Lingshu · Circumferential Impediment

The text

The Yellow Emperor asked Qi Bo: Circumferential impediment in the body moves up and down, shifting with the vessels; above and below, left and right, they answer one another, with no gap that will take a space. I wish to hear of this pain — is it in the blood vessels, or will it be in the spaces of the divided flesh? How does it come to this? When the pain shifts, there is not time enough to send the needle down; when the pain gathers, there is not time enough to set a treatment, and the pain has already stopped. What Dao makes it so? I wish to hear the reason. Qi Bo answered: This is the many impediments. It is not circumferential impediment. The Yellow Emperor said: I wish to hear of the many impediments. Qi Bo replied: Each is in its own place; they start and stop by turns, sit and rise by turns, the right answering the left, the left answering the right. They cannot go around; they start and rest by turns. The Yellow Emperor said: Good. How does one needle them? Qi Bo replied: In needling these, though the pain has already stopped, you must still needle that place, and not let it rise again. The Emperor said: Good. I wish to hear what circumferential impediment is like. Qi Bo replied: Circumferential impediment is in the blood vessels; it follows the vessels upward, follows the vessels downward; it cannot go left and right; each is in its own seat. The Yellow Emperor said: How does one needle it? Qi Bo replied: When the pain comes from above downward, first needle below to send it over, then needle above to slip it free. When the pain comes from below upward, first needle above to send it over, then needle below to slip it free. The Yellow Emperor said: Good. From where is this pain born? By what cause does it have a name? Qi Bo replied: Wind, cold, and damp qi lodge without, in the spaces of the divided flesh; they press hard and become foam. Foam meeting cold gathers; gathering, it pushes the divided flesh apart and splits it; split, there is pain; pain, and the spirit returns to it; the spirit returning, there is heat; heat, and the pain loosens; the pain loosening, there is reversal; reversal, and another impediment starts; starting, it is like this. The Emperor said: Good. I have already obtained the meaning. This is not within, in the zang, and without it has not yet issued at the skin; it dwells alone in the spaces of the divided flesh, and true qi cannot go around — therefore it is named circumferential impediment. Thus in needling impediment, you must first press and follow the six channels below, look at their vacuity and repletion, and at the blood of the great collaterals knotted and not communicating, and at those vacuous with the vessels sunken and empty, and regulate them; iron them and open them; where there is tugging and hardness, turn, draw, and set them moving. The Yellow Emperor said: Good. I have already obtained the meaning. I have also obtained the work. The nine are the principle of the channels yielding; they are the yin and yang illnesses of the twelve channel vessels.

The line

The Yellow Emperor asked Qi Bo: Circumferential impediment in the body moves up and down, shifting with the vessels; above and below, left and right, they answer one another, with no gap that will take a space. I wish to hear of this pain — is it in the blood vessels, or will it be in the spaces of the divided flesh? How does it come to this?

The note

Circumferential impediment moves up and down with the vessels. The many impediments each stay in their place. Circumferential means it is still walking; lodged means it has already sat down.