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(Ling Shu · Re Bing Pian)

Three days after the onset of heat disease, if the Qi Kou pulse is calm and the Ren Ying pulse is agitated, needle the fifty-nine points on the Yang meridians to drain the heat and induce sweating, while tonifying the Yin to supplement its deficiency. (The heat disease mentioned below refers to Shang Han and seasonal epidemics. Three days into heat disease, the pathogen remains in the exterior. If the Qi Kou pulse is calm and the Ren Ying pulse is agitated, it indicates the disease is in the Three Yang meridians and has not entered the Yin compartments. Therefore, one should select the fifty-nine points on the Yang meridians to drain the excess of Yang pathogens and tonify the insufficiency of the Three Yin meridians. The method of the fifty-nine needles is described below. For detailed meanings regarding the degrees of fullness or emptiness of the Ren Ying and Mai Kou pulses and the corresponding tonification or sedation techniques, refer to the Zhong Shi chapter, see Category 1, Section 28.)

If the body heat is severe but both the Yin and Yang pulses are calm, do not needle; for cases that can be needled, treat urgently. If sweating does not occur, use draining methods. The instruction "do not needle" applies because there are signs of death. (Severe body heat with calm Yin and Yang pulses indicates a Yang syndrome presenting with Yin pulses, so needling is inappropriate. If observation suggests the case is still treatable, urgent needling is required; even without sweating, the pathogen will be drained. This instruction "do not needle" is given because the pulse and symptoms are contradictory, indicating signs of death. The same logic applies to the following sections.)

Seven or eight days after the onset of heat disease, if the Mai Kou pulse is rapid like panting and wiry, needle urgently. Sweat will appear spontaneously; needle shallowly at the space between the thumb and index finger. (Seven or eight days into heat disease, the pathogen must have penetrated deeply into the Yin compartments. Thus, the Mai Kou pulse should be rapid and wiry. It is appropriate to urgently needle the Lung Meridian of Hand-Taiyin, causing spontaneous sweating and dispersing the pathogen. However, needling this point should be shallow. The space between the thumb and index finger refers to the Shaoshang point. "Wiry" is written as "short" in some editions.)

Seven or eight days after the onset of heat disease, if the pulse is minute and small, the patient has hematuria and dry mouth, they will die within one and a half days; if a Dai pulse (intermittent pulse) appears, they will die within one day. (Seven or eight days into heat disease, a minute and small pulse indicates deficiency of righteous Qi. Hematuria and dry mouth indicate injury to Yin fluids. Both are fatal conditions. If the pulse becomes irregular and abnormal, known as a Dai pulse, death occurs even more rapidly.)

If heat disease has produced sweat, but the pulse remains agitated, the patient pants, and fever recurs, do not needle the skin. If panting is severe, death will ensue. (After sweating in heat disease, the pathogen should recede. If the pulse remains agitated, breathing is labored, and fever returns, it means the condition has not improved due to sweating, which is a contrary sign. Therefore, do not needle the skin. Needling would further injure the Qi. If panting is severe, death is inevitable.)

Seven or eight days after the onset of heat disease, if the pulse is not agitated, or if it is agitated but not scattered and not rapid, sweat will appear within the next three days. If no sweat appears after three days, death will occur on the fourth day. For those who have not sweated, do not needle the cou-li (pores). (After seven days of heat disease, when the pathogen is about to dissipate, the pulse must be agitated and vigorous, signaling impending sweating. Now, if seven or eight days into heat disease the pulse is not agitated, it belongs to the Yin category. Even if there is a tendency toward agitation, if the force is not expansive or rapid, it indicates deficiency of righteous Qi unable to mobilize, also belonging to the Yin category. Dissipation is unlikely, so wait another three days hoping for sweat. If no sweat appears after three days, and four more days pass, the illness extends beyond ten days. With Yin and Yang out of resonance, death is expected. In such cases, since sweating cannot occur, the Qi must be deficient; therefore, do not needle the cou-li.)

If heat disease initially presents with skin pain, nasal congestion, and facial flushing, treat the skin layer using the first needle (Chan Needle) among the fifty-nine points. Severe nasal obstruction resembling a transverse blockage requires seeking relief from the Lung. If ineffective, seek relief from Fire, which corresponds to the Heart. (Initial skin pain, nasal congestion, and facial flushing indicate the pathogen is in the skin and cou-li, affecting the Lung Meridian. Needling should be shallow in the skin layer, hence using the Chan Needle among the fifty-nine points. "Ke" means deep. "Zhen" refers to the crossbeam of a cart. It describes severe nasal obstruction where internal and external passages are blocked, like a transverse beam. These symptoms belong to the Lung. Lung corresponds to Metal and governs the skin. Thus, treating the skin is equivalent to treating the Lung. If this treatment fails, seek relief from Fire, which corresponds to the Heart. Tonify the Heart meridian to benefit Yang Qi and restrain Metal pathogens, allowing Lung heat to subside. Zhi sounds like zhi.)

If heat disease initially presents with body stiffness, leaning support while febrile, irritability, and dry lips, mouth, and throat, treat the vessels using the first needle (Chan Needle) among the fifty-nine points. Symptoms include skin swelling, dry mouth, and cold sweat. Seek relief from the Heart. If ineffective, seek relief from Water, which corresponds to the Kidney. (Stiffness implies dryness. Leaning indicates weakness. Combined with fever, irritability, and dryness of the lips, mouth, and throat, the pathogen is in the blood vessels, affecting the Heart Meridian. Use the Chan Needle among the fifty-nine points to treat the vessel layer. Skin swelling, dry mouth, and cold sweat are also vessel-related diseases. Heart corresponds to Fire and governs the vessels. Thus, treating the vessels is equivalent to treating the Heart. If vessel treatment fails, seek relief from Water, which corresponds to the Kidney. Tonify Kidney Qi in the bones to strengthen Water, restraining Fire and subsiding Heart heat. Min sounds like min.)

If heat disease presents with dry throat, excessive thirst, frequent fright, inability to rise from bed, treat the flesh using the sixth needle (Yuanli Needle) among the fifty-nine points. Greenish discoloration around the eyes requires seeking relief from the Spleen. If ineffective, seek relief from Wood, which corresponds to the Liver. (Dry throat, excessive thirst, palpitations, limb fatigue, and inability to rise indicate the pathogen is in the muscles, affecting the Spleen Meridian. Use the Yuanli Needle among the fifty-nine points to treat the muscle layer. Greenish discoloration around the eyes indicates Wood Qi overacting on Earth, also a Spleen issue. Spleen corresponds to Earth and governs the flesh. Thus, treating the flesh is equivalent to treating the Spleen. If Spleen treatment fails, seek relief from Wood, which corresponds to the Liver. Tonify Liver tendon Qi so Wood can overcome Earth, subsiding Spleen heat. Yi sounds like yi.)

If heat disease presents with a blue complexion, headache, and restless limbs, treat the sinews using the fourth needle (Fengzhen/Sharp Needle) at the Si Ni points. Sinew tension and uncontrolled tearing require seeking relief from the Liver. If ineffective, seek relief from Metal, which corresponds to the Lung. (Blue complexion reveals Liver color. Headache involves the Jueyin Liver Meridian meeting the Du Meridian at the vertex. Restless limbs reflect Liver pathology in the extremities (nails). These are Liver Meridian issues. Treat the sinew knots using the Fengzhen Needle to drain the Si Ni syndromes. Si Ni refers to liver pathogen excess causing limb coldness. Sinew tension causes inability to walk. Uncontrolled tearing is also a Liver sign. Liver corresponds to Wood and governs the sinews. Thus, treating the sinews is equivalent to treating the Liver. If Liver treatment fails, seek relief from Metal, which corresponds to the Lung. Tonify Lung Qi so Metal can overcome Wood, subsiding Liver heat. Bi sounds like bi.)

If heat disease presents with frequent fright, convulsions, and mania, treat the vessels using the fourth needle (Fengzhen/Sharp Needle), urgently draining excess. Epilepsy with hair loss requires seeking relief from the Heart. If ineffective, seek relief from Water, which corresponds to the Kidney. (Frequent fright indicates Heart pathogen excess. Convulsions result from extreme heat generating wind and injuring Yin blood. Mania indicates extreme heat. These are Heart Meridian issues. Treat the vessels using the Fengzhen Needle to urgently drain excess pathogens. Extreme Yang and Yin deficiency leading to epilepsy cause hair loss (hair being the surplus of blood). The disease centers on the Heart. Heart corresponds to Fire and governs the blood vessels. Thus, treating blood is equivalent to treating the Heart. If Heart treatment fails, seek relief from Water, which corresponds to the Kidney. Tonify Kidney Water to restrain Fire, restoring True Yin. Chong sounds like chi/ji/xi. Zong sounds like zong.)

If heat disease presents with heavy body, bone pain, deafness, and a desire to keep eyes closed, treat the bones using the fourth needle (Fengzhen/Sharp Needle) among the fifty-nine bone points. Symptoms include anorexia, teeth grinding, and blue ears. Seek relief from the Kidney. If ineffective, seek relief from Earth, which corresponds to the Spleen. (Heavy body, bone pain, deafness, and desire to close eyes are Kidney Meridian issues. Disease in Yin leads to closing eyes. Treat the bones using the Fengzhen Needle among the fifty-nine bone points. Anorexia indicates Yin pathogen excess. Teeth grinding relates to teeth being the surplus of bone. Blue ears relate to ears being the orifice of the Kidney. These are Kidney issues. Kidney corresponds to Water and governs the bones. Thus, treating bones is equivalent to treating the Kidney. If Kidney treatment fails, seek relief from Earth, which corresponds to the Spleen. Tonify Spleen Qi in the flesh so Earth can overcome Water, subsiding Kidney pathogen. Nie sounds like nie, meaning bite.)

If heat disease presents with unknown pain location, deafness, inability to control movements, dry mouth, intense Yang heat, yet significant coldness in the Yin aspect, the heat is in the marrow. This is incurable. (Heat disease with unclear pain location, profound deafness, heaviness preventing movement, dry saliva, intense heat during Yang phases, and coldness during Yin phases, indicates the pathogen resides in the Yin compartment with heat deep in the marrow. This is a fatal condition.)

If heat disease presents with headache, temporal and eye vessel pain, and frequent epistaxis, it is a Jue Heat Disease. Use the third needle (Pijian/Needle with Blade Edge), assessing excess and deficiency for tonification or sedation. (Note: The characters "Han Re Zhi" [Cold, Heat, Hemorrhoids] seem superfluous and disconnected from the context. Nie refers to the Naokong point of the Foot-Shaoyang Gallbladder Meridian, or the sideburn bone. HT Mai Tong refers to spasmodic pain in the eye vessels. Nu is epistaxis. Jue Re Bing indicates heat reversing upward. Use the Pijian Needle. Assess excess/deficiency in the affected meridians for tonification/sedation. The terms Cold, Heat, and Hemorrhoids appear extraneous. Rou she sound for Nie. Ru sound for . Chi sound for HT. Nu sounds like nv.)

If heat disease presents with heavy body and intestinal heat, use the fourth needle (Fengzhen/Sharp Needle) at the Shu points and between the toes. Seek Qi from the Stomach Collaterals. (Spleen governs muscles and limbs; pathogen in Spleen causes heaviness. Large and Small Intestines belong to the Stomach; pathogen in Stomach causes intestinal heat. Use the Fengzhen Needle at the Shu points of the Spleen and Stomach meridians, specifically Taibai and Xangu. "Between the toes" refers to foot Shu points. The text mentions five points per hand and foot, totaling eight, referring to these. Seeking Qi from the Stomach Collateral (Fenglong) connects to the Taiyin, allowing retrieval of Spleen Qi. Ge should be read as Luo/Collateral.)

If heat disease presents with acute pain flanking the navel and chest/hypochondriac fullness, needle Yongquan and Yinlingquan using the fourth needle (Fengzhen/Sharp Needle), also needling inside the throat. (Acute pain flanking the navel follows the Foot-Shaoyin Kidney Meridian. Chest/hypochondriac fullness follows the Foot-Taiyin Spleen Meridian. For Shaoyin, needle Yongquan; for Taiyin, needle Yinlingquan. Use the Fengzhen Needle. Needling inside the throat targets the connection of Shaoyin and Taiyin meridians to the pharynx, specifically the Lianquan point.)

If heat disease is about to produce sweat, or if the pulse is favorable for sweating, needle Yuji, Taiyuan, Dadu, and Taibai. Sedation removes heat; tonification induces sweat. If sweating is excessive, needle the horizontal vessel above the medial malleolus to stop it. (Yang Qi reaching the exterior and agitated pulses indicate impending sweat. Yang syndrome with Yang pulse is favorable for sweating. Needle Yuji and Taiyuan (Hand-Taiyin Lung) and Dadu and Taibai (Foot-Taiyin Spleen). Sedation clears heat; tonification induces sweat. Excessive sweating requires needling the horizontal vessel above the medial malleolus, i.e., Sanyinjiao (SP6), to stop sweat. The fourteen points mentioned earlier (Stomach Collateral, Yongquan, Yinlingquan, Yuji, Taiyuan, Dadu, Sanyinjiao) are not part of the fifty-nine points listed later, hence highlighted here. Note: The Han Re Bing chapter states: For disease starting in the arm, needle Hand-Yangming and Hand-Taiyin to induce sweat; for head/neck, needle Neck-Taiyang; for lower leg, needle Foot-Yangming. Sweating from Yin meridians can be stopped by Yang meridians, and vice versa. This principle is exquisite. Although originally for carbuncles, it complements this section. See Category 1, Section 54.)

If heat disease produces sweat but the pulse remains vigorous, this is the extreme of Yin pulses; death ensues. If sweat is produced and the pulse calms, survival is indicated. (After sweating, the pathogen should recede and the pulse should calm. Persistent agitation after sweating indicates isolated Yang failing to consolidate, due to extreme Yin deficiency (Yang without Yin), a contrary sign. Calm pulse after sweating indicates pathogen removal and righteous recovery, a favorable sign. Contrary signs lead to death; favorable signs lead to life.)

If heat disease presents with vigorous/agitated pulses but no sweat, this is the extreme of Yang pulses; death ensues. If pulses are vigorous/agitated but sweat is produced and the pulse calms, survival is indicated. (Vigorous/agitated pulses in heat disease should resolve with sweating. Pulse vigor without sweat indicates extreme Yang亢 (hyperactivity) and Yin deficiency preventing exterior release, leading to death. Sweat followed by calmness is a favorable sign, indicating life. Note: These two sections discuss Yin extreme and Yang extreme respectively. However, agitated pulses always indicate Yang excess. Sweat is transformed from fluids, originating in Yin but manifesting in Yang. Agitated pulse after sweating indicates Yang having no return route due to Yin deficiency. Agitated pulse without sweat indicates Yin exhaustion internally, also Yin deficiency. Thus, pulse vigor relates to Yang; sweat presence relates to Yin. As stated in Ben Shen chapter: Yin deficiency leads to lack of Qi, and lack of Qi leads to death. The emphasis is on "Yin." Yin is the root of living Qi; without root, Qi escapes, leading to death.)

There are nine types of heat disease unsuitable for needling:
1. No sweat, red cheeks (Dai Yang), and hiccups indicate death. (Unsuitable due to death signs. No sweat indicates weak Yin. Red cheeks, called Dai Yang, indicate Yin insufficiency. Hiccups indicate pathogen invading Yangming and extreme Stomach deficiency. Original source exhausted, death is unavoidable. Yue sounds like jue/hui.)
2. Diarrhea with severe abdominal fullness indicates death. (Diarrhea should not accompany fullness. Severe fullness indicates pathogen injuring Taiyin and Spleen Qi failure, leading to death.)
3. Blurred vision with persistent fever indicates death. (Essence of all organs ascends to the eyes. Blurred vision indicates organ essence exhaustion. Persistent fever indicates exhaustion of interior/exterior Yin. Death ensues.)
4. Elderly and infants with fever and abdominal fullness indicate death. (Fever and fullness injure the Spleen. Elderly and infants rely heavily on Spleen Qi; offending them leads to death.)
5. No sweat, vomiting, and lower bleeding indicate death. (No sweat indicates Yin deficiency. Vomiting and bleeding exacerbate Yin injury, leading to death.)
6. Ulcerated tongue base with persistent fever indicates death. (Heart, Liver, Spleen, and Kidney meridians connect to the tongue base. Ulceration plus persistent fever indicates damage to all Three Yin meridians, leading to death.)
7. Coughing with epistaxis, no sweat, or sweat not reaching the feet indicate death. (Cough and epistaxis indicate Lung pathogen moving Yin blood. No sweat or sweat not reaching feet indicates collapse of True Yin, leading to death.)
8. Marrow heat indicates death. (Marrow is the essence of extreme Yin and fills the bones. Pathogen penetrating deepest causes marrow heat, indicating Kidney Qi exhaustion, leading to death.)
9. Fever with spasm indicates death: opisthotonos, convulsions, trismus, and teeth grinding. (Spasm is wind-stiffness disease. Opisthotonos is back arching. Convulsions are limb twitching. Trismus is jaw locking. Grinding teeth is . All constitute spasm. Caused by extreme heat generating wind and severely injuring Yin blood. Fever with spasm is fatal. Jing sounds like jing. Chong sounds like chi/ji/xi. Zong sounds like zong. Jin sounds like jin. Xie sounds like xie.)
All nine conditions are unsuitable for needling. (Needling is useless and may cause harm; thus, avoid needling.)

Regarding the fifty-nine needles:
Three points each on the lateral and medial aspects of both hands, totaling twelve points. (Details of the fifty-nine points follow. Hand lateral/medial points refer to Shaoyang Guanchong, Yangming Shangyang, and Taiyin Shaoshang, Jueyin Zhongchong, Shaoyin Shaochong. Total twelve points. Ci refers to pricking sores/scars. Wei sounds like wei.)
One point between each of the five fingers, totaling eight points; the feet are the same. (Refers to points distal to the metacarpophalangeal joints. Hand meridians: Taiyang Houxi, Shaoyang Zhongzhu, Yangming Sanjian. Shaoyin Shaofu is distal. Taiyin and Jueyin have no points distal to the joint. Four meridians x two sides = eight points. Foot meridians: Taiyang Shugu, Shaoyang Linquan, Yangming Xangu, Taiyin Taibai. Shaoyin does not reach fingers; Jueyin has no points distal to the joint. Four meridians x two sides = eight points. Hence, "feet are the same.")
Six points one cun into the hairline, three on each side. (One cun into hairline is adjacent to Shangxing (DU22). Side points are Wuchu, Chengguang, Tongtian (BL8, BL9, BL10). Three on each side = six points.)
Ten points three cun into the hairline, five on each side. (Moving backward from Shangxing. Three cun lateral, five points each side: Linquan, Mucuang, Zhengying, Chengling, Naokong (GB15-GB20). Ten points total.)
Six points: one each before and behind the ear, one under the mouth, one in the neck. (Before ear: Tinghui (GB2); Behind ear: Wanggu (GB12). Under mouth: Chengjiang (CV24). Neck: Fengfu (DU16). Total six points.)
One point at the vertex (Baihui, DU20). One point at fontanelle (Xinhui, DU22 - *Note: Text says Xinhui one, usually DU22 is Shangxing, Xinhui is DU23? Text says Xinhui one, likely referring to specific point in this context*). One point at hairline (Front: Shenting, CV24? No, Shenting is DU24. Back: Fengfu, DU16. Two points total). One point at Lianquan (CV23). Two points at Fengchi (GB20). Two points at Tianzhu (BL10). (Note: This section lists the fifty-nine points for heat disease. The previous chapter "Shui Re Xue Lun" also lists fifty-nine points. Comparing them, only eighteen points overlap (Baihui, Xinhui, Wuchu, Chengguang, Tongtian, Linquan, Mucuang, Zhengying, Chengling, Naokong, etc.). The rest differ. This chapter focuses on limbs (root of heat drainage), while "Shui Re Xue Lun" focuses on pathogen location (branch of heat drainage). Both are valid. Later texts supplement earlier ones. Total unique points from both chapters plus the fourteen extra points mentioned earlier (minus 18 duplicates) equals 114 points. All are heat-draining points. Practitioners should consult both chapters and apply appropriately.)