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A collection of notes on the topics of classical Chinese, medicine, and traditional culture.
 

This blog is a collection of ruminations, translations, and personal opinions by Sabine and some guest authors. Reflecting my own personality, some posts are academic, some clinical, and some personal, some are excerpts from existing books and some may become part of future books. Please leave a comment with feedback, questions, constructive criticism, and differences of opinion as long as you argue your reasons for disagreement logically. Any personal attacks, uncivil remarks, or self-promoting comments will be deleted.

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Baffling Needling

This post is an excerpt from my forthcoming book, Humming with Elephants," a translation with commentaries and discussion of the "Great Treatise on the Resonant Manifestations of Yin and Yang (Su Wen 5). My translation of the passage is followed by a brief discussion and translations of relevant commentaries and quotations. Warning: This is a pretty technical passage.

Source text from the end of Suwen 5:

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故善用針者,從陰引陽,從陽引陰,以右治左,以左治右,以我知彼,以表知裡,以觀過與不及之理,見微得過,用之不殆。

善診者,察色按脈,先別陰陽;審清濁,而知部分;視喘息,聽音聲,而知所苦;觀權衡規矩,而知病所主;按尺寸,觀浮沉滑澀,而知病所生以治。

無過以診,則不失矣。

As such, practitioners who are skilled at using needles [observe the following guidelines:] from the Yīn guide the Yáng, from the Yáng guide the Yīn; by the right treat the left, by the left treat the right; from their own [experience] know the other; and from the exterior know the interior. By [thus] contemplating the underlying pattern of excesses and insufficiencies [in the patient’s body], they see the subtle [signs] and obtain [control over] what is in excess. Their use [of needles] does not carry any risk!

Practitioners who are skilled at diagnosis investigate the complexion and palpate the flow in the vessels, to first differentiate Yīn and Yáng; scrutinize the clear and the turbid, to thereby know the specific location and level [of the disease]; observe the breathing and listen to the sounds [produced by the patient], to thereby know the location of suffering; contemplate the weights and balance beam [of scales] and the compass and the square, to know what governs the disease; and palpate the chǐ and the cùn pulse and contemplate its floating or sunken, slippery or rough quality, to thereby know what has produced the disease, and thereby [they are able to] treat it.

Because they make no mistakes in their diagnosis, they are never wrong [in their treatment]!


Discussion

Lines Four and Five mention a number of treatment methods that deserve additional explanation and can and have been interpreted in different ways by different commentators and translators. I have therefore attempted to keep my translation above as literal as possible to allow the reader to make up her or his own mind. My notes below simply present some possibilities, based on standard readings. Of course we can also follow Wáng Bīng’s laconic comment on the first line that “all of these are deeply illuminated methods for using needles” (凡此皆深明用鍼之法也) and leave it at that. Mǎ Shì’s commentary, however, should be a little more helpful. While lengthy, it manages to express the underlying sentiment that ties all these phrases together with both elegance and clinical insight.

上文言由皮毛而漸入臟腑,則在外為表,在內為裡,在表為陽,在裡為陰。善用鍼者,知陽病必行于陰也,故從陰以引之而出於陽,知陰病必行于陽也,故從陽以引之而入于陰。

《難經》六十七難曰:五臟募皆在陰,而俞在陽者何謂也?然。陰病行陽,陽病行陰,故令募在陰,俞在陽。此乃指背腹為陰陽,特一端耳,然鍼法之從陰引陽,從陽引陰,不止於此。

《靈樞》終始、禁服、四時氣篇人迎脈盛為陽經病,則瀉陽補陰;氣口脈盛為陰經病,則瀉陰補陽。補瀉施而陰陽和,亦從陰引陽,從陽引陰法也。

凡人身經絡,左與右同,我與彼同,表與裡同,故以右治左,以左治右,以我知彼,以表知裡,如繆刺論以邪之入於經者為巨刺,流溢於大絡而生奇病者為繆刺。繆刺者,以左取右,以右取左。其所謂大絡者,十五絡也;巨刺者,正刺也;繆刺者,與經脈異處也。

Since the text above starts from the skin and body hair and gradually enters into the Zàng and Fǔ Organs, this means that the location on the outside constitutes the exterior, and the location on the inside the interior, and that the location in the exterior constitutes Yáng and the location in the interior constitutes Yīn. The person who is skilled at using needles knows that Yáng disease must move into the Yīn, and as such draws it from the Yīn to exit in Yáng; and knows that Yīn disease must move into the Yáng, and as such draws it from the Yáng to enter the Yīn.

The 67th Difficulty in the Nàn Jīng states: “All the Mù Alarm Points of the Five Zàng Organs are located in Yīn, and all the Shū Transport Points are located in Yáng. What do we mean by this? Answer: “Yīn disease moves into Yáng, and Yáng disease moves into Yīn. For this reason, the Mù Alarm Points are in Yīn, and the Shū Transport Points are in Yáng.” This passage points only to this particular perspective, that the back and the abdomen are Yīn and Yáng. Nevertheless, the needling method of “guiding the Yáng from the Yīn and guiding the Yīn from the Yáng” is not limited to this [meaning] alone.

In the Líng Shū chapters 9, 19, and 42, an abundant pulse at Rényíng means disease in a Yáng channel, and then you drain Yáng and supplement Yīn; an abundant pulse at Qìkǒu means disease in a Yīn channel, and then you drain the Yīn and supplement the Yáng. The application of supplementing and draining and the harmonization of Yīn and Yáng, these are the method of “drawing the Yáng from the Yīn and drawing the Yīn from the Yáng.”

Always in the channels and network vessels of the human body, the left and right are identical, the person’s own [experience] and the other’s are identical, and the exterior and the interior are identical. As such we treat the left by means of the right and treat the right by means of the left; know the other by means of our own [experience]; and know the interior by means of the exterior. This is just like in the “Discourse on Baffling Needling” (Sù Wèn 63) where if the evil has entered the Channels, it means Grand Needling, but if it has poured into the large Network Vessels and engendered strange diseases, it means Baffling Needling. Baffling Needling means to choose the right for the left and to choose the left for the right. What this text refers to as the “large network vessels,” are the fifteen Network Vessels. Grand Needling means straight needling, while Baffling Needling means that the location is different from the flow in the channels.
— Commentary by Mǎ Shì  馬蒔

If the reader is not familiar with the method of “baffling needling” (miù cì  繆刺), Sù Wèn 63 is an entire chapter devoted to this topic. Grand Needling (jù cì 巨刺) is one of the Nine Needling Methods (jiǔ cì 九刺) described in Líng Shū 7 as needling evil in the channels by treating the right from the left and the left from the right side of the body. To differentiate between the indications for Grand Needling, which refers to deeper needling of Channels, and Baffling Needling, which is a more superficial needling technique of the network vessels, I quote the introduction from the “Discourse on Baffling Needling,” Sù Wèn 63:

黃帝問曰︰余聞繆刺,未得其意,何謂繆刺?

岐伯對曰︰夫邪之客於形也,必先舍於皮毛,留而不去,入舍於孫脈,留而不去,入舍於絡脈,留而不去,入舍於經脈,內連五臟,散於腸胃,陰陽俱感,五臟乃傷,此邪之從皮毛而入,極於五臟之次也,如此則治其經焉。今邪客於皮毛,入舍於孫絡,留而不去,閉塞不通,不得入於經,流溢於大絡,而生奇病也。夫邪客大絡者,左注右,右注左,上下左右與經相干,而布於四末,其氣無常處,不入於經俞,命曰繆刺。

帝曰︰願聞繆刺,以左取右以右取左奈何?其與巨刺何以別之?

岐伯曰︰邪客於經,左盛則右病,右盛則左病,亦有移易者,左痛未已而右脈先病,如此者必巨刺之,必中其經,非絡脈也。 故絡病者,其痛與經脈繆處,故命曰繆刺。

The Yellow Emperor asked: “I would like to hear about Baffling Needling.  I have not yet grasped its significance. What do you mean by Baffling Needling?”

Qí Bó replied: “The way evil intrudes through the Form is first by lodging in the skin and body hair. If it remains instead of leaving [the body], it enters more deeply to lodge in the Grandchild Vessels. If it remains instead of leaving, it enters more deeply to lodge in the Network Vessels. If it remains instead of leaving, it enters more deeply to lodge in the Channels, which are internally linked to the Five Zàng Organs. Dispersing in the Intestines and Stomach, Yīn and Yáng are both affected, and the Five Zàng Organs are injured. This is this order in which evil enters from the skin and body hair and finally ends up in the Five Zàng Organs. If it is like this, then you treat the affected Channels. In the present case, evil has intruded through the skin and body hair and entered more deeply to lodge in the Grandchild Vessels. Remaining [in the body] instead of leaving, it has become blocked and congested without moving freely, and is unable to enter the channels, pouring into the Great Network Vessels and engendering strange diseases there. Now when evil intrudes into the Great Network Vessels, it pours from the left to the right, and from the right to the left, up and down and left and right interfering with each other in the Channels and spreading to the four tips. Its Qì has no constant location and does not enter the Channel Transport Shū Points. This is [the situation] that Baffling Needling refers to.

The Emperor said: “I would like to hear about Baffling Needling. Why is it that you choose the right [side of the body] for treating [evil] in the left and the left [side of the body] for treating [evil] in the right? And how do you distinguish it from Grand Needling?”

Qí Bó replied: “As evil intrudes into the Channels, exuberance in the left results in disease in the right, and exuberance in the right results in disease in the left. Moreover, there are also conditions that shift and move around, or cases where pain on the left has not yet stopped but the pulse on the right first [indicates] disease. Situations like these are ones where you must [treat the disease by] Grand Needling, and you must strike the Channels, and not the Network Vessels. As such, in diseases of the Network Vessels, the pain and the channel pulses are in baffling locations and therefore this method is called Baffling Needling.”
— Quotation from the Treatise on Baffling Needling 《繆刺論》
 
1938 banknote with depiction of Yellow Emperor.
 
Sabine WilmsComment