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Huangdi asked: In cases of heat disease accompanied by pain, what is the cause? Qibo replied: Heat disease manifests in Yang pulses, due to the exuberance of the San Yang (Three Yang) channels. If the Renying pulse (pulse at the carotid artery) is one degree faster than the Cunkou pulse, the disease is in Shaoyang (Lesser Yang); two degrees faster, it is in Taiyang (Greater Yang); three degrees faster, it is in Yangming (Yang Brightness). When Yang Qi enters Yin, the disease affects the head and abdomen, resulting in distension and headache.

(Huangdi) asked: What causes body heat, sweating, yet persistent vexation and fullness that does not resolve? (Qibo) said: Sweating with body heat indicates Wind pathogen; sweating with persistent vexation and fullness indicates Jue (reversal) syndrome. This disease is named Feng Jue (Wind Reversal). Taiyang governs the Qi of all Yang channels (Suwen refers to it as Ju Yang), so it is the first to be invaded by pathogens. Shaoyin, being the interior-exterior pair of Taiyang, follows the heat upward when affected. Following upward leads to reversal. Treatment requires simultaneous needling of both exterior and interior channels, along with administering decoctions.

(Huangdi) asked: In warm disease patients who sweat but immediately develop fever again, with rapid and restless pulses, where sweating does not alleviate the condition, and who speak deliriously and cannot eat, what is this disease called? (Qibo) said: It is called Yin-Yang Intersection (Yin Yang Jiao). Intersection implies death. Humans sweat because fluids originate from grain (food), which transforms into essence (Jing). Now, if pathogens contend with healthy Qi in the flesh and bones, and sweating occurs, it means pathogens are retreating and essence prevails. If essence prevails, the patient should be able to eat and not have recurrent fever. Recurrent fever indicates lingering pathogens. Sweat represents essence. Now, sweating followed immediately by fever indicates pathogen victory. Inability to eat means essence receives no nourishment. With heat lingering, life can end instantly. Death is predicted when sweating is accompanied by a rapid and full pulse. If the pulse does not correspond with sweating, it shows the body cannot overcome the disease, making death evident. Delirious speech indicates loss of Zhi (Will/Shen). Loss of Will leads to death. There are three signs of death here, with no sign of life; even if recovery seems possible, death is inevitable.

For wind disease presenting with alternating chills and fever, dry heat sweating, and frequent yawning, initially needle the collateral vessels in the intermuscular spaces. For sweating with alternating chills and fever, needle once every three days until cured after one hundred days.

(Huangdi) asked: What defines Deficiency (Xu) and Excess (Shi)? (Qibo) said: Exuberance of pathogenic factors constitutes Excess; depletion of healthy essence constitutes Deficiency. A Heavy Excess pattern presents with intense internal heat, hot pathological state, and full pulses.

(Huangdi) asked: What if both meridians and collaterals are Excess? (Qibo) said: Both meridians and collaterals being Excess manifests as a rapid Cunkou pulse and a slow Chi (wrist) pulse. Both should be treated simultaneously. Thus, slippery pulses indicate favorable prognosis, while choppy pulses indicate unfavorable prognosis. Deficiency and Excess patterns should be treated according to their corresponding categories (Suwen says "begin"). If the five Zang organs and bones/flesh are smooth and free, longevity is possible. Sudden upward surging of Cold Qi with full and excess pulses leads to survival if the pulse is slippery and smooth, but death if it is reverse and choppy. If the pulse is extremely full, rapid, large, and firm, and the Chi pulse is full (or choppy) and unresponsive, survival depends on whether the pulse is favorable or reverse. Favorable means warm extremities; reverse means cold extremities.

(Huangdi) asked: What is Heavy Deficiency? (Qibo) said: Weak pulse, weak Qi, and weak Chi pulse constitute Heavy Deficiency. "Weak Qi" refers to irregular speech; "Weak Chi" refers to unsteady gait; "Weak Pulse" lacks the image of Yin. In such cases, a slippery pulse indicates survival, while a choppy pulse indicates death. Qi deficiency corresponds to Lung deficiency; Qi reversal leads to cold feet. Survival is possible if it occurs out of season, but death if it occurs in the corresponding season. The same applies to other Zang organs. If the pulse is full and solid with cold extremities and a hot head, survival is possible in Spring and Autumn, as Winter and Summer are contrary to this pattern; treat the primary diseased organ. If meridians are deficient and collaterals are excess, with heat and fullness at the Chi and cold/choppy pulses at the Mai Kou, death occurs in Spring and Summer, but survival in Autumn and Winter. If collaterals are excess and meridians deficient, moxa the Yin channels and needle the Yang channels; if meridians are excess and collaterals deficient, needle the Yin channels and moxa the Yang channels.

(Huangdi) asked: Why should one not exhaust Yin in Autumn/Winter and not exhaust Yang in Spring/Summer? (Qibo) said: Not exhausting Yang means not unnecessarily weakening Yangming in Spring/Summer; Yangming weakness leads to mania. Not exhausting Yin means not unnecessarily weakening Taiyin in Autumn/Winter; Taiyin weakness leads to death. Extreme conditions in Spring are treated via meridians/collaterals; in Summer via meridian-shu points; in Autumn via Six Fu organs; in Winter, when Qi and Blood are closed, treatment relies on herbs with minimal acupuncture/moxibustion. "Minimal acupuncture" does not refer to carbuncles and sores.

For heat disease starting in the arm, first needle Hand Yangming and Hand Taiyin to induce sweating. For heat disease starting in the head, first needle Neck Taiyang to induce sweating. For heat disease starting in the lower leg, first needle Foot Yangming to induce sweating. Hand Taiyin (Lingshu says Hand Yangming) can induce sweating; Foot Yangming can also induce sweating. If excessive sweating occurs after needling Yin points, stop and switch to Yang points; if excessive sweating occurs after needling Yang points, stop and switch to Yin points.

For shivering, teeth chattering, inability to sweat, abdominal distension, and vexation, needle Hand Taiyin. On the third day of heat disease, if the Cunkou pulse is calm and the Renying pulse is restless, needle the 59 points of the Yang channels to drain heat, induce sweating, tonify Yin, and address deficiencies. If body heat is severe but both Yin and Yang pulses are calm, do not needle. For those suitable for needling, act urgently; if no sweat occurs, diarrhea may follow. "Do not needle" applies to cases with signs of impending death. On the 7th-8th day of heat disease, if the Mai Kou pulse is rapid with dizziness, needle urgently; sweat will likely occur spontaneously. Superficially needle the space between the thumb fingers. On the 7th-8th day, if the pulse is minute, the patient has hematuria and dry mouth, death occurs within 1.5 days; if the pulse is intermittent (Dai), death occurs within one day. If heat disease patient sweats but the pulse remains rapid/restless, with wheezing and recurrent fever, do not casually needle; severe wheezing indicates certain death. On the 7th-8th day, if the pulse is not rapid, scattered, or rapid-frequency, and sweat occurs within three days, but no sweat occurs after three days, death occurs on the fourth day. Do not casually needle before sweating.

If heat disease begins with skin pain, nasal congestion, and facial flushing, treat the skin layer using the First Needle (Chan needle) and the 59-point method. For dry nose (Lingshu says diagnose dry nose), seek treatment in the Lung (Skin), not in Fire (Heart). If heat disease begins with body stiffness, vexation, and heat, with chest distress and dry lips/throat, treat the skin layer using the First Needle and the 59-point method. For heat disease with skin swelling, dry mouth, chills, and sweating, seek treatment in the Heart (Pulse), not in Water (Kidney). For heat disease with dry throat, polydipsia, fright, and restlessness, treat the flesh layer using the Sixth Needle (Hao needle) and the 59-point method. For red eyes (Lingshu says green), seek treatment in the Spleen (Flesh), not in Wood (Liver). For heat disease with chest/hypochondriac pain (Lingshu says facial green/chest pain) and restless extremities, treat the sinew layer using the Fourth Needle (Feng needle) at Si Ni points. For sinew spasms and dim vision, seek treatment in the Liver (Sinew), not in Metal (Lung). For heat disease with frequent惊悸 (palpitations/fright), convulsions, and mania, treat the vessels using the Fourth Needle to urgently drain excess. For epilepsy with hair loss, seek treatment in the Heart (Blood), not in the Kidney (Water). For heat disease with heavy body, bone pain, deafness, and desire to close eyes, treat the bone layer using the Fourth Needle and the 59-point method. For bone disease with anorexia, teeth grinding, and cyanotic ears, seek treatment in the Kidney (Bone), not in Earth (Spleen). For heat disease with unknown location, deafness, inability to control movements, dry mouth, extreme Yang heat, and Yin cold, the heat is in the Marrow; this is incurable and fatal. For heat disease with headache, temporal pain, tight eye vessels (or loose), and frequent epistaxis, this is Jue Heat Disease. Use the Third Needle (Di needle) based on excess/deficiency. Accompanied by cold/heat hemorrhoids. For heat disease with heavy body and intestinal heat, use the Fourth Needle at Shu points and between toes, seeking Qi in the Stomach collaterals. For heat disease with urgent pain beside the navel and chest/hypochondriac fullness, use Yongquan and Yinlingquan, inserting the Fourth Needle deeply near the throat. For heat disease about to sweat, or with favorable pulses allowing sweating, use Yuji, Taiyuan, Dadu, and Taibai; draining reduces heat, tonifying induces sweat. For excessive sweating, use the transverse vessel above the medial malleolus to stop it.

If heat disease patient sweats but the pulse remains rapid/full, this is the extreme of Yin pulses and indicates death; if the pulse becomes calm after sweating, survival is indicated. If the pulse is constantly rapid/full without sweating, this is the extreme of Yang pulses and indicates death; if the pulse calms after sweating, survival is indicated.

For Jue syndrome with pain along the spine, stiff neck/head, blurry vision, and strong lumbar/spine, bleed the blood collaterals of Foot Taiyang. For dry throat and sticky oral heat, use Foot Shaoyang points (This section comes from Suwen's Waist Pain chapter and should be placed there).

There are nine fatal signs in heat disease: 1. No sweat with red cheeks (Tai Su notes: no sweat + red cheeks = certain death). 2. Diarrhea with severe abdominal fullness. 3. Unclear vision with unrelenting heat. 4. Elderly or infants with heat and abdominal fullness. 5. No sweat with vomiting blood (Lingshu says vomiting lower blood). 6. Rotting tongue root with unrelenting heat. 7. Coughing with epistaxis, sweating that does not reach the feet. 8. Marrow heat. 9. Heat with convulsions/stiffness. Heat with convulsions involves backward arching of the waist, limb spasms, and locked jaw. These nine conditions are not suitable for needling.

The "59 Points" consist of: 12 points on the inner and outer sides of both hands (3 each); 8 points between the five fingers (1 each); similarly on the feet; 6 points one cun inside the hairline, 0.3 cun lateral (Lingshu omits 'fen'); 10 points three cun inside the hairline laterally; 6 points around ears, front/back of mouth (Lingshu says below mouth), and neck center; 1 point on the vertex, Xinhui, hairline, Lianquan, 2 Fengchi, 2 Tianzhu (Xinhui to Tianzhu missing in Jiayi Jing, supplemented from Lingshu).

Suwen states: The five rows of five points on the head disperse rebellious heat from all Yang channels. Dazhu, Ying Shu, Quepen, and Back Vertebrae (8 points) drain chest heat. Qichong, Zusanli, Shangjuxu, and Xiajuxu (8 points) drain stomach heat. Yunmen, Bitong, Weizhong, and Suikong (8 points) drain limb heat. Five points beside each of the Five Zang Shu points (10 points total) drain Zang heat. All 59 are key points for draining heat.

For cold in the head, epistaxis, and tearing, Shenting treats it. For headache, fever, nasal obstruction, dyspnea, vexation, and no sweat, Qucha treats it. For headache, vertigo, stiff neck, chest/hypochondriac traction, and inability to tilt, Benshen treats it. For heat disease (Suwen adds vexation/fullness) with no sweat, Shangxing treats it; first needle Yexi, then Tianyou and Fengchi. For heat disease with no sweat, bitter vomiting, and heart vexation, Chengguang treats it. For heavy head/neck, sudden collapse, nasal obstruction, rhinorrhea, epistaxis, and dyspnea, Tongtian treats it. For head/neck pain, aversion to wind, no sweat, chills, vomiting, tight eye system, pain radiating to temples, heavy head, and stiff neck, Yuzhen treats it. For clear cheeks (Qianjin says biting cheeks), inability to see, drooling, brow/eye pain, Linqi treats it. For brain wind headache, aversion to wind/cold, rhinorrhea, nasal obstruction, and dyspnea, Chengling treats it. For headache, fever, and tension in the mandible (or pain), Naokong treats it. For post-drunken wind-heat, temporal/eye vertigo, and anorexia with vexation/vomiting, Lvgu treats it (Qianjin places this under Fengmen). For stiff neck with aphasia, Anmen is needled. For heat disease with no sweat, Tianzhu, Fengchi, Shangyang, Guanchong, and Yimen treat it. For neck pain preventing turning, tearing, excessive discharge, rhinorrhea, epistaxis, inner canthus redness/pain, Qi Jue causing ear/eye dullness, and throat/neck tendon spasm, Fengchi treats it. For severe cold damage with heat, vexation, and vomiting, Dazhui treats it. For heavy head, dizzy eyes, chills, cold/heat alternation, and no sweat, Daodao treats it. For feverish headache coming and going, Shendao treats it. For splitting headache, burning fever, no sweat, convulsions (Qianjin says headache), cold/heat, aversion to cold, interior urgency, and waist/abdominal traction pain, Mingmen treats it. For neck pain preventing flexion/extension, headache with chills, convulsions, Qi excess with hypochondriac fullness, cold Qi along the spine, fever, no sweat, and back/waist pain, Dazhu treats it. For wind vertigo headache, nasal obstruction, sneezing, and clear rhinorrhea, Fengmen treats it. For chilling tremors and frequent yawning, Geshu treats it. For heat disease with no sweat, Shanglian and Kongzui treat it (Qianjin says Arm Jue heat disease with no sweat, moxa/needle these points to induce sweat). For shoulder blade stiffness and chills, Pohu treats it. For neck/back pain radiating to the neck, Pohu treats it. For shoulder pain, chest/abdominal fullness, chilling back stiffness, Shentang treats it. For wheezing, rhinorrhea, scapular medial pain, inability to bend/bow, costal pain radiating to the lower abdomen, Yexi treats it. For back pain, aversion to cold, stiff spine, dysphagia, vomiting with saliva, Geshu (Qianjin says Yangguan) treats it. For heat disease with headache and heaviness, Xuanlu treats it. For chest/hypochondriac distension, back pain, aversion to wind/cold, anorexia, and non-retained vomiting, Hunmen treats it. For frequent sneezing, headache, and fever, Hanyan treats it. For heat disease headache radiating to the outer canthus with tension, vexation, no sweat, mandibular/tooth pain, red face, and skin pain, Xuanli treats it. For heat disease lateral headache radiating to the outer canthus, Xuanli treats it. For eye/pupil pain, blindness, stiff neck preventing turning, Yangbai treats it. For head wind headache, rhinorrhea, brow pain, sneezing, bulging eyes, sweating with cold/heat, red face, cheek pain, immobile neck, tight eye system, and convulsions, Zanzhu treats it. For cold/heat chills and teeth chattering, Chengjiang treats it. For body pain, chest/hypochondriac pain preventing turning, Luxi treats it. For shoulder/back pain, cold/heat, cervical lymphadenopathy, large masses, sudden deafness, mental confusion, open eyes/ears difficulty, head/jaw pain, tearing, epistaxis, breathing difficulty, anosmia, wind vertigo, and throat bi, Tianyou treats it. For heat disease with vague chest discomfort, acute abdominal pain, mental confusion, and cold limbs (Qianjin says vexation/no sweat), Shangwan treats it. For body cold/heat, Yindu treats it. For heat disease resembling malaria with tremors, teeth chattering, abdominal distension, and throat sounds, Shaoshang treats it. For cold Jue, heat vexation, shortness of breath, genital dampness/itching, abdominal pain preventing eating/drinking, elbow contracture, fullness, and dry throat/thirst, Yuji treats it. For heat disease with tremors, teeth chattering, abdominal distension, impotence, cough radiating to the sacrum, and urinary leakage (Deficiency pattern); emptiness in the chest, vomiting food, fever, no sweat, frequent hemoptysis/hematochezia, shoulder/back cold/heat, pallor, and tearing (all Deficiency), tonify Yuji. For warm disease with fever lasting over five days and no sweat, needle Taiyuan. Retain needles for one Shichen. If less than five days, do not needle. For heat disease beginning with arm convulsions, puckered lips, flared nostrils, pearl-like sweat under eyes, hardness two cun below nipples, hypochondriac fullness, and palpitations, Lieque treats it.