Library

[Ping An]: This section from the beginning of the chapter to "injury to the lung leads to death" is found in *Suwen* (Basic Questions), Volume 9, Chapter 33, "Commentary on Heat Disease". From the beginning to "drink the decoction", it is found in *Jiayi Jing* (Systematic Classic of Acupuncture and Moxibustion), Volume 7, Part 1, Middle, with only slight differences in arrangement. From Huangdi's question "What is the disease of labor wind?" to "injury to the lung leads to death", it is found in *Jiayi Jing*, Volume 11, Chapter 7. From "hemiplegia, one side of the body unusable" to the end, it is found in *Lingshu* (Spiritual Pivot), Volume 5, Chapter 23, "Heat Disease". From "hemiplegia, one side of the body unusable" to "superficially extract them", it is found in *Jiayi Jing*, Volume 10, Part 2, Lower. From "heat disease, three days later, Qi Kou pulse is quiet" to the end, it is found in *Jiayi Jing*, Volume 7, Part 1, Middle.

Huangdi asked Qibo: There is a person suffering from a warm disease (Wen Bing). After sweating, the fever returns immediately, the pulse is rapid and restless, and does not subside with sweating. The patient speaks deliriously and cannot eat. What is this disease called? Qibo replied: This disease is called Yin-Jiao (Yin-Yang Intersection). "Jiao" implies death. (Sweat is Yin fluid. Fever is excessive Yang Qi. When Yang is excessive, there should be no sweat; when sweat occurs, heat should subside. Now, sweat occurs but heat does not subside; this means Yang pathogen is excessive while Yin rises, and the two intersect, hence the name Yin-Jiao.) Huangdi said: I wish to hear the explanation. (Please explain the struggle between Yin and Yang and the reason for death.) Qibo said: Humans produce sweat because of grain (food), and grain produces essence (Jing). Now, if pathogens contend with healthy Qi in the muscles and bones, and sweat results, it means the pathogen is retreating and the essence is victorious. If the essence is victorious, the patient should be able to eat and not have recurrent fever. Fever represents the pathogen; sweat represents the essence. Now, sweating is followed immediately by recurrent fever, which indicates the pathogen has won. (Essence refers to the refined fluids of food, which become sweat. Cold damage pathogens are referred to as heat. Now, when pathogens and essence contend in the muscles and bones, if essence wins, the pathogen retreats; if the pathogen wins, essence diminishes. Although sweat occurs and then fever returns, it is because the pathogen has defeated the essence, leading to death. Ping An: The text "Fever is the pathogen" appears as "Recurrent fever is the pathogen" in *Suwen* and *Jiayi Jing*.) Inability to eat means essence is depleted. Essence depletion is termed "Dan" (intense heat). If this heat remains and does not dissipate, the five Zang and six Fu organs will all be injured, and life will be imperiled. (Since the heat pathogen has won, essence fluids are exhausted. With exhausted essence fluids, only heat remains. "Dan" means heat. If this heat lingers and does not leave, the five Zang and six Fu organs can all be damaged, implying imminent danger. Ping An: The text "Jing wu jing wu dan ye" appears as "Jing wu bi ye" in *Suwen* and *Jiayi Jing*. "Er liu zhe" appears as "Bing er liu zhe" in *Suwen* and "Re er liu zhe" in *Jiayi Jing*. New Correction states: "*Jiayi Jing* reads 'er re liu zhe'." "Qi jin ke li shang" appears as "Qi shou ke li qing" in *Suwen* and *Jiayi Jing*. The note explaining "jin ke shang zhi neng shi ye" is confusing; it is suspected that the characters "gu bu" were omitted before "neng shi ye".) As stated in the *Re Lun* (Treatise on Heat): "If the pulse remains rapid and vigorous after sweating, death ensues." Now, the pulse does not correspond with the sweating, indicating the body cannot overcome the disease; death is evident. (Since sweating occurs, the pulse should calm down. Now, despite sweating, the pulse remains rapid and vigorous, clearly indicating pathogen victory, confirming certain death. Ping An: "Shi fu" appears as "Qie fu" in *Suwen*. *Jiayi Jing* lacks the three characters "Re lun yue". There is no "shang" character after "mai". The four characters "zhi ding si ye" in the note are missing in Yuan Ke edition.) Delirious speech indicates loss of Zhi (will/mind). Loss of Zhi leads to death. (Zhi refers to memory and is the spirit of the Kidney. The Moving Qi in the Kidney region is the root of human life. If this Moving Qi declines, the spirit and mind depart, leading to death.) Now, seeing three signs of death and no sign of life, even if there is temporary improvement, death is inevitable. (Sweating with persistent heat presents three signs of death: one, inability to eat; two, persistent rapid pulse; three, loss of mind. Having these three signs of death without any sign of life, even if the illness seems to remit, death is certain. There is three parts death and no one part life. Ping An: *Jiayi Jing* reads "ci you san si".)

Huangdi asked Qibo: There is a disease characterized by body heat, sweating, and vexation/fullness, where sweating does not relieve the vexation/fullness. What is this disease? (Body heat and vexation/fullness should resolve with sweating. Since it does not, the question is asked. Ping An: *Jiayi Jing* reads "bing shen re han chu er fan man bu jie zhe he ye".) Qibo said: Sweating accompanied by body heat is due to Wind. Sweating accompanied by unresolved vexation/fullness is due to Jue (reversal). The disease is named Feng-Jue (Wind-Jue). (Wind-heat opens the Couli (pores) causing sweat; this is not sweat from essence/Qi, so persistent body heat is named Wind. Vexation and fullness not resolving is named Jue disease. Having both Wind and Jue, it is named Feng-Jue.) Asked: I wish to hear the explanation. Answered: Taiyang (Greater Yang) governs the Qi of the body and thus receives the pathogen first. Shaoyin (Lesser Yin) is its interior-exterior pair. When heated, Shaoyin follows Taiyang upward. Following upward leads to Jue. (The Moving Qi in the Kidney region is governed by Foot-Taiyang. Foot-Taiyang and Foot-Shaoyin are interior-exterior pairs. Thus, Taiyang receives the pathogen first, ascending along the meridian to the head. Upon receiving heat, the ascending part of Foot-Taiyang follows the heat, resulting in upper heat and lower cold, manifesting as Jue reversal, sweating, unresolved vexation, and fullness.) Asked: How to treat it? Answered: Needle the exterior and interior meridians, and administer decoctions. (One may needle the meridians of Yin-Yang and exterior-interior to attack the exterior, and administer liquid medicines to treat the interior. This is the method for treating Feng-Jue. Ping An: *Suwen* and *Jiayi Jing* have the character "zhang" before "tang".)

Huangdi said: What about the disease of Lao-Feng (Labor Wind)? Qibo said: Lao-Feng typically resides below the Lung. Its symptoms include stiffness and extension of the neck, dim and delayed vision, expectoration of thick phlegm resembling mucus, aversion to wind with chills and tremors. This is a disease of Lao-Zhong (Labor Injury). (Contracting wind due to labor injury is named Lao-Zhong, also Lao-Feng. "Below the Lung" refers to the location of the pathology. "Qiang Shang" means tendency to extend the neck backward. "Ming Shi Wan" means delayed closing of eyes and blurred vision. "Tuo ruo ti" means sputum like pus. Exposure to wind causes immediate chills and tremors; these are the manifestations of Lao-Zhong. Ping An: *Suwen* and *Jiayi Jing* omit "wan" after "shi"; "ji zhen han" reads "er zhen han"; "lao zhong" reads "lao feng". New Correction in *Suwen* says: "Yang Shangshan states: Ming Shi means unclear vision with closed eyes." This differs slightly. *Qian Jin* reads "mu xuan" for "ming shi".) Asked: How to treat it? Answered: Rescue the difficulty in bending and extending. (This disease often manifests as difficulty in bending and extending, so rescue this symptom.) For those with abundant Jing (Essence), recovery takes three days; for average individuals, five days; for those with deficient Jing, seven days. Clear, yellow-green nasal discharge, resembling thick pus and sized like a pill, should be expelled from the mouth or nose. If not expelled, the Lung will be injured, and injury to the Lung leads to death. (Needling to guide the Jing of Taiyang leads to recovery in three days; guiding the Jing of Yangming leads to recovery in five days; for Shaoyang with insufficient Jing, guiding takes seven days, after which clear-yellow turbid nasal discharge appears from the mouth and nose, and the disease resolves. If not expelled, it injures the Lung upwards, inevitably leading to death. Ping An: *Suwen* and *Jiayi Jing* read "zhong zhe" as "zhong nian zhe". New Correction in *Suwen* says: "*Jiayi Jing* reads 'zhong ruo wu ri'." Current *Jiayi Jing* still reads "zhong nian zhe wu ri". *Qian Jin* reads "hou zhi san ri ji wu ri zhong bu jing ming zhe, shi qi zheng ye," which differs. Also, "wei chu" appears as "ke chu" in *Suwen* and *Jiayi Jing*, lacking "chou" below. *Suwen* lacks "kong" after "bi". *Jiayi Jing* reads "kong" as "kong".)

Pian Ku (Hemiplegia): One side of the body is unusable and painful, speech is unchanged, and consciousness is not confused. The disease is located between the Fen-Rou (muscle intervals). Use a large needle to treat, tonify deficiency, and reduce excess, then recovery is possible. (There are five distinctions of Pian Ku: one, hemiplegia with muscle atrophy/retraction; two, hemiplegia without pain (this case involves both non-use and pain); three, speech is normal; four, consciousness is not confused; five, disease is in the muscle intervals. Possessing these five characteristics defines Pian Ku. Ping An: *Lingshu* reads "zhi bu luan" for "zhi bu luan"; *Jiayi Jing* reads "zhi bu luan".) Fei Disease: Body has no pain, limbs cannot be controlled, consciousness is slightly confused, speech is faint but understandable; this is treatable. If severe, unable to speak, it is untreatable. (Fei, pronounced Fu-Fei, is a wind disease. Four characteristics of Fei Wind: one, no body pain; two, limbs cannot be controlled; three, mental confusion; four, inability to speak. Possessing all four indicates severe, untreatable disease. Although no pain and limbs uncontrolled, if consciousness is clear and speech is partially intact, it is treatable. Common names for this disease today were established by modern physicians and are not from classical texts. Ping An: Note "ci bing", Yuan Ke edition mistakenly prints "tong" for "bing".)

Diseases starting in Yang and entering Yin: First treat Yang, then treat Yin, using superficial needling. (Treatment first addresses the root, then the branch; deep needling is not appropriate. Ping An: Yuan Ke edition omits "xian" after "bing". "Fu er qu zhi" appears as "bi shen qi zhi fu chen er qu zhi" in *Jiayi Jing*.)

Heat disease for three days, with Qi Kou pulse quiet and Ren Ying pulse rapid: Treat the Yang meridians, use the Fifty-Nine Points Needling method to vent heat and induce sweating, and solidify Yin to supplement insufficiency. (Three Yang meridians affected, not yet entered Yin, up to the third day. Not yet entered Yin, so Qi Kou is quiet. Three Yang are diseased, so Ren Ying is rapid. Ren Ying refers to the Ren Ying pulse on either side of the Adam's apple of the Foot-Yangming meridian. Since various Yang meridians are affected, the Fifty-Nine Points of Yang are used to vent heat. Because Yang abundance leads to Yin deficiency, Yin is supplemented. Ping An: "Shi qi yin", the bottom half of "shi" is missing in the original manuscript; Yuan Ke prints "xie", likely an error. *Lingshu* and *Jiayi Jing* print "shi". The note "gu bu yin ye" suggests it should be "shi".")

If body heat is severe and both Yin and Yang pulses are quiet: Do not needle. If needling is possible, act quickly; if no sweat, there will be diarrhea. The instruction "do not needle" applies when there are signs of death. (Quiet Yin and Yang pulses indicate Yin-Yang intersection, a sign of death, hence needling is contraindicated. If not Yin-Yang conflict, needle urgently; if no sweat, expect diarrhea. Ping An: *Lingshu* adds "chu" after "han".")

Heat disease for seven or eight days, with Pulse Kou moving, panting, and dizziness: Needle urgently. Sweat will occur spontaneously. Superficially needle the spaces between fingers. (On the seventh day, Taiyang disease declines; on the eighth day, Yangming disease declines. With Two Yang declining, the Pulse Kou should gradually harmonize. If pulse moves/pants and head spins, heat persists. If sweat comes easily, needle the Qi Gu point on the lateral side of the little finger, superficially. If no sweat, needle deeper. Ping An: *Lingshu* and *Jiayi Jing* read "shou da zhi jian" (between thumb and index finger), differing from Yang's note.)

Heat disease for seven or eight days, with minute and weak pulse, hematuria, and dry mouth: Death occurs within one and a half days. (At seven or eight days, Two Yang decline, and the pulse should harmonize. A minute/weak pulse indicates intense heat, leading to hematuria, dry mouth, and death in one and a half days. A small pulse is a sign of internal heat consuming essence. Ping An: Note "er wei xiao zhe", Yuan Ke prints "mai" for "er".")

With a Dai (knotted/intermittent) pulse: Death occurs within one day. (A Dai pulse at seven or eight days of heat disease indicates the cessation of internal Qi, hence death in one day.)

Heat disease where sweat has occurred, but the pulse remains rapid and panting, with recurrent fever: Do not use vulgar needling. Severe panting indicates death. (After sweat, the pulse should regulate. If it remains rapid/panting with recurrent fever, this is Yin-Jiao; do not needle, as needling is dangerous. Severe panting with intense heat indicates death; no needling required. Ping An: *Lingshu* adds "chu" after "han"; "wu yong ci" reads "wu ci fu".")

Heat disease for seven or eight days, pulse not rapid, or rapid but not frequent. If sweat occurs within three days after frequency, good. If no sweat after three days, death on the fourth day. For those not yet needled, do not use vulgar needling. (At seven or eight days, Two Yang decline, so pulse is not rapid. Even if rapid, if not frequent, by the third subsequent day (totaling twelve days), heat declines in all Three Yin and Three Yang, leading to sweat and recovery. If no sweat from day nine to twelve, death on day thirteen. Calculating "three days after" means three days later. Alternatively: Day twelve is the decline of Jueyin; sweat should occur. If not, by day thirteen (four days after day nine), death occurs. Even if not needled, no needling is necessary. Yong originally meant skin. Ping An: *Jiayi Jing* does not repeat "zao". *Lingshu* and *Jiayi Jing* read "san" for the first "shu". "Wei zeng ci zhe", *Lingshu* reads "han", *Jiayi Jing* reads "wei han" two characters. Yong, *Lingshu* reads "cou".")

Heat disease initially presenting with rough skin, leaning posture, vexation, dry lips, and dry throat: Use the First Needle, Fifty-Nine Points. Skin distension, dry mouth, cold sweat. (Intense body heat, coarse skin. Leaning uneasily, vexation, dry lips/throat, internal heat—symptoms of Lung heat disease. The First Needle is Chan Zhen (pointed needle), corresponding to Lung. Large head, sharp tip, shallow insertion to vent Yang Qi. Used with Fifty-Nine Points to vent Yang Qi, skin distension, dry mouth, inducing sweat. Ping An: "Yi fan xi gan chun ai" appears as "qi er re fan gan chun kou ai" in *Lingshu* and "fan er re fan men chun ai gan" in *Jiayi Jing*. *Lingshu* and *Jiayi Jing* add "pi" after "qu"; omit "ci" after "jiu". *Jiayi Jing* adds "re bing" before "fu zhang". *Lingshu* and *Jiayi Jing* add fourteen characters after "han": "Chu, suo mai yu xin, bu de suo zhi shui, shui zhe shen ye". Note "rui", Yuan Ke prints "xi".)

Heat disease with dry throat, polydipsia, frequent fright, and restlessness in bed: Treat the flesh, use the Sixth Needle, Fifty-Nine Points. Seek Qi in Spleen, not Liver (Wood). (Heat disease with dry throat, polydipsia, fright, restlessness, affecting flesh: Use the Liu-1 (Yuan-Li) needle. Corresponding to Spleen, use Fifty-Nine Points on flesh, seeking Splein Shu points, not Liver Shu points, because Liver (Wood) controls Spleen (Earth). Ping An: *Lingshu* reads "wo bu neng qi"; *Jiayi Jing* reads "wo bu neng an". Below "jiu", *Lingshu* has "mu qing" three characters; *Jiayi Jing* has "ci mu chi" four characters.)

Heat disease with chest/hypochondriac pain and restless hands/feet: Treat the sinews, use the Fourth Needle, at Si-Ni, Jin-Bi, Mu-Jin. Seek Qi in Liver, not Lung (Metal). (Chest/hypochondriac pain and restless extremities indicate Sinew disease. Use Fourth Needle. Corresponding to Liver, needle at Si-Ni, Jin-Bi, Mu-Jin. Seek Liver Shu, not Lung Shu, because Lung (Metal) controls Liver (Wood). Suo means seek. Bi means tendon spasm. Mu-Jin means tearing eyes. Ping An: "Er xiong xie tong" appears as "mian qing xiong tong" in *Lingshu*. Below "si zhen", *Jiayi Jing* repeats "zhen"; "jin bi" reads "jin ".)

Heat disease initially with skin pain, nasal obstruction, and facial swelling: Treat the skin, use the First Needle, Fifty-Nine Points. Nasal obstruction means blocked nose. Chong Mian means raised facial skin. Skin pain, nasal obstruction, and facial swelling are Lung-skin Heat diseases. First Needle (Chan Zhen) has large head and sharp tip, shallow insertion to remove skin pathology, hence Fifty-Nine Points for skin. Ping An: "Xian fu tong", Yuan Ke mistakenly prints "chong" for "xian".)

Skin eruptions on the nose: Seek Qi in Lung, not Heart (Fire). (Ke, pronounced He-Duo, refers to nasal disease; some versions read Gou. Heat disease with Ke-Zhen on the nose: Nose belongs to Lung, so skin disease seeks Lung Shu, not Heart Shu, because Heart (Fire) controls Lung (Metal). Ping An: "Zhen bi" appears as "bi gan" in *Jiayi Jing*. From "Re bing xian fu tong" above to "xin ye" here, *Lingshu* and *Jiayi Jing* place this section before "Re bing xian shen se".)

Heat disease with frequent fright, convulsions, and mania: Treat the vessels, use the Fourth Needle, urgently reduce excess. Epilepsy and hair loss will heal. (Fright, convulsions, and mania are Blood diseases, hence treat vessels. Fourth Needle is Feng Zhen (sharp needle), corresponding to Heart. Can vent heat and bleed. Stubborn epilepsy and hair loss will heal. Ping An: "Yong", *Jiayi Jing* reads " ". "Mao", *Lingshu* and *Jiayi Jing* read "fa".)

Seek Qi in Heart, not Kidney (Water). (Blood vessels seek Heart Shu, not Kidney Shu, because Water controls Fire.)

Heat disease with heavy body, bone pain, deafness, and desire to close eyes: Treat the bones, use the Fourth Needle, Fifty-Nine Points. Bone disease with teeth grinding and blue ears: Seek Qi in Kidney, not Spleen (Earth). Another version says stiff spine. (Heavy body, bone pain, deafness, desire to close eyes are Kidney-bone Heat diseases. Treat bones with Fourth Needle, Feng Zhen, 1.6 cun long, sharp tip, vents heat and bleeds. Use Fifty-Nine Points to treat teeth grinding, blue ears, and bone pain. Seek Kidney Shu, not Spleen Shu, because Earth controls Water. Ping An: *Lingshu* and *Jiayi Jing* add "ci" after "jiu"; add "bu" before "shi". *Jiayi Jing* adds "chi" after "qing". "Yi yun ji qiang" four characters are absent in *Lingshu* and *Jiayi Jing*.)

Heat disease with unawareness of pain, inability to control the body, dry mouth, extreme Yang heat, and significant Yin cold: Heat is in the Marrow. Death, untreatable. (Yang heat disease: Yang pulse is very hot, Yin pulse is quite cold. Heat in the marrow leads to certain death and untreatability. Ping An: "Suo tong", *Jiayi Jing* reads "suo bing", adding "er long" two characters; *Lingshu* agrees.)

Heat disease with headache, temporal pain, orbital vessel pain, and frequent epistaxis: This is Jue-Re (Reversal Heat). Use the Third Needle. Assess excess/deficiency. Treat cold-heat hemorrhoids. (Headache, temporal/orbital vessel pain, and epistaxis indicate Jue-Re. Third Needle is Di Zhen (mound needle), sharp like millet, 2.5 cun long. Presses vessels to extract Qi, allowing pathogen to exit alone. Used for Jue-Re, cold-heat, and hemorrhoid diseases. Ping An: "Mu mai", *Lingshu* reads "mu HT mai tong"; *Jiayi Jing* reads "mu mai jin". Below "Jue Re", *Lingshu* and *Jiayi Jing* add "bing".)

Heat disease with heavy body and intestinal heat: Use the Fourth Needle, at Shu points and between toes/fingers. Seek Qi in Stomach Collaterals until Qi arrives. (Heavy body and intestinal heat are Stomach Heat diseases. Fourth Needle is Feng Zhen. For Stomach heat, use Feng Zhen on Stomach Shu and eight Stomach collateral points on hands/feet, stopping when Qi arrives. Ping An: "Shu", *Lingshu* reads " "; *Jiayi Jing* reads "Yu".)

Heat disease with periumbilical pain/tightness, hypochondriac/chest fullness: Yong Quan and Yin Ling Quan. Use Fourth Needle, needle the throat. (Periumbilical pain is Spleen Meridian Heat. Chest/hypochondriac fullness is Kidney Meridian Heat. Use Feng Zhen on these two points. Ping An: *Lingshu* and *Jiayi Jing* read "ji tong xiong xie man" for "tong ji xiong xie man"; add "li" after "ai".)

Heat disease where sweat is about to appear, or pulse is smooth allowing sweat: Yu Ji, Tai Quan (Tai Yuan), Da Du, Tai Bai. Reduce to eliminate heat; Tonify to induce sweat. If sweat is excessive, take the transverse vein above the ankle to stop it. (For heat disease with sweat or smooth pulse allowing sweat, use Yu Ji (medial base of thumb), Tai Yuan (wrist depression), Da Du (base of big toe depression), Tai Bai (medial foot, medial cuneiform depression). These four points belong to Hand/Foot Taiyin and treat heat. Reduce to eliminate heat, tonify to induce sweat. If sweat is excessive, take the visible Foot-Taiyin transverse vein above the ankle to stop sweat. Ping An: *Lingshu*,)