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Chapter 33 of 78
黄帝内经·素问
Overall Paraphrase
This chapter centers on four complex syndromes in febrile (warm-heat) disorders: Yinyang Jiao (intertwining of yin and yang), Feng Jue (wind reversal), Lao Feng (wind affliction due to overexertion), and Shen Feng / Feng Shui (kidney wind / wind-water).
The Yellow Emperor asked: Some patients with febrile disorders break out in a sweat but soon develop a fever again soon after. The pulse is rapid and agitated, and is not alleviated by sweating. They may even speak deliriously and be unable to eat. What disease is this?
Qi Bo replied: This is called Yinyang Jiao (the intertwining and unresolved struggle between yang-heat pathogenic qi and yin-essence vital qi). It is a critical condition.
Qi Bo explained: Human sweat originates from water and grain. Water and grain can transform into essence qi. When pathogenic qi contends with vital qi between the bones and flesh, the ability to sweat indicates that pathogenic qi has retreated and essence qi has prevailed. If essence qi prevails, one should be able to eat and no longer have fever. Now, if fever persists after sweating, it indicates that pathogenic qi prevails; if one cannot eat, essence qi loses its source of replenishment; if the pathogen remains and does not retreat, life may be overturned swiftly. Moreover, the Discussion on Heat states: "If the pulse remains restless and forceful after sweating, death ensues." Now, the pulse not corresponding with sweating indicates that vital qi cannot overcome the pathogenic qi—the signs of death are already evident. Raving delirium is loss of will (the spirit-mind failing to remain anchored within), and loss of will also indicates death. Now, with all three fatal signs present and no sign of vitality, even if the surface condition seems temporarily improved, the end is still perilous.
The Yellow Emperor asked: There are those who have body heat, sweating, and vexation with chest oppression. After sweating, the oppression and fullness do not resolve. What disease is this?
Qi Bo said: If sweating occurs but the body remains hot, it is due to wind pathogen; if sweating occurs but vexation and fullness are not relieved, it is Jue (rebellion of qi movement). The disease is named Feng Jue. Great Yang (the Bladder channel) governs the exterior qi of the entire body, so it is the first to be affected by wind pathogen; Shaoyin and the Great Yang are interior-exterior paired. When Shaoyin is affected by heat, its qi reverts upward, rushing forth along with the Great Yang channel qi, thus forming Jue.
The Yellow Emperor asked how to treat it. Qi Bo said: Needle both the exterior and interior channels, and combine with decoction medication for regulation. This reflects the ancient principle of "treating both exterior and interior simultaneously." The specific manipulation falls within academic theory and doctrinal method, and is not meant as medication guidance.
The Yellow Emperor asked: What disease is Lao Feng?
Qi Bo said: Lao Feng is located below the lung. When it occurs, it causes stiffness of the neck, blurred vision, spitting of phlegm-drool resembling nasal discharge, aversion to wind, and chills with shivering. This is Lao Feng.
The treatment principle is to relieve difficulty in bending and extending (stooping and looking up), using the Great Yang channel to guide and regulate qi. Those with abundant essence qi may recover in about three days; those of middle age, about five days; those with insufficient essence qi, about seven days. If coughing produces greenish-yellow pus-like sputum, about the size of a pill, discharged from the mouth or nose, recovery follows; if it cannot be discharged, the lung will be damaged, and damage to the lung is dangerous.
The Yellow Emperor asked: For someone with Shen Feng, presenting with facial swelling, a sensation of fullness and obstruction, and difficulty speaking, can needling be applied?
Qi Bo said: This is a deficiency condition; it should not be needled. If one inappropriately needles when it is not indicated, the disease qi will certainly arrive within five days.
The Yellow Emperor asked: What happens when the disease qi arrives? Qi Bo said: There will be shortness of breath, frequent fever, heat rising from the chest and back to the head, sweating, hot hands, dry mouth with bitter taste and thirst, yellow urine, puffiness below the eyes, rumbling in the abdomen, a heavy body making walking difficult, cessation of menstruation, vexation and oppression with inability to eat, inability to lie supine—and lying supine induces coughing. The disease is named Feng Shui, and the related discussion is found in the Acupuncture Methods (Cifa).
The Yellow Emperor asked to hear the reasoning. Qi Bo said: "Where pathogenic qi congregates, the qi there must be deficient." When the yin aspect is weakened, yang pathogens will invade. Hence there is shortness of breath, frequent heat, and sweating. Yellow urine indicates heat in the lower abdomen. Inability to lie supine is due to disharmony of the stomach. Coughing aggravated when lying supine is due to qi pressing upward against the lung. In all cases of water qi, slight puffiness often appears first below the eyes.
Why? Water belongs to yin, and the area below the eyes also belongs to yin; the abdomen is the dwelling of Zhiyin (the most yin). Thus, when water settles in the abdomen, it necessarily makes the area below the eyes swell first. True qi reverting upward causes dry mouth and bitter tongue, and the inability to lie supine—lying supine then produces coughing up of clear water. All water disorders often prevent peaceful lying; when lying down, one is easily startled; when startled, coughing worsens. Rumbling in the abdomen indicates the disease is rooted in the stomach. When water qi affects the spleen, there is vexation and oppression with inability to eat; if food cannot go down, it is due to obstruction at the gastric cavity. The body is heavy and walking difficult because the stomach channel descends to the feet. Amenorrhea is due to the blockage of the uterine vessel (Bao Mai, the channel connecting to the uterus); the uterine vessel belongs to the heart and connects to the uterus. Now, because qi presses upward against the lung, heart qi cannot descend and communicate, thus menstruation ceases.
The Yellow Emperor said: Excellent.
The contest between sweat and essence qi
The ancients held that sweat is transformed from water and grain essence qi. If fever abates after sweating and the pulse becomes calm, it signifies pathogen retreat and vital qi victory; if fever persists after sweating with a restless pulse, it signifies pathogen victory and vital qi decline. This is the core basis for judging prognosis in febrile diseases.
The essence of Yinyang Jiao
Yinyang Jiao is the unresolved intertwinement of yang-heat pathogenic qi and yin-essence vital qi. If the patient cannot eat, essence qi loses its source; if raving delirium occurs, the spirit-mind has lost its anchor. When these three signs appear together, they indicate exuberant pathogenic qi and the collapse of vital qi.
The pathogenesis of Feng Jue
The Great Yang governs the exterior, and Shaoyin is the interior. Wind pathogen attacks the exterior, stirring Shaoyin qi to rebel upward, forming a condition of both exterior and interior involvement. Thus, the treatment principle is to regulate both exterior and interior—simultaneously expelling exterior pathogen and calming the interior rebellion.
Lao Feng and the strength of vital qi
Deficiency after overexertion allows wind pathogen to take advantage and attack the lung, with the disease location below the lung. Whether phlegm and nasal discharge can be expelled relates directly to the patency of lung qi; the abundance or deficiency of essence qi directly determines the duration of the disease.
Shen Feng mistaken needling and Feng Shui
Shen Feng is inherently a deficiency condition. Mistaken needling further damages vital qi, leading to water qi overflowing and qi movement becoming disordered. The core pathogenesis is "where pathogenic qi congregates, the qi there must be deficient"—when yin is deficient, yang pathogens invade; when water is retained, swelling first appears below the eyes.
The high fever, post-sweating fever persistence, rapid pulse, impaired consciousness, and inability to eat described under Yinyang Jiao bear resemblance, from a modern viewpoint, to severe manifestations of certain critical infectious diseases. The ancients' comprehensive assessment of prognosis through sweat, pulse, mentation, and food intake holds notable observational value; however, the designation of "fatal signs" is not absolute—timely medical intervention under modern conditions can significantly alter outcomes.
The fever, sweating, and vexation with fullness in Feng Jue may be associated with autonomic dysfunction and thermoregulatory imbalance during febrile states. The ancient notion of "simultaneous treatment of exterior and interior" reflects an early concept of whole-body regulation.
The aversion to wind, chills with shivering, and cough with purulent discharge described in Lao Feng share similarities with modern respiratory tract infections accompanied by purulent sputum. The ancients' emphasis on the expulsion of phlegm as crucial to prognosis echoes the importance that modern airway management places on sputum clearance.
The swelling appearing first below the eyes, yellow urine, inability to lie flat, and amenorrhea described in Shen Feng / Feng Shui show similarities to certain renal-origin edema and cardiorenal syndrome presentations. However, ancient disease names cannot be directly equated with specific modern diseases. The principle of cautious needling in deficiency conditions still carries reference value in modern acupuncture practice.
Historical limitations: Concepts such as yin-yang, exterior-interior, and the uterine vessel cannot be directly mapped onto modern anatomy and physiology; some "fatal signs" lack precise quantification and should be viewed rationally without blind application.
This content is based on classical Chinese medicine 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 experience discomfort, please consult a medical professional promptly.