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(From *Suwen: Ping Re Bing Lun* and *Qi Bing Lun*, with an appendix on the treatment of wind stroke)

The Yellow Emperor asked: There is a condition called Kidney Wind (Shen Feng, a disease pattern characterized by wind pathogen affecting the Kidney system), where the patient presents with facial edema (swelling due to fluid retention), a dull complexion, and heavy, unclear speech. Can this be treated with acupuncture? (*Suwen: Ping Re Bing Lun*). "Ran" refers to edema. "Mang ran" refers to the loss of luster in the complexion. "Yong" refers to speech that is heavy and unclear. The Kidney meridian passes through the throat and flanks the root of the tongue. When afflicted by wind pathogen, the Kidney meridian becomes obstructed, leading to unclear speech. (" " sounds like "Fu", " " sounds like "Mang".) Qibo replied: Deficiency patterns should not be needled. If needled when inappropriate, after five days the healthy Qi will inevitably be further compromised. (Deficiency patterns are inherently unsuitable for needling. If one treats swelling as an Excess pattern and uses draining needle techniques, the True Qi will become even more deficient, allowing the pathogen to enter via the deficiency. The mention of "five days" refers to the cycle of Zang Qi returning to the injured organ, causing the pathogenic factor to intensify.) The Yellow Emperor asked: What happens when it arrives? Qibo said: Upon arrival, there will certainly be shortness of breath, intermittent fever, heat rising from the chest and back to the head, hot palms, dry mouth with a bitter taste and thirst, yellow urine, edema under the eyes, borborygmus (rumbling in the abdomen), heaviness of the body making movement difficult, amenorrhea (absence of menstruation), irritability with inability to eat, inability to lie flat on the back, and coughing when lying flat. This disease is named Feng Shui (Wind Water, a type of edema caused by wind pathogen). The discussion is found in the section on acupuncture methods. (The Kidney governs water; when wind pathogen affects the Kidney meridian, it is named Feng Shui. The discussion is in *Shui Re Xue Lun*, detailed in Acupuncture Category 38. The explanations in this section follow the text below: meanings such as heat rising from chest/back to head and hot palms were omitted, possibly due to lost bamboo slips. This illness arises because Kidney Yin deficiency is compounded by erroneous needling, severely damaging True Yin. Since the Kidney and Bladder are exterior-interior pairs, the Kidney meridian ascends from the foot to the chest, while the Bladder meridian descends from the head/neck through the shoulders and back. Yin deficiency leads to Yang hyperactivity, so heat rises from the shoulders/back to the head causing sweating. The Pericardium meridian enters the palm; insufficient Kidney Water leads to excess Heart Fire, hence hot palms. *Ping Ren Qi Xiang Lun* states: Facial swelling is called Wind. Calf swelling is called Water. See Category 59.) The Yellow Emperor said: I wish to hear the reasoning. Qibo said: Wherever pathogenic factors gather, Healthy Qi must be deficient. (Pathogens enter due to deficiency, hence where pathogens gather, Healthy Qi is deficient. The classic text only has these two sentences. Why did later authors add: "If it remains and does not depart, the disease becomes Excess"? This statement is logically flawed. "Gathering" implies pathogenic excess; why wait for it to remain to become excess? While remaining can lead to excess, remaining often leads to greater deficiency. Clinging to previous statements as absolute truth leads to misapplication of tonification and drainage. This remark is not only superfluous but harmful; it must be examined carefully.) In cases of Yin deficiency, Yang must gather, resulting in shortness of breath, intermittent fever, and sweating. (Yin deficiency leads to lack of Qi, causing shortness of breath and intermittent fever. Yang tends to disperse and gathers in the Yin aspect, causing sweating.) Yellow urine indicates heat in the lower abdomen. (Heat in the lower abdomen means the pathogen is in the Yin aspect, hence yellow urine.) Inability to lie flat indicates disharmony in the Stomach. Lying flat exacerbates coughing because Qi presses upward against the Lung. ("Zheng yan" means lying flat on the back. The Kidney meridian penetrates the Liver and Diaphragm into the Lung, with a branch entering the chest. Kidney pathogenic factors rise from below, causing Stomach Qi to rebel and become disharmonious, thus exacerbating coughing and pressing against the Lung when lying flat.) In all cases of water-dampness, slight edema first appears under the eyes. The Yellow Emperor asked: Why say this? Qibo said: Water is Yin, and the area under the eyes is also Yin. The abdomen is the residence of Supreme Yin. Therefore, when water accumulates in the abdomen, it necessarily causes edema under the eyes. (Edema under the eyes resembling a sleeping silkworm indicates water-dampness in the abdomen.) Rebellion of True Qi causes bitter taste in the mouth and dry tongue. One cannot lie flat; lying flat causes coughing up clear fluid. All patients with water diseases cannot lie comfortably; lying down causes palpitations/fright, which exacerbates coughing. (Water pathogen stagnates in the Zang organs, causing Qi rebellion. Qi rebellion prevents comfortable lying, causing fright and severe coughing.) Borborygmus originates in the Stomach. Pressure on the Spleen causes irritability and anorexia; inability to swallow food is due to obstruction in the epigastrium. Heaviness of the body and difficulty walking relate to the Stomach meridian in the feet. (Spleen and Stomach belong to Earth, which controls Water. If Earth is weak, Cold Water insults it, causing borborygmus and food retention. The Stomach governs muscles, and its meridian runs along the feet. Water-dampness residing in the muscles causes heaviness and immobility.) Amenorrhea is due to closure of the Bao Mai (Uterine Vessels). The Bao Mai belongs to the Heart and connects to the Bao (Uterus). Now, Qi presses upward against the Lung, preventing Heart Qi from descending, hence amenorrhea. (The Bao is the Uterus, the seat of Ministerial Fire. The Heart governs Blood vessels and is the seat of Sovereign Fire. Yang Qi circulates up and down, so the Bao Mai belongs to the Heart and connects to the Uterus to regulate menstruation. Now, Qi presses against the Lung, blocking the Yang pathway; Heart Qi cannot descend, closing the Bao Mai and stopping menstruation. As mentioned above, these are conditions where deficiency makes needling inappropriate, showing the great harm of erroneous needling.) The Yellow Emperor said: Excellent.

The Yellow Emperor asked: There is a condition where the face is swollen as if there were water, the pulse is large and tight, the body has no pain, the form is not emaciated, and the patient cannot eat or eats very little. What is this disease called? (*Suwen: Qi Bing Lun*.) "As if there were water" means facial edema that resembles water but is not true water accumulation. A large pulse indicates Yin deficiency. A tight pulse indicates Cold pathogen. Absence of body pain and non-emaciated form indicate the pathogen is in the Zang, not the Exterior. Wind carrying Kidney pathogen damages the Spleen and Stomach, hence anorexia. Qibo said: The disease originates in the Kidney and is named Kidney Wind. (Since the disease originates in the Kidney and is named Kidney Wind, it is clearly not external wind. Thus, among the Five Winds, some arise internally, illustrating that wind has internal and external distinctions that must be differentiated. My commentary: Diseases named Wind are most prone to misdiagnosis because their interior/exterior nature is unclear. External wind comes from the eight directions; Internal wind is the primary disease of the Zang. Eight winds entering from outside must present with fever, aversion to cold, headache, and body pain—clearly external. Five winds arising internally have no external signs but suddenly manifest like wind, indicating internal injury. Yet, since it is not external, why does the Classic state "All sudden stiffness belongs to Wind" and "All wind tremors and dizziness belong to the Liver"? The Liver is the Eastern Zang, stores Blood, and governs Wind. Blood disease fails to nourish sinews; Sinew disease causes tremors, dizziness, and stiffness. These variations stem from Liver Wood transformation, hence "belong to Wind." The term "belong" implies that the Five Qi each have their domains, e.g., "All dampness, swelling, and fullness belong to the Spleen." To be "struck" is External; to "belong" is Internal. Wang Andao distinguished between True Stroke and Similar Stroke, which must be observed. Later generations misunderstood this, mistaking Similar Stroke for True Stroke, and even attributing internal collapse and sudden syncope to Wind, a grave error. External pathogens attack the muscle-surface, leading mostly to Yang Excess. Internal injury results from wine, sex, fatigue, emotions, and diet, damaging Zang Qi, leading to Yin deficiency. Damage to Zang Qi: Spleen failure affects limbs and phlegm-fluids; Kidney disease affects marrow and two orifices; Heart disease affects blood vessels and spirit; Lung disease affects Ying-Wei and voice; Liver disease affects sinews/claws and hypochondrium. All these Zang-related "Wind" diseases stem from Yin deficiency. Only Li Donggan grasped this: Stroke involves sudden coma and unconsciousness, not external wind, but self-disease of original Qi. People over forty with declining Qi often suffer this. At forty, Yin Qi halves, making them susceptible—is this not Yin deficiency? Humans are born of Yang but rooted in Yin. If the root declines, illness ensues; if it fails, danger looms. The root is True Yin. People know Yin deficiency exists but fail to distinguish two types: deficiency of Water within Yin affects Essence and Blood; deficiency of Fire within Yin affects Spirit and Qi. Yang decline leads to Qi loss, causing mental confusion (Fire deficiency?). Yin depletion leads to physical decay, causing limb flaccidity (Water deficiency?). Treating spiritual detachment and physical decay without addressing Water/Fire sources, using Wind treatments, is perilous. Consider nature: drought brings dryness, dryness brings wind. Wind-Wood transformation follows Dryness, which is a sign of Yin deficiency. Thus, treating Similar Stroke requires tonifying True Yin to save the root; restoring Yin eliminates wind and dryness. However, external pathogens are not devoid of deficiency (Qi deficiency is deficiency). Internal injuries are not devoid of excess (stagnation is excess). Treat deficiency by identifying Yin/Yang and directly tonifying; treat excess by identifying Phlegm/Qi and temporarily resolving. One must weigh the severity of interior/exterior and excess/deficiency to adjust treatment. Even those with chronic Yuan Qi deficiency may suddenly collapse without phlegm, with incontinence and deep coma—this is Jue exhaustion, unrelated to Wind. Without large doses of Ginseng and Rehmannia or seven-year-old moxa to rescue the nearly extinct Qi, recovery is impossible. Failing to distinguish interior/exterior and excess/deficiency, and merely using Wind herbs because of the name "Wind," is fatal. Wind herbs are drying and damage Yin; they are dispersing and damage Qi. Treating internal injury as external excess accelerates death. Ban Gu's saying that "not taking medicine is the best medical practice" was directed at such practitioners.) Kidney Wind with anorexia, frequent fright, and subsequent heart Qi atrophy leading to death. (Wind originating in the Kidney insults Spleen Earth, causing anorexia. Kidney pathogen attacks the Heart, causing loss of Shen protection, hence fright. If Heart Qi atrophies and cannot recover after fright, both Heart and Kidney fail, and Water and Fire are trapped, leading to death.) The Yellow Emperor said: Excellent.