灵枢经·刺节真邪 Discourse on the Categories of Needling, and on True and Evil Qi

Huangdi asked Qibo: "I have heard that there are five guarding regimens of needling — what are they?" Qibo replied: "Indeed there are five guarding regimens: the first is called 'Shaking Off the Dust' (zhen'ai); the second, 'Dispelling the Blindness' (fameng); the third, 'Removing the Nails' (quzhao); the fourth, 'Stripping Off the Robe' (chexi); and the fifth, 'Resolving Confusion' (jiehuo)." Huangdi said: "You speak of these five guarding regimens, Master, but I do not yet understand their meaning." Qibo said: "'Shaking Off the Dust' means needling the outer channels to remove yang disease; 'Dispelling the Blindness' means needling the transport points of the bowels to remove disease of the bowels; 'Removing the Nails' means needling the joints and the limb network vessels; 'Stripping Off the Robe' means needling all of the unusual transport points of the yang channels; 'Resolving Confusion' means fully understanding how to regulate yin and yang, to supplement and drain what is in excess or deficient, and to shift the balance between them."

Huangdi said: "You spoke of the guarding regimen called 'Shaking Off the Dust,' yet you explain it as needling the outer channels to remove yang disease — I do not understand what this means. I wish to hear it in full." Qibo said: "In 'Shaking Off the Dust,' the yang qi surges greatly in reversal, filling and swelling the chest; the patient heaves his shoulders in labored breathing, the great qi rebels upward, he pants and gasps, sitting slumped forward, and finds even the smell of dust or smoke intolerable; he cannot eat without becoming breathless. Let me speak of 'Shaking Off the Dust' — its effect is swifter even than the shaking off of dust." Huangdi said: "Good. How is it applied?" Qibo said: "It is applied at Tianrong." Huangdi said: "And for one who coughs, whose qi rebels upward, who is exhausted and clumsy in movement, and who suffers chest pain, how is it applied?" Qibo said: "It is applied at Lianquan." Huangdi said: "Is there a measure to observe in applying it?" Qibo said: "In needling Tianrong, one should not exceed one li in depth; in needling Lianquan, one stops once the blood changes in color." Huangdi said: "Excellent."

Huangdi said: "You spoke of the guarding regimen called 'Dispelling the Blindness,' but I still do not grasp its meaning. Now 'dispelling the blindness' concerns one whose ears can hear nothing and whose eyes can see nothing — yet you explain it as needling the transport points of the bowels to remove disease of the bowels. Through which transport point is this accomplished? I wish to hear the reason." Qibo said: "How subtle a question this is! This is the great essence of needling, the utmost of the needling art, belonging to the realm of spiritual brilliance — something that spoken word or written text still cannot fully convey. Let me speak of 'Dispelling the Blindness' — its effect is swifter even than the dispelling of blindness." Huangdi said: "Good. I wish to hear it in full." Qibo said: "In needling for this, one must do so at midday, needling Tinggong, aiming so as to reach the pupil, so that a sound is heard within the ear — this is the transport point." Huangdi said: "Good. What is meant by 'a sound heard within the ear'?" Qibo said: "In needling this pattern, one presses firmly with the hand upon both nostrils, and then has the patient abruptly hold his breath and cry out — the response will surely be felt through the needle." Huangdi said: "Good. This is what is called 'acting upon what cannot be seen' — needling without visual observation, yet grasping the disease as though it were seen, so that spirit and brightness meet one another."

Huangdi said: "You spoke of the guarding regimen called 'Removing the Nails,' yet you explain it as needling the joints and the limb network vessels. I wish to hear it in full." Qibo said: "The lower back and spine are the great joints of the body; the limbs and shins are the channels by which a person walks and moves freely; the penis and scrotum are the pivot within the body, the sign of yin essence, and the pathway of the fluids. Thus when eating and drinking are not moderated, and joy and anger arise at improper times, the fluids overflow within and descend to lodge in the testicles; the pathway of blood becomes obstructed, and the swelling grows larger day by day without ceasing, so that bending and stretching become difficult and walking becomes impossible. In this disease, water gathers glistening within, neither rising nor descending; it is treated with the pi-needle or the stone lancet. Its form cannot be hidden, and it is always exposed and cannot be concealed — hence it is called 'Removing the Nails.'" Huangdi said: "Good."

Huangdi said: "You spoke of the guarding regimen called 'Stripping Off the Robe,' yet you explain it as needling all of the unusual transport points of the yang channels, which have no fixed location. I wish to hear it in full." Qibo said: "This concerns a case in which the yang qi is in excess while the yin qi is insufficient. When yin qi is insufficient, heat arises within; when yang qi is in excess, heat arises without. When internal and external heat contend with one another, the patient feels hotter than if embracing burning charcoal; outwardly he dreads the touch even of silk or cotton cloth, unable to bear it near his body, nor even near his sleeping mat. The pores become blocked and closed, so that sweat cannot be released; the tongue becomes scorched and the lips wither, drying out further day by day, and the patient no longer distinguishes good food from bad in eating and drinking." Huangdi said: "Good. How is this treated?" Qibo said: "One needles Tianfu and Dazhu, three punctures each, and further needles Zhonglü, in order to remove the heat; one supplements the Foot and Hand Taiyin channels, in order to remove the sweating. Once the heat is removed and the sweating diminishes, the effect is swifter than the stripping off of a robe." Huangdi said: "Good."

Huangdi said: "You spoke of the guarding regimen called 'Resolving Confusion,' yet you explain it as fully understanding how to regulate yin and yang, to supplement and drain what is in excess or deficient, and to shift the balance between them. How, then, is confusion actually resolved?" Qibo said: "When great wind evil lodges in the body, the blood vessels become unevenly deficient on one side — where deficient, there is insufficiency, and where replete, there is excess. The body loses its balance between light and heavy, tilting and slumping to one side; the patient no longer knows east from west, nor north from south; he is now up, now down, now turned over, now turned back, tumbling about without constancy, worse even than ordinary confusion." Huangdi said: "Good. How is this treated?" Qibo said: "One drains what is in excess and supplements what is deficient, so that yin and yang are restored to balance. When the needle is used in this way, its effect is swifter than the resolving of confusion." Huangdi said: "Good. Let this be stored in the chamber of the Numinous Orchid, and I dare not let it be recklessly disclosed."

Huangdi said: "I have heard that there are five evils treated by needling — what are the five evils?" Qibo said: "There is the disease that carries welling-abscess, the disease of excessive fullness, the disease of narrowness and smallness, the disease of heat, and the disease of cold — these are called the five evils." Huangdi said: "How does one needle the five evils?" Qibo said: "In needling the five evils, there are no more than five methods: intense heat is made to dissolve and vanish; swelling and accumulation are made to disperse and disappear; cold impediment is warmed further; smallness is supplemented with yang; and largeness must be removed. Let me set forth these methods."

In needling welling-abscess evil in general, do not confront it head-on while it is at its height; alter its habitual course and shift its nature. If pus has not yet formed, the fragile pathway can still be redirected; drive the evil from its lodging place, so that, finding no place to settle, it disperses and vanishes. Wherever excess occurs along the yin or yang channels as a welling-abscess, needle its transport point and drain it.

In needling great evil in general, make it smaller day by day: drain and dislodge its excess, and thereby increase its deficiency. Strike swiftly at its open pathway, needling the evil itself; observe closely the flesh and muscle, taking care not to go against what is true and proper. Needle between the flesh and muscle of the yang channels.

In needling small evil in general, make it larger day by day: supplement its deficiency, and thereby there will be no harm. Observe where it lies, and meet it at its boundary, so that, whether near or far, the qi fully arrives; when the evil can no longer invade from without, it exhausts itself of its own accord. Needle between the flesh and muscle.

In needling heat evil in general, disperse it outward until it pales and fades away, letting it wander off and never return, and thereby there will be no more disease. Open up a passage, throw open the gate, so that the evil may find its way out — then the disease will be cured.

In needling cold evil in general, make it warm day by day: insert and withdraw the needle slowly, so as to summon the spirit qi. Once the gate is closed, the qi does not scatter; deficiency and excess become regulated, and the qi is thereby preserved.

Huangdi said: "What needles are properly used for these?" Qibo said: "In needling welling-abscess, use the pi-needle, the sword-shaped needle; in needling the great excess, use the sharp-pointed needle; in needling the small deficiency, use the round-sharp needle; in needling heat, use the caizhen, a slender tapering needle; in needling cold, use the haozhen, the fine, hair-like needle."

Let me now speak of an explanatory discourse: the human body corresponds to Heaven and Earth, and accords with the four seasons; the human being takes part with Heaven and Earth, and so this correspondence can be explained. Where the ground below is damp and marshy, reeds and cattails grow above it — this is how one may know the relative abundance of a person's physical form and qi. Yin and yang correspond to cold and heat: when it is hot, moistening rains fall from above, and the roots and stalks of plants hold little sap; in the human being, the qi lies at the exterior, the skin is relaxed, the pores are open, the blood and qi thin out at the surface, sweat is greatly released, and the skin is moist and glossy. When it is cold, the earth freezes and the water turns to ice; in the human being, the qi lies within, the skin becomes dense, the pores are closed, sweat does not come out, the blood and qi are strong and concentrated within, and the flesh is firm and rough. At such a time, even one skilled at conducting water cannot make it flow through ice; even one skilled at digging through earth cannot break through the frozen ground; and even one skilled in using the needle cannot immediately relieve reversal disorder of the four limbs when the blood vessels are congealed and bound, firm and pressed together, no longer flowing back and forth — this too cannot at once be softened. Thus one who would conduct water must wait for the weather to turn warm, so that the ice melts and the frozen ground thaws, before the water can flow and the earth can be dug. The human pulse and vessels are just the same. In treating reversal disorders, one must first apply warming compresses to harmonize the channels — the palms and armpits, the elbows and legs, the nape and spine — in order to bring them into balance; once the fire qi has penetrated through, the blood and vessels then begin to flow. Only afterward does one examine the disease: if the pulse is moist and glossy, one needles it to bring it to balance; if it is hard and tight, one breaks through it to disperse it, stopping only once the qi has descended — this is what is called 'releasing the knot.'

The general method of using the needle lies in regulating the qi. Qi accumulates in the stomach, from which nutritive qi and defensive qi are made to flow freely, each along its own pathway. Ancestral qi (zongqi — the qi formed from the union of respired air and the qi of grain, which gathers in the chest) collects in the Sea of Qi; that which descends flows into the Qi Thoroughfare (qijie), and that which ascends travels along the pathway of respiration. Thus when reversal cold occurs in the feet, it is because the ancestral qi fails to descend, and the blood within the vessels congeals and stagnates; if one does not use warming to regulate it, one cannot resolve the condition.

One who uses the needle must first examine whether the channels and network vessels are excess or deficient, palpating along their course, pressing and plucking at them, observing where they respond and move — only then does one select the point and needle it. When the six channels are all in balance, this is called 'without disease'; even if disease is present, it is called one that resolves of itself. If, in a single channel, the upper part is excess and the lower part deficient so that the flow is obstructed, this must be because a transverse network vessel, engorged and full, presses upon the great channel, causing the obstruction; one observes this and drains it — this too is what is called 'releasing the knot.'

When there is cold above and heat below, first needle the Taiyang points at the nape, retaining the needle for a long while; once needling is complete, apply warming compresses to the nape and shoulder blades, allowing the heat to descend and merge with the lower region, stopping only then — this is what is called 'pushing it upward.' When there is heat above and cold below, observe the deficient vessel that has sunk into the channels and network vessels, and needle it, stopping only once the qi has descended — this is what is called 'drawing it downward.'

When great heat pervades the whole body, and the patient is manic, seeing, hearing, and speaking of things that are not real, one examines the Foot Yangming channel and its great network vessel and needles them; if deficient, one supplements it, and where there is stagnant blood with excess, one drains it. One has the patient lie face-up, and, standing at his head, presses the pulsating vessels of the neck firmly with the four fingers of both hands, holding them for a long while, kneading and pinching along them, pushing downward as far as the supraclavicular fossa, and then, stopping and beginning again as before, continues until the heat is dispelled, only then stopping — this is what is called 'pushing it out to disperse it.'

Huangdi said: "There are cases where a single vessel gives rise to dozens of different diseases — sometimes pain, sometimes welling-abscess, sometimes heat, sometimes cold, sometimes itching, sometimes impediment, sometimes numbness — the transformations are endless. What is the reason for this?" Qibo said: "All of these are produced by evil qi." Huangdi said: "I have heard that there is true qi, upright qi, and evil qi. What is meant by true qi?" Qibo said: "True qi is that which is received from Heaven; it combines with the qi of grain to fill and nourish the body. Upright qi (zhengqi) is upright wind — wind that comes from a single direction, being neither a replete wind nor a vacuous, thief-like wind. Evil qi is the thieving harm done to a person by vacuous, thief-like wind; when it strikes a person, it penetrates deeply and cannot leave of its own accord. Upright wind, when it strikes a person, penetrates only shallowly; it combines with the body's own qi and departs of its own accord, for its qi arrives weak and soft, unable to overcome the true qi, and so it departs by itself."

When vacuous, thief-like evil wind strikes a person, it makes him shiver and his body tremble, raising the fine body hair and opening the pores. If it penetrates deeply and, within, strikes against the bone, it becomes bone impediment; if it strikes against the sinews, it becomes sinew contracture; if it strikes within the vessels, it becomes blood stasis, and where blood fails to flow freely, it becomes welling-abscess. If it strikes the flesh and contends with the defensive qi, then, where yang prevails, it becomes heat, and where yin prevails, it becomes cold. When it becomes cold, the true qi departs; once departed, there is deficiency, and in deficiency, cold lodges between the skin and flesh. When this qi is expelled outward, the pores open, the fine body hair stirs, and the qi moves back and forth — this produces itching. If it lingers and does not depart, it becomes impediment. If the defensive qi fails to circulate, it becomes numbness.

When vacuous, thief-like evil wind lodges unevenly in one half of the body, penetrating deeply and settling within among the nutritive and defensive qi, then, as the nutritive and defensive qi gradually decline, the true qi departs, and the evil qi alone remains, giving rise to hemiplegia. Where the evil qi lies more shallowly, there is pain confined to one side of the vessel.

When vacuous, thief-like evil wind penetrates deeply into the body, cold and heat contend with one another, lingering long and becoming fixed within. Where cold prevails over heat, the bones ache and the flesh withers; where heat prevails over cold, the flesh rots and the muscle decays into pus, and if this injures the bone within, the injury to the bone within becomes bone-corrosion. Where there is a preexisting affliction of the sinews in front, so that the sinews are bent and cannot be extended, and the evil qi lodges between them without dispersing, this gives rise to sinew-tumor (jinliu). Where there is a binding-up, and qi gathers there, and defensive qi lodges there without returning, so that fluids remain long in that place and combine with the stagnant qi, this becomes intestinal-tumor (changliu) — a condition that, if longstanding, takes several years to form, and which feels soft when pressed with the hand. Where there is already a binding-up, and qi gathers there, and fluids are retained there, and evil qi strikes into it, the congealing binds tighter day by day, connecting and accumulating in one place, this becomes a xiliu, a hardened, longstanding nodular swelling, which feels firm when pressed with the hand. Where there is a binding-up that penetrates deeply into the bone, so that qi becomes bound up with the bone, and bone and qi merge together, growing larger day by day, this becomes bone-welling (guju, a bone abscess). Where there is a binding-up that strikes into the flesh, and the ancestral qi gathers there, and the evil qi lingers without departing — if there is heat, it transforms into pus; if there is no heat, it becomes a flesh-welling (rouju, a flesh abscess). Now, all these several conditions of qi arise in no fixed place in the body, yet each has its own fixed name.