Library

(The full text of "Ni Shun Pian" from *Ling Shu*)

Huangdi asked Bo Gao: I have heard that Qi has distinctions between reversal (Ni) and smooth flow (Shun), pulses exhibit fluctuations in excess and deficiency, and acupuncture treatment follows general principles. May I inquire about these? Bo Gao replied: The reversal and smooth flow of Qi correspond to the Yin and Yang of Heaven and Earth, as well as the Four Seasons and Five Elements. (Humans are interconnected with Heaven and Earth and resonate with the Sun and Moon; when the ascending and descending, excessive and deficient Qi of Yin and Yang is in its proper position and harmonious, it is termed "Shun" (smooth/normal); when it is not in its proper position and discordant, it is termed "Ni" (reversed/abnormal).) The excess and deficiency of pulses serve to diagnose the excess or deficiency, surplus or insufficiency of Blood and Qi. (The excess and deficiency of pulses are described in terms of forcefulness or lack thereof, thus allowing for the diagnosis of the excess or deficiency of Blood and Qi.) The general principles of acupuncture require clearly knowing whether a disease is amenable to acupuncture, not amenable to acupuncture, or beyond the point where acupuncture can be effective. (The meaning of three-stage needling is detailed below. Furthermore, if one knows a disease is amenable to needling because excess pathogenic factors reside in the meridians, this aligns with what is stated in *Mai Du Pian*: use draining methods for excess conditions and medicinal decoctions for tonification in deficiency conditions. Regarding conditions not amenable to needling, this refers to contraindications, such as those mentioned in *Zhong Shi Pian*: do not needle after recent sexual intercourse, recent exertion, fullness, hunger, great fright, or great fear; and also includes the "Heavenly Taboos" from *Ba Zheng Shen Ming Lun* and the "Five Taboos" from *Wu Jin Pian*. Regarding conditions beyond the point of effectiveness, this refers to deterioration where recovery is impossible, such as stated in *Ben Shen Pian*: if the five Zang organs are already damaged, acupuncture cannot treat them. These three categories represent the immediate relevance of this section.) Huangdi said: How does one observe/diagnose these? Bo Gao said: As military strategy states: Do not engage an army with overwhelming momentum, and do not attack a formation that is solid and organized. (Peng peng describes overwhelming momentum; tang tang describes an organized formation. Not engaging or attacking is to avoid their sharpness. Peng sounds like 'peng'.) Acupuncture methodology states: Do not needle patients with intense heat (He he), do not needle patients with profuse sweating (Lu lu), do not needle patients with chaotic and turbid pulses (Hun hun), and do not needle patients whose symptoms contradict their pulse. (He he indicates extreme heat. Lu lu indicates profuse sweating. Hun hun indicates difficulty in distinguishing excess from deficiency. Symptoms contradicting the pulse indicate a mismatch between physical signs and Yin-Yang nature. All these are conditions not amenable to needling. He is pronounced Hao or Xiao; Lu is pronounced Lu.) Huangdi asked: How does one observe conditions amenable to needling? Bo Gao said: Expert physicians intervene before the disease arises; next best is intervening before the disease becomes excessive; next is intervening after the disease has declined. (Intervening before arising means treating at the embryonic stage. Intervening before excess means treating at the initial stage. Intervening after decline means recognizing an opportunity to capitalize on the weakness. All these are conditions amenable to needling.) Incompetent physicians needle when the pathogen is just attacking, when the physical constitution is excessively strong, or when symptoms contradict the pulse. (Needling when the pathogen is attacking fails to avoid the sharpness of the incoming evil. Needling when the constitution is strong reflects seeing only the exterior without knowing the interior. Contradiction between symptoms and pulse varies in severity; slight contradiction requires caution to avoid harm and is not yet suitable for needling; severe contradiction indicates separation of Yin and Yang and loss of harmony between form and Qi, making needling impossible. Physicians who do not understand this and force needling will inevitably fail, hence they are called incompetent.) Therefore, it is said: When the pathogen is in excess, do not dare to damage [the healthy Qi]; needle after it has declined, and success is guaranteed. (Excess pathogens should be drained; why fear damage? One merely fears that where pathogenic qi gathers, healthy qi must be deficient; if attacking pathogens without removing them, healthy qi may be depleted first. Hence, when in excess, do not dare to damage. Although the disease seems to have declined and might seem unnecessary to treat, one must realize that while pathogenic qi appears calm, the root of the disease is solid; capitalizing on this momentum to extract the root is easy and effective. Hence, needling after decline guarantees success.) Therefore, it is said: Experts treat disease before it arises, not after it has arisen. This is what is meant. (This view is consistent with *Si Qi Tiao Shen Lun*, see Category 7 on Preservation of Health.)