《黃帝內經素問補註釋文》Vol. 23

The malaria-type fever (nüè) of the Foot Taiyang channel (zú tàiyáng jīng) causes lower-back pain, a heavy head, and a chill rising from the back. The Foot Taiyang channel enters at the crown of the head and connects with the brain. It then emerges at the back of the head and descends along the neck, the inner edges of the shoulders, and both sides of the spine, down to the lumbar region. A branch separates from the inner shoulder, descends on both sides, passes through the buttocks, and runs past the bishu (the pivot where the thigh root meets the hip). This explains the lower-back pain, head heaviness, and chill rising from the back.

First the patient feels cold, and later fever rises with great intensity. Here "hè hè" and "yē yē" both describe severe heat. Yang Qi (vital energy) in the Foot Taiyang channel is insufficient, so the patient first feels cold. When the cold reaches its extreme, it turns to heat, which is why fever follows.

After the fever subsides, the patient sweats, but the illness is slow to heal. When the fever first rises, Qi is deficient, producing heat. After the fever recedes, Qi recovers, and sweating follows. This shows that the pathogenic factor remains strong, and the upright Qi cannot yet overcome it, so the illness is hard to cure.

Needle the xizhong (the cleft point, where the Qi and blood of a channel gather and which is used for treatment) and let blood. The cleft point of the Foot Taiyang channel is called Jinmen (Golden Gate). It lies below the outer ankle, is also called Guanliang (Barrier Bridge), and connects with the Yangwei vessel (yángwéi mài). Jinmen may be needled to about three fen, or treated with three moxa cones. According to the Huangdi Zhonggao Tujing (Illustrated Scripture of the Yellow Emperor's Central Announcements), the Weizhong point can also be used. In older usage, Weizhong was called xizhong. Weizhong lies at the center of the transverse crease behind the knee, in the popliteal fossa. It is the he-sea point of the Foot Taiyang channel. It may be needled to about five fen, retained for seven breaths, or treated with three moxa cones. The collators note that the Jiayi Jing (Systematic Classic of Acupuncture and Moxibustion) gives this location as the "popliteal center" (guózhōng). The xizhong here should therefore be located in the popliteal fossa behind the knee.

Malaria-type fever of the Foot Shaoyang channel (zú sháoyáng jīng) causes fatigue and weakness throughout the body, and the body feels as though it cannot stretch out.

The chill is not severe, and the fever is not severe either. This is because yang Qi has not yet grown strong, which is why the symptoms take this form.

In the Jueyin (Liver Channel) pattern of malaria, the patient does not want to see people. On seeing someone, they feel uneasy and restless at heart.

The Gallbladder and the Liver are paired. When Liver qi is weak, pathogenic qi disturbs the Liver's qi movement. This is why the patient does not want to see people, and why they feel uneasy at heart when they do.

The fever is intense, and the patient sweats heavily.

When the pathogenic qi is strong, the fever becomes severe. Because it is also affected by wind pathogen, the patient sweats heavily.

One should needle Xiaxi (GB-43), a point on the Foot Shaoyang Gallbladder Channel. Xiaxi lies in the fork between the little toe and the ring toe, in the depression in front of this section. It is the ying (spring) point of the Foot Shaoyang Gallbladder Channel. The needle is inserted three fen deep and retained for three exhalations. If moxibustion is used, three moxa cones may be applied.

In the malaria of the Foot Yangming Stomach Channel, the patient first feels chills, with waves of cold and a strong sensation of cold. Only after a long while does fever set in. After the fever subsides and the patient sweats, they enjoy looking at sunlight and moonlight and at firelight, and feel comfortable only in these conditions.

When Yang qi is deficient, the exterior of the body feels cold first. When Yang qi is depleted to the extreme, pathogenic qi turns and becomes strong, so the chills are severe and the fever comes only after a long delay. After the fever recedes and the sweating stops, Yin qi grows strong within the body, and Yang qi cannot overcome Yin. For this reason, the patient enjoys sunlight, moonlight, and firelight, and feels comfortable only in them.

One should needle Chongyang (ST-42), a point on the Foot Yangming Stomach Channel located on the dorsum of the foot. Chongyang lies on the foot's upper surface, about five cun above the instep (fu), at the place where the dorsalis pedis artery pulses between the bones. It is situated three cun above Xiangu (ST-43), and it is the yuan (source) point of the Foot Yangming Stomach Channel. The needle is inserted three fen deep and retained for ten exhalations. If moxibustion is used, three moxa cones may be applied. The character for fu is read as "fu."

In the malaria of the Foot Taiyin Spleen Channel, the patient feels emotionally oppressed and often sighs deeply.

When heart qi flows into the lung, it ordinarily brings ease to the mind. But once the spleen is diseased, the heart, as the mother organ, cannot aid the spleen. The fire qi of the heart descends into the spleen but cannot rise to the lung. In addition, a branch of the Foot Taiyin Spleen Channel rises from the stomach, passes through the diaphragm, and flows into the heart. For this reason the patient feels emotionally oppressed and often sighs deeply.

The patient has no appetite, often alternates between chills and fever, and sweats.

The spleen governs transformation and transportation of food and drink and nourishes the body throughout. Now pathogenic qi invades the spleen, so the organs cannot receive the nourishment of spleen qi. The earth phase of the spleen is hosted in the four seasons, and at this time the pathogenic qi contends with it. For this reason the patient has no appetite, often alternates between chills and fever, and sweats. The New Collation notes (Xin Jiaozheng) say that, according to the record in the Jiayi Jing (the ABC Classic of Acupuncture and Moxibustion), this should read "more chills and less fever."

When the illness is at its height, the patient is prone to vomiting. After vomiting, the severity of the illness lessens.

The Foot Taiyin Spleen Channel enters the abdomen, connects with the spleen, and links with the stomach. It then rises through the diaphragm and runs alongside the throat. For this reason, when the pathogenic qi flares up, the patient tends to vomit, and after vomiting the illness eases.

Once the severity has eased, one should select points and needle for treatment. The phrase "select points after the severity has eased" refers to needling the jing (well) points, the shu (stream) points, and the Gongsun (SP-4) point. Gongsun lies behind the base of the big toe.

Foot Shaoyin (Zu Shaoyin) malaria causes frequent vomiting, and during an attack there is more cold than heat or more heat than cold. The Foot Shaoyin meridian connects with the liver and the diaphragm, enters the lungs, and passes along the throat, which is why vomiting occurs. The kidneys belong to the yin organs, and yin qi can produce cold. Now that yin qi is deficient, heat predominates over cold. New Collation notes that the Jiayi Jing (Classic of Acupuncture and Moxibustion, A and B) gives the original text as "frequent vomiting, more heat than cold."

When the patient wishes to shut the doors and windows and remain alone, the disorder is difficult to cure. This describes a disorder of the Foot Yangming (Zu Yangming) stomach meridian, in which the patient wants to be alone in a quiet, closed room. The stomach belongs to Earth, but the illness appears in the region governed by the kidney water. Earth controls Water, so the condition is hard to resolve. Both Taizhong (Taizhong) and Taixi (Taixi) can treat it. Taizhong lies in the hollow behind the inner ankle and is the luo-connecting point of the Foot Shaoyin, the point where a branch channel leaves the main meridian. Needling may be inserted four fen (a body-inch, tongshencun, a unit of measurement based on the patient's own body proportions) and retained for seven breaths. If moxibustion is used, three cones may be applied. Taixi lies in the hollow above the calcaneus, where the arterial pulse can be felt behind the inner ankle. It is the shu-stream point of the Foot Shaoyin, where qi is transported. Needling may be inserted three body-inch fen and retained for seven breaths. If moxibustion is used, three cones may be applied. New Collation notes that the Jiayi Jing reads, "When the illness is hard to cure, select Taixi." It also records that the Jiayi Jing places Taizhong at "the middle of the heel," while the commentary on the "Chapter on Lumbar Pain" places it at "the arterial pulse in the middle of the heel street." The commentary on the "Water Points" places it behind the inner ankle, and this passage places it in "the street-middle behind the inner ankle." Since the authorities differ, the Jiayi Jing should be followed.

Foot Jueyin (Zu Jueyin) malaria causes lower back pain, distension of the lower abdomen, and difficult urination, resembling long (urinary retention) but not a true case of it. The patient often feels the urge to urinate, is fearful, lacks strength, and feels stifled in the abdomen. The Foot Jueyin meridian ascends along the inner thigh, enters the pubic region, encircles the genitals, and reaches the lower abdomen, which explains these symptoms. Long refers to the blockage of urination, and yiyi describes a stifled, oppressed feeling. New Collation notes that in the Jiayi Jing, the phrase "frequent urge to urinate" (shu bianyi) is written as "frequent belching" (shu yi).

Needling Taichong (Taichong), the shu-stream point of the Foot Jueyin, treats this disorder. Taichong lies in the hollow about two body-inches behind the root of the big toe. Needling may be inserted three body-inch fen and retained for ten breaths. If moxibustion is used, three cones may be applied.

According to the commentary on the chapter "Puncturing for Lumbar Pain" (Ci Yao Tong Pian), this point lies behind the lumbar vertebra at this segment, between the vertebrae, where a pulse can be felt beating.

Lung malaria (fèi nüè) makes a person feel cold within the chest. After the chill becomes severe, fever follows, and during the alternation of chills and fever the patient is prone to fright, as though seeing something. Acupuncture should be applied to the Hand Taiyin Lung Channel (shǒu tài yīn fèi jīng) and the Hand Yangming Large Intestine Channel (shǒu yáng míng dà cháng jīng).

Lieque (liè quē) is the principal treatment point, located one and a half cun behind the wrist. The cun is a unit of proportional measurement (tóng shēn cùn, "same-body cun"), used to locate points relative to the patient's own body. Lieque is the luo-connecting point (luò xué, the place where a channel branches to link with its paired channel) of the Hand Taiyin Lung Channel. The needle is inserted three fen deep and retained for the duration of three breaths. If moxibustion is used, five moxa cones may be burned; one zhuang refers to a single cone lit and applied once. Hegu (hé gǔ), a point on the Yangming channel, may also be used. Hegu lies in the depression where the thumb and index finger meet, along the course of the Hand Yangming channel. The needle is inserted three fen deep and retained for six breaths, and three moxa cones may be burned.

Heart malaria (xīn nüè) causes irritability and a strong desire for cold water, while chills predominate and fever is less marked. Acupuncture should be applied to the Hand Shaoyin Heart Channel (shǒu shào yīn xīn jīng).

Shenmen (shén mén) is the principal treatment point, located in the depression at the protruding end of the ulna, at the back of the palm. It is the shu-stream point (shū xué, the point where qi flows into and gathers in the channel) of the Hand Shaoyin Heart Channel. The needle is inserted three fen deep and retained for seven breaths. If moxibustion is used, three cones may be burned. The collator notes that the Taisu records this passage as "desires cold water, and the cold is more pronounced, with less marked fever."

Liver malaria (gān nüè) gives the patient a bluish-green complexion, frequent sighing, and an appearance as though close to death. Acupuncture should be applied to the Foot Jueyin Liver Channel (zú jué yīn gān jīng) until bleeding occurs.

Zhongfeng (zhōng fēng) is the principal treatment point, located in the depression one and a half cun in front of the inner ankle. It is found with the foot tilted upward and becomes palpable when the foot is straightened. It belongs to the Foot Jueyin channel. Usually the needle is inserted four fen deep and retained for seven breaths. If moxibustion is used, three cones may be burned. If bloodletting is used, as the text describes, the procedure ends when the bleeding stops.

Spleen malaria (pí nüè) causes chills and abdominal pain. During the fever, the abdomen rumbles, and sweating follows once the rumbling ceases. Acupuncture should be applied to the Foot Taiyin Spleen Channel (zú tài yīn pí jīng).

Shangqiu (shāng qiū) is the principal treatment point, located in the depression slightly forward of and below the inner ankle, on the Foot Taiyin channel. The needle is inserted three fen deep and retained for seven breaths. If moxibustion is used, three cones may be burned.

Kidney malaria (shèn nüè) causes aversion to cold and trembling, lower back and back pain, restlessness, constipation, blurred vision (the original reads mù xiōng xiōng rán, "eyes dim and hazy"), and cold hands and feet. Acupuncture should be applied to the Foot Taiyang Bladder Channel (zú tài yáng páng guāng jīng) and the Foot Shaoyin Kidney Channel (zú shào yīn shèn jīng).

Taixi (tài xī) is the principal treatment point. The method of locating it follows the approach described earlier for treating malaria through the Foot Shaoyin channel.

Stomach malaria (wèi nüè) makes a person prone to hunger yet unable to eat. After eating anything, the patient feels fullness in the chest and abdomen, and the belly becomes distended.

This occurs because stomach heat and spleen deficiency together produce hunger without appetite. After eating, the food cannot be properly transformed, so fullness and distension arise in the chest and abdomen.

When the affected area is fairly large, the treatment should follow the instructions below and needle the transverse vessel (hengmai) of the Foot Taiyin channel.

The Xinjiao Zheng (New Collation) notes that the Taisu (Plain Questions compilation) writes "qiebing" as "jubing."

For treatment, needle the transverse vessels of the Foot Yangming and Foot Taiyin channels so that they bleed.

Three points on the Foot Yangming channel are used: Lidui, Jiexi, and Sanli. Lidui (Sharp Exchange) lies at the end of the second toe, beside the big toe, about the width of one chive leaf from the nail. It is the jing-well point of the Foot Yangming channel. The needle may be inserted one fen (about 0.3 centimeters) and retained for one exhalation (hu). If moxibustion is used, apply one zhuang (moxa cone). Jiexi (Stream Ravine) lies three and a half cun behind Chongyang, in the depression above the ankle joint, on the Foot Yangming channel. The needle may be inserted five fen and retained for five exhalations. If moxibustion is used, apply three zhuang. Sanli (Three Miles) lies three cun below the knee, on the outer edge of the shinbone, between two muscles. It is the he-sea point of the Foot Yangming channel. The needle may be inserted one cun and retained for seven exhalations. If moxibustion is used, apply three zhuang.

These three points are used on the Foot Yangming channel, while the Foot Taiyin channel is treated by bleeding its transverse vessel. The "transverse vessel" refers to the large vessel that runs obliquely in front of the inner ankle; it is a luo (connecting) vessel of the Foot Taiyin channel.

The Xinjiao Zheng notes that, on close examination, Jiexi lies three and a half cun behind Chongyang. However, the Jiayi Jing (Systematic Classic of Acupuncture and Moxibustion) records it as one and a half cun, and the commentary to the Qixue Lun (Discourse on the Acupoint Cavities) records it as two and a half cun.

When malaria attacks and the whole body is in full fever, needle the pulse on the dorsum of the foot. This refers to the vessel of the Foot Yangming channel. Opening the point so that blood flows out will cause the body to cool down immediately.

The Foot Yangming channel carries a large volume of qi and blood. When fever is at its peak, qi and blood are vigorous, so letting out a small amount of blood brings the heat down quickly.

When malaria is about to bring on chills, needle points on the Hand Yangming, Hand Taiyin, Foot Yangming, and Foot Taiyin channels. This too involves opening the points to let blood out, and the needling should follow the jing-well, shu-stream, and other points of each channel.

When a malaria patient's pulse is full, broad, and rapid, needle the back-shu points. Use needles of medium size, and insert one needle beside each of the five quyu (lateral back points). The amount of bleeding should be decided by the patient's build: for a thin person, needle shallowly and let out little blood; for a stout person, needle deeply and let out more blood. The back-shu point is Dazhu (Great Shuttle), and the five quyu points are Yixi (Sighing Sobs).

When a malaria patient's pulse is fine, small, firm, and rapid, apply moxibustion to a point on the inner side of the lower leg on the Foot Shaoyin channel, and needle the jing-well point on the toe.

The Foot Shaoyin point for moxibustion is Fuliu (Returning Current). Fuliu lies in the depression two cun above the inner ankle, on the Foot Shaoyin channel. The needle may be inserted three fen and retained for three exhalations. If moxibustion is used, apply five zhuang. The jing-well point on the toe is Zhiyin (Reaching Yin), which lies on the outer side of the little toe, about the width of one chive leaf from the nail, on the jing-well point of the Foot Taiyang channel. The needle may be inserted two fen and retained for one exhalation. If moxibustion is used, apply three zhuang.

"Pulse firm yet small" means that the pulse, though firm, is fine and weak. Both the channel and the luo vessels are deficient, so it is appropriate to apply moxibustion to the Foot Shaoyin point on the lower leg and, at the same time, needle the jing-well point at the tip of the Foot Taiyang toe.

The corner of the nail is about the size of a chive leaf. This is the jing-well point (jǐngxué) of the Foot Taiyang (Bladder) channel, the point at the extremity of the meridian. Needling may go in by one tongshencun (a body-inch measured against the patient's own proportions) to a depth of one fen, and the needle is retained for the length of five breaths. If moxibustion is used, three zhuang (three burned cones of moxa) may be applied.

For malaria with a pulse that is full, large, and rapid, one may needle the back-shu points (shù xué, the points where qi is transported to the back), taking one point from the Five Wuqu-Shu (wǔqū shù, five back-shu points) and one from the back-shu points, in order to regulate the blood and vessels. This passage means that needling should follow three principles, adjusted to the patient's build and the depth of the points, so that the needle reaches the blood vessels. The points among the Five Wuqu-Shu include Dazhu and Yixi, and Yixi is the one mainly used.

The Newly Collated Edition says: On close reading, the text from "malarial pulse full and large" through to this commentary totals fifty-five characters and should be deleted. This passage repeats what came before. It is an addition by Wang Bing that followed the flow of the text and has no distinctive principle behind it. It is not as precise as Shi'an's commentary, so it is not transcribed here.

For malaria with a pulse that is slow, large, and empty, one should use medicine rather than needling. A slow pulse indicates wind-evil, a large pulse indicates excess qi, and an empty pulse indicates blood deficiency. Blood deficiency with excess qi, further invaded by wind-evil, calls for medicine to expel the evil, and bloodletting by needle is not appropriate.

In treating malaria, one should begin about the time it takes to eat a meal before an attack. If the opportunity is missed, the chance of treatment is lost. Before an attack, true qi and evil qi are separate, and the evil has not yet risen, so treatment is possible. Once the opportunity before the attack has passed, true qi and evil qi join together. Treating at that point would instead damage the true qi, which is why it is said that the opportunity is lost.

The Newly Collated Edition says: On close reading, the whole passage from "malarial pulse full and large" through to this point was placed in the fourth volume in the Quan Yuanqi Edition, and Wang Bing moved it here to continue the commentary.

For all kinds of malaria in which no pulse can be felt at the wrist, one should prick between the ten fingers to let blood. Once the blood has flowed, the illness will certainly improve. First examine the body for red spots like red adzuki beans, and prick and bleed all of these places. The twelve kinds of malaria each have different times of attack, so one should observe the patient's symptoms and judge which channel is affected. From the symptoms, one can know which meridian is diseased.

Needling should begin about the time it takes to eat a meal before an attack. One needling reduces the severity of the illness, two needlings bring visible results, and three needlings will cure the illness. If it is still not cured, prick the two collateral vessels beneath the tongue and let blood.

A detailed explanation follows below.

If it is still not cured, needle Xizhong (that is, Weizhong, BL-40) to let blood from the enlarged vessel. Then needle the points below the neck and beside the spine, and the illness will certainly improve. These points all belong to the Foot Taiyang channel. Xizhong is Weizhong. The points beside the spine refer to Dazhu, Fengmen, Refu, and the like. Dazhu lies in the depression below the first thoracic vertebra at the nape, one and a half cun to each side.

Insert the needle three fen into the body, using the proportional body measurement known as the three-fen method, and retain it for the time it takes to breathe seven times. If using moxibustion, apply five cones; one burning moxa cone is counted as one application.

Fengmen and Refu are located on either side below the second vertebra, each one and a half proportional inches from the spine. Insert the needle five fen and retain it for the time it takes to breathe seven times. If using moxibustion, apply five cones.

The New Corrected Edition says: On checking the Jia Yi Jing, the record for the Dazhu point specifies five cones, though the Jia Yi Jing also has a reading of seven. The commentary to the “Discussion of the Qi Cavities” specifies seven, while the commentaries to the “Discussion of Heat Disease” and “Heat Cavities” both specify five.

The points where the two vessels beneath the tongue lie are the Lianquan point. Lianquan is the name of an acupuncture point. It is located beneath the jaw, above the Adam’s apple, and below the root of the tongue, where the Yin Linking Vessel and the Ren Vessel meet. Insert the needle three proportional fen and retain it for the time it takes to breathe three times. If using moxibustion, apply three cones.

When treating malaria with acupuncture, first ask where the attack begins, then needle the corresponding area first. If headache and a heavy feeling in the head appear first, needle the crown, both temples, and the area between the eyebrows, and let them bleed. The crown refers to points such as Shangxing and Baihui; the temples refer to the Xuanlu point; and the area between the eyebrows refers to points such as Zanzhu.

If pain in the neck and back appears first, needle the corresponding areas first. For the neck, use Fengchi and Fengfu; for the back, use Dazhu and Shendao.

If pain in the lower back and spine appears first, needle the Xizhong point and let it bleed. If pain in the arms appears first, needle the Hand Shaoyin and Hand Yangming channels, as well as the areas between the ten fingers.

The New Corrected Edition says: Some versions read “Hand Yin-Yang”; the complete edition also reads “Hand Yin-Yang.”

If soreness in the lower legs appears first, needle the Foot Yangming channel and the areas between the ten toes, and let them bleed. Sources differ over what “ten toes” refers to; the original text is thought to contain a missing passage.

During an attack of wind malaria, the patient sweats and fears wind. Needle the back transport points of the Three Yang channels and let them bleed. Here, “Three Yang” refers to the Taiyang channel. The New Corrected Edition says that the Jia Yi Jing reads “Foot Three Yang.”

If the soreness in the lower legs is severe and cannot be endured even when pressed, it is called “bone-marrow disease.” Use a lancet needle to prick the Juegu point and let it bleed; the condition will then ease. Juegu is the Yangfu point. Its location can be determined by referring to the methods for locating the Zhongfu and transport points in the “Discussion of the Qi Cavities.”

For slight pain in the body, needle the Zhiyin point. The New Corrected Edition says that the Jia Yi Jing omits the words “Zhiyin.”

Do not needle the Jing-Well points of the Yin channels to the point of bleeding; needle them once every other day. Jing-Well points are located at the tips of the fingers or toes, while the Jing-Well point of the Foot Shaoyin channel lies in the hollow of the sole.

If a malaria attack brings no thirst and occurs every other day, needle the Foot Taiyang channel.

The collator says: According to the Nine Scrolls, this passage reads “Foot Yangming,” as in the Taishu.

If the patient is thirsty and the attacks occur every other day, needle the Foot Shaoyang channel.

The collator says: According to the Nine Scrolls, this passage reads “Hand Shaoyang,” as in the Taishu.

If warm malaria occurs without sweating, perform the Fifty-Nine Needles, an ancient method for treating heat disorders that involves needling fifty-nine sites.

From “stomach malaria” onward, a comparison with the indications described in the Illustrated Canon of the Yellow Emperor’s Central Treatise shows that some differ from those in this text. This suggests that another method of treatment existed in ancient times.

Treatise on Qi Reversal

The Yellow Emperor asked: When cold and heat move back and forth among the five zang and six fu organs, what disorders do they cause?

Qibo replied:

When the kidneys transmit cold to the liver, abscesses and swelling form, and Qi becomes deficient.

The liver stores blood. When cold enters the liver, Yang Qi cannot unfold. As Yang Qi stagnates, blood gathers and fails to circulate freely. This leads to abscesses and swelling, and also leaves the person short of Qi.

The collator says: In the version by Quan Yuanqi, this passage reads “the kidneys transmit cold to the spleen.” Quan Yuanqi’s commentary explains that after the kidneys are affected by cold, the cold pathogen passes to the spleen. The spleen governs the muscles; when cold enters the muscles, they congeal and harden, and the hardened areas turn to pus, forming abscesses and swelling. Blood is damaged, and Qi is also depleted; hence the phrase “Qi becomes deficient.” The Jia Yi Jing likewise reads “transmit cold to the spleen.” Wang Bing, misled by an erroneous text, interpreted it as “the liver”—an error that even a learned person might make.

When the spleen transmits cold to the liver, abscesses and swelling form, and the sinews and channels contract.

The spleen governs the muscles, and the liver governs the sinews. When the muscles are warm, the sinews relax; when the muscles are chilled, the sinews tighten, causing contraction. When the muscles are chilled, Defensive Qi, which circulates at the body’s surface and protects it, gathers and fails to flow freely. This leads to abscesses and swelling.

When the liver transmits cold to the heart, the person becomes mad, and the center of the chest and diaphragm becomes obstructed.

The heart belongs to Yang, and the spirit resides within it. When cold approaches the heart, the mind becomes disordered, causing madness. Yang Qi and cold contend with each other, obstructing the area between the chest and diaphragm and blocking its center.

When the heart transmits cold to the lungs, it causes “lung wasting.” Lung wasting is marked by drinking one measure of water but passing two measures of urine. This disorder cannot be cured.

The heart belongs to Yang, yet it is attacked by cold. When the cold cannot disperse, it passes to the lungs. Carried by the heart’s Fire, the cold scorches the essence of the lungs’ Metal (in Five Phases theory, the lungs belong to Metal and the heart to Fire), producing “middle wasting.” The Qi of the lungs is depleted and can no longer provide support, so the person drinks one measure of water but passes two measures of urine. Metal is overcome by Fire, making the illness extremely severe and incurable.

When the lungs transmit cold to the kidneys, it causes “surging water.” In surging water, pressing the abdomen does not make it feel hard. Water Qi remains in the large intestine, and when the person walks quickly, rumbling sounds come from the intestines, as though a pouch were filled with watery gruel.

The lungs govern Qi, and the kidneys govern water. When cold in the lungs enters the kidneys, the kidney Qi becomes excessive. When it grows too strong, it surges upward into the lungs; hence the name “surging water.” The large intestine …

When the lung’s paired organ is chilled, cold invades both the lung and the kidney, leaving no outlet above or below. Water Qi then stagnates in the large intestine. The kidney, chilled and congealed by cold, cannot produce fluids, so water accumulates in the large intestine and cannot flow freely. Thus, when a person walks, the intestines rumble with the sound of gurgling water, as though a bag were filled with watery gruel. This is a water disorder. The New Collation says: On checking the Jia Yi Jing, the phrase “this is a water disorder” reads instead, “the lung governs the treatment.”

When the spleen transmits heat to the liver, palpitations and nosebleeds occur. The liver stores blood and governs palpitations, so when pathogenic heat harasses the liver, the heart is startled and blood flows from the nose.

When the liver transmits heat to the heart, death follows. The liver belongs to Wood and the heart to Fire; their two Yang heats combine, and Fire and Wood intensify one another. Thus, when liver heat enters the heart, it is said to lead to death. The Yin-Yang Treatise says: “When the liver transmits to the heart, this is called Generating Yang. Illnesses of this kind of Generating Yang cause death within four days.” The New Collation says: On checking the Yin-Yang Treatise, its original meaning differs from the one given here. Wang Bing should not have cited that mistaken passage to support this interpretation.

When the heart transmits heat to the lung, continued transmission and transformation produces ge xiao, a disorder involving intense heat in the diaphragm and wasting thirst with excessive drinking. A slanting membrane lies between the heart and lung, with its lower end connected inward to the diaphragm. Thus, when heart heat enters the lung, it eventually produces internal heat in the diaphragm, resulting in wasting thirst and excessive drinking.

When the lung transmits heat to the kidney, continued transmission and transformation produces rou zhi, a disorder in which the sinews and bones are poorly nourished and the limbs move abnormally. “Rou” means that the sinews are weak and without strength; “zhi” means that the bones are rigid and unresponsive. When both sinews and bones are affected by heat, the bone marrow is not nourished, so the bones become rigid and unable to move while the sinews grow slack and weak. “Zhi” is pronounced “zhi.”

When the kidney transmits heat to the spleen, continued transmission and transformation causes depletion and intestinal discharge, a kind of diarrhea; in severe cases, death follows and there is no remedy. The spleen belongs to Earth and can restrain the kidney, which belongs to Water. Now the kidney transmits heat to the spleen, so spleen Earth can no longer control Water and becomes diseased. In time, this leads to depletion. The statement that intestinal discharge leads to death means that the kidney governs the lower burner and symbolizes Water, which should be cold. Now, however, it transmits heat, and the essence and Qi are consumed within the body. The lower burner loses its ability to govern and contain. Even if the intestinal discharge stops, Qi can no longer be gathered and held.

When the womb, the receiving chamber near the bladder, transmits heat to the bladder, urinary retention and blood in the urine occur. The bladder is the organ that stores fluids, while the womb governs reception. When heat enters the bladder, the outer part of the womb is heated and the Yin channels overflow inward. This causes urinary retention and blood in the urine. The Treatise on Correct Principles says: “When heat is in the lower burner, blood appears in the urine.” This refers to the condition described here.

When the bladder transmits heat to the small intestine, the intestinal passage between the diaphragm becomes obstructed; upward, this causes sores and ulceration in the mouth.

The channels of the small intestine connect with the Heart, descend along the throat, pass through the diaphragm, reach the Stomach, and belong to the small intestine. Therefore, when the small intestine is attacked by heat, the heat pathogen can descend and obstruct the intestines and diaphragm, causing constipation; it can also rise and cause sores and ulceration in the mouth. “Mi” means ulceration. (“Mi” is pronounced mí.)

When heat in the small intestine passes to the large intestine, it can form “fujia” (also written “fujia,” a disorder associated with stagnation of Qi and Blood) and cause menstrual blood to stagnate and fail to flow.

Once heat in the small intestine has entered the large intestine, the heat in the two places binds together, causing Blood to overflow and forming fujia. When Blood becomes sluggish and cannot flow freely, menstrual blood stagnates and fails to come. That is why it is said to form fujia and cause menstrual stagnation. “Fu” is another form of “fu.” In one version, the character “jia” is written as “shan”; this is a copying error.

When heat in the large intestine passes to the Stomach, a person eats a great deal yet grows thinner over time. This disorder is called “shiyi.”

The Stomach is where food and drink gather, and Stomach Qi nourishes the muscles outwardly. Heat consumes food and drink and scorches the muscles, so a person grows thin despite eating a great deal. “Shiyi” refers to food being quickly digested and discharged after it is eaten, without nourishing the skin and flesh. “Yi” means to change or shift.

The New Collation says: In the Jia Yi Jing, the character “ru” is written as “you.” Wang Bing’s annotation reads “eats well and becomes thin,” but the wording is difficult to make sense of. It is better to follow the Jia Yi Jing, write “you,” and read it together with the following passage.

When heat in the Stomach passes to the Gallbladder, it is also called “shiyi,” with the same meaning as above.

When heat in the Gallbladder passes to the brain, it causes soreness in the nose and gives rise to “biyuan” (turbid nasal discharge that flows without stopping).

Fluid from the brain seeps downward and becomes turbid nasal discharge. Because it flows continuously like a spring, the condition is called “biyuan.” “E” refers to the bridge of the nose. The Foot Taiyang channel begins at the inner corner of the eye, ascends to the forehead, meets at the crown, then enters and connects with the brain. The Foot Yangming channel begins at the nose, meets at the bridge of the nose, and also connects with the Foot Taiyang channel. When heat is present in the brain, the Foot Taiyang channel flows counter to its proper direction and becomes excessively active together with the Foot Yangming channel. Their forces bind at the bridge of the nose, causing soreness there. “Xin” means soreness. Thus, the following passage says:

As the illness progresses, there may be nosebleeds, bloody discharge, and blurred vision.

The Foot Yangming channel meets at the bridge of the nose and also connects with the Foot Taiyang channel. When heat becomes intense, the Yang collaterals—the surface network of the Yang channels—overflow with Blood. This overflow causes nosebleeds, with Blood flowing like sweat. “Mie” means bloody sweat. After excessive bleeding, the Foot Yangming and Foot Taiyang channels become depleted and can no longer nourish the eyes, resulting in blurred vision. “Ming” means dim or blurred. (“Mie” is pronounced miè.)

These disorders, then, are caused by Qi counterflow.

“Jue” means Qi counterflow. All the disorders described above are caused by Qi flowing in the wrong direction.

Treatise on Coughing

The Yellow Emperor asked, “Why does the Lung cause people to cough?” Qibo replied, “The five Zang…”

Disorders of the six bowels can all cause coughing; coughing is not limited to diseases of the Lungs. The Yellow Emperor said, “I would like to hear how each of these kinds of cough presents.” Qibo replied:

The skin and body hair correspond to the Lungs. When pathogenic Qi first attacks the skin and body hair, it follows their corresponding organ and enters the Lungs.

The pathogenic Qi referred to here is cold Qi.

When cold food and drink enter the Stomach, they travel upward along the Lung channel and reach the Lungs, making them cold. When the Lungs are chilled, pathogenic Qi inside and outside the body interact and lodge in the Lungs, causing a Lung cough.

The Lung channel arises from the Middle Burner—the area between the chest and abdomen—descends to connect with the Large Intestine, circles around the entrance to the Stomach, then passes upward through the diaphragm and belongs to the Lungs. This is why cold Qi travels upward along the Lung channel to reach the Lungs.

Each of the five Zang organs is susceptible to illness in the season corresponding to it. Outside its corresponding season, pathogenic influences pass in sequence to the other organs.

Here, “season” refers to the months governed by each of the five Zang organs. In months when an organ is not in season, it is generally not attacked directly, so pathogenic influences pass in sequence to the other organs.

Human beings and Heaven and Earth resonate with one another, so each of the five Zang organs has a season in which it takes charge. When a person is exposed to cold and suffers an attack of cold Qi, illness follows: mild illness presents as coughing, while severe illness brings diarrhea or pain.

Mild cold Qi affects the skin and body hair from the outside, then reaches the Lungs from within, causing a cough. Severe cold Qi penetrates deeper into the body. If it injures the internal organs, it causes pain; if it enters the intestines and Stomach, it causes diarrhea and dysentery.

If pathogenic influences strike in autumn, the Lungs are affected first; if in spring, the Liver; if in summer, the Heart; if during “Ultimate Yin”—here referring to the season governed by the Spleen—the Spleen; and if in winter, the Kidneys.

This is because the corresponding organ is then in season and is therefore the first to be attacked by pathogenic Qi.

The New Collation says that neither the Quan Yuanqi edition nor the Tai Su contains the three characters “when attacked in autumn,” and suspects that this passage contains an error or extraneous text.

The Yellow Emperor asked, “How can these kinds of cough be distinguished?”

This asks for the symptoms of the various kinds of cough.

Qibo replied:

A Lung cough presents with panting and audible breathing during a cough; in severe cases, the person coughs up blood. The Lungs govern the storage of Qi and correspond to breathing, which is why coughing brings panting and sounds from the throat. In severe cases, the Qi activity in the Lung network vessels becomes disordered, causing the person to cough up blood.

A Heart cough presents with pain in the chest and heart during a cough, and a sensation as though something were lodged in the throat. In severe cases, the throat becomes swollen and painful, and may even become obstructed.

The Hand Jueyin Heart-Master channel, which is associated with the Heart Protector, arises in the chest and belongs to the Heart Protector. The Hand Shaoyin channel, the Heart channel, arises from the Heart and belongs to the Heart network. A branch of the Heart channel runs upward along the Heart network and approaches the throat, which accounts for these symptoms.

The New Collation says that the Jia Yi Jing writes “gurgling” in place of “as though something were lodged there.” It also notes that the account of the Hand Shaoyin channel says it approaches the pharynx as it ascends, but does not say that it approaches the throat.

A Liver cough presents with pain below the ribs on both sides during a cough. In severe cases, the person cannot turn around; if they do, the areas below the ribs on both sides feel distended.

The Foot Jueyin channel (the Liver channel of Foot Jueyin) passes upward through the diaphragm, spreads along both sides of the chest and ribs, and runs behind the throat, which explains these symptoms. The term “flank” here also refers to the rib area.

Spleen cough presents as a dull ache beneath the right ribs when coughing, with pain extending to the shoulder and back. In severe cases, movement is difficult, and any movement makes the coughing worse.

The Foot Taiyin channel (the Spleen channel of Foot Taiyin) passes upward through the diaphragm and runs alongside the throat. A branch of the channel divides from the Stomach and then passes upward through the diaphragm. This explains the symptoms described above. Spleen Qi is connected with the Lung, so the pain extends to the shoulder and back. Spleen Qi governs the right side, so there is a dull, deep ache in the right flank. The character “ju” is pronounced “ji” here and means “severe.”

Kidney cough presents as pain in the lower back and back that pulls at both areas when coughing; in severe cases, saliva is coughed up.

The Foot Shaoyin channel (the Kidney channel of Foot Shaoyin) runs upward along the inner rear edge of the thigh, passes through the spine, and connects with the Kidney and Bladder. Its main pathway rises from the Kidney, passes through the Liver and diaphragm, enters the Lung, and runs along the throat beside the root of the tongue. A branch of the Bladder channel also divides from the inner side of the shoulder, runs downward alongside the spine to the lower back, then follows the inner side of the spine and connects with the Kidney. This explains the symptoms described above.

The Yellow Emperor asked, “What are the forms of cough affecting the six Bowels, and where do these illnesses come from?”

Qibo replied, “When coughs affecting the five Viscera persist for a long time, they spread to the six Bowels. If Spleen cough persists, the Stomach is affected. Stomach cough presents as coughing accompanied by vomiting; when the vomiting is severe, roundworms are brought up.”

The Spleen and Stomach are exterior and interior counterparts, working together. The Stomach channel runs along the throat, enters the supraclavicular fossa, passes downward through the diaphragm, and connects with the Stomach and Spleen. Thus, when Spleen cough persists, the Stomach is affected. Cold in the Stomach causes vomiting. When the vomiting is severe, Qi in the intestines surges upward, bringing up roundworms. The character “hui” is pronounced “hui” and refers to roundworms.

If Liver cough persists, the Gallbladder is affected. Gallbladder cough presents as coughing accompanied by vomiting bile.

The Liver and Gallbladder are exterior and interior counterparts. The Gallbladder channel runs downward from the supraclavicular fossa into the chest, passes through the diaphragm, and connects with the Liver. Thus, when Liver cough persists, the Gallbladder is affected. Gallbladder Qi readily surges upward, causing warm, bitter bile to be vomited.

If Lung cough persists, the Large Intestine is affected. Large Intestine cough presents as loss of bowel control while coughing.

The Lung and Large Intestine are exterior and interior counterparts. The Large Intestine channel enters the supraclavicular fossa and connects with the Lung, so when Lung cough persists, the Large Intestine is affected. The Large Intestine transports and eliminates waste. When cold enters it, Qi can no longer contain the contents, resulting in incontinence. The New Collation states that according to the Jia Yi Jing, the phrase “loss of control” here should read “loss of stool,” meaning bowel incontinence.

If Heart cough persists, the Small Intestine is affected. Small Intestine cough presents as passing gas while coughing, with the two occurring at the same time.

The Heart and Small Intestine are exterior and interior counterparts. The Small Intestine channel enters the supraclavicular fossa and connects with the Heart, so when Heart cough persists, the Small Intestine is affected.

When a cough persists for a long time, the pathogenic influence can affect the small intestine. When cold becomes predominant in the small intestine, Qi descends into the large intestine. During coughing, the Qi of the small intestine also surges downward, which is why there is flatulence.

When a kidney cough persists for a long time, the pathogenic influence can affect the urinary bladder. If the bladder is diseased, coughing is accompanied by involuntary urination. The kidney and bladder are paired. The bladder channel runs from the inner side of the shoulder blade down the back to the lower back, then enters and follows the muscles on either side of the spine. It connects with the kidney and belongs to the bladder. This is why an unresolved kidney cough can affect the bladder. The bladder is the bowel organ that stores fluids, so when it is diseased, involuntary urination occurs.

A cough that persists for a long time can also affect the Three Burners (here referring to the functions of the upper and middle burners). A Three Burner cough presents as coughing, abdominal distention, and a lack of desire to eat or drink. The pathogenic influences gather in the stomach and affect the lungs, causing increased nasal discharge and spittle, facial swelling, and Qi to rebel upward.

The Three Burners mentioned here do not refer to the Hand Shaoyang Sanjiao channel, but to the upper and middle burners. The upper burner begins at the upper opening of the stomach, connects with the throat and extends upward, passes through the diaphragm, spreads through the chest, and reaches the armpits. The middle burner also reaches the stomach opening and lies behind the upper burner. The Qi of food and drink received by the middle burner separates out the waste, transforms fluids, refines their essence, and then sends it upward to the lung vessels, where it becomes blood. This is why it is said that pathogenic influence gathers in the stomach and affects the lungs.

When the upper and middle burners are diseased, pathogenic Qi steams the lungs and obstructs lung Qi, leading to increased nasal discharge and spittle, facial swelling, and rebellious Qi. Abdominal distention and loss of appetite occur because the stomach is cold. The stomach channel descends from the supraclavicular hollow, runs down along the inner side of the breast and through the abdomen, and reaches the Qi Street (near the groin). One of its branches also descends internally from the lower opening of the stomach along the abdomen and joins the main channel at the Qi Street. The stomach is now affected by pathogenic Qi, which accounts for these symptoms.

Why does this passage not refer to the lower burner? The lower burner divides at the ileum and connects with the bladder. Food and drink are normally together in the stomach; after digestion, the waste descends together to the large intestine. The fluid is then separated and seeps through the lower burner into the bladder. This shows that the lower burner’s course lies far from the stomach opening, so the Three Burners mentioned here do not include the lower burner.

The New Corrected Edition says: On consulting the A-B Classic of Acupuncture and Moxibustion, the phrase “descends along the abdomen” in the description of the stomach channel is written as “descends alongside the navel,” meaning that it runs downward on both sides of the navel.

The Yellow Emperor asked, “How should this be treated?” Qibo replied, “To treat a disease of a viscera, select its Shu point; to treat a disease of a bowel organ, select its He point; if there is swelling, select the Jing point.”

The Shu points of the viscera are the third specific points counted from near the wrist or ankle along their corresponding channels. The He points of the bowel organs are the sixth specific points. The Jing points are specific points belonging to the channels of the viscera.

The fourth point is where the fu vessels emerge. Regarding the fifth point, the Ling Shu Jing says, “The place where the vessel Qi gathers is called a shu; where it passes along is called a jing; where it flows in is called a he.” This is what is meant here.

The Yellow Emperor said, “Well said.”

Supplementary Annotations and Explanations to the Plain Questions of the Yellow Emperor’s Inner Classic, Volume 23.