Loading...
Chapter 32 of 78
黄帝内经·素问
Overall Paraphrase
1. Liver Heat Disorder
In a person with heat disorder of the liver, there first appears yellow urine, abdominal pain, a preference for lying down, and fever in the body. When pathogenic heat contends with healthy qi, there may be delirious speech, easy startling, fullness and pain in the rib-side regions, restless movement of the hands and feet, and inability to sleep peacefully. On Geng-Xin days (Metal, which overcomes Wood), the condition worsens; on Jia-Yi days (Wood, when wood qi is flourishing), healthy qi returns, and there may be a general sweating with resolution of heat. If heat qi surges upward and the condition deteriorates, there is risk of death on Geng-Xin days. The ancient method of needling selects the Foot-Jueyin Liver Meridian and the Foot-Shaoyang Gallbladder Meridian. If hot qi rebels upward, there will be headache and dizziness, which is due to meridian qi rushing upward to the head.
2. Heart Heat Disorder
In a person with heat disorder of the heart, there is first a feeling of discontent in the heart, and only after several days does fever appear. When pathogenic qi contends with healthy qi, there may be sudden heart pain, vexation and stuffiness, nausea with desire to vomit, headache, red facial complexion, and absence of sweating. On Ren-Gui days (Water, which overcomes Fire), the condition worsens; on Bing-Ding days (Fire, when fire qi is flourishing), there may be profuse sweating with resolution of heat. If heat qi rebels upward, there is risk of death on Ren-Gui days. The ancient method of needling selects the Hand-Shaoyin Heart Meridian and the Hand-Taiyang Small Intestine Meridian.
3. Spleen Heat Disorder
In a person with heat disorder of the spleen, there first appears heaviness of the head, pain in the cheek region, vexation in the heart, a bluish facial complexion, desire to vomit, and fever in the body. When pathogenic qi contends with healthy qi, there may be lumbar pain with inability to bend or extend, abdominal fullness with diarrhea, and pain in both lower jaw regions. On Jia-Yi days (Wood, which overcomes Earth), the condition worsens; on Wu-Ji days (Earth, when earth qi is flourishing), there may be profuse sweating with resolution of heat. If heat qi rebels upward, there is risk of death on Jia-Yi days. The ancient method of needling selects the Foot-Taiyin Spleen Meridian and the Foot-Yangming Stomach Meridian.
4. Lung Heat Disorder
In a person with heat disorder of the lungs, there first appear sensations of cold, piloerection (hair standing on end), aversion to wind and cold, yellow tongue coating, and fever in the body. When pathogenic qi contends with healthy qi, there may be wheezing and coughing, pain that wanders through the chest, breast region, and back, inability to take deep breaths, severe headache, and sweating followed by a feeling of cold. On Bing-Ding days (Fire, which overcomes Metal), the condition worsens; on Geng-Xin days (Metal, when metal qi is flourishing), there may be profuse sweating with resolution of heat. If heat qi rebels upward, there is risk of death on Bing-Ding days. The ancient method of needling selects the Hand-Taiyin Lung Meridian and the Hand-Yangming Large Intestine Meridian, with a small amount of bloodletting about the size of a soybean; the original text holds that the heat can then be quickly resolved.
5. Kidney Heat Disorder
In a person with heat disorder of the kidneys, there first appears lumbar pain, soreness and weakness of the calves, thirst with frequent drinking of water, and fever in the body. When pathogenic qi contends with healthy qi, there may be pain and stiffness of the nape, cold and sore calves, heat in the soles of the feet, and unwillingness to speak. If heat qi rebels upward, there is pain in the nape accompanied by dizziness and a sensation of swaying. On Wu-Ji days (Earth, which overcomes Water), the condition worsens; on Ren-Gui days (Water, when water qi is flourishing), there may be profuse sweating with resolution of heat; if heat qi rebels upward, there is risk of death on Wu-Ji days. The ancient method of needling selects the Foot-Shaoyin Kidney Meridian and the Foot-Taiyang Bladder Meridian.
Regarding the pattern of sweating in the above heat disorders of various viscera, the ancients held that this occurs mostly on the corresponding flourishing day, when healthy qi overcomes pathogenic qi, leading to profuse sweating and resolution of heat.
6. Redness First Appearing on the Face and "Treating Disease Before It Develops"
In liver heat disorder, the left cheek becomes red first; in heart heat disorder, the forehead becomes red first; in spleen heat disorder, the nose becomes red first; in lung heat disorder, the right cheek becomes red first; in kidney heat disorder, the chin becomes red first. Although the disease has not yet fully manifested, as long as redness is observed in the corresponding region, needling can be performed — this is called "treating disease before it develops" — intervening before the disease has taken shape. When a heat disorder begins from its corresponding body region, it may resolve on the corresponding dated cycle; if the needling method is used incorrectly, recovery may be delayed by three full cycles; if treatment errors are repeated and healthy qi becomes increasingly disordered, there may be risk of death. For all heat disorders that should resolve through sweating, when the corresponding flourishing day arrives, there will be profuse sweating.
7. Care and Regulation for Heat Disorders
In ancient treatment of heat disorders, patients were first given cool water to drink, after which needling was performed; they were advised to wear thin clothing, stay in cool surroundings, and stop once the body was cooled down. This reflects the ancient care approach of "for heat, use cold" in treating heat disorders.
8. Meridian-Based Needling Methods for Heat Disorders
For heat disorder beginning with chest and rib-side pain with restless hands and feet, needle the Foot-Shaoyang Gallbladder Meridian, with supplementation of the Foot-Taiyin Spleen Meridian; for severe cases, use the fifty-nine needling points (the special group of fifty-nine needling sites used in ancient practice for heat disorders). For heat disorder beginning with arm pain, needle the Hand-Yangming and Hand-Taiyin meridians, and stop once sweating occurs with heat resolution. For heat disorder beginning from the head, needle the Taiyang meridian at the nape, and stop once sweating occurs with heat resolution. For heat disorder beginning from the foot and lower leg, needle the Foot-Yangming meridian, and stop once sweating occurs with heat resolution. For heat disorder manifesting first as heavy body, bone pain, deafness, and somnolence, needle the Foot-Shaoyin meridian; for severe cases, use the fifty-nine needling points. For heat disorder manifesting first as dizziness with fever and fullness in the chest and rib-sides, needle the Foot-Shaoyin and Foot-Shaoyang meridians.
9. Combined Assessment of Color and Pulse
When the meridian qi of the Taiyang system manifests in the cheekbone region, this indicates heat disorder. If the nutritive qi (yin qi — the refined substances circulating in the vessels) has not yet become entangled with pathogenic qi, it may be said that sweating is imminent, and recovery may occur at the corresponding date. If there is contending manifestation of the Jueyin pulse color, the time of death will be no more than three days. If a heat disorder internally involves the kidneys, signs will appear at sites governed by the Shaoyang meridian. When the Shaoyang meridian qi manifests on the front of the cheek, this is heat disorder; if nutritive qi has not yet become entangled, sweating will occur, and the disorder may resolve with time and appropriate care; if contending with Shaoyin pulse signs, the time of death will be no more than three days.
10. Back Acupoints and Facial Color Diagnosis
For back acupoints in heat disorders: below the third vertebra governs heat in the chest; below the fourth vertebra governs heat in the diaphragm; below the fifth vertebra governs liver heat; below the sixth vertebra governs spleen heat; below the seventh vertebra governs kidney heat. The nutritive qi resides in the sacral region, in the depression above the third vertebra at the nape. In facial color diagnosis: disordered qi below the cheek moving upward toward the cheekbone suggests major abdominal masses (accumulations in the abdomen); the lower jaw region governs abdominal fullness; behind the cheekbone governs rib-side pain; the upper cheek region governs the area above the diaphragm.
Heat disorders classified by the five viscera: This chapter classifies heat disorders into five types according to the liver, heart, spleen, lungs, and kidneys, with each type having prodromal symptoms, typical manifestations during the contention of pathogenic and healthy qi, corresponding meridian needling selections, and prognostic dates. This embodies the application of the viscera doctrine of the Inner Canon to heat disorders.
The Five-Phase Ten Heavenly Stems waxing and waning model: The ten heavenly stems assigned to the five phases are used to explain changes in the course of disease: the condition worsens on days when "that which overcomes me" prevails, sweating and resolution occur on days when "my own qi" flourishes, and if healthy qi becomes disordered, death may occur on "that which overcomes me" days. This is a concrete derivation of the ancient concepts of "correspondence between heaven and man" and "the contention of healthy and pathogenic qi."
The "treating disease before it develops" principle: Each visceral heat disorder has a corresponding facial region that reddens first. Before the disease has fully manifested, early detection and early intervention are possible through color diagnosis. This is a classic expression of the preventive medicine philosophy of Chinese medicine.
Combining color and pulse assessment with meridian-based treatment: It uses facial color diagnosis to determine which viscus and meridian the disease resides in, combines whether the pulse color is entangled to judge prognosis, and selects appropriate meridians for needling based on the starting location and symptoms of the heat disorder. The core is "treatment based on syndrome differentiation" and "guiding according to the tendency of the disease."
The principle of "treating heat with cold": Heat disorders are managed by drinking cool water, wearing thin and cool clothing, and staying in cool places, reflecting the fundamental care direction for heat diseases.
The descriptions of heat disorder symptoms in this chapter — such as fever, restlessness, rib-side pain, cough, yellow urine, thirst, and headache — represent the ancients' careful observation of infectious fevers and systemic accompanying symptoms. Some of these overlap with nonspecific manifestations of febrile illnesses in modern medicine.
The predictions of "worsening," "sweating resolution," and "death" according to heavenly stem days are theoretical derivations of the ancient Five-Phase model and are not reliable prognostic tools in modern practice. The outcome of a heat disorder depends on etiology, constitutional factors, treatment, and many other variables, and cannot be predicted based on heavenly stem dates.
The divisions of facial color diagnosis and the back acupoint correspondences possess some empirical observational value from antiquity, but lack specificity under modern anatomy, physiology, and pathology. They should be viewed judiciously and should not be used as diagnostic criteria.
Methods such as needling to drain heat and bloodletting in small amounts reflect the ancients' physical intervention approaches for heat disorders. Acupuncture should only be performed by qualified professional practitioners, and self-attempts are inappropriate; its clinical efficacy still requires validation through modern evidence-based research.
The practices of "drinking cold water, wearing cold garments, staying in cool places, and stopping once the body is cold" reflect ancient care methods. Modern mechanisms of fever are complex, and the excessive cooling approach implied by "stop once the body is cold" should not be blindly adopted. A comfortable environment, moderate cooling, adequate hydration, and targeted treatment of the cause should be emphasized.
During fever or recovery from heat disorders, living spaces should be well ventilated and cool, clothing and covering should be loose and breathable, and excessive trapping of sweat should be avoided. Drink an appropriate amount of warm water to help maintain fluid balance.
Keep emotions stable; agitation and anger can easily intensify heat. During the course of a heat disorder, rest is essential, with reduced mental exertion and physical consumption.
In daily life, pay attention to body signals such as facial color, thirst, urine color, and sweating patterns. When abnormalities are noticed, adjust routine accordingly, but do not self-diagnose.
During hot summer months, take precautions against heat and on cooling measures, keep the diet light, and avoid excessive pungent and drying-hot foods. After exposure to cold in winter, avoid sudden heavy warming or tonifying measures, which may close pathogenic heat inside.
In cases of persistent fever, high fever that fails to resolve, or significant accompanying symptoms, seek medical attention promptly. Do not mechanically apply classical texts to your own condition.
Associated Concepts
Further Reading
本内容基于中医经典古籍，仅供传统文化学习与研读，不构成任何医疗诊断、用药或治疗建议；如有不适请及时就医。
This content is based on classical Chinese medicine texts and is provided for the study and appreciation of traditional culture only. It does not constitute any medical diagnosis, prescription, or treatment advice. If you experience discomfort, please seek prompt medical attention.