: "In one already so injured, if the white of the eye turns bluish-green and the black of the eye grows small, this is the first contrary sign. If, upon taking medicine, the patient vomits, this is the second contrary sign. If there is abdominal pain with severe thirst, this is the third contrary sign. If the shoulders and neck become unable to move freely, this is the fourth contrary sign. If the voice becomes hoarse and the complexion drains of color, this is the fifth contrary sign. Where these five signs are absent, the case is favorable."

Huangdi said: "All diseases have their contrary and favorable signs — may I hear of these as well?" Qibo said: "Abdominal distension, fever, and a large pulse — this is the first contrary sign. Rumbling and fullness in the abdomen, cold limbs with diarrhea, and a large pulse — this is the second contrary sign. Unremitting nosebleed with a large pulse — this is the third contrary sign. Coughing with blood in the urine and wasting of the body, with a small, taut pulse — this is the fourth contrary sign. Coughing with wasting of the body, fever, and a small, rapid pulse — this is called the fifth contrary sign. In cases such as these, death occurs within no more than fifteen days."

Great abdominal distension, cold in the four extremities, wasting of the body, and severe diarrhea — this is the first contrary sign. Abdominal distension with blood in the stool, and a large, intermittently interrupted pulse — this is the second contrary sign. Coughing with blood in the urine, wasting of the flesh and body, and a beating, forceful pulse — this is the third contrary sign. Vomiting blood, fullness in the chest drawing into the back, with a small, rapid pulse — this is the fourth contrary sign. Coughing and vomiting, abdominal distension together with diarrhea of undigested food, and an interrupted pulse — this is the fifth contrary sign. In cases such as these, death occurs within less than a single two-hour period. A physician who fails to discern these signs and needles the patient regardless is said to be treating contrary to the proper course.

Huangdi said: "Your account of the needle is truly magnificent — matched to Heaven and Earth, reckoning the patterns of the heavens above and measuring the order of the earth below, distinguishing the five viscera within, arranging the six bowels without, encompassing the twenty-eight meeting-points of the channel vessels, complete with all their cyclical order. Yet it can kill a living person, and cannot revive the dead — can you reverse this?" Qibo said: "It can kill a living person; it cannot revive the dead." Huangdi said: "Hearing this, I would consider it unkind, and yet I wish to hear this teaching, though I will not put it into practice on others." Qibo said: "This is a manifest truth, and it must necessarily be so — like a blade or sword that can kill a person, or like wine that can make a person drunk: even without examining the patient, this much can already be known."

Huangdi said: "I wish to hear this fully." Qibo said: "That from which a person receives qi is grain. That into which grain pours is the stomach. The stomach is the sea of water, grain, qi, and blood. That through which the sea sends forth cloud-like qi is all under Heaven. That through which the stomach sends forth qi and blood is the channel passageways. These passageways are the great network vessels of the five viscera and six bowels — one need only intercept and drain them there."

Huangdi said: "Is there a fixed count for above and below?" Qibo said: "If one intercepts qi at Wuli (LI-13), it should be stopped after the middle passage; five arrivals and it is done — for after five passes, the qi of the viscera there is exhausted. Thus five times five is twenty-five, and the transport point's qi is drained to its limit. This is what is called robbing the patient of his heavenly-endowed qi; it does not sever his life or curtail his allotted years." Huangdi said: "I wish to hear this fully." Qibo said: "One who peers in at the gate and then needles there causes death within the household; one who has already entered the gate and then needles there causes death in the hall itself." Huangdi said: "Excellent is this method, and luminous is this Way. I ask that it be inscribed upon a jade tablet, to be treasured as a weighty treasure and transmitted to later generations as a prohibition upon needling, so that the people will not dare transgress it."