Nguyen Van Nghi
Tran Viet Dzung
Christine Recours-Nguyen
huangdi
neijing
LINGSHU
Volume II
Books IV and V
N.V.N. Edition
Translated from the French by
Edward S. Garbacz, MD
With Additional Commentary by
Sean Christiaan Marshall, D. Ac.
7.
“Understanding the meaning of the Dao of Acupuncture is
like becoming liberated from doubt, like awakening from a drunken state,
like coming clearly out of a sleep. In contrast, those who do not
understand the Dao remain “mute” before their patient; and mistakenly
understanding, sufficiently enough, the cause of the evolution of the
disease, he gropes along “in the darkness” in order to attempt discovering
a solution... .”
Ma Yuan Tai
Tang dynasty
(618-906 A.D.)
no 8/9.
INTRODUCTION
We complete, finally, Volume II of the Lingshu which has demanded of us a
sum of efforts and comprehension of several years.
It was initially planned to split this work up into two volumes, but the
abundance of commentaries has lead us to publish it in three works.
This very old book, this cult book, has been subject over the centuries to
numerous translations, transcriptions, discussions and analyses.
There exists then inevitable archaisms and inherent linguistic difficulties
in the evolution of the language, unrecognizable social and literary habits,
customs/habits/type√, climate, the pathology and philosophy of this time.
We must appreciate the exact measure, placing it constantly in the context of
the era;
we must nullify the traps of what is left unsaid, allusions, hierarchical
terms, obscure analogies and maxim phrases√.
In this manner, up to the present, none of the modern translations of the
Lingshu, also deserving fut-elle, have statisfied us. One demands on the part of the
translator to be an eminent historian and literary sinologist, and, above all, a
grounded/grassroots/practical acupuncturist de terrain, rich in his own√
experience and an acupuncturist of culture/knowledge√ saturated with the great
Chinese medical classics.
Indeed, our work is not perfect; it presents/sets out again more or less, of
uncertainties; most certainly we hope that physicians of the next generation will be
able to improve it.
But present-day physicians will be able to draw interesting teachings on the
pathophysiology and therapeutics of Acupuncture/Moxabustion, to fill the gaps, to
perfect the practice of acupuncture and to be urged to carry out research work
according to the criteria of modern science, entirely respecting Daoist mind/ spirit/
thinking.
This 2nd volume consists of Books IV and V.
• Book IV consists of 7 chapters and develops various themes:
10.
_ Etiology, classification, therapeutics and prognostics of the extravagant and
capricious syndromes of certain diseases of Yin and Yang nature (Yin Madnesses and
Yang Madnesses).
_ Diseases of Heat etiology and treatment: hemiplegia, quadriplegia, cutaneous
pain, facial edema, limb spasms, ostealgia, deafness, bruxism, headaches, epistaxis,
etc.
_ Diseases of Afflux etiology and treatment: 9 types of cardialgia, 9 types of
headache, deafness and buzzing, spinal pain, lumbalgias, gonalgias, nuchal pain,
tonsillitis, epistaxis, disorders of behavior, disorders of diuresis, abdominal pains,
limb flaccidity, etc.
_ Erratic pain and cyclic pain and the therapeutic techniques of “Top-Bottom”
and “Left/Right-Right/Left”.
_ “Singular” diseases and treatment: yawning, hiccups, grief, trembling from
cold, eructations, sneezing, muscular laxity, passage of tears, sialorrhea, sighing,
tinnitus, biting the tongue ... .
• Book V consists of 20 chapters and concerns the following studies:
_ Attitudes of the sage: men of state and physicians. Favorable and unfavorable
problems of Yin and Yang and problems of “attachment to life” and “fear of death”.
_ Fundamental characteristics of the energy: “^6 Energies”, Jing
(quintessence), Qi (energy), Xin (interstitial liquids), Ye (viscous liquids), Xue (blood)
and Mai (vessels).
_ Studies of the “4 Seas” and their transmittable points: Sea of “Cereal Water”,
Sea of the Jingmai, Sea of Energy and Sea of Marrow.
_ Five disorders of the energy and unfavorable phenomena of Yin and Yang.
Method of conduction of the energy (Dao Qi).
_ Etiology, classification, diagnosis and therapy of the intumescences.
_ Five facial zones (Wu Guan) and the constant principles of examination of
the complexions/colors.
_ Treatment according to the build of the individual.
_ Blood stasis and treatment.
_ Properties of the pure and impure energy of the human organism.
_ Solar and lunar movements in the determination of emptiness and fullness,
growth and decline, of Yin and Yang.
_ Acupuncture and the evolution of the disease according to the chains of
production and destruction of the law of the 5 Movements.
_ Analysis of the different types of dreams and treatment.
_ Conformity of the energy of the body with that of the day divided into 4
seasonal periods and therapeutic principles of the Wu Shu (5 Shu antique points).
_ Mechanism of triggering of disease as a function of the state of the
musculo-skeletal and epidermo-dermal systems.
_ Favorable and unfavorable states of the 5 organs/6 bowels as a function of
anatomic aspects (morphology, disposition ...).
_ Basic principles of medical reasoning of Acupuncture and Moxabustion.
In this way, present-day acupuncture physicians saturated with scientific
knowledge must work out of these ancient texts, knowing how with respect the
archaic and magical aspects which saturate
ipso facto Chinese thought of more than
3000 years beforehand and in drawing from new elements in order to, paradoxically,
modernize the practice of their art.
Scientific thinking and fundamental Chinese thinking are not contradictory.
They are the perfect representation of the duality of the world. They are like Yin and
Yang; they are at once opposed, indivisible and complementary. To possess these two
modes of thought, these two types of medical knowledge, is to pose, more than every√
other, a serene, critical and universal look at medicine.
The reading of the Lingshu remains one of the first acts to accomplish in
order to reach there.
no 12/13.
Book IV
Book IV consists of 7 chapters:
Chapter 22:
Yin Madness and Yang Madness
(Dian Kuang)
Chapter 23:
Diseases of Heat
(Re Bing)
Chapter 24:
Diseases of Afflux
(Jue Bing)
Chapter 25:
Causes of Disease
(Bing Ben)
Chapter 26:
Various Diseases
(Za Bing)
Chapter 27:
Erratic and Cyclic Pains
(Zhou Bi)
Chapter 28:
Oral Questions
(Kou Wen)
no 14/15.
CHAPTER XXII
Yin Madnesses and Yang Madnesses
(Dian Kuang)
Chapter 22 of the Lingshu is devoted to the study of the Yin-Madnesses and the
Yang-Madnesses (Dian Kuang).
Pathological approaches to these illnesses are grouped together in several
phases from which the syndromes are classified and treated according to the
principle of choice of the channels as a function of the “4 seasons”.
The causes of Calm Madnesses and Agitated Madnesses are not beyond the scope
of sadness, chagrin, fear, fright, worry, excessive joy, orientation of the essential
energy toward insufficiency, digestive disturbance... and treatment must be based on
deep analysis of the syndromes.
This chapter of the Lingshu does not deal with mental disorders. The term Dian
Kuang does not in any way signify manic-depressive psychoses, but “madnesses” in
the sense of designating the excessive and capricious prodromes of some illnesses of
Yin nature and Yang nature and, particularly, illnesses called
Contrary Afflux
(Jue Ni).
PARAGRAPH 1
“The ocular angle split toward the external part of the cheekbone
is Wai Zi (external canthus of the eye), and the angle directed toward the
side of the nose, Wei Zi (internal canthus of the eye).
The upper eyelid belongs to Wai Zi, and the lower eyelid, to Nei Zi. ”
EXPLANATIONS AND COMMENTARIES
16.I - Zhang Shi explains:
“The energy of Taiyin controls the maintenance of the canthii of the eyes, that of Taiyang involves the upper eyelid and that of the Yangming, the lower eyelid.
Therefore, to speak of the upper eyelid belonging to Wai Zi and the lower eyelid belonging to Nei Zi is to speak of the energy of Taiyang and Yangming also controlling the canthii of the eye.
The Hand Taiyin (Lu) responds to Heaven and Foot Taiyin (Bl), to Earth. Taiyang controls the opening (of the eye) and Yangming, the closing. The energy of Heaven and that of Earth
lights the day and darkens the night. Such is the response of man to day and night, to the opening and closing, of Heaven and Earth.
During one respiration, the opening and closing are intended to respond to the expiratory movement, inspiratory movement and the clepsydra.
Is the energy of opening and that of closing are not evident, Yin energy and Yang energy are without distinction, Shen (mental) and Chi (will) lose their connection in growing dark, and transform into Dian Kuang (Yin Madnesses and Yang Madnesses). This is why treatment of these illnesses especially consists of needling the points of the Taiyang, Taiyin and Yangming channels of the foot and hand.”
II - Ma Shi clarifies:
“Paragraph 1 demonstrates the external energetic morphology of the eye because the eyes are the sites of manifestaion of the Jing Shen (pure energy and mental) of the organs and bowels and because examination of the Shen at the level of the eyes constitutes the first diagnostic action in the illnesses called Yin Madnesses/Yang Madnesses.”
III - N.V.N.:
The external energetic morphology of the eye can be diagrammed in the following fashion: 17.
Figure 1:
Energetic morphology of the eye.
PARAGRAPH 2
“At its start, the Dian illness (Yin Madnesses) manifests by the
following signs:
_ sadness
_ feeling of heaviness of the head and headaches
_ gaze fixed toward the top and redness of the eyes.
At a more advanced degree:
_ anxiety, restlessness
Examine well Tian Ding (1) and needle the points belonging to the
Taiyang, Yangming and Taiyin; stop treatment as soon as the complexion
c h a n g e s . ”
EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
“The Dian illnesses (Yin Madnesses) and Kuang illnesses (Yang Madnesses) are due to an obstruction of the Yin and Yang energy of the bottom, causing an afflux toward the top.
Shaoyin is a priori (innate) Water-Fire and Taiyin is a posteriori (acquired) Earth... . The “Water-Fire” energy of Heaven and Earth must be balanced above and down below; the opposite is synonymous with illness.
The Jing (quintessence) of Water is the Chi (will) and the Jing of Fire is the Shen 18. (mental). When the Shen and Chi are not at ease, they manifest as sadness.
Fixed upward gaze and redness of the eyes are phenomena due to an afflux of the energy of the heart.
Anxiety, restlessness is the result of the contrary flow (afflux- Jue Ni) of the energy encroaching on Taiyang and Yangming and also on Jueyin (XB).
To examine Tian Ding is to observe the complexion (Heaven) located in the inter-eyebrow space.
The upper half of the body is Yang and is controlled by the Hand Taiyin (Lu) and Hand Yangming (LI). This is why needling these two channels permits purifying the energy of this part of the body; and needling the Hand Taiyang (SI) permits cooling the Jueyin (XB) to suppress the anxiety.
The heart controls the blood. As a result, during needling, the change in color of the blood (complexion) is a sign attesting that the Shen Qi (mental energy) is purified, the determining condition of cure of the Dian illnesses (Calm Madnesses).”
II - Ma Shi clarifies:
“From this paragraph to Paragraph 8, study is centered on the classification of the Dian illnesses whose beginning signs are demonstrated in Paragraphs 2, 3 and 4.
The Hand Taiyang (SI), Hand Yangming (LI) and Hand Taiyin (Lu) are the 3 specific channels in the treatment of the beginning signs of the Dian illnesses (Yin Madnesses).”
III - N.V.N.:
The points of these 3 channels recommended by Zhang Jing Yue (1563-1640 A.D.) are: 1 - Hand Taiyang (SI):
_ Zhizheng (SI 7), Luo point (needle depth 0.3 cun, moxa 3 times) and Xiaohai (SI 8), He point (needle depth 0.2 cun, moxa 3 times)
2 - Hand Yangming (St):
_ Pianli (LI 6), Luo point (needle depth 0.5 cun, moxa 3 times) and Wenliu (LI 7), Xi point (needle depth 0.3 cun, moxa 3 times).
3 - Hand Taiyin (Lu):
_ Taiyuan (Lu 9), Luo point (needle depth 0.2 cun, moxa 3 times) and Lieque (Lu 7), Luo point (needle depth 0.2 cun, moxa 7 times).
PARAGRAPH 3
19.
“At its start, the Dian illness (Yin madnesses) manifests by such
signs as:
_ deviation of the mouth and moaning
_ dyspnea
_ palpitations and fear.
Examine the Hand Yangming (LI) and Hand Taiyang (SI) and
needle the left side if the right side is tense or the right side if the left
is tense; stop treatment as soon as the complexion changes.”
EXPLANATIONS AND COMMENTARIES
I - Ma Shi explains:
“With deviation of the mouth accompanied by moaning or dyspnea, palpitations and fear... one must needle the Hand Yanging (LI) and Hand Taiyang (SI). The tension is not pathologic if it is bilateral; it becomes so when it manifests on a single side. This is why one needles the side opposite the affected side and interrupts the needling upon change of the complexion.” II - Zhang Shi states:
“This paragraph demonstrates the mechanism of obstruction/afflux of the energy, causing disturbances of opening and closing , determinant factors of the Dian illnesses.
Tears, cries and fear originate from disturbances of the energy of Taiyang. Dyspnea is due to the impurity of the energy of Yangming.
Yet, the energy of Taiyang governs opening and that of Yangming, closing. This is why the above-cited pathologic signs originate from these two channels.
Ma Men Zung states: “The Hand Taiyang (SI) constitutes the external system of the heart and the Hand Yangming (LI), the external system of the lung. As a result, “tears and fear” originate from the heart and “dyspnea”, from the lung.
Tears, anxiety, dyspnea therefore result from the impurity of the energy of the opening and closing. In this case, the illness localizing at the exterior goes to reach the interior.” (2) III - N.V.N.:
The notions of “closing-opening-hinge” have been many a time demonstrated and
described in our works since 1965. Their complete assimilation permits the appreciation of the permanent mobility of the energy of the 3 Yang, Taiyang, Shaoyang, Yangming, from which all energetic pathology result.
PARAGRAPH 4
20.
“At its start, the Dian illness (Yin madnesses) manifest in the first
place by stiffness of the body, then by spinal pain.
Needle the Foot Taiyang (Bl), Foot Yangming (St), Foot Taiyin (Sp)
and Hand Taiyang (SI); interrupt the needling as soon as the complexion
c h a n g e s . ”
EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
“Stiffness of the body results from the obstuction/afflux of the energy at the level of the Taiyang (Water-Cold).
2. The explanation of Ma Men Zung justifies treatment according to the technique called “Summit-Root”.
Spinal pain comes from the encroachment of the “cold” energy on “Earth’. This is why one must needle the Foot Taiyang (Bl), Foot Yangming (St) and Foot Taiyin (Sp).”
According to Liang Zhen: “The previous 3 paragraphs (2, 3, 4) only broach the starting phase of Jue Ni (Obstruction/Contrary Afflux) at the level of the Taiyin, Taiyang and Yangming channels, that is to say, at the level of the energetic layers and not the anatomic layers.
The illnesses still within the energetic layers can easily be “purified” and “dispersed”. They become incurable from their penetration into the anatomic layers. As a result, the Dian illnesses localizing in the bones, muscles... are usually fatal. (3)
The good physician treats the prodromes, while the poor physician waits until illnesses are declared before applying therapy.”
II - N.V.N.:
a - Translations into Western language have completely changed the spirit of the text. Here, it concerns stiffness of the body with spinal pain due to an obstruction/afflux of the energy and not epilepsy (!).
b - The points recommended by Zhang Jing Yue are:
1 - Foot Taiyang (Bl): Weizhong (Bl 40), Feiyang (Bl 58), Pushen (Bl 61) and Jinmen (Bl 63). 2 - Foot Yangming (St): Sanli (St 36) and Jiexi (St 41).
3 - Foot Taiyin (Sp): Yinbai (Sp 1) and Gongsun (Sp 4). 4 - Hand Yangming (LI): Pianli (LI 6) and Wenliu (LI 7).
PARAGRAPH 5
“In the struggle against the Dian illnesses, the physician is
advised to be at the bedside of the patient often in order to observe the
evolution of the disease and determine the channel to needle.
2 1 .During the crisis, one must carefully study the channel affected
and practice bleeding. The blood conserved in a gourd will coagulate by
the next crisis; if not, apply 20 moxas to the coccyx.”
EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
“This paragraph shows the therapy of the Dian iillnesses according to the principle of distinction of the “water” energy and “fire’ energy, of the energy of Heaven and energy of Earth.
The Fire of Taiyang is the Sun. The Water of Taiyin is the Earth.
During bleeding to diagnostic and therapeutic ends, it is recommended to conserve the blood in a container made of the skin of gourd and observe the phenoenon of coagulation.
Coagulation of blood comes from the passage of the energy of the afflux toward the Hand Taiyin (Lu) and Hand Taiyang (SI) conforming to the sensitivity of the energy of the Taiyang within the natural world.
3. This phrase corroborates our opinion on the misinterpretation of the old translation of the term “Dian Kuang”.
In contrast, non-coagulation results from the deep penetration of the energy of the afflux into “Earth-Water”. This is why one must apply 20 moxas to Changqiang (GV 1).
The Neijing said: “When the vessels are retained at the bottom, one must apply
moxabustion”. In our case, the illness is maintained at the level of 2 channels, Foot Taiyang (Bl) and Foot Taiyin (Sp). One must then apply moxabustion at the level of the coccyx, site of reunion of the 3 vessels: Taiyang (Bl), Taiyin (Sp) and Dumai (GV),”
Figure 2:
Changqiang (GV 1): reunion-meeting point of the 4 vessels (CV, GV, Taiyang, Taiyin).
PARAGRAPH 6
22.
“Dian of the bones (Gu Dian) is an ailment deeply reaching the
bones and marrows. The clinical signs are:
_ blockage and swelling of the Shu (kinetic) points and of the
areas of distribution of the flesh, etc...
_ weight loss
_ sweating and anxiety
_ frothy vomiting
_ flowing out of the energy toward the bottom.
The illness is incurable.”
EXPLANATION AND COMMENTARIES
Zhang Shi explains:
“Here, it concerns illness of the Foot Shaoyin (Ki) contaminating the Hand Shaoyin (He). Frothy vomiting is due to the ascent of the energy toward the top, rising up to the exterior. The kidney is the source organ of the production of the vital energy.
The energy flowing out toward the bottom belongs to the Shaoyin.
Therefore, one witnesses a phenomenon of concomitant escape of Yin and Yang, from the bottom and top. The illness is therefore incurable and the text does not propose treatment.
This paragraph and the following two deal with material illnesses (having form: Xing), that is to say, illnesses at the level of the bones and muscles. This is why one does not speak of Yin and Yang of Tai (Yang) and of Shao (Yin).”
PARAGRAPH 7
“Dian of the muscles (Jin Dian) is an ailment which deeply
reaches the muscles and is characterized by such signs as:
_ asthenia
_ spasm
_ rapid and changing (Da) pulse.
It is advised to needle Dazhu (Bl 11) belonging to the great
vessel-channel of the neck.
If these signs are accompanied by frothy vomiting and flowing out
of the energy toward the bottom, the illness is incurable.”
EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
“The pulse is always changing (Da) in Jin Dian. 23. The Foot Taiyang (Bl) maintains the muscles in “water”. This is why one needles Danzhu (Bl 11), located in the 1st intercostal space, 1.5 cun to the side of the 1st dorsal vertebral apophysis, to 0.5 cun depth and apply 7 moxas.
“Vomiting and flowing out of the energy toward the bottom...” denotes that illnesses of the organs/bowels are material illnesses having escape of the energy as a consequence.”
II - N.V.N.:
Danzhu (Bl 11), “reunion point of the bones” is not only specific on the treatment of bony ailments, but also in the treatment of neuro-psychiatric illnesses, particularly psychasthenia.
Figure 3:
Dazhu (Bl 11): reunion-meeting point of 3 vessels: Foot Taiyang, Hand Taiyang, Hand Shaoyang.
PARAGRAPH 8
“Dian of the vessels (Mai Dian) is characterized by a sudden fall.
The vessels at the level of the 4 limbs are edematous and lax and the
pulse is full. One must urgently practice bleeding by acupuncture.
24.
If the pulse is not full, one must perform moxabustion at the
Taiyang located at the neck, at Daimai (GB 26), 3 cun from the lumbar
vertebrae and at the dorsal Shu points of the region of the “distribution
of the flesh”.
If these signs are accompanied by frothy vomiting and flowing out
of the energy toward the bottom, the illness is curable.”
EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
“The Jingmai play the role of softening the tendons and bones and insures joint movements. Therefore, the individual affected by Dian Illnesses falls down.
The 12 Jingmai manifest at the Jing, Ying... points of the hands and feet. This is why, when they are affected by the Dian illness, they are swollen and slack. In this case, one must perform bleeding by acupuncture. If concerns the illness retained at the bottom, at the Foot Taiyang (Bl); it is advised to apply moxabustion at the point of the Foot Taiyang (Bl) of the cervical region.
The Daimai (vessel of the belt) starts at Zhangmen (Li 13), at the level of the false ribs, arrives at the point of the same name, Daimai (GB 26), encircles the body and links the Jingmai of this region, among which is the Foot Taiyang (Bl).
The point Daimai (GB 26) is located 3 cun below the tip of the 11th rib.” II - N.V.N.:
a - We can cite Zhang Jing Yue:
Treatment of this illness (Mai Dian), when the vessels are edematous and slack, consists of needling to bleed them. In the opposite case, one must apply moxas to the points Tianzhu (Bl 10) and Dazhu (Bl 11) of the Foot Taiyang (Bl), Daimai (GB 26) of the Foot Shaoyang (GB) and to the points located in the small valleys (Xi) and valleys (Gu) at the level of the swollen and slack regions.
According to the book entitled “Classification, Diagnosis and Treatment”, the flowing out of the energy toward the bottom implies an escaping of the energy of the kidney. This Emptiness-Escaping of the energy is fatal.
b - The Daimai (belt channel), starting at Zhangmen (Li 13), is an important notion to retain. (Figure 4)
25.
PARAGRAPH 9
“The rapid evolution of Dian (Yin madness) illness, like that of
Kuang (Yang madness), is fatal, therefore incurable.”
EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
“Fullness of Yin is the origin of the Dian illness, and that of Yang, the Kuang illness. The speed of the manifestation of Dian, like that of Kuang, originates from the concomitant disturbances of Yin and Yang; the illness is then grave.
Clinically, one must always recall that Zhong Yin and Zhong Yang phenomena (concomitance or juxtaposition of Yin and Yang) are fatal.”
II - N.V.N.:
Since 1969, with Chamfrault, we had translated Dian and Kuang as Yin Madness and Yang Madness (conforming to the explanation of Zhang Shi).
Recall that the term “manic-depressive psychosis” does not designate Dian and Kuang which are two distinct illnesses.
PARAGRAPH 10
26.
“Kuang (Yang madness) illness starts first with sadness, then
forgetfulness, anger and fear. Everthing comes from preoccupation and
h u n g e r .
Treatment consists of needling the Hand Taiyin (Lu) and Hand
Yangming (LI) until the change of color of the blood and also the Foot
Taiyin (Sp) and Foot Yangming (St).”
EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
“From this paragraph, the study is centered on Kuang illnesses organized into emptiness and fullness types.
“... first with sadness” because the illness is secondary to the insufficiency of the kidney. “... then forgetfulness and fear” because the Shen-Chi (mental/will) is in emptiness. “... anger” comes from the emptiness of the liver with afflux of Yang (of the liver). Liver-Wood and Shen-Chi are created by the kidney.
This Kuang illness always originates, on the one hand, from a state of mind in the grip of obsession qui anxiety or disturbance until moral suffering, and, other the hand, from a state of starvation.
“Worries, sadness...” injure the lung and “hunger” slows the production of Cereal Jing (Gu Jing), hence insufficiency of the Jing of the Kidney. In this case, the insufficiency of Yin causes the fullness of Yang, determining factor of Kuang.
blood stasis and exterminate the afflux phenomenon.
The two channels, Foot Taiyin (Sp) and Foot Yangming (St), must be needled in tonification to augment the production of the Cereal Jing with the goal of maintaining the energy of the kidney. • In the majority of cases, the Dian illnesses are due to the fullness of Yin, and the Kuang illnesses, to the emptiness of Yin. Bian Que (alias Qin Yue Ren-500 A.D.) said: “The concomitance of Yin (Zhong Yin) manifests by Dian, and the comcomitance of Yang, by Kuang.” These phenomena of concomitance are due to the emptiness of Yin with fullness of Yang or from the emptiness of Yang with fullness of Yin.. This means to say that if Yin is in emptiness, Yang is in fullness; one then must disperse Yang and tonify Yin.
In pratice, one must always recall that the Jing Qi (Yin Quintessence) is produced by the Yangming (St) and that the Yang Qi (Yang energy) has its source in Yin. Such is one of the aspects of the reciprocal relationship of Yin and Yang. Understanding the antagonistic and
complementary aspects of these 2 phenomena (Yin and Yang) permits advancing onto the true path of medicine.”
27. II - N.V.N.:
We recall again the teaching of Zhang Jing Yue:
“The insufficiency of Shen (Mental) is the cause of anxiety; preoccupation and disturbance of the Hun (vegetative soul) cause immoderate ambitions. The Jing (quintessence) then is found in shortage.
Chi (will) in a disturbed state is the cause of forgetfulness.
Invasion of the energy of the liver on the spleen causes anger and fits of rage. The insufficiency of blood is the cause of fear.
All these signs originate from anxiety and hunger, which injures the energy of the organs. It is then advised to needle:
_ Taiyuan (Lu 9) and Lieque (Lu 7) of the Hand Taiyin (Lu) _ Pianli (LI 6) and Wenliu (LI 7) of the Hand Yangming (LI) _ Yinbai (Sp 1) and Gongsun (Sp 4) of the Foot Taiyin (Sp) _ Sanli (St 36) and Jiexi (St 41) of the Foot Yangming (St) and leave the needles in place until the change of the complexion.”
PARAGRAPH 11
“In the Kuang illness starting with such signs as
_ insomnia and anorexia
_ self-satisfaction and certainty of being skillful, intelligent and
noble
_ screaming and insults
_ agitation day and night,
one must needle the Hand Yangming (LI), Hand Taiyang (SI) and
Hand Taiyin (Lu). Moreover, one must examine the “sublingual area” of
the neck and the Hand Shaoyin (He) in order to perform needling in the
event of fullness.”
EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
“This paragraph shows the Kuang illness caused by fullness of the energy of the heart. Fullness of Yin energy causes hypersomnia, and fullness of Yang energy, insomnia. During penetration of cereal energy into the stomach, Jing Qi (quintessence) reaches the heart. When the energy is in fullness, the individual does not feel the sensation of hunger.
The heart is sovereign organ. When the energy of the heart is in emptiness, the individual experiences the feeling of inferiority and thinks he is poverty-stricken, and, in the event of fullness of the energy of the heart, the individual is proud and arrogant and believes he is worthy and magnanimous.
Screaming and insults originate from the fullness of Yangming.
Fire-Heart in a state of fullness invades Fall-Metal. The lung is comparable to an umbrella covering the heart. When the fire rises up toward the top, the energy of Heaven becomes impure. This is why one must needle the Hand Taiyang (SI) to disperse the fullness of Fire-Heart and needle the Hand Yangming (LI) and Hand Taiyin (Lu) to cool and calm the illness, thereby reducing the invasive movement and revolt of the energy.
This illness is of Shen Qi (mental) origin and not from Xue Mai (blood vessels) origin. One must examine well the “sublingual area of the neck” and bleed the Xue Mai of the heart in the event of fullness.
In this way, therapeutically, in illnesses of the Shen Qi (psyche/mind), one must treat the bowel to purify the organ because the bowel is Yang responding to the energy. In contrast, if the illness of Shen Qi reaches the Xue Mai, one must treat the Luomai of the corresponding organ.” II - Ma Shi clarifies:
“The previous paragraph demonstrates the precursor signs of Yang madnesses, and this one describes the beginning signs.
III - N.V.N.:
According to Zhang Jing Yue,
1 - The points used concerning the Hand Yangming, Hand Taiyang and Hand Taiyin channels are cited in the previous paragraphs.
2 - the “sublingual area of the neck” designates the point Lianquan (CV 23). (4) 3 - The points of the Hand Shaoyin are Shenmen (He 7) and Shaochong (He 9).
PARAGRAPH 12
“Kuang characterized by:
_ logorrhea ( 5 )
_ fear
_ groundless laughter
_ obsession with music and singing
29.
_ erring ways, bad habits
is due to fright.
One must needle the Hand Yangming (LI), Hand Taiyang (SI) and
Hand Taiyin (Lu).”
4. This point has a vessel which goes to the base of the tongue.
EXPLANATIONS AND COMMENTARIES
Zhang Shi explains:
“Here, Kuang illness first manifests at the kidney, then reaches the heart, triggering fear. Yin in an empty state and Yang in a full state becomes indicated by logorrhea and panic. The classics stated: Fullness of the enery of the heart becomes characterized by logorrhea, and emptiness, by sadness. In the event of fullness, Xin-Chi (heart-will) is compressed. This is why the individual likes to sing and listen to music to become calm.
The combined disturbances of Shen and Chi direct the individual to run aimlessly. Treatment consists of needling the Hand Taiyang (SI) to purify the heart in a state of fullness and the Hand Yangming (LI) and Hand Taiyin (Lu) to maintain the kidney in a state of emptiness.”
PARAGRAPH 13
“Kuang characterized by
_ visual and auditory hallucinations
_ and screaming
is due to the loss of the energy.
One must needle the Hand Taiyang (SI), Hand Yangming (LI), Hand
Taiyin (Lu) and Foot Taiyin (Sp) and the “2 sides of the chin”.”
EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
“Here, Kuang is due to the insufficiency of the energy of the kidney causing the emptiness of the energy of the heart.
Above and down below, “Fire” (heart) energy and “Water” (kidney) energy support one another and become tempered. This is why the insufficiency of the kidney energy provokes the emptiness of the heart with appearance of the above-cited signs.
It is recommended to needle the points of the Hand Taiyang (SI), Hand Taiyin (Lu) and Hand Yangming (LI) to “purify” hallucinations and to tonify Foot Taiyin (Sp) and Foot Yangming (St) to augment the production of the cereal energy (Gu Qi) because the 5 organs need the energy of Yangming to develop their functions. 30.
The kidney is a water organ. It receives the Jing Qi (pure energy; quintessence) of the 5 organs (Figure 5). The energy (6) forms from Jing (quintessence). This classic has mentioned: “The energy of the stomach ascends toward the top and projects into the lung.”
One part of this energy, via the pharyngeal route, rises up toward the head. On the one hand, it becomes exteriorized at the “orifices” (5 sense organs) and, on the other hand, it reaches the 2 sides of the chin up to the head.
Here, our masters of old did not speak of the Foot Yangming (St), but mentioned the 2 sides of the chin to designate the facial portion of the Foot Yangming linked to the Shangjiao (UJ) and Zhongjiao (MJ).”
II - N.V.N.:
The explanation of Zhang Shi allows us to understand the important role of reception of the Jing of the 5 organs at the level of the kidney (Figure 5).
Figure 5:
PARAGRAPH 14
31.“Kuang manifesting by such signs as:
_ bulimia
_ visual hallucinations
_ silent laughing
come from elation.
One must needle first the Foot Taiyin (Sp), Foot Taiyang (Bl) and
Foot Yangming (St) and then secondly the Hand Taiyin (Lu), Hand
Taiyang (SI) and Hand Yangming (LI).”
EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
“ 1 - Excessive joy injures the Xin (heart) and Chi (will) causing the “Xu Kuang” (Kuang in a state of emptiness).
Bulimia is due to emptiness of the energy of the heart and visual hallucinations, to the emptiness of Shen Qi (mental energy).
2 - During penetration of nutritional energy into the stomach, the impure energy reaches the heart. This is why one must first tonify the Foot Taiyin (Sp) and Foot Yangming (St) to
maintain the Jing (quintessence) of the heart and the Foot Taiyang (Bl) to activate the production of organic liquid in order to temper the Shen Qi; then secondly needle the Hand Taiyang (SI) and Hand Yangming (LI) to disseminate the Kuang syndrome.
3 - In illnesses caused by the Foot Shaoyin (Ki), one must first needle the channels of the foot, and in the illnesses caused by the Hand Shaoyin (He), one must do the opposite. This is a marvelously effective method to reestablish the exchange of the energy of the top and bottom.”
II - N.V.N.:
We have also noted in the Nanjing:
“During escaping of Yang, the individual perceives demons, and during escaping of Yin, vision is disturbed.”
PARAGRAPH 15
“If Kuang is not as serious as in the previous case, it is advised to
needle the 2
Ququan (Li 8) (left and right) at the side of an artery.
If they are in fullness, one must make them bleed by acupuncture
and cure is virtually instantaneous. If this is not the case, one must
apply 20 moxas to the coccyx.”
EXPLANATIONS AND COMMENTARIES
32. Zhang Shi explains:“Here it concerns a general study of Kuang during its first manifestations, being able to be cured by needling the point Ququan (Li 8).
In summary, the Kuang illness originates from emptiness or fullness of the energy of the heart. In contrast, if it is due to the emptiness or fullness of the energy of the kidney, Water reaches Wood then arrives at Fire. This is why, at the starting phase of the Kuang illness without signs of sadness, fear, anger, visual hallucinations... cure can be obtained on the field by needling the poing Ququan (Li 8) because the disturbance manifests at the level of the energy of the liver without touching the Shen Qi. If cure is slowed, the application of 20 moxas to the coccyx is recommended to eliminate the pathogenic energy of the liver by the lower route.”
PARAGRAPH 16
“In Feng Ni (contrary afflux of wind) manifesting by such signs
a s
_ sudden edema of the 4 limbs
_ trembling with cold
_ anxiety during hunger
_ displeasure during satiety
one must needle the Hand Taiyin (Lu) and its external and internal
relationships, the Foot Shaoyin (Ki) and Foot Yangming (St).
If the individual feels cold in the muscles, one must needle the
Ying-stream points, and if he feels cold in the bones, the well and
Jing-river points.”
EXPLANATIONS AND COMMENTARIES
Zhang Shi explains:
“Jue (afflux) is a massive arrival of energy, triggering factor of the Dian illness. 1 - The kidney is a water organ and wind is a force susceptible to displace the mass of water in the form of waves. As a result, Feng Ni (contrary afflux of wind) implies a massive attack of wind provoking a contrary flow (afflux/Jue Ni) of the water energy of the Foot Shaoyin (Ki), hence sudden edema of the 4 limbs with shivers.
2 -Wind injures kidney water and causes emptiness of the heart energy (according ot he inhibitory law of the 5 movements). This is why the subject is anxious and annoyed when hungry.
If perverse Wind-Wood injures the Center-Earth (spleen and stomach), the individual is usually agitated and angered when his appetite is satisfied. 33.
3 - To needle the system of “external-internal, Yin-Yang” relationship of the Hand Taiyin (Lu) is to liberate the perverse wind, and to needle the Foot Shaoyin (Ki) and Foot Yangming (St) is to harmonize the contrary afflux (Ni), thereby warming up the cooled energy.
4 - To speak of “cold of the flesh” is to explain that the “cold” energy has reached the dermal system. Therefore, one must needle the Ying-Fire points in order to warm up the flesh and muscles conforming to the principle according to which Earth (spleen) governs heat and fire (heart) maintains Earth.
The term “cold in the bones” implies that the perverse energy is still found within the water organ (kidney). One then must needle the Jing-well point to disperse (7) the perverse energy.
5 - Chu Ma Rong has said: “To needle the external and internal realationship of the Hand Taiyin (Lu) is to perform a provoked sweat, as is made by Herba Ephedrae (Ma Huang), with the purpose of aerating the sweat glands, associated with Semen Armeniaca amarae (Xingren) to maintain Lung-Metal, because the aeration permits the energy of the interior to diffuse to the exterior.”
PARAGRAPH 17
“In Jue Ni (contrary afflux) with such signs as:
_ cold feet
_ sensation of bursting of the thorax
_ lancinating pain of the abdomen
_ annoyance and anorexia
_ large or small, steady or rapid pulse,
• if the body is hot, one must needle the Foot Shaoyin (Ki)
• if the body is cool, one must needle the Foot Yangming (St).
In the event of coolness, one must tonify, and in the event of heat,
one must disperse.”
EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
“This paragraph explains contrary afflux (Jue Ni) of the energy of the Foot Shaoyin (Ki). 1 - The kidney organ sends out a large vessel which exteriorizes at the point Qijie (other name Qichong-St 30). This vessel descends, runs alongside the inner thigh, arrives at the knee, reaches the internal malleolus and penetrates into the sole of the foot. For this reason, at the time of the contrary afflux of the energy of the kidney, the soles of the feet are icy cold.
2 - “Sensation of bursting of the thorax...” is due to a gathering of the energy which, from the abdomen, affluxes toward the heart and thorax. 34.
3 - The basic substance of the blood vessels come from the kidney... . The large or small, regular or rapid pulse results from the engorgement of the Jingmai following an contrary afflux of the energy of the kidney.
4 - The kidney is the source organ of the vital energy. The body is warm because the phenomenon called “fullness-contrary afflux” intervenes; one must disperse Foot Shaoyin (Ki). In contrast, the body is cold because the phenomenon called “emptiness-contrary afflux” intervenes; one must tonify Foot Yangming (St) to maintain the Jing (quintessence) of the kidney organ.
5 - The previous Paragraph 16 demonstrated the syndrome of afflux of external origin (Jue); this one deals with the syndrome of afflux of internal origin. These affluxes are the primary causes of the Dian illnesses. This is why the treatment of the Jue syndromes (afflux) constitutes a preventive method of these illnesses called Yin Madnesses (Dian).”
II - N.V.N.:
1 - Regarding the choice of points, Zhang Jing Yue recommends: _ Yongquan (Ki 1) and Rangu (Ki 2) of the Foot Shaoyin (Ki) and _ Lidui (St 45) and Neiting (St 44) of the Foot Yangming (St).
These points are specific in the treatment of Jue Ni (contrary afflux).
2 - The “large vessel” (cited above by Zhang Shi), which exteriorizes at the point
Qichong (St 30) and reaches the inner thigh to the sole of the foot, is the descending branch of the Chongmai (Firgure 6).
Figure 6:
PARAGRAPH 18
35.“In Jue Ni (contrary afflux) characterized by such signs as:
_ swelling and abdominal fullness
_ boborygmi
_ thoracic fullness with respiratory difficulty,
one must needle the sub-thoracic points, at the two hypochondria,
at the place where the cough responds to pressure of the hand, and the
dorsal Shu (Bei Shu) points at the place where the patient experiences
relief with the pressure of the fingers.”
EXPLANATIONS AND COMMENTARIES
I - Zhang Shi instructs:
“This paragrph explains the illness caused by Jue Ni at the level of Taiyin and Yangming. Swelling and abdominal fullness indicate Jue Ni at the level of the Foot Taiyin (Sp) and Foot Yangming (St).
Boborygmi indicates the presence of Jue Ni at the level of the Hand Yangming (LI). Thoracic fullness with difficulty breathing explains the evolution of Jue Ni toward the Hand Taiyin (Lu).
The points located at the two hypochondria are none other than Zhongfu (Lu 1) and Yunmen (Lu 2) of the Hand Taiyin (Lu).”
II - N.V.N.:
The sub-thoracic points mentioned, at the two hypochondria, do not belong to the Hand Taiyin (Lu) but to the Foot Jueyin (Li). According to Zhang Jing Yue, it concerns Zhangmen (Li 13) and Qimen (Li 14). Ma Shi also had spoken of these.
Zhangmen (Li 13) is located below the tip of the 11th rib. This is the Mu point of the spleen and “reunion” point of the energy of the organs. The Nanjing states: The energy of the 5 organs reunites at Zhangmen (Li 13). Ailments of the organs are treated with this point. The Dacheng adds: “This point treats boborygmi, swelling/abdominal fullness... .”
Qimen (Li 14) is located 3.5 cun to the side of Juque (CV 14), in the 6th intercostal space (Figure 7).
36.
Figure 7:
Localization of Zhangmen (Li 13), Qimen (Li 14), Dabao (Sp 21) and Riyue (GB 24).
PARAGRAPH 19
“When the interior is obstructed, the illness manifests by
oligo-anuria. One must needle the Foot Taiyang (Bl) and Foot Shaoyin (Ki),
as well as the point at the coccyx, with long needles.”
EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
“In this paragraph, the energy of Jue Ni does not gather at the top, but at the bottom, hence oligo-anuria.
One must needle the Foot Shaoyin (Ki) and Foot Taiyang (Bl) and the point located at the coccyx in order to disseminate the afflux, thereby favoring diuresis.”
II - N.V.N.: 37. The points favoring diuresis recommended by Zhang Jing Yue are:
_ Yongquan (Ki 1) and Jiaoxin (Ki 8) of the Foot Shaoyin (Ki) and
_ Weizhong (Bl 40), Feiyang (Bl 58), Pushen (Bl 61), Jinmen (Bl 63) of Foot Taiyang (Bl). The “point located at the coccyx” is Changqiang (GV 1). (8)
PARAGRAPH 20
“In the Jue Ni syndromes, one must needle the Taiyin and Jueyin.
In serious cases, it is advised to add the Shaoyin and Yangming.”
EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
“This paragraph justifies the treatment of the Jue Ni syndromes.
Because, when the energy of the afflux of the energy of the Foot Shaoyin (Ki) arrives in abundance at the heart to trigger the Dian Kuang (Yin Madnesses and Yang Madnesses), one must needle the Jueyin because the “water” energy maintains Liver-Wood and, from there, it reaches Heart-Fire. This is why, at the start of the illness, one must needle Ququan (Li 8) (9). If the case is serious, one must disperse the Foot Shaoyin (Ki).”
II - Ma Shi states:
“In the Jue Ni syndromes, it is advised to needle Foot Taiyin (Sp) and Foot Jueyin (Li). In serious cases, add Foot Shaoyin (Ki) and Foot Yangming (St) (Ex: Fuliu- Ki 7, Jiexi- St 41, etc.).”
PARAGRAPH 21
“In syndromes of insufficiency of the energy characterized by
such signs as:
_ chills
_ shortness of breath and cracked voice
_ arthralgia
_ sensation of heaviness of the body
_ fatigue of the limbs with trouble moving,
one must tonify the Foot Shaoyin (Ki).”
8. All of these points are described in MTC- NVN Edition.
EXPLANATIONS AND COMMENTARIES
38. I - Zhang Shi explains:
“This paragraph concerns the insufficiency syndrome of the energy of the Foot Shaoyin (Ki), determining factor of the triggering of the illness called Xu Ni (Emptiness-Contrary Afflux).
The heart governs speech and the lung, the voice. But they become manifest due to the “active” energy (Dong Qi) (10) of the kidney. As a result, in the insufficiency of the energy of the kidney, speech is no longer possesses its connected nature (11). In this case, it is advised to urgently tonify the Foot Shaoyin (Ki), that is to say, the “root energy” (source energy).” II - N.V.N.:
According to Zhang Jing Yue, this illness is due to emptiness of the Jing (quintessence) of the kidney, causing a contrary flow (Jue Ni), hence the necessity to tonify the Foot Shaoyin (Ki).
PARAGRAPH 22
“Short respiration is synonymous with a more or less prolonged
suspension of respiration (apnea). It is gasping for breath with poorer
effort. One must tonify the Foot Shaoyin (Ki) and bleed the Xue Luo
(blood capillaries).”
EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
“This paragraph justifies the reascent of the energy in a state of “loss”, susceptible to triggering the syndrome called Emptiness-Yang Madnesses (Xu Kuang), while the previous one demonstrates the syndrome of “loss” of the energy of the Foot Shaoyin (Ki), that is to say, the syndrome of insufficiency of the energy located down below.
Short respiration originates from the energy in a state of insufficiency down below
with encroachment on the top. Thus, one must tonify the Foot Shaoyin (Ki) and bleed the Xue Luo.”
II - N.V.N.:
Paragraph 22 and the previous one concern the emptiness of the energy. One does not tonify the Hand Taiyin (Lu) (mother of energy) but the Foot Shaoyin (Ki) (“source” of the energy) because “Yang has its origin in Yin” and “energy is created from Jing (quintessence).”
Therefore, the search for the root of the illness represents a primary phase in Oriental medicine, necessary before any therapy.
10. The “active” energy is a very mobile, very dynamic energy which, at every moment, changes direction.
39.
CHAPTER XXIII
Diseases of Heat
(Re Bing)
(1)
Chapter 23 is devoted to the diseases of heat: classification and description of
diseases, therapy and prognosis.
The methods of needling of the different forms of the diseases of heat and
their contraindications are clearly set forth.
The description of the diseases of heat at the level of the different anatomic
layers (skin, flesh, muscles, blood and vessels, tendons and bones) is based on the
principles of the 5 Movements at the level of the channels (liver, heart, spleen, lung
and kidney) in order to determine the therapeutic rules by acupuncture,
The 59 energetic “anti-heat” points are mentioned.
This chapter consists of 28 paragraphs.
PARAGRAPH 1
“In the syndrome Tian Ku (hemiplegia) (1), characterized by a
painful paralysis of half of the body, without change in language and
without disturbance of will (Chi), the disease is localized in the
“demarcation of the flesh” (epidermo-dermal system); one must employ
“great needling” in order to tonify the essential energy in a state of
insufficiency and to disperse the perverse energy in a state of excess.”
EXPLANATIONS AND COMMENTARIES
40. I - Zhang Shi explains:
“Chapter 23 studies the diseases of heat of three different etiologies: _ exogenous etiology, caused by an infiltration of Wind-Cold
_ endogenous etiology, following a syndrome of heat at the level of the 5 organs
_ mixed etiology, resulting from simultaneous disequilibrium of the interior and exterior, of Yin and Yang, of the essential energy and perverse energy.
Paragraph 1 concerns the disease of heat of external origin.
Here, perverse Wind-Cold infiltrates into half of the body. Ying (nutritive) energy and Wei (defensive) energy grow weak, the source energy escapes and the perverse energy inserts itself alone, triggering Tian Ku (hemiplegia), with disturbance of motility and pain.
The heart governs speech, and the kidney, Chi (will). Therefore, “absence of change in language and disturbance of will” indicates that the interior is intact and that the perverse energy is localized only at the exterior. One must then use the “great needling” method (Ju Zhen) to tonify the essential energy and disperse the perverse energy.”
II - N.V.N.:
_ Regarding Tian Ku (hemiplegia), complementary studies are developed in the Suwen (Chapters 3 (“Relationship of the Vital Energy with that of Heaven”), 7 (“Special Study on Yin and Yang”), 42 (“Dissertation on Wind”), 48 (“Dissertation on the Great Singularities”), 75
(“Discourse on the Illustrious Teaching”) and 77 (“Analysis of the 5 Errors”) - N.V.N. Edition). _ “Great Needling” cannot be translated as “a large needle” because it concerns here an acupuncture technique opposite to that called “needling in opposition” (Mu Zhen) (see Suwen, Ch. 63 (“Disocurse on Needling on the Opposite Side”). One can therefore not correctly translate Oriental medical classics like the Neijing without being an acupuncturist.
The Great Needling used in the treatment of hemiplegia of external origin consists of needling points of the side affected to reestablish the circulation of the Jingluo and harmonize the blood and energy.
PARAGRAPH 2
“In Fei (quadriplegia), the paralysis of the 4 limbs is not painful.
If the Chi (will) is not totally altered and if the voice is not very
41.
weak, the disease is curable. In contrast, it is incurable if there is
a n a r t h r i a .
This disease first starts at Yang, then it reaches Yin. One must
first treat Yang and secondly, Yin. The needling done on Yang must be
s u p e r f i c i a l . ”
EXPLANATONS AND COMMENTARIES
I - Zhang Shi explains:
“The Fei disease (quadriplegia) belongs to the Feng-Re (Wind-Heat) group.
The non-painful nature of the paralysis indicates that perverse energy has not yet reached the interior.
Wind-Wood deteriorates the “Center-Earth”; the spleen maintains the Zi (intelligence) and governs the 4 limbs. As a result, the integrity of the Zi in the paralysis of the 4 limbs denotes that the perverse energy becomes localized only in the “mid-external, mid-internal” area and that the source energy is not yet altered.
Weakness of the voice announces that the perverse energy disturbs the essential energy. The disease, which is still found at the energetic level, is curable.
In contrast, the presence of anarthria is a sign revealing the disease located at the level of the organ, therefore difficult to treat.
The exterior is Yang, the interior is Yin. The disease manifests in the first place in the area of “demarcation of the flesh” (Yang), and in the second place, in the interior (Yin). One must consequently first needle Yang then Yin.
Superficial needling permits evacuation of the perverse energy localizing at the exterior.”
II - Ma Shi teaches:
“This paragraph demonstrates the needling method against Fei disease (quadriplegia). The previous paragraph concerns painful paralysis and this one, non-painful paralysis. The previous paragraph speaks of paralysis of the hemi-body, and this one, of paralysis of the 4 limbs.
Tian Ku (hemiplegia) and Fei (quadriplegia) therefore are two different diseases.
Non-aggravation of the disturbance of the Shen (mental) and Chi (will), weakness of voice and perceptiveness of mind are indicators of the curability of the disease. In contrast, in the case of aggravation of the disturbance of the Shen and Chi with anarthria, the disease is incurable.
One must clearly specify the level of attack of the peverse energy in order to perform appropriate treatment. Because, if the disease starts in the first place by the Yang channels and in the second place by the Yin channels, one must needle first the Yang channels, then the Yin channels. The needling must be superficial because Yang is found at the exterior.
42. The text mentions neither the disease starting via the Yin channels then evolving toward the Yang channels nor the needling done at the Yin channels before the Yang channels nor deeper needling, probably because the disease starting via the Yin channels is incurable.”
PARAGRAPH 3
“In the heat disease evolving for 3 days, where the Qi Kou pulse
(right radial pulse) is calm and Renying (left radial pulse) is agitated,
one must needle the points of the Yang channels, choosing among the
“59 (anti-heat) Points” to evacuate the perverse heat and favor
perspiration, all in respecting the principle “render the Yin channels full
to tonify the insufficiency”.
In the case of too high a fever where the Yin pulse and Yang pulse
are calm, needling is expressly advised against.
If acupuncture is still judged possible, the needling must be
immediate because, even without provoked sweating, the perverse
energy can be eliminated to the exterior.
To say not to needle is it evoke a fatal syndrome.”
EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
“In the heat disease evolving over 3 days, the perverse energy comes to cross the 3 Yang channels and goes to reach the 3 Yin channels.
The expression “Qi Kou is calm and Renying is agitated” indicates that perverse energy lodges in Yang and still has not reached Yin. One must then needle the Yang channels.
The 59 Points (anti-heat) possess at one time the power to evacuate and to sudorificate. The principle to render full the Yin channels to tonify insufficiency implies not letting the perverse energy insert itself into the Yin channels in a state of insufficiency.
In the case of too high a fever where the Yin and Yang pulses are calm, the essential energy of the 3 Yang channels and 3 Yin channels are in a state of emptiness; therefore, the prognosis is fatal and acupuncture is useless. In contrast, in the case where acupuncture is judged still to be possible, needling must be immediate to evacuate the perverse energy by the sweat gland route when it is found in the Yang part (of the body) or in order to excrete it via the low route. Such is the therapeutic principle of serious disease caused by perverse heat without alteration of the
essential energy. 43.
Zhang Yai Chi has said: “The heat diseases are of the Shanghan type (evolutive diseases of cold). In effect, they evolve following the 6 channels, and, on the 7th day, they return to their point of departure. The disease is specifically energetic; this is why diagnosis is performed at Qi Kou and Renying.”
“Without sweating, one must excrete it by the low route” has the same meaning as that of the phrase drawn from the Suwen: In the disease of heat of less than 3 days, only sudorification is advised. When it exceeds 3 days, only purgation is indicated.” (2)
2. Also see “Evolutive Diseases of the 3 Yin and 3 Yang” (According to the Shanghan Lun) -N.V.N. Edition.
II - Ma Shi teaches:
“The theme of Paragraphs 3 to 21 is devoted to the diseases of heat.
In this paragraph, the signs and pulses are in aggreement; it is advised to needle to provoke sweating so as to expel the perverse energy.
If the pulse and signs are not in aggreement, acupuncture is useless.
In the heat disease of more than 3 days, Qi Kou is calm and Renying is agitated because the Yang channels are affected. In the case where the signs and pulses are in aggreement, one must needle the Yang channels to disperse the perverse energy.
In contrast, in slightly elevated fever, if the Qi Kou pulse is calm and Renying is agitated and if Yin channels and Yang channels are simultaneously calm, the signs and pulses are not in aggreement; the prognosis is fatal and needling is without purpose.
Because the perverse energy is in fullness, the pulse is agitated. The fullness of perverse energy with very high fever is the indicator of the insufficiency of the essential energy; a pulse which is no longer agitated is a fatal sign”
PARAGRAPH 4
“In the disease of heat greater than 7-8 days with Mai Kou (radial
pulse) agitated, dyspnea and short respiration, it is advised to urgently
needle; sweating is spontaneous. The needling is performed at the level
of the thumb.”
EXPLANATIONS AND COMMENTARIES
44.
I - Ma Shi explains:
“In this paragraph, the signs and pulse of the disease of heat are clearly emphasized. It is advised to needle the Hand Taiyin (Lu).
Because, in the disease of heat exceeding 7-8 days with Mai Kou agitated, dyspnea and short respiration, one must employ the technique of sudorification by needling the point Shaoshang (Lu 11), clearly most indicated.”
II - Zhang Shi clarifies:
“Here, although the heat disease lasts for 7-8 days, the perverse energy is still located at the exterior; one must needle urgently to evacuate it because its non-liberation by the 8th day marks its imminent progression toward the Yin channels, the serious phase of the disease.
Agitation of Mai Kou associated with dyspnea and short respiration are warning signs of the persistence of the peverse energy within the external energetic layers. As a result, it is advised to disperse Shaoshang (Lu 11) to excrete the perverse energy by the sweat gland route.” III - N.V.N.:
According to You Ba Rong, needling the point Shaoshang (Lu 11) has the same sudorific effect as Herba Ephedra (Mahuang). (3)
3. See Wording 35 of the Shanghan Lun of Zhang Zhongjing, translated under the title “Evolutive Diseases of the 3 Yin and 3 Yang” - N.V.N. Edition.
PARAGRAPH 5
“In the disease of heat greater than 7-8 days, revealed by such
signs as:
_ galloping√ and small pulse
_ hematuria
_ and dryness of the mouth,
death follows in 1 day and a half. If the pulse is changing (Da),
death follows in 1 day.”
EXPLANATIONS AND COMMENTARIES
I - Zhang Shi explains:
“This paragraph demonstrates the case of non-liberation of the disease of heat evolving toward the Shaoyin (He), therefore of fatal prognosis.
On the 7th day, the disease ends its progression at the level of the 6 channels (3 Yin and 3 Yang) and returns to its point of departure.
On the 8th day, the non-liberation of perverse heat marks a new evolutive cycle of the
disease.
The small and galloping√ pulse of the Shaoyin (He) (4) responds to Ministerial Fire. 45. Hematuria indicates the localization of the disease at the level of the Water Organ
responding to the Foot Shaoyin (Ki).
Dryness of the mouth indicates the localization of the heat disease at the level of Imperial Fire responding to the Hand Shaoyin (He).
Evaluation of death at 1 day and a half expresses the fatal occurrence in the period of time occurring between 1 and 2 days, moment of the disappearance of Yin energy and of Yang energy, of water and fire.
The pulse starts at the kidney, but it is controlled by the heart. The changing (Da) pulse signals the exhaustion of the energy of the lower part of the body, hence death in 1 day”.
II - N.V.N.:
The Da pulse (5) cannot be translated as “large” pulse but as “changing” pulse because this pulse assumes an intermittent nature (a more or less long stop between several beats).
Generally, the changing (Da) pulse is the indicator of the evolution of the disease toward worsening or improvement of the disease.
4. Here it must mean Hand Jueyin (XB).
5. See explanation in the Maijing (“Classic of Pulses”) of Wang Shu He - N.V.N. Edition, and also in Chapter 29 (“Teachings Transmitted by the Masters”) of this classic (Volume II).
PARAGRAPH 6
“After sweating, if the heat disease still presents with such signs
a s :
_ agitated pulse
_ dyspnea
_ and fever,
needling the cutaneous areas is advised against.
If the dyspnea worsens, it is death.”
EXPLANATIONS AND COMMENTARIES
Zhang Shi explains:
“After sweating, the pulse is still agitated because the too virulent Yang-Heat is not eliminated via the sweat gland route.
Dyspnea and fever are the signs revealing the evolution of the disease toward the interior. Acupuncture performed at the skin is useless, therefore advised against.
The aggravation of the dyspnea reveals the state of fullness of the perverse energy lodged in the interior, provoking disturbances of the Yin energy and Yang energy, hence the lethal prognosis.”
46.
PARAGRAPH 7
“In the disease of heat exceeding 7-8 days and manifesting by a
non-agitated or agitated pulse but without diffuse and rapid nature,
sweating is spontaneously produced at the end of 3 days.
If sweating does not appear at the end of 3 days, death follow on
the 4th day.
During the period of absence of sweating, needling the sweat
gland area is not advised.”
EXPLANATION AND COMMENTARIES
Zhang Shi explains:
“The absence of agitated pulse indicates the liberation of the exterior.
The agitated pulse without diffuse and rapid nature signals the incomplete evacuation of perverse heat and the normal state of the essential energy.
Three days later, that is, on the 11th day (8+3), the perverse heat progresses again toward Li-Yin (Interior-Yin) where it encounters the Xin-Ye (organic liquid) which expels it via the sweat gland route, factor of cure. As a result, during the waiting period of 3 days, it is useless to needle the sweat gland areas.
In contrast, the absence of sweating after 3 days of waiting... is due to the fullness of the Yang-Heat (perverse) and to the exhaustion of the Yang energy (of the body). This is why death follows on the 4th day... .
If the previous paragraph studies the heat disease localizing at the exterior which, in spite of sweating, progresses toward the interior, this one has for its object the localization of the perverse energy in the Yin part, determining factor of spontaneous sweating. Therefore, sweating provoked there is useless.
This study allows comprehension that Yang can penetrate within Yin and that Yin can exit from Yang.”
PARAGRAPH 8
“In the disease of heat manifesting by such signs as:
_ cutaneous pain
_ nasal obstruction
_ edema of the face,
one must use Chan type needles (No. 1) (6) and needles according to
the technique of the “59 points’ (anti-heat).
47.
In the event of nasal ulceration, one must treat the lung and
needle the skin. In the absence of a result, one must treat Fire, that is to
say, the heart.”
EXPLANATIONS AND COMMENTARIES
I - Ma Shi explains:
“This paragraph concerns the case of fixation of perverse energy at the level of the skin, hence the necessity of needling this area. In the absence of results, the heart must be tonified to accentuate its triumphant action over the lung.
The lung responds to Metal and links with the skin. The disease of heat starts at the skin with nasal obstruction and heavy sensation of the eyelids, evoking facial edema; one must then needle the skin to expel the perverse heat.
To needle the skin implies inevitably “to needle the skin without injuring the flesh”. Nasal ulceration is an ailment of the skin and to needle the skin consists of acting on the energy of the lung (because it unites with the skin). If that proves ineffective, one must act on Fire, that is to say the heart, because tonifying the heart amounts to augmenting the potential of Fire and diminishing that of Metal. To act thusly is to repel the perverse heat lodged in the lung.”
II - Zhang Shi instructs:
“Paragraph 8 and the following ones deals with heat diseases localized in the interior (organs).
