Library

Ping An: This section, from the beginning to the end of the chapter, is found in Volume 8, Chapter 55, "Ni Shun" (Reversal and Compliance) of the *Ling Shu* (Spiritual Pivot). From "Ci fa yue wu ci he he zhi re" (The acupuncture method states: do not puncture when the heat is blazing) to "bu zhi yi bing" (do not treat established disease), it is found in Volume 5, Chapter 1 of the *Jia Yi Jing* (Classified Classic of Acupuncture and Moxibustion). From "Bo Gao yue bing fa wu ying pang pang zhi qi" (Bo Gao said: In military strategy, do not confront the surging qi) to "yu mai xiang ni zhe" (those where the disease contradicts the pulse), it is also found in Volume 1 of the Japanese *I Shin Ho* (Medical Heart Mirror).

Huang Di asked Bo Gao: I have heard that Qi has aspects of reversal and compliance, pulses have distinctions of fullness and deficiency, and there are general principles for acupuncture. May I ask you to explain them? (These three questions are posed to highlight the key to regulating Qi.) Bo Gao replied: The reversal and compliance of Qi correspond to the Yin and Yang, the Four Seasons, and the Five Phases under Heaven. (First, knowing reversal and compliance means understanding the Qi of the Four Seasons and Five Phases that are in reversal or compliance, and puncturing according to this. Ping An: In the *Ling Shu*, "under Heaven" is written as "Heaven and Earth".) The fullness and deficiency of pulses are used to observe the excess and deficiency, surplus and insufficiency of Blood and Qi. (Second, knowing how to observe the pulse means observing the excess and deficiency of Blood and Qi at the Cun Kou and Ying acupoints.) The general principles of acupuncture require clearly knowing whether a disease is suitable for puncture, not yet suitable for puncture, or no longer suitable for puncture. Third, knowing the methods of puncture means knowing which diseases can be punctured, which cannot yet be punctured, and which cannot be punctured. "Yue" refers to rules or laws. Huang Di said: How should one observe this? Bo Gao said: Military strategy states: Do not confront an army with surging momentum, (Pang, pronounced 'Pu Dong', indicates strong military momentum. Ping An: The *I Shin Ho* adds the character "yue" after "bing fa".) Do not attack an enemy formation that is solid and imposing. The acupuncture method states: Do not puncture patients with blazing high fever, (He, pronounced 'Hu Du', indicates intense heat. Tang tang describes the imposing appearance of a large army. When military momentum is strong, one does not attack immediately but waits for it to decline before striking. Similarly, in acupuncture, when pathogenic Qi is strong, one uses regulation and massage to reduce its overwhelming force before puncturing; hence, it is said not to puncture when the heat is blazing.) Do not puncture patients with profuse sweating (Lu lu indicates severe depletion of Blood and Qi leading to extreme deficiency, so puncture is contraindicated.), Do not puncture patients with turbid and chaotic pulses (Hun hun indicates turbidity and disorder. When observing such chaotic pulses, the disease cannot be determined, so puncture is contraindicated.), Do not puncture patients whose symptoms contradict their pulse patterns. (When the physical symptoms do not match the pulse, or vice versa, it is called contradiction. Ni means contrary.) Huang Di said: How does one observe the conditions suitable for puncture? Bo Gao said: Superior practitioners puncture before the disease arises; (Even if internal and external pathogens exist, if no clinical signs have appeared, puncturing at this stage is considered superior practice.) Next, they puncture before the disease becomes excessive; (If a minor illness has formed but has not yet become severe, puncturing at this stage is considered superior practice. Ping An: The *Jia Yi Jing* writes "wei sheng" as "wei cheng".) Next, they puncture after the disease has declined; (Although the disease has declined, it may not resolve immediately; puncturing at this stage is considered intermediate practice.) Inferior practitioners puncture when the pathogen is actively invading, when the condition is at its peak, or when the symptoms contradict the pulse. (Fang refers to facing directly or being in the midst of; Xi refers to repetition or accumulation. When the disease accumulates, symptoms flare up again, and the clinical picture contradicts the pulse, puncturing at this stage is considered inferior practice.) Therefore, it is said: When the pathogen is strong, do not rashly damage the healthy Qi; puncture only after it has declined, and success is guaranteed. (This illustrates the difference in efficacy between skilled and unskilled practitioners.) Therefore, it is said: Superior practitioners treat disease before it manifests, and do not treat established disease. This is what is meant. (Wei bing refers to the state of disease before onset. Yi bing refers to established disease. Ping An: The *Ling Shu* and *Jia Yi Jing* write "zhi bu bing" as "zhi wei bing". The *Jia Yi Jing* omits the four characters "ci zhi wei ye".)