Lingshu · Needling the Joints: True and Pathogenic

The text

The Yellow Emperor asked Qi Bo: I have heard that needling has five joints. How is that? Qi Bo said: There are indeed five joints. The first is called shaking off dust. The second is called opening the covered. The third is called removing the nail. The fourth is called taking off clothes. The fifth is called resolving confusion. The Yellow Emperor said: You speak of the five joints, and I do not yet know their meaning. Qi Bo said: Shaking off dust: needle the outer, to send away yang illness. Opening the covered: needle the fu transports, to send away fu illness. Removing the nail: needle the joints and the branch networks. Taking off clothes: needle all the odd transports of the various yang. Resolving confusion: know fully how to attune yin and yang, to supplement and drain surplus and insufficiency, and to tilt and shift them toward each other. The Yellow Emperor said: The joints of needling speak of shaking off dust, and you then say needle the outer channels, to send away yang illness. I do not know what is meant. I wish to hear it through to the end. Qi Bo said: Shaking off dust: yang qi greatly reverses, filling the chest above; there is angry staring and breathing from the shoulders; great qi reverses upward; panting and gasping, sitting and lying prone; the illness hates dust and smoke, and one cannot get the breath. Let me speak of shaking off dust — it is still faster than shaking dust. The Yellow Emperor said: Good. How does one take it? Qi Bo said: Take it at Tianrong. The Yellow Emperor said: For coughing and qi rising, chest pain cramped and bound — how does one take it? Qi Bo said: Take it at Lianquan. The Yellow Emperor said: Is there a measure in the taking? Qi Bo said: In taking Tianrong, do not go beyond one li. In taking Lianquan, stop when the blood changes. The Yellow Emperor said: Good. The Yellow Emperor said: The joints of needling speak of opening the covered, and I have not obtained the meaning. Opening the covered: the ear has nothing it hears, the eye has nothing it sees — and you then say needle the fu transports, to send away fu illness. Which transport makes it so? I wish to hear the reason. Qi Bo said: Subtle is the question. This is the great covenant of needling, the utmost of the needle, of the kind of spiritual brightness. Mouth and book-scroll still cannot reach it. Let me speak of opening the covered — it is still faster than opening a covering. The Yellow Emperor said: Good. I wish to hear it through to the end. Qi Bo said: In needling this, it must be at midday. Needle Tinggong; strike the pupil; a sound is heard in the ear — this is its transport. The Yellow Emperor said: Good. What is meant by a sound heard in the ear? Qi Bo said: In needling the pathogen, press both nose-caves firmly with the hand and quickly lie back; the sound must answer at the needle. The Yellow Emperor said: Good. This is what is meant by doing what is not seen, and without the eye looking, seeing and taking it — spiritual brightness meeting. The Yellow Emperor said: The joints of needling speak of removing the nail, and you then say needle the joints and the limb networks. I wish to hear it through to the end. Qi Bo said: The lumbar spine is the great joint of the body. The limbs and shins are the person's tubes for hurrying and soaring. The stalk and pendant are the mechanism within the body, the sign of yin jing, the road of the fluids. Thus when food and drink are not kept in measure, when joy and anger miss their time, the fluids overflow within and then flow down to the testes; the blood-road does not pass; day by day it grows large without rest; bowing and looking up are not easy; hurrying and soaring cannot be done. This illness is brightly of water, neither going up nor going down. The lance-stone is what takes it. The form cannot be hidden; it often cannot be covered — therefore it is named removing the nail. The Emperor said: Good. The Yellow Emperor said: The joints of needling speak of taking off clothes, and you then say needle all the odd transports of the various yang, which have no constant place. I wish to hear it through to the end. Qi Bo said: This is yang qi having surplus and yin qi insufficient. When yin qi is insufficient there is inner heat; when yang qi has surplus there is outer heat. Inner heats contend with each other, hot as holding charcoal. Outwardly one fears silk and cotton coming near; one cannot come near the body, and cannot come near the mat. The interstices close, and sweat does not go out. The tongue is scorched, the lips withered, dried as cured meat, the throat dry; food and drink do not distinguish the fine from the foul. The Yellow Emperor said: Good. How does one take it? Qi Bo said: Take it at Tianfu and Dazhu, three scars; also needle Zhonglü, so as to send the heat away. Supplement the foot and hand taiyin, so as to send the sweat away. When heat leaves and sweat thins, it is faster than taking off clothes. The Yellow Emperor said: Good. The Yellow Emperor said: The joints of needling speak of resolving confusion, and you then say know fully how to attune yin and yang, to supplement and drain surplus and insufficiency, and to tilt and shift them toward each other. How is confusion resolved? Qi Bo said: Great wind is in the body; the blood vessels are vacant on one side. The vacant is insufficient; the replete has surplus. Light and heavy cannot be obtained; one tilts, leans, crumples, lies prone; does not know east and west, does not know south and north; now up, now down; now reversed, now overturned; inverted without constancy — worse than being lost. The Yellow Emperor said: Good. How does one take it? Qi Bo said: Drain what has surplus; supplement what is insufficient; yin and yang are leveled and restored. Using the needle like this is faster than resolving confusion. The Yellow Emperor said: Good. I ask that it be stored in the chamber of the Numinous Orchid, and not dare to bring it out lightly. The Yellow Emperor said: I have heard that needling has five pathogens. What are the five pathogens? Qi Bo said: There is illness that holds a swelling; there is what receives the large; there is the narrow and small; there is the hot; there is the cold. These are called the five pathogens. The Yellow Emperor said: How does one needle the five pathogens? Qi Bo said: The methods of needling the five pathogens do not go beyond five chapters: dan-heat is extinguished; gathered swellings are scattered and gone; cold impediment is increasingly warmed. The small is increasingly yang; the large must be sent away. Let me speak of the methods. In all needling of swelling-pathogen, do not meet the ridge. Change the custom, shift the nature; do not obtain pus. Change the brittle road and travel again; leave its village; if it is not at ease in its dwelling, it then scatters and is gone. All yin and yang that have passed into a swelling: take their transports, and drain. In all needling of large pathogen, day by day make it smaller. Drain and seize its surplus, and then increase vacancy. Strike its passage; needle its pathogen; the flesh draws near. Look and there is nothing; return it to the true. Needle among the divided flesh of the various yang. In all needling of small pathogen, day by day make it larger. Supplement what is insufficient, and then there is no harm. Look at where it is; meet it at the border. Far and near all arrive; it cannot get outside. If you invade and set it going, it spends itself. Needle among the divided flesh. In all needling of heat-pathogen, send it over and it pales. It goes out wandering and does not return — then there is no illness. Open a passage; part the door; let the pathogen be able to go out, and the illness is then finished. In all needling of cold-pathogen, day by day make it warmer. Go slowly and come slowly; bring the spirit. When the door is already closed, qi does not divide; vacancy and repletion are attuned, and the qi remains. The Yellow Emperor said: How are the official needles? Qi Bo said: In needling a swelling, use the lance needle. In needling the large, use the sharp needle. In needling the small, use the round-keen needle. In needling the hot, use the chisel needle. In needling the cold, use the hair-fine needle. Let me speak of the discourse of resolving. It answers heaven and earth; it matches the four seasons. The person takes part in heaven and earth, and so can be resolved. Below there is seepage; above, reeds and rushes grow — this is how one knows the more and less of form and qi. Yin and yang are cold and heat. In heat there is enriching rain and it is above; the roots have little juice; a person's qi is without; the skin is slack, the interstices open; blood and qi diminish; sweat greatly discharges; the skin is moist-glossy. In cold the ground freezes and water ices; a person's qi is in the center; the skin is tight, the interstices close; sweat does not go out; blood and qi are strong; the flesh is firm and astringent. At such a time, one good at making water travel cannot go upon ice. One good at piercing the ground cannot chisel frost. One good at using the needle also cannot take the four reversals. When blood vessels congeal and knot, hard and beating, not coming and going, they also cannot be softened at once. Therefore one who makes water travel must wait for heaven to warm, ice to melt and frost to loosen — then water can travel and the ground can be pierced. A person's vessels are still like this. In treating reversal, you must first apply a warm iron and attune the channels: palm and armpit, elbow and foot, nape and spine, so as to attune them. When fire-qi has already opened, the blood vessels then travel. Then look at the illness: if the vessels are moist-glossy, needle and level them; if hard and tight, break and scatter them. When qi goes down, stop. This is what is meant by untying a knot. The kind of using the needle lies in attuning qi. Qi gathers in the stomach, so as to open ying and wei, each traveling its road. Ancestral qi remains in the sea; what is below pours into the qi-street; what is above runs to the road of breath. Thus when reversal is in the feet, ancestral qi does not go down; the blood in the vessels congeals and stays; without fire to attune it, you cannot take it. One who uses the needle must first observe the repletion and vacancy of the channels and networks; press and follow them; press and flick them; look at what answers and moves — and only then take them and send them down. When the six channels are attuned, it is called not ill; even if ill, it is called finishing of itself. When one channel is replete above and vacant below and does not pass: there must be a crosswise network, abundant, added upon the great channel, making it not pass. Look and drain it. This is what is meant by untying a knot. Cold above and heat below: first needle the taiyang of the nape, and stay long. After needling, apply a warm iron to the nape and the shoulder-blade; when heat joins below, stop. This is what is meant by pushing and sending upward. Heat above and cold below: look at the vacant vessels sunken in the channels and networks, and take them; when qi goes down, stop. This is what is meant by drawing and sending downward. Great heat throughout the body, madness and seeing amiss, hearing amiss, speaking amiss: look at the foot yangming and the great networks and take them. The vacant, supplement; if there is blood and it is replete, drain. Have the person lie face up; sit before the head; with the four fingers of both hands press the neck vessels; hold long; roll and press; push down into the empty basin, then stop again as before. When the heat leaves, stop. This is what is meant by pushing and scattering. The Yellow Emperor said: There is one vessel that gives birth to tens of illnesses — sometimes pain, sometimes swelling, sometimes heat, sometimes cold, sometimes itching, sometimes impediment, sometimes numbness — changing without end. What is the reason? Qi Bo said: These are all what pathogenic qi gives birth to. The Yellow Emperor said: I have heard that as for qi, there is true qi, there is correct qi, there is pathogenic qi. What is meant by true qi? Qi Bo said: True qi is what is received from heaven, joined with grain-qi, and so fills the body. Correct qi is correct wind, coming from one quarter — neither full wind nor vacant wind. Pathogenic qi is the thief-injury of vacant wind upon a person; it strikes a person deep, and cannot leave of itself. Correct wind strikes a person shallowly; it joins and leaves of itself; its qi comes soft and weak, and cannot overcome true qi, and so leaves of itself. When vacant pathogen strikes a person, there is shivering and the form is moved; it raises the fine hairs and opens the interstices. If it enters deep and inwardly beats upon the bone, it becomes bone-impediment. If it beats upon the sinews, it becomes sinew-spasm. If it beats within the vessels, it becomes blood closed and not passing, and becomes a swelling. If it beats upon the flesh and contends with wei qi: if yang overcomes, it is heat; if yin overcomes, it is cold. In cold, true qi leaves; leaving, there is vacancy; vacancy, then cold. If it beats between the skin, its qi issues outward; the interstices open, the fine hairs shake; qi comes and goes — then it is itching. If it stays and does not leave, it is impediment. If wei qi does not travel, it is numbness. If vacant pathogen is received aslant in half the body and enters deep, dwelling inwardly in ying and wei: when ying and wei slightly decline, true qi leaves and pathogenic qi alone remains, and it issues as withering of one side. If the pathogenic qi is shallow, the vessel has pain on one side. When vacant pathogen enters the body deep, cold and heat contend; they stay long and lodge inward. If cold overcomes the heat, the bones hurt and the flesh withers. If heat overcomes the cold, the flesh rots and the muscle decays into pus; inwardly it injures bone; inwardly injuring bone is bone-eating. If something has rushed ahead upon the sinews, the sinews bend and cannot stretch; pathogenic qi dwells between them and does not return, and issues as a sinew lingering. If something has knotted, qi returns to it; wei qi remains there and cannot return; the fluids stay long, join, and become an intestinal lingering; the long-standing take several years to complete; press with the hand and it is soft. If something has already knotted, qi returns to it; the fluids remain; pathogenic qi strikes it; the congealing day by day grows easier and worse; they join and gather to dwell, and become an old tumor; press with the hand and it is hard. If something has knotted and struck deep in the bone, qi relies on the bone; bone and qi join, and day by day grow larger — then it is a bone flat-abscess. If something has knotted and struck the flesh, ancestral qi returns to it; the pathogen remains and does not leave; if there is heat it transforms into pus; if there is no heat it is a flesh flat-abscess. All these several qi issue from no constant place, yet they have constant names.

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The Yellow Emperor asked Qi Bo: I have heard that needling has five joints. How is that?

The note

Shaking off dust, opening the covered, removing the nail, taking off clothes, resolving confusion. The five joints are five ways of drawing a person out of covering. True and pathogenic: first tell who is the host.