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Chapter 9 of 13
脉经
Holistic Paraphrase The Maijing, Volume 7 primarily compiles Zhang Zhongjing's Treatise on Cold Damage regarding the indications, contraindications, and erroneous-treatment complications of therapeutic methods including sweating, emesis, purging, warming, moxibustion, needling, water therapy, and fire therapy. The latter half focuses on prognostication of critical febrile conditions, yin-yang intermingling, lesser yin reversal counterflow, excess-of-excess and deficiency-of-deficiency states, exhaustion of the five visceral qi, and pulse signs indicating time of death.
The ancients repeatedly emphasized one principle: Treatment must follow the pulse and manifestations—one must never administer medication rashly based on a single symptom. Failure to distinguish exterior from interior, deficiency from excess, cold from heat—resulting in erroneous sweating, erroneous emesis, erroneous purging, erroneous moxibustion, erroneous needling, or erroneous application of water and fire—may turn mild illness severe and severe illness fatal. Therefore, this volume is not a "prescription manual," but rather a summary of "contraindications and risk awareness" in the treatment of exogenous febrile diseases in antiquity.
The ancients believed that sweating was used to resolve taiyang exterior patterns. Typical manifestations include fever, aversion to cold, body pain, and a floating pulse. However, if the disease has already entered the interior, or the patient has a constitution of yin deficiency, blood depletion, yang deficiency, dry throat, blood loss, prolonged sweating, strangury, or sores, then forceful sweating must not be induced. Sweating should also not be profuse and drenching, but rather should achieve "a slight sweat over the entire body—stop the method once the disease is resolved."
"In lesser yin disease, the pulse is fine, deep, and rapid—the disease is at the interior, and one must not induce sweating"
Fine, deep, and rapid pulse indicates the disease is no longer at the exterior but at the interior—applying the sweating method at this point would be a fundamental error of direction.
"When the pulse is floating and tight, the proper pattern is body pain, which should be resolved by sweating. If the cubit pulse is slow, one must not induce sweating"
Although floating-tight pulse with body pain resembles an exterior pattern, a slow cubit pulse indicates insufficiency of nutrient qi and blood depletion—further sweating would further damage the righteous qi.
"When there is closure and blockage in the throat, sweating must not be induced. If sweating is induced, this will cause vomiting of blood, gradual qi collapse, and cold counterflow of the hands and feet"
In those with throat blockage and impeded qi movement, further sweating readily stirs blood and damages yang, resulting in vomiting of blood and cold extremities.
"In all cases of inducing sweating, one should cause the sweat to reach the hands and feet thoroughly all around; a period of about two hours is best, but one does not want the sweat to flow off like running water"
Sweating should be to the degree that the hands and feet are slightly moist—profuse sweating like running water must not be allowed.
The essence of sweating lies in relying on yang qi's steaming transformation and yin blood's nourishing support to transmit exterior pathogens out through the sweat pores. Hence the ancients said, "Yang added to yin constitutes sweat." When yang deficiency prevents steaming transformation, when blood depletion prevents sweat formation, and when interior heat is not at the exterior—one cannot force sweating. This principle explains why so many clauses state "no yang—cannot sweat," "blood depleted—cannot sweat," "disease at the interior—cannot sweat."
The consequences of erroneous sweating observed by the ancients—such as thirst, restlessness, palpitations, cold counterflow of extremities, spirit clouding and delirious speech—show certain phenomenal overlaps with post-high-fever dehydration, electrolyte imbalance, circulatory disturbance, and neurological abnormalities in modern medicine. This demonstrates that the ancients' understanding of "the harm of excessive sweating" had a practical evidentiary basis.
At the onset of an external contraction, one may keep warm and rest, using slight sweating as the limit; those who habitually sweat easily, have dry throat, palpitations, or fear cold are not suitable for "detoxification" through profuse sweating. After sweating, promptly supplement with warm water and avoid exposure to wind.
The ancients believed that the spring season is appropriate for the emesis method. The emesis method is applicable to true pathogens in the chest, retained food in the upper region, and phlegm-dampness obstructing the diaphragm, manifesting as oppression and blockage in the chest, qi rushing upward toward the throat, and wanting to vomit but being unable to do so. However, if there is erroneous vomiting in taiyang disease, lesser yin deficiency-cold, or counterflow cold of the four limbs, vomiting must not be used.
"A disease resembling the cassia pattern, without headache or stiff neck, with a slightly floating pulse at the inch opening, fullness and hardness in the chest, qi rushing upward striking the throat, unable to breathe—this indicates cold in the chest, and should be treated by vomiting"
Though it resembles the cassia pattern, headache and neck stiffness are not prominent—rather, severe chest blockage with qi rushing upward indicates cold phlegm and true pathogen in the chest, which the ancients considered treatable by emesis.
"In all cases of counterflow cold of the four limbs, the emesis method must not be used; this also applies to deficient constitutions"
Those with cold counterflow of the limbs and insufficient yang qi, as well as all deficiency patterns, cannot use the emesis method.
The principle of the emesis method is "what is high above, expel it upward"—applicable only to pathogens located in the upper region with stagnant true excess. The emesis method itself greatly consumes righteous qi, hence it is prohibited in deficiency-cold conditions and counterflow patterns.
Modern medicine rarely uses induction of vomiting for exogenous febrile diseases. Only in cases of accidental poison ingestion or certain gastric retention conditions is it performed by trained professionals. Ordinary individuals should not self-induce vomiting.
Maintain moderation in eating and drinking, and avoid overeating and food stagnation. The weak, the elderly, and children especially should not self-induce vomiting by stimulating the throat.
The ancients believed that the autumn season is appropriate for the purging method. The purging method applies to yangming interior excess, heat binding, retained food, blood stasis accumulation, and water binding in the chest and hypochondrium—all true heat-binding conditions. However, when the exterior pattern has not resolved, or in cases of yang deficiency, blood depletion, stirring qi in the abdomen, counterflow cold of the four limbs, or the desire to vomit—purging must not be used. Erroneous purging will damage spleen yang and injure fluids, producing hardness and fullness below the heart, uncontrollable diarrhea, abdominal fullness with inability to eat, and even fatal outcomes.
"If the taiyang pattern has not resolved, purging must not be used—purging in this case constitutes going against the proper order"
When the exterior pattern has not been resolved, the purging method cannot be used, otherwise the exterior pathogen will sink into the interior.
"In lesser yin disease, two to three days after onset, dry mouth and dry throat—purge urgently"
This embodies the principle of "urgent purging to preserve yin." When lesser yin disease manifests dry mouth and throat, it indicates heat binding damaging yin, requiring rapid downward drainage.
"With diarrhea, a floating and large pulse—this indicates deficiency, because of forceful purging"
After purging, a floating and large pulse is not real heat, but rather deficiency resulting from erroneous purging.
The purging method targets "interior, excess, heat, and binding." The ancients particularly emphasized "exterior first, then interior"—one cannot attack downward while the exterior is unresolved. Erroneous purging causes pathogenic qi to sink inward, producing chest-binding, glomus patterns, uncontrollable diarrhea, and other conditions.
The ancient "purging method" cannot be directly equated with modern laxatives. Conditions of high fever, dry bound stool, spirit clouding and delirious speech—which the ancients treated with downward drainage to purge the bowels and drain heat—do have a basis in clinical observation. However, modern diseases such as severe infection, intestinal obstruction, and lower gastrointestinal bleeding must be evaluated by physicians; one must not self-administer purgative patent medicines.
Maintaining regular bowel movements is important, but long-term use of stimulant laxatives is inadvisable. In the early stage of exogenous febrile illness, especially when accompanied by chills and diarrhea, one should not blindly "clear fire and promote bowel movements."
This section centrally discusses complex transformed patterns that appear after erroneous or excessive use of sweating, vomiting, and purging: such as unremitting sweat leakage, aversion to wind, difficult urination, palpitations, hardness and fullness below the heart, vexation and insomnia from deficiency, simultaneous deficiency of exterior and interior, chest-binding, jaundice, and blood accumulation.
"In taiyang disease, after three days, sweating has been induced, and vomiting, purging, and warm needling have been applied without resolution—this is a destructive disease... Observe the pulse and manifestations, understand which error was committed, and treat according to the presenting pattern"
After multiple erroneous treatments, taiyang disease has become a "destroyed disease"—one can no longer mechanically apply the original formula but must re-identify the pattern anew.
"In any disease, if sweating has been induced, if vomiting, if purging, if blood has been lost, and there is no fluid but yin and yang harmonize on their own, it will inevitably heal by itself"
As long as fluids, yin, and yang can restore themselves, many mild conditions will resolve spontaneously—excessive treatment is counterproductive.
The core pathological mechanism after erroneous treatment is "depletion of fluids, depletion of yang qi, and derangement of qi movement." The repeated appearance of palpitations, restlessness, glomus fullness, and abnormalities of urination and defecation in the clauses all reflect damage to righteous qi and loss of normal ascending-descending movement.
"Where yin and yang harmonize on their own, it will inevitably heal by itself" shares conceptual resonance with "supportive care and awaiting spontaneous recovery." Excessive medication, repeated sweating, and aggressive purging will burden the body further.
When ill, do not stack multiple potent medications. During recovery, eat lightly, rest adequately, and allow the body to recover gradually.
The ancients believed that the winter season is appropriate for the warming method. The warming method is used for interior deficiency-cold patterns, such as diarrhea with undigested food, abdominal fullness, body pain, deep pulse, lesser yin vomiting and diarrhea, and cold hands and feet—commonly treated with Sini Tang-type formulas (here stated only as theoretical explanation).
"With diarrhea, abdominal fullness, and body pain—first warm the interior"
Although there is body pain, the diarrhea with abdominal fullness indicates severe interior deficiency-cold; the interior should be warmed first.
"In lesser yin disease, with a deep pulse—urgently warm it"
A deep pulse indicates the interior; lesser yin disease mostly involves debilitation of yang qi, requiring urgent warming.
The warming method restores yang qi—a concrete application of "cold is treated with heat." When interior cold is pronounced, even if exterior signs are present, one must first rescue the interior yang; otherwise, once yang qi dissipates, the condition will deteriorate sharply.
The ancient warming method addressed late-stage presentations of severe infection with hypothermia, cold extremities, diarrhea, and faint pulse—phenomenally resembling aspects of circulatory failure and pre-septic shock in modern medicine, though the mechanisms differ. The warming method must be used under the guidance of a physician.
In winter, pay attention to keeping the lower back, abdomen, and feet warm. Those who habitually fear cold and have loose stools should reduce intake of raw and cold foods and may appropriately warm and nourish.
The moxibustion method tends toward warming and supplementation; therefore, when there is a fine, rapid pulse, intense floating heat, or excess-heat with yin deficiency, moxibustion is not appropriate—otherwise it will assist fire and damage yin, scorch the bones and injure the sinews. In cases of deficiency-cold diarrhea or lesser yin with cold back, moxibustion may be used. The needling method emphasizes supplementing deficiency and draining excess, but under conditions of great anger, great fatigue, great intoxication, great fullness, great hunger, great thirst, or great fright, needling should not be performed.
"With a fine, rapid pulse, moxibustion must be carefully avoided; fire as pathogen will produce vexation and counterflow—pursuing deficiency and expelling excess, blood disperses within the vessels"
Fine, rapid pulse often indicates yin deficiency with heat—erroneous moxibustion will assist fire, damage yin, and stir the blood.
"In lesser yin disease, one to two days from onset, the mouth is harmonious but appetite does not feel right, and the back is aversive to cold—moxibustion should be applied"
In lesser yin yang deficiency with a cold-aversive back, moxibustion may be used to warm yang.
"Do not needle with great anger, do not needle with great fatigue, do not needle with great intoxication, do not needle with great fullness, do not needle with great hunger, do not needle with great thirst"
Strong emotional disturbance, exertion, intoxication, satiety, hunger, and intense thirst are all conditions contraindicated for needling.
Moxibustion tends toward warming yang—applying it in cases of excess-heat, yin deficiency, or blood depletion amounts to "adding heat where heat already exists." Needling must avoid unstable bodily states to prevent fainting during needling and derangement of qi movement.
Acupuncture stimulation may indeed affect the autonomic nervous system and circulation. Needling under conditions of fasting, intoxication, or excessive fatigue readily precipitates reactions such as fainting at the needle. Moxibustion health preservation should also distinguish constitution—heat-constitution individuals should not moxa freely.
Before moxibustion health practice, assess your constitution; do not perform it under hunger, excessive fullness, after alcohol, or in overtime fatigue. Acupuncture treatment should be sought at accredited medical institutions.
This section addresses the "water method" and "fire method." The water method refers to drinking water, dousing with water, and cold-water compress; the fire method refers to fire fumigation, warm needling, and burning tile ironing on the back. The ancients held that with thirst and stomach dryness, one may drink small amounts of warm water frequently. However, when the stomach is deficiency-cold, drinking water easily causes retching. The fire method was mostly used for cold patterns—using it incorrectly in excess-heat patterns will produce jaundice, delirious speech, vexation and thirst, bleeding, and even yang collapse.
"In taiyang disease, after sweating has been induced with profuse sweating, stomach dryness, vexation preventing sleep—the patient desires water; one should let him drink small amounts little by little, allowing the stomach qi to harmonize, and healing will follow"
After severe sweating with thirst, water may be drunk, but in small amounts and slowly, on limited schedules, letting the stomach qi harmonize.
"In yangming disease, after being exposed to fire, slight sweat on the forehead with difficult urination—jaundice will inevitably develop"
When yangming already possesses interior heat and the fire method is then applied, the heat pathogen becomes still more exuberant, readily producing jaundice and difficult urination.
"In taiyang disease, when fire fumigation has been used, sweat does not come, and the patient will inevitably become agitated"
Applying fire fumigation in an exterior-heat pattern without producing sweat—only producing restlessness—indicates the fire method has been misapplied.
The water method's principle is "small amounts, warm ingestion, prohibited in stomach cold." The fire method belongs to warming-heating therapies and is suitable only for cold patterns; erroneous application in excess-heat patterns amounts to "pouring oil on fire."
Fever with profuse sweating after onset—supplementing with small repeated amounts of warm water—aligns with modern fluid management principles; consuming large amounts of water in a short time may also cause discomfort. Heavy wrapping and roasting over heat during high fever may intensify heat injury and is inadvisable.
After fever and sweating, drink warm water in small repeated amounts—do not drink ice water, do not gulp down large quantities. In cold seasons, moderate external warmth is fine, but "sweat trapping with heavy covering" during high fever is unsuitable approach.
The concluding section extensively discusses critical febrile conditions and determinations of life and death—including yin-yang intermingling, lesser yin reversal counterflow, exhaustion of yin and yang, excess-of-excess and deficiency-of-deficiency, the ten inversions of febrile disease, exhaustion of the five visceral qi, and pulse signs indicating death's timing.
"In warm disease, after sweating, fever immediately recurs, with the pulse agitated and rapid—not diminished by sweating—with wild speech and inability to eat—this disease is named yin-yang intermingling; one who manifests this will die"
In febrile disease, if high fever persists after sweating, the pulse remains rapid and urgents, with spirit clouding, disordered speech, and inability to take food—this indicates the righteous cannot overcome the pathogen—the ancients regarded this as a fatal marker.
"In febrile disease, after sweating has been obtained, the pulse is still agitated and surging—this is the extreme of the yang pulse—death; where sweating has been obtained and the pulse becomes quiet—life"
After sweating, when the pulse transitions from agitation to quiet, that represents improvement; still agitated, rapid, and urgents indicates critical danger.
"In excess-of-excess: the flesh is greatly hot, the disease qi is hot, and the pulse is full; in deficiency-of-deficiency: the pulse is deficient, the qi is deficient, and the cubit is deficient"
Pathogenic qi exuberance constitutes excess; essential qi loss constitutes deficiency—extreme excess-heat, or joint depletion of qi, blood, yin, and yang, both represent dangerous states.
"In febrile disease: abdominal fullness and distension, body heat, inability to urinate or defecate, with an uneven, fine-surging and rapid pulse—once an inversion is seen, leading to death"
These "ten inversions" clauses describe critical signs—high fever, abdominal distension, blockage of urination and defecation, abnormal pulse—as grave emergencies.
The heart of prognosis lies in whether the pulse and manifestations correspond, and whether yang qi and yin essence are failing. The ancients judged disease trends through whether the pulse became quiet after sweating, whether the extremities regained warmth, whether the patient could eat, and whether consciousness cleared.
"Spirit clouding following high fever, cold extremities, anuria, dyspnea, and bleeding" finds certain phenomenal correspondence with modern sepsis, septic shock, and multiple organ dysfunction—all critical alarms. However, specific prescriptions like "death within so many days" or "pulse at four, five beats per respiration" must not be taken as literal modern diagnostic criteria.
During febrile illness, if there appear shortness of breath, altered consciousness, cold hands and feet, reduced urine output, frequent vomiting and diarrhea, or bleeding—seek immediate medical attention. Do not delay.
Related Concepts:
Further Reading: Shanghan Lun: Patterns and Treatment of Taiyang Disease Pulse Signs, Shanghan Lun: Patterns and Treatment of Yangming Disease Pulse Signs, Shanghan Lun: Patterns and Treatment of Shaoyin Disease Pulse Signs, Jinkui Yaolüe: Pulse Signs of Viscera, Meridians, and Sequential Disease Patterns, and others.
This content is based on classical texts of traditional Chinese medicine and is provided solely for the study and research of traditional culture. It does not constitute any form of medical diagnosis, medication guidance, or treatment advice. Please seek timely medical attention if you experience any discomfort.