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Liver Heat Disease: Urine turns yellow first, abdominal pain, excessive sleeping, and body heat. (This discusses heat diseases of the five Zang organs. The five Zang organs are generated by the Five Elements. The Ten Heavenly Stems transform into the Earthly Five Elements. The Twelve Meridians of Man correspond to the Six Qi of Heaven. Pathogenic factors of Cold Damage attack the Qi of the Three Yin and Three Yang meridians; thus, death occurs on the third or sixth day, and recovery takes twelve days. Heat diseases of the five Zang organs involve the Five Elements; therefore, life and death depend on the Heavenly Stems. Diseases involving the Six Qi are external pathogenic factors affecting the muscle and form; diseases of the five Zang organs are internal causes damaging the spirit and consciousness of the Zang organs. As stated in the *Ling Shu*: Wind and cold damage the form; worry, fear, anger, and resentment damage the Qi. When Qi is damaged, the Zang organs are affected, resulting in Zang disease; when cold damages the form, it results in form disease. "First" refers to having this internal heat prior to the appearance of these symptoms. The Liver governs free flow, so urine becomes red and yellow. The Liver meridian circles the genitalia, reaches the lower abdomen, and ascends, causing abdominal pain. The Liver stores the Hun (Ethereal Soul); when Hun is damaged, there is excessive sleeping. Wood and Fire govern the Qi, causing body heat. This describes an internal disease starting in the Qi level, moving from below to above, from inside to outside. Ni Chongzhi said: "First" means having this internal heat symptom before it contends with external heat.) If heat contends (Re Zheng), there is delirious speech and fright, fullness and pain in the hypochondrium, restlessness of the hands and feet, and inability to lie down peacefully. (Heat contention is the struggle between cold and heat. This describes external pathogenic factors invading the five Zang organs internally, contending with internal heat to form a severe disease. External pathogens invading the five Zang organs internally refer to what is stated in the *Yin Yang Ying Xiang Da Lun*: Heavenly pathogenic factors, upon invasion, harm the five Zang organs. Generally, wind and cold pathogens initially damage the skin and hair; if left untreated, they enter the muscle layers and then the meridians; if still untreated, they invade the five Zang organs internally. Thus it is said: Treating Zang organ diseases has a fifty-fifty chance of death or survival. Contending with internal heat to form severe disease refers to transmission and transformation mentioned in the *Yu Ji Zhen Zang Lun*, where entry does not follow the usual order. Worry, fear, grief, joy, and anger prevent orderly transmission, leading to major diseases. It means that while external wind-cold and internal Zang injury have a sequence, internal injury from the Five Emotions disrupts this order, causing major illness. Damage to Hun causes delirium. The East corresponds to Liver Wood; its disease manifests as fright and alarm. The Liver meridian spreads over the costal region, causing fullness and pain. Excessive wind-wood heat invades the four extremities. When one lies down, blood returns to the Liver; if Liver Qi is damaged and cannot store blood, one cannot sleep peacefully. Wang Zifang said: Cold transforms into heat, hence called heat contention.) Condition worsens on Geng-Xin days; profuse sweating on Jia-Yi days leads to recovery; if Qi rebels, death occurs on Geng-Xin days. (Disease in the Liver aggravates on Geng-Xin days. If not fatal on Geng-Xin, recovery begins on Jia-Yi days. Profuse sweating indicates righteous Qi overcoming pathogenic factors and expelling them outward. Qi rebellion indicates heat invading and reversing inward.) Needle the Foot-Jueyin (Liver) and Foot-Shaoyang (Gallbladder) meridians. (Huangdi asked: How difficult is the treatment of external diseases? Bogao answered: For diseases starting in the form without entering the Zang, reduce the needling days by half; for diseases starting in the Zang with subsequent form manifestation, double the needling days. This is the principle of treating external vs. internal difficulties. Form-first disease without Zang entry means external pathogens have not yet entered to contend with Zang heat. Zang-first disease with form response means Zang heat emerges to the form, corresponding to external heat. Pathogens aggregating and reversing inward are hard to treat; internal heat emerging to match the form is easy to cure with needling. Yang Yuanru said: This section is descriptive; it should be supported by sovereign-minister dialogues.) If Qi rebels, there is headache and dizziness, as if spinning, due to pulse Qi rushing to the head. (Yuan Yuan means rotation/spinning. This describes Liver heat manifesting externally, corresponding to form heat. Excessive heat reverses upward to the head, causing spinning headaches. Generally, the Three Yang meridians ascend to the head. Liver heat contends with Shaoyang, causing pulse Qi to rush upward. One must understand that disease in Qi relates to Pulse, and disease in Pulse relates to Qi; the pathway of Pulse and Qi requires deep contemplation.) Heart Heat Disease: First, unhappiness/melancholy; after several days, fever develops. (The emotion of the Heart is Joy, but Fear overcomes it. Initial unhappiness is due to Fear injury. The Heart is the Sovereign Official; Zang heat is a disorder of Spirit/Consciousness. Thus, the Heart is singled out to clarify that Zang heat diseases are disorders caused by the Five Emotions.) If heat contends, sudden heart pain, vexation, frequent vomiting, headache, red face, and absence of sweat occur. (External-internal contention, heat harassing the Spirit Zang, causes sudden pain. Shaoyin disease involves desire to vomit but inability, hence frequent vomiting. The Heart is Yang within Yang (Taiyang), causing headache. The Heart's brilliance manifests in the face, causing redness. The Heart governs Blood, hence no sweat. Dong Weiyuan said: Discussing heat contention requires viewing both internal and external symptoms.) Condition worsens on Ren-Gui days; profuse sweating on Bing-Ding days leads to recovery; if Qi rebels, death occurs on Ren-Gui days. (Heart disease aggravates on Ren-Gui days. If not fatal on Ren-Gui, recovery begins on Bing-Ding days. Rebellion means no improvement.) Needle the Hand-Shaoyin (Heart) and Hand-Taiyang (Small Intestine) meridians. (Hand-Shaoyin and Hand-Taiyang are exterior-interior pairs; needle both to drain heat.) Spleen Heat Disease: First, heavy head, cheek pain, heart vexation, blueish complexion, desire to vomit, and body heat. (Yin Qi ascends from the foot to the head, causing initial heaviness. the Yangming meridian traverses the cheeks, causing cheek pain. Spleen collaterals connect to the Heart, causing heart vexation and blueish complexion. Heat harasses the Stomach, causing desire to vomit. The Spleen governs muscles, causing body heat.) If heat contends, lower back pain preventing flexion and extension, abdominal fullness, diarrhea, and pain in both mandibles occur. (The Classic states: Yang diseases cause opisthotonos and inability to bend forward; Yin diseases cause inability to extend backward. Yang is Heaven Qi, governing exterior; Yin is Earth Qi, governing interior. Yin Zang heat inside, Yang heat outside, their contention causes lower back pain preventing movement. The abdomen is the enclosure of Spleen Earth, causing fullness and diarrhea. Stomach's fierce Qi rushes to the head, following the jaw to Renying, causing sub-mandibular pain.) Condition worsens on Jia-Yi days; profuse sweating on Wu-Ji days leads to recovery; if Qi rebels, death occurs on Jia-Yi days. (Spleen disease aggravates on Jia-Yi days. If not fatal on Jia-Yi, recovery begins on Wu-Ji days. Rebellion prevents outward expulsion via sweat.) Needle the Foot-Taiyin (Spleen) and Foot-Yangming (Stomach) meridians. (Foot-Taiyin and Foot-Yangming are exterior-interior pairs.) Lung Heat Disease: First, chills, erection of lanugo, aversion to wind and cold, yellow tongue coating, and body heat. (Skin and hair are the exterior of the Lung. Internal Zang heat causes external chills and aversion to wind/cold. Generally, extreme heat presents as cold. The Lung connects to the throat, causing yellow tongue. The True Qi of the Zang is high in the Lung, governing Ying and Wei Qi and Yin-Yang, causing body heat.) If heat contends, wheezing and coughing, pain radiating through the chest and back, inability to take deep breaths, unbearable headache, sweating with chills occur. (Heat harasses the Lung, causing wheezing, coughing, and dyspnea. The Lung governs Qi in the chest; Qi injury causes pain radiating through the chest and back. Among Zang organs, the Lung corresponds to Heaven. The Hand-Yangming meridian ascends to the head, causing unbearable headache. Heat contention inside causes sweating and subsequent chills. Wang Bing said: Lung collateral vessels connect to the ear, causing unbearable headache. Ni Chongzhi said: The Lung resides in the chest, with Shu points on the shoulder and back.) Condition worsens on Bing-Ding days; profuse sweating on Geng-Xin days leads to recovery; if Qi rebels, death occurs on Bing-Ding days. (Lung disease aggravates on Bing-Ding days. If not fatal on Bing-Ding, recovery begins on Geng-Xin days. Rebellion leads to death on the day of being overcome.) Needle the Hand-Taiyin (Lung) and Hand-Yangming (Large Intestine) meridians, bleed until the amount of blood is like a soybean, and it will stop immediately. (This states that needling the Six Meridians should always drain, never tonify. The Lung is the Chief of the Five Zang, used here to illustrate.) Kidney Heat Disease: First, lower back pain, soreness of the knees and shins, thirst with frequent drinking, and body heat. (The waist is the residence of the Kidney, causing initial back pain. The Kidney governs bones, causing knee/shin soreness. The Kidney is the Water Zang; fluids cannot nourish upwards, causing thirst and frequent drinking. Note: All five Zang heat diseases feature body heat, as internal heat moves from inside to outside. Zang heat contention mostly shows internal symptoms, as external heat contends inside.) If heat contends, neck pain and stiffness, aversion to cold with knee/shin soreness, heat in the soles of the feet, and reluctance to speak occur. (External heat in Taiyang causes headache and stiffness. Internal heat in the Kidney causes chills and knee/shin soreness. Heat in the soles is heat flowing into the Yin thigh. Reluctance to speak is because the Kidney is the source of generating Qi.) If Qi rebels, there is neck pain, dizziness, and dull, lingering pain. (Contending Qi rebelling upward causes neck pain. Dull and lingering pain is mild pain. The Bladder is the Kidney's residence; Taiyang is the master of all Yang Qi, ascending. Kidney heat follows Taiyang Qi to rush to the head. This is Yin-Yang heat contending internally and externally, following pulses and rising Qi, all Yin emerging to Yang, causing only headache without death.) Condition worsens on Wu-Ji days; profuse sweating on Ren-Gui days leads to recovery; if Qi rebels, death occurs on Wu-Ji days. (Kidney disease aggravates on Wu-Ji days. If not fatal on Wu-Ji, recovery begins on Ren-Gui days. Compliance leads to outward expulsion via sweat; rebellion leads to internal damage to the True Zang, causing death.) Needle the Foot-Shaoyin (Kidney) and Foot-Taiyang (Bladder) meridians. (Foot-Shaoyin and Foot-Taiyang are exterior-interior pairs. The Qi of the Five Zang and Six Fu organs is interconnected.) For all cases requiring sweating, sweating occurs on the day of their respective Overcoming (Sheng) phase. (The day the own Qi is prosperous is called the Overcoming day. Sweating allows heat to escape outward, leading to self-healing. This is "rising from its own position." Note: This section discusses combined syndromes of meridian Qi, hence "profuse sweating" and "sweating." Qi-level sweating is profuse; meridian-level sweating is slight.) Liver Heat Disease: Redness appears first on the left cheek. (This describes internal heat from the Five Emotions, which must first manifest in color. Each of the Five Colors has its location. Liver belongs to Wood and is located in the East, so redness appears first on the left cheek. Brightness and Five Colors are the brilliance of Qi. Worry, fear, anger, and resentment damage Qi; Qi damage harms the Zang, causing Zang disease. Since it is seen in color now, it is still at the Qi level. Hence, "Treat before disease arises." "Before disease" means the disease has not yet reached the Zang.) Heart Heat Disease: Redness appears first on the forehead. (The *Se Wu Pian* states: Que is between the eyebrows, Ting is the forehead. The head faces Que and Ting; the Royal Palace is at the lower pole. Heart combines with Fire and is located in the South, so redness appears first on the forehead. Yan refers to the forehead.) Spleen Heat Disease: Redness appears first on the nose. (Earth is located in the Center, so redness appears first on the nose.) Lung Heat Disease: Redness appears first on the right cheek. (Lung belongs to Metal and is located in the West, so redness appears first on the right cheek.) Kidney Heat Disease: Redness appears first on the chin. (The area below the cheeks is called Yi. Kidney belongs to Water and is located in the North, so redness appears first on the chin. This reflects post-heaven Bagua imagery.) Even if the disease has not fully manifested, if redness is seen, needle it. This is called "Treating Before Disease Arises." (Internal Zang heat must first manifest in color. "Disease not fully manifested" means sick but not yet contending with external heat. Seeing the color and immediately needle it is called "Needling Before Disease." It means when Zang Qi is diseased but the form has not responded, one should needle first to prevent Ying Qi contention and difficult-to-treat conditions.) Heat diseases arising from specific facial regions resolve by the expected time. (This reiterates that heat appearing first in color in the five Zang organs is easier to cure. "Region" refers to the face. Arising from the region, e.g., Liver heat with left cheek redness, resolves with profuse sweating on Jia-Yi days. This is disease in the fundamental Qi of the five Zang, not contending with external heat, so it resolves by the appointed time. In contrast, symptoms like yellow urine, abdominal pain, and body heat involve tangible form layers and may contend with external heat, posing risks of reversal.) If needling is done incorrectly (reversely), it takes three cycles (nine days) to resolve. Repeated reversal leads to death. ("Reverse" means turning reversal into compliance. If one fails to treat before disease arises, allowing internal-external contention and Qi reversal inward, urgent needling is required, resolving in three days. If not treated urgently, allowing internal-external Yin-Yang heat to heavily reverse inward leads to death. Note: Bogao said: Wind-cold damages form; emotions damage Qi; Qi damage harms Zang. Cold damages form, responding in form. This is the correspondence of form, Qi, exterior, and interior. Emperor asked: How to needle? Bogao answered: For nine-day diseases, three needleings suffice. Three needleings equal three cycles. Nine days indicate prolonged disease with internal-external contention.) For all cases requiring sweating, profuse sweating occurs on the Overcoming day. (This reiterates that heat diseases arising from facial regions resolve with profuse sweating by the appointed time. Overcoming day refers to the day the own Qi is prosperous, e.g., Jia-Yi for Liver, Bing-Ding for Heart.) For all treatments of heat diseases, drink cold water, then needle. Wear cold clothing, stay in cool places, and continue until the body feels cool. ("All heat" refers to the exterior Three Yang and interior Five Zang, with internal-external heat contention. Drinking cold water cools the interior. Cold clothing and places cool the exterior. Needling should continue until the body is cool.) Heat disease starting with chest/hypochondriac pain and hand/foot restlessness: Needle Foot-Shaoyang, Tonify Foot-Taiyin. (This outlines needling methods for external heat in the Three Yang. Chest/hypochondriac pain indicates Shaoyang onset. Foot-Shaoyang governs sinews; extreme heat causes spasm and restlessness. The *Ling Shu* states: For heat disease with restless limbs, select sinew areas. Thus, needle Foot-Shaoyang to drain Yang branch heat. Tonify Foot-Taiyin to resist incoming pathogens. When pathogens are in Shaoyang, the Three Yang represent daytime, and Taiyin is susceptible.) Severe cases: Use the Fifty-Nine Points. (Severe disease implies extreme Yang heat affecting the interior. The *Shui Re Xue Lun* states: Five rows of five points on the head disperse Yang heat. Dazhu, Ying Shu, Qianmen, Bei Shu (8 points) drain chest heat. Qichong, Zusanli, Shangjuxu, Xiajuxu (8 points) drain stomach heat. Yunmen, Guyu, Weizhong, Suikong (8 points) drain limb heat. Five points beside each Zang Shu (10 points) drain Zang heat. These 59 points are all related to treating heat. Emperor asked: Why does cold transform into heat? Bogao answered: Extreme cold generates heat. This means cold injuries become heat diseases; if heat is extreme in exterior Yang and enters the interior, use the 59 points. Note: *Kong Xue Yuan Jing* lacks Guyu point, has Jianyu point. Yaoshu is also named Suikong.) Heat disease starting with arm pain: Needle Hand-Yangming and Hand-Taiyin until sweating stops. (Upper body is governed by Hand-Taiyin and Hand-Yangming. Arm-onset heat is upper-body Yang disease. Thus, needle Hand-Yangming and Hand-Taiyin; Hand-Taiyin governs the exterior.) Heat disease starting with head pain: Needle Neck-Taiyang until sweating stops. (Head-onset is Taiyang disease. Needling the neck refers to Fengchi and Fengfu. Taiyang is master of Yang Qi, connected to Fengfu; needling induces sweating.) Heat disease starting with leg/calf pain: Needle Foot-Yangming until sweating stops. (Yang Qi originates from the exterior of the five toes. Leg-onset heat is Yang disease starting from below. Thus, needle Foot-Yangming to induce sweating.) Heat disease starting with heaviness, bone pain, deafness, and desire to close eyes: Needle Foot-Shaoyin. Severe cases: Use the Fifty-Nine Points. (This Yin-originating heat disease requires Foot-Shaoyin selection. Kidney governs bones and is the Qi source; Qi injury causes heaviness. Kidney opens into the ears, causing deafness. Shaoyin disease features drowsiness, causing desire to close eyes. Severe cases also use the 59 points. *Ling Shu* states: For heat disease with heaviness, bone pain, deafness, and drowsiness, select bones using the Fourth Needle (Five-Nine Bone Points). Foot-Shaoyin governs bones, so select bone points. Five-Nine Bone Points select empty bone acupoints. Shaoyang and Shaoyin govern pivots. Heat in Shaoyang can enter Yin interior; heat in Shaoyin can pivot outward. Thus, severe Yin/Yang branch diseases use the 59 points. Zhang Zhaohuang said: Shaoyang is governed by Fire Qi; Shaoyin by Heat Qi. Thus, diseases in Shaoyang/Shaoyin involve extreme heat.) Heat disease starting with dizziness, vertigo, fever, and chest/hypochondriac fullness: Needle Foot-Shaoyin and Foot-Shaoyang. (This describes the connection between Shaoyin and Shaoyang Qi. Yin-Yang exit/entry pivots. Dizziness/vertigo with fever indicates Shaoyang onset. Chest fullness suggests impending interior Yin entry. Thus, needle Foot-Shaoyin and Foot-Shaoyang to pivot outward. Note: The previous three sections use "first" sixteen times, indicating priority in treating internal, external, Qi-level, or color-manifested issues to prevent contention. Zhang Zhaohuang said: First section discusses Shaoyang heat; previous section Shaoyin heat; this section discusses Shaoyin-Shaoyang combination, i.e., Minister Fire and Sovereign Fire interaction.) Taiyang meridian color shining on the zygomatic bone indicates heat disease. If the color has not yet merged, and sweating is achieved now, wait for the appropriate time to resolve. If Taiyang and Jueyin meridian colors appear together, death will not exceed three days. (This discusses external Six Qi heat and internal five Zang heat, initially at the Qi level, not yet reaching the Collateral/Color level. Urgent sweating is needed to prevent internal-external merging. *Shang Han Lun* states: Taiyang disease features floating pulse. Taiyang pulse indicates Six Qi disease, starting in exterior Taiyang Yang, an external heat disease. Rong (Brilliance) refers to redness on the zygoma/cheeks, indicating internal five Zang heat manifesting in color. "Bone" means hidden in the skin. At this stage, Zang brilliance has not merged with exterior Yang Qi, nor has exterior heat merged with Zang Qi. Skilled physicians say: Taiyang disease can be resolved via exterior sweating. Internal Zang heat, even if unmanifested, if redness is seen, should be needle-treated ("Treat Before Disease"). If sweating is achieved now, waiting for the time suffices. If not resolved via sweating, Taiyang heat merges with Zang heat. If Taiyang and Jueyin pulses contend, death occurs within three days. Note: This aligns with *Yu Ji Zhen Zang Lun* on non-sequential transmission due to emotional injury. Exterior pathogens start in Taiyang, transmitting sequentially. Non-sequential entry is due to Five Emotions injuring the five Zang. Taiyang-Jueyin pulse contention indicates Taiyang heat merging with Liver heat. Taiyang is the beginning of Yang; Jueyin is the end of Yin. Their contention represents exterior pathogens entering non-sequentially with Zang heat. Yang-Yin pulse contention is a death sign, so all five Zangs need not be listed. Understand: Exterior Yang heat progresses Qi -> Meridian -> Zang; Zang heat progresses Qi -> Meridian -> Exterior. Heat exiting to Yang branch survives; heat heavily reversing to Yin Zang dies. First section: Internal heat contending with external; this section: External heat contending with internal.) If heat connects internally to the Kidney, it is the color of the Shaoyang meridian. (This describes exterior Yang heat contending with Zang heat, non-sequentially entering, specifically connecting Shaoyang and Kidney. *Ben Shu Pian* states: Shaoyang belongs to Kidney. Shaoyang Qi originates from the Kidney; thus, heat connecting to the Kidney manifests as Shaoyang meridian color.) Shaoyang meridian color shining on the front of the cheek indicates heat disease. If the color has not yet merged, and sweating is achieved now, wait for the appropriate time to resolve. If Shaoyang and Shaoyin meridian colors appear together, death [occurs].