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Huang Di Nei Jing Ling Shu: The Ancient Classic on Needle Therapy


Journal of Chinese Medicine • Number 111 • June 2016


the incurably ill and therefore depended on proficiency in devising a prognosis.


Diagnosis itself is subject to a hierarchy in the Ling


shu. In chapter 4 we read that those who need only to look at patients to recognize their health problems are “enlightened,” or ming 明. The designation for the second- highest competence that healers who need to feel the pulse can attain is a striking one. These individuals are merely “divine,” shen 神. One might think that the “divine” would tower above all else. Yet that is precisely what the author of this text avoided expressing. The “divine” here is not to be associated with “gods” in the numinous sense; it simply means “prominent,” not even “very good”: that was reserved for the enlightened ones. The idea of the “divine” was downgraded here the same way as when one calls something divine in English (or in German as göttlich): One could just as well say “wonderful” or “fantastic.” It has nothing to do anymore with the deity venerated by a religion. At the bottom of the ranking is the healer who has to ask the patient questions. Anyone depending on that was merely a practitioner, gong 工. The special esteem for the mere observation of a patient as the basis for an exact diagnosis might seem astonishing. However, it had a quite concrete background. Let us go back to the very first reference to a doctor-patient relationship in the history of Chinese literature. It was an encounter recorded in the Shi ji 史記 by Sima Qian 司馬遷 in about 100 BCE, of 扁鵲 Bian Que and the Marquis Huan of Qi. Bian Que took part in an audience of the sovereign and noticed from a distance that he needed treatment that could still heal an illness in its early stages. However, when he raised the matter he was harshly rebuffed. The story had a sad end, as the Marquis refused to take even subsequent warnings seriously and was eventually no longer curable. Besides being the oldest known doctor- patient relationship in China, it also shows how difficult it is for a doctor to approach a ruler. The Ling shu refers to this problem repeatedly, and most clearly in chapter 29. It is nearly impossible to convince rulers and other lofty individuals to submit to a detailed, personal examination of their bodies. Touching them, for example to take their pulse, is virtually unthinkable. The only way to examine such people when they are suffering is from a due distance. The Ling shu offers many diagnostically relevant parameters that inform the observer about a patient’s inner condition. According to chapter 4 of the Ling shu, the correlation between the inside and outside is as immediate as the striking of a drum and the sound the drum emanates, and – especially – as characteristic as the relationship between an object and its reflection in clear water. Of primary importance are complexions, especially in the face, to the right and left of the nose, under the eyes and in other telling places, such as the fingernails, where a yellow color, for example, would indicate a problem with the gall bladder according to chapter 47. Correspondences


laid down in the Five Phases doctrine between externally recognizable colors and internal organs provide essential insights for a subsequent treatment. Certain other features also yield key information. Whether the eyes are large or small tells the observer something about the gall bladder. The condition of the lips yields information about the spleen. Whether the patient has to raise his or her shoulders to breathe says something about the lung. The size of the skeleton, dimensions of the nape, the expansion of the rib cage indicate the condition of the stomach and diet. For all of the short-term repositories and long-term depots there are “indicators” on the body’s exterior that the observer must note in his diagnosis. The height of the nasal bone, the size of the nostrils, the bags under the eyes – all these facts told the keen observer something about the condition of his subject, without even having to touch him or – hardly conceivable with a high-ranking individual – interview him. Yet there is also a conscious change of perspective. In chapter 74, Huang Di demands exactly the opposite of Qi Bo. He did not want to inspect complexions or investigate the flow in the vessels of various body parts. Instead, he wanted to know how one could recognize something about an illness merely by examining the condition of one place on the wrist. The instruction that Qi Bo gives him illustrates that transition from visual and tactile inspection of the vessels of the wrist and the surface of the skin above them to the inspection of movements in the vessels. A term commonly used until quite recently in Chinese medicine for feeling the pulse is kan mai 看脈, literally “observing the vessels.”13


When Qi Bo refers to the diagnostically relevant


conditions of a certain section of the wrist as “slack or tense,” “minimal or enlarged,” or “smooth or rough,” the boundaries between the perception of these values of the skin or as characteristics of the movement in the vessels are blurred. Whether the vessels are “diminished” or swollen as the result of obstructed blood and qi must likewise be included in the evaluation of an illness.


8. Conditions of Illness The maladies discussed in the Ling shu are associated mainly with xie qi 邪氣, or “evil qi.” They can enter the body from the outside as wind, cold, warmth, heat or moisture. Once inside they remain static in one place or they move farther inside, from the skin to deep in the long- term depots and even the bone marrow. A third possibility is that they are transported from one long-term depot to another. Of the kinds of evil qi that enter the body, one distinguishes between “proper evil,” zheng xie 正邪, and xu xie 虛邪, or “depletion evil.” The former are climatic qi determined by the seasons, such as heat, cold, etc. which are basically “proper,” zheng 正, because they appear during the appropriate season. They are nonetheless “evil” because the enter the human body uninvited. “Depletion evil,” on the other hand, are in the wrong place from the


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