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Chapter 31 of 78
黄帝内经·素问
Overall Paraphrase
The Yellow Emperor asked: The heat diseases spoken of now all belong to the category of cold damage (febrile diseases triggered by external cold pathogens). Some recover, some die. Those who die do so within six to seven days, while those who recover do so after ten days or more. Why is this? I do not understand the principle behind it and wish to hear the reason.
Qi Bo replied: Greater Yang (i.e., the Taiyang Channel, the outermost channel of yang qi in the human body, governing the exterior of the entire body) is the commander of all yang channels. Its channel connects upward to Fengfu (an important acupoint at the back of the neck), and therefore it governs the yang qi of the entire body. When a person contracts cold pathogens, the body instead becomes feverish—this is a manifestation of yang qi rising to resist the pathogen. Although the heat may be intense, it generally does not lead to death. However, if there is dual contraction of cold (both the exterior and interior channels are affected simultaneously, such as Taiyang and Shaoyin developing illness together), then there is certainly danger to life.
The Yellow Emperor said: I wish to hear the specific manifestations.
Qi Bo said: On the first day of cold damage, the Taiyang Channel is affected by the pathogen, so there is headache and neck pain, with stiffness of the lower back and spine. On the second day, the Yangming Channel is affected. Yangming governs the muscles, and its channel runs alongside the nose and connects upward to the eyes, so the body becomes feverish, the eyes hurt, the nose feels dry, and one cannot lie down peacefully. On the third day, the Shaoyang Channel is affected. Shaoyang governs the gallbladder, and its channel runs along both flanks and connects to the ears, so there is pain in the chest and flanks, and deafness. If all three yang channels have been affected by the pathogen, but it has not yet penetrated into the five viscera, then inducing sweating can cure it. On the fourth day, the Taiyin Channel is affected. The Taiyin channel is distributed in the stomach and connects upward to the throat, so there is abdominal fullness and dryness of the throat. On the fifth day, the Shaoyin Channel is affected. The Shaoyin channel runs through the kidneys, connects upward to the lungs, and links to the root of the tongue, so the mouth becomes dry, the tongue parched, and thirst develops. On the sixth day, the Jueyin Channel is affected. The Jueyin channel runs along the genitals and connects to the liver, so there is irritability, fullness, and contraction of the scrotum. If all three yin and three yang channels, along with the five viscera and six bowels, are affected by disease, and the Rong and Wei (nutritive qi and defensive qi, i.e., the nourishing qi circulating within the vessels and the defensive qi operating outside them) cannot function normally, and the qi of the five viscera becomes blocked and impassable, then death will result.
If it is not a case of dual contraction of cold, then on the seventh day, the pathogenic qi of the Taiyang Channel declines, and the headache lessens; on the eighth day, the pathogenic qi of the Yangming Channel declines, and the body heat subsides somewhat; on the ninth day, the pathogenic qi of the Shaoyang Channel declines, and hearing begins to return somewhat from deafness; on the tenth day, the pathogenic qi of the Taiyin Channel declines, abdominal fullness disperses and returns to normal, and one begins to desire food; on the eleventh day, the pathogenic qi of the Shaoyin Channel declines, thirst stops, fullness dissipates, the dry tongue has healed, and sneezing occurs; on the twelfth day, the pathogenic qi of the Jueyin Channel declines, the scrotum relaxes, the lower abdomen feels comfortable, the pathogenic qi of the disease has all dispersed, and the illness gradually recovers.
The Yellow Emperor asked: How should it be treated?
Qi Bo said: In treatment, one should respectively dredge the viscera and channels of each channel involved, and the pathogenic qi will decline day by day and recovery will follow. If the course of disease is less than three days, one can use the method of promoting sweating to cure it; if it has already reached three days or more, one can use the method of draining heat to cure it.
The Yellow Emperor asked: After a heat disease has already recovered, there are sometimes lingering symptoms. Why is this?
Qi Bo said: These lingering symptoms are all because food was taken forcefully while the heat was still intense, thus residual heat has been left behind. In such situations, the disease has already declined, but residual heat remains latent in the body. Because the qi of ingested food and water combines with the residual heat, and the two heats mingle, lingering symptoms arise.
The Yellow Emperor said: Good. Then how should these lingering symptoms be treated?
Qi Bo said: Observe the patient's deficiency or excess condition, and regulate the derangement or normalcy of qi and blood—this will bring about recovery.
The Yellow Emperor asked: What prohibitions should patients with heat disease observe?
Qi Bo said: When a heat disease is slightly improving, eating meat will cause relapse, and eating too much will result in residual heat remaining. These are the prohibitions for heat disease.
The Yellow Emperor asked: In patients with dual contraction of cold, what are their pulse manifestations and symptoms?
Qi Bo said: In a patient with dual contraction of cold, on the first day the Taiyang Channel and the Shaoyin Channel develop illness simultaneously, resulting in headache, dry mouth, irritability, and fullness; on the second day the Yangming Channel and the Taiyin Channel develop illness simultaneously, resulting in abdominal fullness, body fever, lack of desire to eat, and delirious speech; on the third day the Shaoyang Channel and the Jueyin Channel develop illness simultaneously, resulting in deafness, scrotal contraction, and coldness of the four limbs. If water and gruel cannot be swallowed and the mind becomes clouded and confused, death will occur by the sixth day.
The Yellow Emperor asked: The five viscera have already been damaged, the six bowels are obstructed, and Rong and Wei cannot circulate. In such circumstances, why does it still take another three days before death occurs?
Qi Bo said: The Yangming Channel is the one with the most exuberant qi and blood among the twelve channels. Therefore, after a person becomes clouded and confused, another three days must pass before the qi and blood of the Yangming Channel are exhausted, and only then does death occur.
Any warm-heat disease formed due to cold damage, if it occurs before the summer solstice, is called a warm disease; if it occurs after the summer solstice, it is called a summer-heat disease. In summer-heat disease, one should allow the sweat to be excreted naturally along with the summer heat, and should not forcibly stop the sweating.
The central academic thought of this chapter is the embryonic form of the six-channel pattern differentiation and transmission laws.
🌊 Six-Channel Transmission Model: The ancients observed that externally contracted heat diseases have a transmission process moving from the exterior to the interior and from the shallow to the deep. The six channels (Taiyang → Yangming → Shaoyang → Taiyin → Shaoyin → Jueyin) are used to describe the developmental stages of the disease. This is a pathological progression model of layers, with Taiyang governing the exterior, Yangming governing the interior, Shaoyang governing the half-exterior-half-interior, and the three yin channels involving deeper visceral and qi-blood levels. The statement of "one channel per day" should not be mechanically understood as one channel per day, but rather reveals a systematic recognition of the law of disease progressing from shallow to deep and transmitting layer by layer.
🔥 The Mechanism of "Injured by Cold but Developing Heat": When cold pathogens bind the exterior, defensive yang becomes constrained, and yang qi rises to resist the pathogen, becoming stagnant and transforming into heat. This reflects TCM's fundamental understanding of the "struggle between righteous and pathogenic qi"—fever itself is a manifestation of righteous qi resisting the pathogen, hence "even intense heat generally does not cause death."
⚖️ The Severity of Dual Contraction of Cold: When both exterior and interior channels are affected simultaneously (such as Taiyang and Shaoyin developing illness together), it indicates that the pathogenic qi has bypassed the body's defense layers and penetrated directly, and the righteous qi cannot organize effective layered resistance. This is a clinical summary of the state of "pathogenic exuberance with righteous decline."
💨 Treatment Principles: Within three days (when the disease is still in the three yang channels and has not entered the viscera), use the sweating method to expel the pathogen; after three days (when the disease has entered the yin channels and the pathogen has penetrated deeply), use the draining method to clear interior heat. This established the later treatment doctrine of "if it is on the surface, sweat it out; if it has entered the interior, drain it."
🍖 Mechanism of Dietary Prohibitions: In the later stages of heat disease, when residual heat has not yet cleared, if the patient forcibly eats (especially thick-flavored foods like meat), the qi of water and grains combines with the residual heat, leading to "shi fu" (relapse caused by improper diet). This is among TCM's earliest systematic discussions of the relationship between diet and disease recovery.
The Logical Value of Six-Channel Transmission: From a modern medical perspective, the development of externally contracted febrile diseases does follow a dynamic process—from localized infection to systemic response, from superficial to deep. The six-channel transmission model is not a precise pathophysiological description, but it provides a layered, dynamic framework for observing disease. This view of disease progression "from exterior to interior and from mild to severe" shares logical similarities with modern medicine's understanding of infectious diseases "from localized to systemic, from mild to severe."
Observation That "Intense Heat Does Not Necessarily Mean Death": The ancients, without thermometers and antibiotics, already observed that fever itself does not equate to poor prognosis—the key lies in the state of the patient's righteous qi. This indeed aligns with modern medicine's emphasis on "fever as a host defense response." However, it must be acknowledged honestly: the ancients could not distinguish between viral, bacterial, and other pathogens, nor did they understand specific pathological mechanisms. Judgments such as "death is inevitable" are no longer applicable under today's medical conditions.
The Mechanical Limitation of "One Channel Per Day": The "one channel per day" transmission pattern is a theoretical model, not clinical fact. Later physicians (such as Zhang Zhongjing), while inheriting the six-channel framework, clearly broke away from the mechanical statement of "one channel per day," emphasizing instead "observe the pulse and manifestations, know what deviation has occurred, and treat according to the manifestations." This must be objectively stated.
Diet and Recovery: Modern medicine equally emphasizes dietary management during the recovery phase of febrile illnesses—after high fever, digestive function has not fully recovered, and premature intake of greasy, rich foods will indeed increase the digestive burden and may even cause discomfort. The concept of "shi fu" shares common ground with the modern rehabilitation medicine principle of "gradual resumption of diet."
Related Concepts:
Further Reading:
This content is based on classic TCM ancient texts and is provided solely for the study and appreciation of traditional culture. It does not constitute any medical diagnosis, medication prescription, or treatment advice. If you feel unwell, please seek medical attention promptly.